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Distribution of Gingival Inflammation in Mouth breathing patients: An Observational pilot study

  • Post Graduate Institute of Dental Sciences, Rohtak
  • Post Graduate Institute of Dental Sciences.RohtakHaryana India 124001

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Background: Mouth breathing has been reported to affect gingival health in children. However, studies on the effect of mouth breathing in adult patients are scarce. The objective of present cross sectional study was to examine the relationship between mouth breathing and gingival condition and to evaluate the distribution of gingival inflammation in young adult mouth breathing patients. Methods: Study groups comprised of participants with mouth breathing (test group) and nose breathing (control group) patients with gingivitis. Both the groups underwent periodontal examination. PI, GI and BOP % sites were recorded and analyzed statistically for the differences in mean values. Results: Mouth breathing patients showed higher full mouth GI and BOP scores. Upper anterior segment in mouth breathing patients showed highest GI and BOP followed by lower anterior segment, lower posterior and upper posterior region. Conclusion: Within the limits of present study, our findings suggest that relative to control group participants, test group i.e. patients with mouth breathing had higher gingival inflammation and bleeding sites in upper anterior region. Keywords: Mouth breathing; gingivitis; young adult; cross sectional pilot study
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Journal of Dentistry Indonesia 2016, Vol. 23, No.2, 28-32
Distribution of Gingival Inflammation in Mouth Breathing Patients: An
Observational Pilot Study
Rajinder Kumar Sharma, Anu Bhatia, Shikha Tewari, Satish Chandar Narula
Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana 124000, India
Correspondence e-mail to:
Mouth breathing has been reported to affect gingival health in children. However, studies on the effect of mouth
breathing in adult patients are scarce. Objective: To examine the relationship between mouth breathing and gingival
condition and to evaluate the distribution of gingival inammation in young adult mouth breathing patients.
Methods: Study groups comprised of participants with mouth breathing (test group) and nose breathing (control
group) patients with gingivitis. Both the groups underwent periodontal examination. PI, GI and BOP % sites were
recorded and analyzed statistically for the differences in mean values. Results: Mouth breathing patients showed
higher full mouth GI and BOP scores. Upper anterior segment in mouth breathing patients showed highest GI and
BOP followed by lower anterior segment, lower posterior and upper posterior region. Conclusion: Within the limits
of present study, our ndings suggest that relative to control group participants, test group i.e. patients with mouth
breathing had higher gingival inammation and bleeding sites in upper anterior region.
Keywords: gingivitis, mouth breathing, young adult
Mout h bre ath i ng may be rega rde d as ben ign, harmless,
self-effacing and unsuspecting way of breathing.
Mouth breathing syndrome is a term used when mouth
supplements the nose for breathing.1 Oral breathing
patterns exclusively are rare or non-existent.1 For ma ny,
it hardly matters whether breathing is done through
mouth or nose. Consequently, the debilitating effects
of mouth breathing may be disregarded and thus, are
failed to be noticed even by dental professionals.
Primary etiological factor for chronic gingivitis is dental
plaque; however, anything that favors plaque formation,
accumulation and retention will perpetually aggravate
existing gingivitis. Results of epidemiological studies
in dic ate that mout h bre ath i ng may cause an incre ase in
susceptibility of gingival inammation.2,3 Although the
denite mechanism of the damaging effects of mouth
breathing on gingiva is still unknown; irritation from
surface dehydration, reduced resistance of epithelium
to plaque, and the absence of cleansing effects of
saliva have been suggested as some of the reasons for
increased gingivitis prevalence in mouth breathers.3,4
Evidence regarding the relationship between mouth-
breathing and gingivitis has contradictory positions.
While Sutcliffe et al reported a total lack of correlation
between mouth breathing and gingivitis, others like
Alexander et al proposed a partial association asserting
that mouth breathing in itself is of no consequence
except in the presence of crowding and calculus.5,6
However, previous studies observed a definite
association between mouth breathing and chronic
gingivitis.2, 3,7
In light of the paucity of denite research information
concerning the effect of mouth breathing on gingival
inammation, the current pilot study was conducted
with an aim to nd out the distribution of gingival
inammation within the oral cavity in mouth breathers
and to explore any association between mouth
breathing, plaque level and gingivitis.
Journal of Dentistry Indonesia 2016, Vol. 23, No.2, 28-32
Study design and sample
The study population consisted of patients who
attended the outpatient section of the Department of
Periodontics and Oral Implantology, Post Graduate
Institute of Dental Sciences, Rohtak, India. Study was
conducted in agreement with the ethical principles
embodied in Helsinki Declaration of 1975, as revised
in 2008, and was approved by the institutional review
board (PGIDS/2013/IEC/94, 2013). The study was
conducted between April 2013 and August 2014. The
study consisted of two groups: test group comprising
of 30 mouth breathing patients with incompetent lip
seal, with an age ra nge of 20 -35 yea r s and age matched
control group of 34 nose breathing participants.
Diagnosis of mouth breathing
Diagnosis of mouth breathing was made on the basis
of history and clinical examination of the patients.
Patients were enquired if in their opinion, they were
mouth breathers or not, whether they sleep with their
mouth open and also whether on waking they had
dryness of mouth. Clinical examination included
several diagnostic tests for mouth breathing. Firstly, the
subjects were asked to breathe while closing one of the
nostrils with lips sealed. Nose breathers demonstrated
good control of alar muscle which was absent in mouth
breathers. Secondly, mirror test. Double sided mirror
was held horizontally below the nostrils of patients who
were instructed to breathe normally. Fogging on lower
side of mirror suggested mouth breathing.8 Third ly,
Buttery test. Buttery shaped piece of cotton was
placed below the nostrils on upper lip. Fluttering of
cotton wisp indicated breathing pattern. If the upper
bres were displaced then the breathing was considered
through the nose and if lower fibres quivered, it
suggested mouth breathing.9 Forthly, Water holding
te st. Parti cipants were aske d to l l the mou th wi th water
and hold it for three to ve minutes. Mouth breathers
suffered difculty completing this task whereas nasal
breathers did it with relative ease.8
For fullling the criteria of mouth breathing, subjects
were required to give a positive history along with
minimum of two clinical tests suggestive of mouth
breathing habit.The inclusion criteria for the study were
presence of > 20 teeth; systemically healthy patients
with gingivitis in the age group of 20-35 years; and
no periodontal treatment within past 6 months prior
to inclusion into the study. The exclusion criteria
included presence of clinical signs or symptoms of
any acute infection in the oral cavity; use of systemic
antibiotics or anti-inammatory therapy in the last
3 months before start of study; any known systemic
(e.g. hepatic, renal, haematological or cardiovascular)
disease; pregnancy and lactation; systemic conditions
with gingival manifestations and non-plaque induced
gingival inammation; xerostomia and drugs reported
to cause it; and current or former smokers.
Periodontal measurements
The full-mouth periodontal examination of all
individuals was done by measurement of Loe and
Silness gingival index (GI) and Silness and Loe plaque
index (PI) on all teeth except third molars. These
indices were recorded on four sites (mesiobuccal,
midbuccal, distobuccal and palatal aspects) around each
tooth with University of North Carolina-15 (UNC-15)
periodontal probe. Bleeding sites were registered on
six sites per tooth in a dichotomous way, and scores
were expressed as the percentage of positive sites per
patient (BOP %).
In order to ensure investigator blinding as well as to
preclude inter examiner variability, oral examination
was carried out by one investigator (AB). Investigator
was masked to the study group to which the patient
belongs. Examiner reproducibility was determined by
ca r r y i ng out double clin ical periodo nta l data recordin g
on ten patients. Operator calibration for GI was based
on >85% intra-examiner exact reproducibility.
Statistical analysis
Post hoc power analysis was done using statistical
software (G power With a sample size of 64
and signicance level of two-sided α = 0.05, xed-
effect size was calculated taking upper anterior GI as
primary outcome variable. With these measurements,
statistical power exceeded 95%, with allocation ratio
of 1:1 between two groups. Results are reported
as mean ± standard deviation. The normality of
distribution of data was examined using Shapiro-Wilk
test. Data was found to be non-normally distributed.
All the measurements were subjected to intergroup
comparisons and analyzed by Mann-Whitney U test.
Al l stat ist ica l analys es were car rie d out usi ng st atis tic al
software (SPSS V. 19) with a two-tailed p value of 0.05
used as a threshold for signicance.
Study group comprised 64 adult patients. Table 1
illustrates the demographic and clinical parameters
among the mouth breathing and nose breathing groups.
Average age of patients in test group was 24.6 years
and average age of control group was 25.0 years.
Full mouth plaque score between two groups did not
differ significantly. Patients with mouth breathing
demonstrated signicantly higher full mouth GI and
BOP (%) (p<0.05) than nose breathing group. The
dentition was analyzed after being divided into four
segments - two anterior segments – each comprising
of either upper or lower anterior teeth and two lateral
zones- upper and lower, comprising of remaining teeth.
Table 2 showed comparison of segment wise periodontal
parameters between two groups. Control group showed
higher plaque scores as well as gingival index in lower
posterior area followed by lower anterior regions.
Journal of Dentistry Indonesia 2016, Vol. 23, No.2, 28-32
Upper posterior segment still showed higher values
of PI and GI than upper anterior region in control
group. In test group, highest plaque score was found
in lower anterior region followed by upper anterior,
lower posterior and upper posterior segments. GI value,
however, was highest in upper anterior region as was
BOP % sit es in te st group. Also, lower ante r ior seg ment
showed GI higher score as compared to lower posterior
area. Upper posterior region in mouth breathing group
exhibited lowest score of GI and BOP% sites.
In mouth breathing patients, facial surfaces of upper
anterior teeth showed greater PI, GI and BOP% as
compared to palatal surfaces (Table 3). Also, inter-
dental sites of facial surfaces had higher scores than
mid-facial regions in test group.
Although a correlation between mouth breathing and
oral conditions in children has been reported, there are
few such studies in young adults. Also, there are only
a few reports dealing with the regional distribution
of gingival inammation in the oral cavity. The aim
of this study was thus to examine the relationship
between mouth breathing and gingival condition in
young patients and to assess the distribution pattern
of inammation in such patients.
Mouth breathing habit is widely reported among
school going children.10 If left untreated, it can lead
to morphological alterations in the facial growth and
various adverse effects on physiological, social and
mental health.11 Compared with the previous studies
where mouth breathing patients were recruited from
younger age groups (less than 14 years), participants
in our study were older and thus, ndings of this study
may be applicable to a broader range of population with
similar characteristics. The age and gender distribution
was rea son ably wel l bal anc ed in both the gro ups. The re
were more females in mouth breathing group. Study
population belonged to same ethnic background and
was recruited from middle class families.
Results of our study showed higher plaque score
in lower dentition as compared to upper dentition
in control group. Lower posterior areas showed
greatest accumulation of plaque followed by lower
anterior region. Upper posterior region harbored
more plaque compared to upper anterior area. In nose
breathing patients, pattern of distribution of gingival
inammation and BOP % sites closely followed the
areas of plaque accumulation. Thus, upper anterior
area showed least gingival inammation and bleeding
sites in nose breathing patients. These observations
were similar to the results of previous studies that
demonstrated higher levels of plaque on molar, lingual
and posterior surfaces than on anterior teeth.12,13
Contrary to above observation, in mouth breathing
group, upper anterior area showed greatest GI score and
BOP % sites. This observation of our study is consistent
with results of previous studies that demonstrated
maxillary anterior area as most susceptible to gingival
inflammation in mouth breathing subjects.2 ,7,14 In
lower arch, lower anter ior segment showed greater
Tab le 1. Comparison of demog raphic and clinical per iodontal
parameters among nose breathing and mouth breathing
Parameters Group
Nose breathing
Mouth breathing
(n=3 0)
Age (years) 25.02 ± 3.78 24.67 ± 3.51
Male : Female 1.31 : 1 1.66 : 1
Full Mouth PI 1.47 ± 0.50 1.48 ± 0.62
Full Mou th GI 1.71 ± 0.37 1.93 ± 0.31*
Fu l l M o u t h
74.10 ± 20. 20 83.50 ± 18.91*
* p<0.05
Table 2. Comparison of seg ment wise periodontal parameters
among nose breathing and mouth breathing group
Segment Parameters Group
Upper anterior PI 1.34 ± 0.48 1.52 ± 0.62
GI 1.58 ± 0.37 2.09 ± 0.28*
BOP (%) 67.21 ± 24.13 91.88 ± 8.01*
Upper posterior PI 1.44 ± 0.56 1.33 ± 0.61
GI 1.65 ± 0.45 1.68 ± 0.35
BOP (%) 73.93 ± 22.84 77.75 ± 24.85
Lower anterior PI 1.52 ± 0.58 1.54 ± 0.70
GI 1.77 ± 0.44 1.99 ± 0.46*
BOP (%) 77.09 ± 22.46 85.60 ± 21.57*
Lower posterior PI 1.54 ± 0.53 1.40 ± 0.61
GI 1.80 ± 0.47 1.70 ± 0.40
BOP (%) 76.30 ± 21.91 78.20 ± 24.98
Table 3. Comparison of periodontal parameter in upper
anterior region in mouth breathing group
Parameter Facial surface
Palatal surface
PI 1.57 ± 0.65 1.46 ± 0.59
GI 2.17 ± 0.27 2.00 ± 0.33*
BOP(%) 95.11 ± 9.80 88.10 ± 16.14*
Journal of Dentistry Indonesia 2016, Vol. 23, No.2, 28-32
gingival in ammation and bleeding as compared to
corresponding posterior segment. Noticeably, the result
of our study als o showed th at th e upper po ste r ior area in
mouth breathing patients had least amount of gingival
in ammation. Plaque scores in this segment was also
least as compared to rest of the areas.
The importance of normal hydration state of peri-
odontium in the maintenance of periodontal health is
underscored by the increase in gingival in ammation
that inevitably follows the chronic mouth breathing
habit. Also, in a recent study mizutani et al has ob-
served that xerostomia was related to gingival disease
activity and % BOP through the accumulation of dental
plaque.15 The great propensity for gingival in amma-
tion in mouth breathers probably stems from dryness of
affected area causing the loss of the protective powers
of saliva. Saliva has an essential role in protecting the
tissues against dessication. Alteration of homeostatis of
hydration state of gingiva can be caused by continuous
exposure to the dry air of tissues of oral cavity. Without
the shielding effects of adequate salivary ow, peri-
odontal tissues might become prone to disease. Patients
with chronic mouth breathing habit might suffer from
dry mouth which could eventually create a predisposi-
tion to oral infection and progressive gingivitis.15 Simi-
la r observation wa s made in Al- awa di et al’s study who
noticed increase in PI and GI in mouth breathing group
as compared to nose breathing group and attributed this
to reduced salivary  ow rate in mouth breathers.16 Since
gingivitis is a disease of microbial origin, the mouth
breathing related (increase in) gingival in ammation
could be an expression of increased or altered microbial
population dynamics in the oral cavity.
Previous studies by Wagaiyu et al and Gulati et al7
have assessed the effects of mouth breathing, lip
competency and upper lip coverage of maxillary incisor
teeth simultaneously on gingival health.2-7 Both these
studies revealed that mouth breathing patients with
incompetent lip seal and wide exposure of maxillary
labial gingiva had more gingival in ammation. Our
study population composed of test group including
mouth breathers with incompetent lip seal and gingival
exposure in order to create homogeneity of test group
sampled and also to lessen the inf luence of other
confounding factors.
Though the distribution of gingival units bearing
in ammation as well as severity of in ammation in
these units was uniform to a large extent in mouth
breathing patients, there was no characteristic clinical
picture depicting inflammatory changes in the
marginal tissues of this population. Clinical picture in
mouth breathing patients demonstrated that marked
gingival inflammation was confined to anterior
Figure 1. Mou th br eat hing pat ient a) Lip po si tio n at rest ; b) Ant erior regi on showing sever e ging iv al in am m at ion ; c) Max ill ary
palatal aspect; d) Left lateral region showing in ammation upto premolar; e) Right lateral region showing in ammation upto
Journal of Dentistry Indonesia 2016, Vol. 23, No.2, 28-32
regions of maxilla. Interdental papilla and marginal
gingiva belonging to areas exposed to the drying
effects of inspired air also exhibited marked gingival
inammation in mouth breathing patients. Incidence
and severity of ginigival inammation was signicantly
lower in the areas not supposed to be in the pathway of
inspired air during mouth breathing.
When upper anterior area is investigated in mouth
breathers, facial surface showed higher GI score
and BOP% sites than the palatal surface. On further
analyses of the facial surface, inter-dental sites had
higher score than mid-facial sites in mouth breathers.
Thus, upper anterior area in mouth breathing patients
demands attention and can be regarded as a seat for
early detection or screening of gingival inammation.
Dental plaque formation and gingival inammation
are the earliest and most common indicators of
periodontal disease in children and adolescents.
Not only are individuals with mouth breathing
susceptible to gingival inammation, but also such
changes start manifesting at quite young age in life.
Therefore, controlling oral health behaviour and
evaluating mouth breathing would effectively prevent
periodontal disease at an early stage in young people.
The stringent inclusion and exclusion criteria, study
population derived from the same ethnic background,
and exclusion of smokers were some of the strengths
of present study. The results of this study should be
interpreted cautiously in light of its limitations. As
this study was cross-sectional, it remains uncertain
as to whether mouth breathing is the cause of gingival
inf lammation. Prospective cohort studies may be
required to fully elucidate the mechanism involved.
In conclusion, the results of present study indicate
that the mouth breathing patients with incompetent
lip seal had higher scores of gingival inammation in
adults, especially in upper anterior segment. Also, the
distribution of gingival inammation in such patients
differs when compared to nasal breathers. Thus,
clinician should be more vigilant while screening such
individuals as mouth breathing could be one of the risk
factors in gingivitis.
There are no potential conf licts of interest or any
nancial or personal relationships with other people
or organizations that could inappropriately bias the
conduct and ndings of this study.
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and upper lip coverage and their relationship with
gingival inammation in 11-14year-olds. J Clin
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3. Jacobson L. Mouthbreathing and gingivitis. 1.
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randomized clinical trial of salivary substitute
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(Received February 2, 2016; Accepted June 24, 2016)
... This test consists of the use of a double-sided mirror, it is placed under the nostrils between the nose and the mouth horizontally. If the mirror fogs up on the side where the nostrils are, it indicates a normal breathing pattern (nasal); but if the fogging is in the lower part, an abnormal breathing pattern (buccal) is suggested [16,28]. ...
... A piece of cotton is placed in the shape of a butterfly under the nostrils on the upper lip. The movement of the cotton will indicate the breathing pattern; if the cotton fibers move upwards, it indicates a nasal breathing pattern, if the lower fibers move, it indicates mouth breathing [16,28]. ...
... This test consists of asking the patient to fill their mouth with water and hold it for 3 to 5 minutes. Patients who indicate nasal breathing retain water without difficulty, while patients with an oral breathing pattern cannot complete the test in the indicated time [16,28]. The most cited diagnostic tests in the literature are the mirror test and the water retention test [29]. ...
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Introduction: Mouth breathing is a syndrome characterized by the exclusive passage of air through the oral cavity because of a pathological condition due to nasal, pharyngeal, or habitus obstruction. Objective: To analyze the impact of mouth breathing habit on the development of the stomatognathic system. Materials and Methods: Search through PubMed, Science Direct, Scielo, Web of Science (WOS) and Google Scholar, it is a qualitative approach research, documentary bibliographic type, cross-sectional, retrospective in the search, descriptive-analytical design and deductive method; following inclusion and exclusion criteria, 49 articles were included. Analysis and Discussion of Results: Obstructive, inflammatory and functional factors are associated with mouth breathing; mirror test, butterfly and water retention test characterize the mouth breather ; they present adenoid facies, skeletal class II, narrow upper dental arch, anterior open bite, lip incompetence and tongue in a lower position than usual, gingival inflammation, dental caries, halitosis, obstructive sleep apnea, snoring, alteration of phonemes and masticatory deficiency; the use of steroids, antibiotics, antiallergic drugs, surgical treatment, speech therapy and myofunctional therapy are the standard therapy. Conclusion: Mouth breathers present skeletal, facial, oral and soft tissue changes and associated pathologies; their treatment will depend on their etiology
... Wagaiyu et al. [17] also showed that gingival inflammation and plaque accumulation were more evident in the anterior maxillary region of oral breathers. Sharma et al. [19] found that oral breathers had higher GI and BOP in all regions of their mouth. These studies were consistent with the current investigation in terms of pre-adenotonsillectomy conditions. ...
... In contrast, a study showed that oral breathing is not associated with gingival bleeding [20]. Sharma et al. [19] and Nascimento Filho et al. [21] reported that oral breathing had no effect on the prevalence and extent of gingivitis unless there were significant amounts of germ in the mouth. Also, increased prevalence of gingivitis in oral breathers can be associated with dental crowding. ...
Full-text available
Objectives: Enlarged adenoids can lead to obstruction of the nasopharyngeal airway and subsequent oral respiration. Oral breathing can cause dry mouth, dehydration in gingival tissue, and resistance to plaque accumulation. This study aimed to evaluate the impact of tonsillectomy on oral health status, salivary pH and flow rate, and common complications caused by tonsillar hypertrophy in children. Materials and Methods: An analytical before-and-after study was conducted on 60 children aged 5-12 years who required tonsillectomy. We gathered data through a questionnaire and collected unstimulated saliva using the spitting method for five minutes. Salivary pH was measured by a pH meter and its volume was determined with a calibrated test tube. The plaque index, bleeding index and modified gingival index were determined using a disclosing tablet, Williams’ probe and observational examination, respectively. All measurements were repeated one month after tonsillectomy. Paired t-test was used for data analysis. Results: We found a significant increase in mean pH and salivary flow rate after tonsillectomy and observed a decrease in oral health indices among the children one month after surgery. Over half of the children who reported complications such as dry mouth, itchy nose and throat, snoring, night sweats, and sleep disturbances experienced complete recovery after tonsillectomy. Conclusion: Based on the results obtained in the present study, children with enlarged adenoids showed significant improvements in salivary pH, salivary flow rate, and oral health indices, one month after tonsillectomy.
... The mean age group was found to be 28.03 years. Rajinder K et al, in their study has observed that the prevalence was more in male population and the mean age was 24.6 years and mouth breathing Patients had higher scores of gingival inflammation (Sharma et al., 2016), this is in accordance with our study.According to Abdul B et al Reply the plaque deposition in patients with malocclusion was more prevalent in the female population [58%], the study in contrast to the present study where the prevalence was seen in male patients (Memon et al., 2015). Fatemeh J et al, in the study observed that the presence of gingivitis is more in girls [53.7%] and prevalence of mouth breathing was found to be 19.7% (Jahanimoghadam and Shamsaddin, 2016). ...
... Mouth breathers inspire and expire through the mouth, as a consequence of reduced patency of the nasal airways. The constant airflow from mouth breathing could dry the teeth and mucosa, especially in the anterior portion of the mouth (Pacheco et al., 2015), leading to chronic gingival inflammation (Sharma et al., 2016), an increased level of Streptococcus mutans (CFU > 10 5 ), and a higher plaque index (PlI), although no significant difference was found in mean buffering capacity of saliva and the salivary flowrate (Mummolo et al., 2018). A higher risk of dental erosion and caries also exist among mouth breathers because of a decrease in intraoral pH compared with normal breathing during sleep (Choi et al., 2016). ...
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Mouth breathing induces a series of diseases, while the influence on microbiota of oral cavity and salivary proteins remains unknown. In this study, for the first time, profiles of oral–nasal–pharyngeal microbiota among mouth-breathing children (MB group, n = 10) were compared with paired nose-breathing children (NB group, n = 10) using 16S ribosomal DNA (rDNA) (V3–V4 region) high-throughput sequencing. The differentially expressed salivary proteins were revealed using label-free quantification (LFQ) method, and their associations with bacterial abundance were measured by canonical correspondence analysis (CCA). The overall bacterial profiles differed between the two groups, and the differences were related to the duration of mouth breathing. The diversity of oral–pharyngeal microbiota was significantly higher, and the nasal–pharyngeal species tended to be consistent (unweighted UniFrac, p = 0.38) in the MB group. Opportunistic pathogens were higher in relative abundance as follows: Acinetobacter in the anterior supragingival plaque, Neisseria in unstimulated saliva, Streptococcus pneumoniae in the pharynx, and Stenotrophomonas in the nostrils. The expression level of oxidative-stress-related salivary proteins (lactoylglutathione lyase and peroxiredoxin-5) were upregulated, while immune-related proteins (integrin alpha-M and proteasome subunit alpha type-1) were downregulated in MB group. The differentially expressed proteins were associated with specific bacteria, indicating their potentials as candidate biomarkers for the diagnosis, putatively early intervention, and therapeutic target of mouth breathing. This study showed that mouth breathing influences the oral–nasal–pharyngeal microbiota and enriches certain pathogens, accompanied with the alterations in the salivary environment. Further research on the pathological mechanisms and dynamic changes in longitudinal studies are warranted.
... 10 Mouth breathing has also been reported to play a role in gingival inflammation. [11][12][13][14] Hydration status has been found to affect wound healing in animal studies. Fast healing response is observed in skin wounds under moist conditions. ...
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Introduction Dryness is known to be associated with inflammatory diseases such as dry eye disease and atopic dermatitis. There is significant water loss from the oral cavity during mouth breathing. This study is conducted to estimate the influence of mouth breathing on the outcome of scaling and root planing (SRP) in chronic periodontitis (CP). Materials and methods CP patients comprising of 33 mouth breathers (MBs) and 33 nose breathers (NBs) were recruited. Thirty patients in each group completed the study. At baseline, plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) were measured. SRP was done in both groups. At the 4th, 8th, and 12th week, PI, GI, and BOP were recorded. PD and CAL were also assessed at the 12th week. Results At the 12th week, there was significantly less improvement in GI at palatal sites of maxillary anterior and maxillary posterior teeth in MB group. Sixty-nine percent of BOP positive sites with PD >4 mm were converted into BOP negative sites with PD ≤4 mm in maxillary posterior palatal sites in NB. This success was 38% in MB. Conclusion Control of periodontal inflammation by SRP in CP patients is affected at palatal sites of mouth breathers.
Non extraction therapy is NOT a treatment goal. It is merely a means of effectuating a treatment goal. The same mindset applies to extraction therapy – it is a means to an end. The first diagnostic consideration in contemporary orthodontic therapy should be to decide where one wants to place the teeth. This answer is based on a host of considerations that are driven by patient preferences, professional experience and expertise, and evidence based data relating to the clinical issues at hand. Treatment considerations follow and they too are based on a number of factors such as anatomical, physiological, and functional limitations, patient cooperation, and biomechanical expertise to name a few. In the end, the decision to extract teeth or not should support the five goals that provide support for the bases behind professional orthodontic intervention: 1) the creation of a harmonious balance in the alignment of the dentition, 2) maximizing occlusal contacts, 3) enhancing dentofacial esthetics, 4) creating a functional occlusion, and 5) achieving a relatively physiologic stable result.
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Dental plaque causes chronic gingivitis, but aggravating factors could be related to mouthbreathing and ankyloglossia. An adult female with a complaint of "bleeding gums" and an adult male with a complaint of "painful gums" were seen at a periodontal clinic. Authors found markedly enlarged tonsils compromising the airway with associated gingivitis in the female patient and ankyloglossia with associated mild gingivitis and Miller's class II gingival recession in the male patient. For these particular cases, chronic mouth-breathing and ankyloglossia appeared to be important in the aetiopathogenesis of chronic gingivitis and periodontitis.
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To assess dental plaque on different regions of the dentition prior to and immediately after toothbrushing. Subjects refrained from oral hygiene for 22-26 hours prior to baseline whole mouth plaque assessments by the Turesky modification of the Quigley-Hein Index (TMQH). All subjects brushed with a marketed soft-bristled toothbrush and a fluoride dentifrice for 1 minute prior to post-brushing plaque assessments similar to baseline. One calibrated clinical examiner conducted all measurements. 30 subjects (mean age 23 years) completed the study. Irrespective of arch, posterior teeth harbored higher frequencies for scores of 3-5 than corresponding anterior teeth prior to brushing. In comparison to the pre-brushing examination, scores of 0-1 were more common in the post-brushing evaluation, however, greater frequencies of higher plaque were observed on posterior than on anterior regions. Irrespective of gender, subject or arch, anterior teeth harbored lower mean amounts of plaque than posterior teeth by ANOVA at both clinical examinations (P < 0.0001). Additionally, irrespective of arch, lower mean scores for plaque were observed on anterior teeth than from posterior teeth or the whole mouth at both examinations (P < 0.001). Lingual and molar surfaces consistently harbored large densities of plaque and represented areas with the least plaque removal after toothbrushing. Mid-vestibular sites represented the areas with the highest percent removal of plaque at 65% and harbored significantly lower levels of plaque than proximal sites during all phases of the study (P < 0.0059).
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To investigate the etiology, main clinical manifestations and other concurrent findings in mouth-breathing children aged 3 to 9 years and resident in the urban area of Abaeté (MG), Brazil. This study was based on a representative random sample of the town population, of 23,596 inhabitants. Clinical diagnosis of mouth-breathing was defined as a combination of snoring, sleeping with mouth open, drooling on the pillow and frequent or intermittent nasal obstruction. Children with a clinical diagnosis of mouth-breathing underwent nasal endoscopy, allergy skin tests and X ray of the rhinopharynx, full blood tests, eosinophil counts, total IgE assay and fecal parasitology. Data were analyzed using SPSS version 10.5. The main causes of mouth-breathing were: allergic rhinitis (81.4%), enlarged adenoids (79.2%), enlarged tonsils (12.6%), and obstructive deviation of the nasal septum (1.0%). The main clinical manifestations of mouth breathers were: sleeping with mouth open (86%), snoring (79%), itchy nose (77%), drooling on the pillow (62%), nocturnal sleep problems or agitated sleep (62%), nasal obstruction (49%), and irritability during the day (43%). Certain clinical manifestations are very common among mouth-breathing children. These manifestations must be recognized and considered in the clinical diagnosis of mouth-breathing.
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The gingival health of 201 schoolchildren aged 11-14 years was assessed at 6 sites on all the incisor and first molar teeth by recording separately the presence or absence of redness and bleeding on probing. Crowding of the incisor teeth was recorded as labio-lingual displacement and mesio-distal overlap. A 2nd examiner recorded the presence or absence of plaque at these sites and assessed mouthbreathing, lipseal and upper lip coverage of the maxillary incisors. Mouthbreathing, increased lip separation and decreased upper lip coverage at rest were all associated with higher levels of plaque and gingival inflammation. Multivariate analysis indicated that this association was statistically significant for mouthbreathing and lip coverage but increased lip separation was not independently related to plaque and gingivitis. The relationship of mouthbreathing and decreased upper lip coverage with gingivitis was most evident in the upper anterior segment and was still evident after covariate analysis to take account of variations due to gender, overcrowding and amount of plaque. However, allowance for these factors also suggested that the influence of mouthbreathing was restricted to palatal sites, whereas lip coverage influenced gingival inflammation at both palatal and labial sites.
Background: Mouth breathing can lead to introduce cold, dry unprepared air that insults the tissue of oral cavity, nasopharynx and lung, leading in turn to pathological changes in oronasal cavity, nasopharyngeal and other respiratory tissue, mouth breathing associated with nasal obstruction may lead to many health problems, in particular oral health problems such as inflammation of gingiva, oral dryness, change in oral environment that may decrease pH, salivary flow rate and increase bacteria and dental caries.Aims of the present study were to assess the oral health condition among mouth breather associated with nasal obstruction, including dental caries, oral cleanliness and gingival health condition as well as to evaluate the changes in salivary physical characteristics and salivary mutans streptococci counts, and their relation to oral variables in comparison to a control group. Materials and Methods: Thirty patients with mouth breathing associated with nasal obstruction (15 females and 15 males) were selected as a study group with an age range (18-22) years old, all subjects were examined by ENT specialist to confirm mouth breathing. A 30 gender and age matched healthy looking subjects without nasal obstruction were selected as control. The diagnosis and recording of dental caries was according to severity of dental caries lesion through the application of D1_4MFS(Manji et al., 1989). Plaque index of (Silness and Loe, 1964) was used for plaque assessment; gingival index of (Loe and Silness, 1963) was used for gingival health condition assessment. Stimulated salivary samples were collected according to (Tenovuo and Lagerlof, 1996) and the following variables were recorded: microbiological analysis included the salivary counts of mutans streptococci, salivary flow rate, salivary pH (potential of hydrogen) and then measurement of salivary viscosity by using Ostwald's viscometer. Results: Results of the present study showed that the mouth breathing group had statistically highly significant, higher plaque and gingival indices than nose breathing group (P<0.01) with a positive highly significant correlation between them in mouth breathing and nose breathing groups (r=0.56, r= 0.64, respectively).The salivary flow rate was lower among mouth breathing with highly significant difference than nose breathing (P<0.01), also salivary pH was lower among mouth breathing but with significant differencecompare to nose breathing (P<0.05); statistically a negative highly significant correlation was recorded among mouth breathing group between salivary flow rate with gingival index (r= -0.56). It has been found that salivary viscosity was not statistically significant difference between mouth breathing group and nose breathing group. The salivary viscosity was found to be inversely significantly correlated with salivary flow rate among mouth breathing group (r= -0.38). While it was positively not significantly correlated with plaque index, gingival index and counts of mutans streptococci among mouth breathing group. Data analysis of the present study showed that salivary mutans streptococci counts among mouth breathing group were higher than that among nose breathing group, difference was statistically highly significant (P<0.01). Conclusion: Mouth breathing associated with nasal obstruction may have an effect on oral health status, leading to an increase in periodontal disease and changes in dental caries.
We investigated the outcome of conventional periodontal treatment in mouth breathing patients with chronic periodontitis, and compared the efficacy of applying salivary substitute to the anterior sextants as an adjunct to conventional treatment in such patients. In this randomized, investigator-blind, clinical study involving parallel groups, 40 mouth breathing patients were divided into two groups: a control group (CG, n = 20) comprising patients who received scaling and root planing (SRP), and a test group (TG, n = 20) who received salivary substitute as an adjunct to SRP for treatment of chronic periodontitis. The patients were followed up at various time intervals, and improvement of the gingival index (GI) was examined as the primary outcome. Student's t-test, repeated-measures ANOVA and Mann-Whitney U test were applied for statistical analysis. Although periodontal parameters were improved in both groups after 8 weeks of follow-up, the test group showed better improvement in terms of GI and percentage bleeding on probing. Within the limits of this study, our results suggest that the use of salivary substitute has a beneficial adjunctive effect for improvement of periodontal parameters in mouth breathing patients with chronic periodontitis. (J Oral Sci 57, 241-247, 2015).
Background and Objective Xerostomia is a subjective symptom of dryness in the mouth. Although a correlation between xerostomia and oral conditions in the elderly has been reported, there are few such studies in the young adults. The aim of this study was to examine the relationship of xerostomia with the gingival condition in university students.Material and MethodsA total of 2077 students (1202 male subjects and 875 female subjects), 18–24 years of age, were examined. The disease activity and severity of the gingival condition were assessed as the percentage of teeth with bleeding on probing (%BOP) and the presence of teeth with probing pocket depth of ≥ 4 mm, respectively. Additional information on xerostomia, oral health behaviors, coffee/tea intake and nasal congestion was collected via a questionnaire. Path analysis was used to test pathways from xerostomia to the gingival condition.ResultsOne-hundred and eighty-three (8.8%) students responded that their mouths frequently or always felt dry. Xerostomia was related to %BOP and dental plaque formation, but was not related to the presence of probing pocket depth ≥ 4 mm. In the structural model, xerostomia was related to dental plaque formation (p < 0.01), and a lower level of dental plaque formation was associated with a lower %BOP. Xerostomia was associated with coffee/tea intake (p < 0.01) and nasal congestion (p < 0.001).Conclusion Xerostomia was indirectly related to gingival disease activity through the accumulation of dental plaque. Nasal congestion and coffee/tea intake also affected xerostomia. These findings suggest that xerostomia should be considered in screening for gingivitis risk in young adults.
Background: This study was taken to assess the prevalence of deleterious oral habits among 6-12 year old school going children. Materials & methods: A sample size of 832 children was finalized with simple random sampling technique including 444 males and 388 females. To get the demographic information and presence of harmful oral habits a closed-ended questionnaire was developed. Clinical evaluation was also done using mirror and water tests. Chi-square test was done to compare the prevalence of oral habits among different age groups and gender at p<0.05. Results: Bruxism (17.3%) was most commonly seen followed by bottle feeding (10.1%), thumb sucking (8.7%), nail biting (5.8%), tongue thrusting (4.9%) and mouth breathing (4.3%). Prevalence of all deleterious habits were more among female children and it also showed significant differences according to age. Conclusion: The data showed high prevalence of these oral habits. This highlighted the need for preventive orthodontic treatment at early age of life so that future occurrence of malocclusion can be avoided. How to cite the article: Garde JB, Suryavanshi RK, Jawale BA, Deshmukh V, Dadhe DP, Suryavanshi MK. An epidemiological study to know the prevalence of deleterious oral habits among 6 to 12 year old children. J Int Oral Health 2014;6(1):39-43.
The vast majority of health care professionals are unaware of the negative impact of upper airway obstruction (mouth breathing) on normal facial growth and physiologic health. Children whose mouth breathing is untreated may develop long, narrow faces, narrow mouths, high palatal vaults, dental malocclusion, gummy smiles, and many other unattractive facial features, such as skeletal Class II or Class III facial profiles. These children do not sleep well at night due to obstructed airways; this lack of sleep can adversely affect their growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity. It is important for the entire health care community (including general and pediatric dentists) to screen and diagnose for mouth breathing in adults and in children as young as 5 years of age. If mouth breathing is treated early, its negative effect on facial and dental development and the medical and social problems associated with it can be reduced or averted.