|Year : 2012 | Volume
| Issue : 1 | Page : 27-31
The effect of mouth breathing on dentofacial morphology of growing child
S Malhotra1, RK Pandey1, A Nagar2, SP Agarwal3, VK Gupta4
1 Department of Pediatric and Preventive Dentistry, CSMMU, Lucknow, Uttar Pradesh, India
2 Department of Orthodontics, CSMMU, Lucknow, Uttar Pradesh, India
3 Department of Otorhinolaryngology, CSMMU, Lucknow, Uttar Pradesh, India
4 Public Health Dentistry, FODS, CSMMU, Lucknow, Uttar Pradesh, India
|Date of Web Publication||3-May-2012|
D162, South City, Raibareilli Road, Lucknow, Uttar Pradesh
| Abstract|| |
Backround: The oral mode of respiration cause postural adaptations of structures in the head and neck region producing the effect on the positional relationship of the jaws. Aim: The aim of this study is to verify the skeletal relationship of mouth and nose breathing child. Study design: A cross sectional study was performed to assess the association of changed mode of respiration with dentofacial growth. Materials and Methods : One hundred children among which 54 were mouth breathers and 46 were nasal breathers of 6-12 years of age were submitted to clinical examination and cephalometric radiographical analysis. Statistical analysis : Chi-square test for proportions and independent sample's 't'test for parametric data is used. Result: The mean values of N-Me (P<0.001) ANS-Me (P<0.001) and SN-GoGn (P<0.001) for mouth breathers is significantly higher. ArGo-GoMe (P=0.003) and (P<0.011) for 6-9 and 9-12 years age group, respectively, were significantly low in nasal breathers group. Conclusions: Changed mode of respiration was associated with increased facial height, mandibular plane angle and gonial angle.
Keywords: Cephalometrics, dentofacial growth, mouth breathing
|How to cite this article:|
Malhotra S, Pandey R K, Nagar A, Agarwal S P, Gupta V K. The effect of mouth breathing on dentofacial morphology of growing child. J Indian Soc Pedod Prev Dent 2012;30:27-31
|How to cite this URL:|
Malhotra S, Pandey R K, Nagar A, Agarwal S P, Gupta V K. The effect of mouth breathing on dentofacial morphology of growing child. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2014 Dec 20];30:27-31. Available from: http://www.jisppd.com/text.asp?2012/30/1/27/95572
| Introduction|| |
The prime physiological functions of the oral cavity are respiration, suckling, swallowing, mastication and speech. All these functions are balanced; the disturbance in one oral function results to an abnormal growth and development of bony and soft tissue structures of the craniofacial complex.
The effect of respiratory function on the development of orofacial structures have been the matter of debate among researchers for over a century. The mouth breather customarily refers to one who primarily breathes through mouth even though they do have some nasal capacity.
Bone is the second hardest substance in the human body with the characteristics of being extremely susceptible to deformities when submitted to small forces. The reduced nasal respiratory function causes altered tongue posture which result in inferior positioning of mandible and inducing changes in neck and facial muscular activity leading to development of dental and facial characteristics. 
Bresolin D et al.  evaluated allergic mouth-breathing subjects and concluded that mouth breathers had longer faces Tourne LP  concluded that the switch from a nasal to an oronasal breathing pattern induces functional adaptations that include an increase in total anterior face height and vertical development of the lower anterior face. Faria PT et al.  indicated that changed mode of breathing was associated with maxillo-mandibular retrusion in relation to the cranial base in the mouth breathers and the SNGoGn and NSGn angles were greater in the mouth-breathing group.
Thus the present study was envisaged to evaluate the effect of mouth breathing on dentofacial pattern and to compare the dentofacial pattern between mouth breathing and nasal breathing children.
| Materials and Methods|| |
The present study was conducted in the Department of Pedodontics with Preventive dentistry, CSMMU, Lucknow, in collaboration with Department of Otorhinolaryngology, CSMMU, Lucknow.
The subjects for the present study composed of 100 children among which 54 were mouth breathers and 46 were nasal breathers. Gender wise distribution was observed as 66 and 34 males and females, respectively. The subjects studied were ranged in the age of 6-12 years.
Selection of cases
The cases were selected for the present study having no history of orthodontic, oral or nasal surgical treatment or bone deformity and muscular dystrophy. The cases with history of birth injuries and past illness were excluded from the study.
Assessment of nasal function
The selected case subjects were tested to assess the adequacy of nasal breathing in pedodontic clinic by asking them to breathe through their nose for one minute after putting water in their mouth and in otorhinolaryngology clinic by fogging or condensation on mirror which was placed both near nose and mouth simultaneously and also examined by rhinoendoscopy.
Assessment of dentofacial changes
The lateral cephalogram obtained for the study were obtained by a cephalostat with the Frankfort Horizontal plane parallel to the floor and teeth in centric occlusion with relaxed lips (Profit) Fuji X-ray film (8" Χ 10") with speed E were exposed at 80 Kvp; 40 mA for 2 seconds from a fixed distance of 60 inches following the standard technique employed in the Department of Radiology, Faculty of dental sciences, CSMMU, Lucknow. Rotograph Plus cephalostat were used.
Cephalometric landmarks used in the study
The cephalometric landmarks used in the present study were identified on tracing of cephalometric X-ray film using roentgenographic cephalometric technique.
The various linear and angular measurement of landmark present on cephalometric tracings were recorded as nasal breathers and mouth breathers for comparison with cephalometric variables of a normal child.
The quatatative analysis of results was performed using the proportions and means. The comparison between nasal breathers and mouth breathers was performed using Chi-square test for proportions and independent sample's 't'test for parametric data .
| Results|| |
In the present study the dentofacial growth were determined by comparing lateral cephalograms of nasal breathing with mouth-breathing children.
In age group 6-9 years statistically significant differences were seen for
N-Me (P=<0.001) and ANS-Me (P=<0.001). The mean values of mouth-breathers group were significantly higher as compared to nasal breathers group for the variables N-Me and ANS-Me. The mean values of nasal breathers were higher as compared to mouth breathers for S-Go, S-Ar and Ar-GO but statistically the differences were not significant as shown in [Table 1].
|Table 1: Comparison of linear cephalometric variables between nasal breathers and mouth breathers in 6-9 years age group|
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The mean values for angular variables for the age group 6-9 years were significantly low in nasal-breathers group for the variables SN-GoGn (P=<0.001), PP-MP (P=0.001) ArGo-GoMe (P=0.003) and NS-Gn (P=<0.001). No statistically significant difference was seen for the variable SN-PP, SNA, SNB and ANB as shown in [Table 2].
|Table 2: Comparison of angular cephalometric variables between nasal breathers and mouth breathers in 6-9 years age group|
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In age group 9-12 years, in nasal-breather group and mouth-breather group not much significant difference were observed for the variable N-ANS. (P=0.057) It was evident that the mean values for N-Me (P=<0.001) ANS-Me (P=<0.001) were found significantly higher among mouth breathers as compared to nasal breathers as shown in [Table 3].
|Table 3: Comparison of linear cephalometric variables between nasal breathers and mouth breathers in 9-12 years age group|
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Among angular variables, age group 9-12 years, significant differences between the two groups were seen for all the variables except SN-PP and ANB. The significant values were recorded for SNA (P=<0.001) and SNB (P=<0.001). The SNA and SNB values were found to be higher for the nasal breathers. The values for SN-GoGn (P<0.001), PP-MP (P=0.001), ArGo-GoMe (P<0.001) and NS-Gn (P<0.001) were found to be greater for mouth breathers as shown in [Table 4].
|Table 4: Comparison of angular cephalometric variables between nasal breathers and mouth breathers in 9-12 years age group|
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| Discussion|| |
Children who breathe predominantly through their mouth pose difficult problems for health care professionals. The dental professional apprehend that faces of the mouth breathers might develop aberrantly, possibly because of disruption of normal functional relationships caused by chronic airway obstruction and altered path of airway.
Oral respiration, low tongue posture and elongation of lower anterior facial height are apparent at three years of age but more commonly detected after age five. The deleterious impact of decreased nasorespiratory function is virtually complete by puberty. Hence the age group 6-12 years is selected for the present study.
In the present study the nasal breathing impaired subjects demonstrated significant statistical difference in total anterior facial height and greater lower anterior facial height, which was greater in mouth breathers, in age groups 6-12 years as shown in [Table 1] and [Table 3] which was in conformity with studies by Linder-Aronson,  Principato JJ et al.,  Cheng MC et al.,  Tourne LP,  Ung N et al. 
The SN-GoGn angle was statistically significant in mouth-breathing group, as shown in [Table 2] and [Table 4] showing more accentuated inclination of the mandibular plane in these subjects, which is in accordance with the results obtained by McNamara JA  Solow  and Trask GM et al.  Contrary Frasson JM et al.  found no significant difference between nasal breathers and mouth breathers. It was seen that there was decrease in this angular measurement as the age increases.
The morphological pattern measured by the SN-Gn as shown in [Table 2] and [Table 4] was statistically correlated with type of breathing, as mouth-breathing subjects promote posterior rotation of mandible thereby enhancing the facial height. Harvold et al.  while studying animals and Faria  also observed higher values.
In the present study an increase in gonial angle in mouth breathers was found and which was statistically significant as shown in [Table 2] and [Table 4]. Bresolin et al.  who studied on North American Caucasians and results of Ung et al.  and Yang K  confirms the finding of the present study. This cephalometric measurements were not in accordance with the reports of Mattar et al.  and Lessa et al.  who concluded that there was decrease in this angular measurement in older age group in nasal breathers and mouth breathers.
The palatal plane to mandibular plane angle was greater and statistically significant in mouth breathers as shown in [Table 2] and [Table 4]. Trask GM et al.  reported after analyzing the effect of allergic rhinitis on dental and facial skeleton which are in concurrence with the present study.
On the other hand, the cephalometric measuments in the antero-posterior plane showed characteristic combination of craniofacial deformity. In the age group 9-12 years as shown in [Table 4] maxillomandibular retrusion to the cranial base in mouth breathers was noted. These result were consistent with LinderAronson  Behlfelt K  upon evaluating the effect of enlarged tonsils and tonsillectomy on the dentofacial morphology and Sakaguchi et al.;  however, in younger individuals of the age group 6-9 years as shown in [Table 2], demonstrated no statistical significant difference. The present study showed positive co-relationship with the finding of Watson et al.,  as depicted in [Table 2].
The purpose of the present study was to ascertain that breathing mode is related to facial growth. The data of the present study showed no quantitative evidence that the subjects were, indeed, accurately classified by their predominant mode of respiration. because sample selection was performed by visual rather than functional criteria The condensation on mirrors, clinical rhinological and radiographic examination have been correlated with epidemiologic surveys and being utilized for making comparisons in assigning etiological roles.
The presence of mouth breathing in pediatric patients is a relatively common fact and may result in a series of changes of facial skeleton.
| Conclusions|| |
The present study led to the conclusion that all subjects with mouth-breathing habit exhibited significant increase in facial height, mandibular plane angle and gonial angle.
Hence a joint effort by pedodontist, orthodontist, otorhinolaryngologist and pediatrician is thus required for reducing continuing detrimental effects of breathing impairments on facial characteristics.
| References|| |
|1.||Klein JC. Nasal respiratory function and craniofacial growth. Arch Otolaryngol Head Neck Surg 1986;112:843-9. |
|2.||Bresolin D, Shapiro PA, Shapiro GG, Chapko MK, Dassel S. Mouth breathing in allergic children and its relationship to dentofacial development. Am J Orthod 1983;83:334-40. |
|3.||Tourne LP. The long face syndrome and impairment of the nasopharyngeal airway. Angle Orthod 1990;60:7-76. |
|4.||Faria PT, de Oliveira Ruellas AC, Matsumoto MA, Anselmo-Lima WT, Pereira FC. Dentofacial morphology of mouth breathing children. Braz Dent J 2002;13:129-32. |
|5.||Linder-Aronson. Adenoids: Their Effect on the mode of breathing and nasal airflow, and their relationship to characteristics of the facial skeleton and the dentition. Acta Otolaryngol 1970;265(suppl.):5-132. |
|6.||Principato JJ, Kerrigan JP, Wolf P. Pediatric nasal resistance and lower anterior vertical face height. Otolaryngol Head Neck Surg 1986;95:226-9. |
|7.||Cheng MC. Evaluation of craniofacial morphology and occlusion in patients with nasal obstruction. master thesis, case Western Reserve University 1988. |
|8.||Ung N, Koenig J, Shapiro PA, Shapiro G, Trask G. A quantitative assessment of respiratory patterns and their effects on dentofacial development. Am J Orthod Dentofacial Orthop 1990;98:523-32. |
|9.||McNamara JA. Influence of respiratory pattern on craniofacial growth. Angle Orthod 1981;51:269-300. |
|10.||Solow B, Siersbaek-Nielsen S, Greve E. Airway adequacy, head posture, and craniofacial morphology. Am J Orthod 1984;86:214-23. |
|11.||Trask GM, Shapiro GG, Shapiro PA. The effects of perennial allergic rhinitis on dental and skeletal development: A comparison of sibling pairs. Am J Orthod Dentofacial Orthop 1987;92:286-93. |
|12.||Frasson JM, Magnani MB, Nouer DF, de Siqueira VC, Lunardi N. Comparative cephalometric study between nasal and predominantly mouth breathers. Rev Bras Otorrinolaringol 2006;72:72-82. |
|13.||Harvold EP, Vaargevik K, Chierici G. Primate experiments on oral sensation and dental malocclusions. Am J Orthod 1973;63:494-508. |
|14.||Yang K, Zeng X, Yu M. A study on the difference of craniofacial morphology between oral and nasal breathing. Child Dent Cadmos 2002;37:385-7. |
|15.||Mattar SE, Anselmo-Lima WT, Valera FC, Matsumoto MA. Skeletal and occlusal characteristics in mouth-breathing pre-school children. J Clin Pediatr Dent 2004;28:315-8. |
|16.||Lessa FC, Enoki C. Breathing mode influence in craniofacial development. Rev Bras Otorrinolaringol 2005;71:156-60. |
|17.||Behlfelt K. Enlarged tonsils and the effect of tonsillectomy. Characteristics of the dentition and facial skeleton. Posture of the head, hyoid bone and tongue. Mode of breathing. Swed Dent J Suppl; 72:1-35. |
|18.||Sakaguchi N, Oota I, Yahata S, Igarashi. The effect of mouth breathing on respiratory function and maxillofacial development in children Health Sciences University of Hokkaido, sapporo, Japan, 2002. |
|19.||Watson RM, Warren EW, Fisher ND. Nasal resistance, skeletal classification and mouth breathing in orthodontic patients. Am J Orthod 1968;54:367-79. |
[Table 1], [Table 2], [Table 3], [Table 4]
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