A Conversation About Mouth Breathing

​Mouth breathing is not genetic. We are born obligate nasal breathers. If the mouth is open at rest at any age we need to explore further. If the mouth is open with mouth breathing then ruling out a nasal obstruction is your first step. If the mouth is open with nasal breathing then it may be muscular or a habit. The good news is that you can correct both of these at any age. A simple way you can explore and get more information is to take a make-up mirror and place it under the nose. Can you see condensation from both nostrils? If you can, then air is flowing and the nose is at least partially working. Let’s explore further.

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Let’s Get Physical
Mouth breathing seems to be under-discussed and underestimated. We seem to overlook mouth breathing with the idea that if we are breathing and upright then that is all that matters, right? Well mouth breathing happens for a reason and it can be functional. In the case of a physical nasal obstruction, it is about survival. This is why we should never use lip taping without a proper assessment and reassurance that the nose is clear. If we lip tape with a nasal obstruction, several things may happen. Blood oxygen levels will drop, anxiety will increase, additional pressure is placed on the heart and respiratory drive increases. Suffocating a person is not a useful experience.
There will be other red flags for an airway obstruction and these are worth discussing with your GP. According to the American Academy of Pediatric Dentistry the following are red flags for nasal obstruction that require Ear, Nose and Throat (ENT) referral. Look for snoring three or more nights per week, pauses in breathing during sleep, abrupt wakening followed by shortness of breath, frequent waking, unusual sleeping positions, restless sleeping, bedwetting, excessive daytime sleepiness, attention problems, morning headache, morning dry or sore throat and of course mouth breathing. If you are nodding your head to some of these, please make an appointment with your GP to discuss a referral to an ENT. It may be helpful to take some videos of your child sleeping so your GP can witness what you see. It might assist with a complete assessment.
If the thought of surgery creates anxiety for you, please know I understand. It is a sensitive issue. Particularly with children, we don’t take a general anesthetic lightly. At an ENT appointment, you start with a consultation and assessment. Your specialist will have a look at the airways with a particular interest in the size of the tonsils and adenoids. It’s not always about infections, it’s about the size and if they are physically blocking the airway. There are times when they may recommend a non-surgical approach first. Sometimes, if the obstruction is so large then it becomes a serious health risk which far outweighs the risks of surgery. Best case scenario, no surgery is needed and you know you can safely work with nasal rehabilitation training and expect a successful outcome. Yes, it may be an expensive process but what price do you place on being able to breathe?
 

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​It All Starts at the Nose
The body is exceptionally smart, it will adjust and adapt to survive. If an airway obstruction has been managed and mouth breathing continues, it’s time to rehabilitate the nose, the breathing muscles and the rate and rhythms associated with healthy breathing. Persistent mouth breathing should not be ignored. Mouth breathing in childhood is now considered a major risk factor for obstructive sleep apnoea (OSA) later in life. OSA is linked with nearly every chronic disease and new research has shown an association with diseases of the brain such as Alzheimer’s
 
The nose is our first line of defence and an innate part of our immune system. Breathing means life and nasal breathing is an essential component of good health. There are about thirty functions of the nose and by-passing this with mouth breathing has consequences for the whole body. The nose is our filtering system of particles that move through the air. Smoke, dust and pollens get trapped in the nose which prevents them becoming lodged in and irritating the lungs. It’s the first line of defence against bacteria, viruses and fungi in the air. The nose prepares the air, ready for the body to use. It adds the perfect amount of moisture and heat so as to prevent cooling and drying of the airways. Nasal breathing reduces narrowing of the airways. For example, for an asthmatic, those three out of thirty functions already could potentially prevent an attack.
Have you ever considered that the size of the nostrils is small for a reason? If you consider the size of an open mouth versus the size of the nostrils, the nostrils are much smaller. This helps to regulate the volume of air that we breathe. There is a concept of breathing too much air or ‘over-breathing’. This may seem strange initially but it’s about chemistry. One factor is carbon dioxide (CO2). Did you know that we need healthy levels of CO2 in our blood as well? Healthy levels of CO2 actually help to deliver oxygen around the body. CO2 assists with keeping blood vessels dilated. This extends further than the airways. It’s in every part of our body including the tiny vessels to the skin of our fingertips and toes.
 
Conversations with the Brain
The good news is that the simple act of nasal breathing improves the health of the nose. Use it or lose it! Slowing the breath can assist with stress relief, relaxation and calming of the nervous system. Inside our nose, we have tiny little sensors that connect directly with the brain. The innate sense of smell for example triggers emotions. From the first day of our life, we are connected to our mother’s scent. This is associated with safety, warmth and food. As we grow, we carry emotions associated with memories. The smell of coming home to a wood fire on a cold winter’s day, home cooked meals, flowers blooming in spring, a salty sea breeze on a summer’s day. Smells can be hugely personal. I remember the smell of tractor grease as a fond memory of my grandfather. I’m sure many other people would find tractor grease unpleasant.
 
Mouth Breathing and Oral Health
As a dental professional I see the effects of mouth breathing on oral health as well. When the lips are sealed, saliva is able to lubricate all of the mouth and teeth. Saliva contains minerals which protect teeth and gums. Mouth breathing changes the microbiome of the mouth and contributes to dryness which increases the risk of decay and periodontal disease. I frequently see inflamed gums and increased plaque and stain in people who chronically breathe through the mouth.
Chronic mouth breathing leads to a change in oral rest posture too. Let’s consider what is ‘normal’ for a minute. The lips should be closed and the tongue should be lightly suctioned to the roof of the mouth. This creates positive forces on growing jaws. The analogy, the tongue is the expander and the lips are the braces, is a simple way of thinking about it. Now if the mouth has to open to breathe, then the intraoral pressure changes. This is just one environmental factor. There are multiple, varied and complex processes that occur with craniofacial growth but more and more research supports that open mouth breathing contributing to a more adverse vertical growth pattern. It’s not just at rest posture either because chewing and swallowing are much easier when we nasal breathe. Kids who have to mouth breathe while eating and drinking tend to be slower, messier and pickier.
 
Look Into It
I would like to take this opportunity to start a call to action. Have a look at your children or partner at rest. Are their lips open or closed? Ask them, ‘do you prefer to breathe through your nose or mouth?’ You may be surprised at the answer. Can they continue to nasal breathe with light exercise like walking? Sneak in to your child’s bedroom at night. Look, listen, feel. Are their lips closed or open? Can you hear their breathing? It should be silent. Are they using their nose or mouth? Do some more research and remember, we have a nose for a reason, use it or lose it!