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Mouth Breathing: Physical, Mental and Emotional Consequences

March 9, 2017
by P. McKeown; M. Macaluso


Breathing is one of the most vital functions of the human body. Every breath we take can have a positive or negative impact on our bodies depending on how it is performed; and it has been well established that normal breathing should be achieved through the nose. However, it may be detoured to the oral cavity in the presence of an airway obstruction. 35

During normal breathing, the abdomen gently expands and contracts with each inhalation and exhalation. There is no effort involved, the breath is silent, regular, and most importantly, through the nose. Abnormal breathing or mouth breathing on the other hand; is often faster than normal, audible, punctuated by sighs, and involves visible movements of the upper chest. This type of breathing is normally only seen when a person is under stress, but for those who habitually breathe through their mouths, the negative side effects of stress and over-breathing become chronic. Habitual mouth breathing has serious implications on an individual’s lifelong health, including the development of the facial structures. This article explores the benefits of nasal breathing over mouth breathing, and provides a self-help exercise to help decongest the nose.

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1. Nasal breathing and the Importance of Nitric Oxide
Nasal breathing has been well documented to providing various benefits. The nose is equipped with a complex filtering mechanism which purifies the air we breathe before it enters the lungs. 11 Breathing through the nose during expiration helps maintain lung volumes and so may indirectly determine arterial oxygenation. 28

One of the most important reasons for nasal breathing, is due to the production of nitric oxide (NO). 9 NO exists in the human breath, but little is known about its site of origin or enzyme source. Most NO in normal human breath derives locally from the nose where it can reach high levels during breath-holding. 39 This incredible molecule, is said to be produced in mammalian cells by specific enzymes and is believed to play a vital role in many biological events including regulation of blood flow, platelet function, immunity, and neurotransmission. 18 Although this gas is produced in minute amounts, when it is inhaled through the nose into the lungs, it will follow the airstream to the lower airways and the lungs where it aides in increasing arterial oxygen tension; hence enhancing the lungs capacity to absorb oxygen. 18 Nitric Oxide also plays an important role in reducing high blood pressure, maintaining homeostasis, immune defense and neurotransmission. 6

2. Effects of Mouth Breathing
Habitual mouth breathing, conversely involves an individual breathing in and out through the mouth for sustained periods of time, and at regular intervals during rest or sleep.

It is well documented that mouth breathing adults are more likely to experience sleep disordered breathing, fatigue, decreased productivity and poorer quality of life than those who nasal-breathe. 16,22,23 In children, the harmful effects of mouth breathing are far greater, since it is during these formative years that breathing mode helps to shape the orofacial structures and airways.
Children whose mouth breathing is left untreated for extended periods of time, can set the stage for lifelong respiratory problems and including, a less attractive face to name a few. As a result, malocclusions such as a skeletal Class II or Class III, along with a long lower face height (characterized as “long face syndrome”), and high palatal vaults may also be noted. 14 These resultant craniofacial alterations associated with mouth breathing can significantly aggravate or increase the risk of snoring and obstructive sleep apnea in both children and adults.

A study conducted by Fitzpatrick et al, demonstrated the critical role of the soft palate in determining oral or nasal airflow. The study showed that during mouth breathing, the soft palate will tend to move posteriorly against the posterior pharyngeal wall, thus closing the nasopharyngeal airway. Whereas, during nasal breathing, the soft palate moves inferiorly and anteriorly until it lays against the dorsum of the tongue, thus closing the oropharyngeal airway.

The opening of the mouth during sleep in normal subjects and in patients with obstructive sleep apnea was also documented in this study. Mouth opening, even in the absence of oral airflow, has been shown to increase the propensity to upper airway collapse. The two most likely explanations for the latter finding are that jaw opening is associated with a posterior movement of the angle of the jaw and compromise of the oropharyngeal airway diameter, and that posterior and inferior movement of the mandible may shorten the upper airway dilator muscles located between the mandible and hyoid and compromise their contractile force by producing unfavorable length-tension relationships in these muscles. 10 Therefore, it is of utmost importance to address mouth breathing accordingly.

Unfortunately, it has been noted that there is a lack of awareness regarding the negative impact of airway obstruction via mouth breathing on normal facial growth and physiologic health; and as a result, may be confused for (ADD) and hyperactivity. 14 According to the National Sleep Foundation, attention deficit hyperactivity disorder (ADHD) is linked to a variety of sleep problems. Children and adults behave differently as a result of sleepiness. Adults usually become sluggish when tired while children tend to overcompensate and speed up. For this reason, sleep deprivation is sometimes confused with ADHD in children. Children may also be moody, emotionally explosive, and/or aggressive as a result of sleepiness. In a study involving 2,463 children aged 6-15, children with sleep problems were more likely to be inattentive, hyperactive, impulsive, and display oppositional behaviors. 35,37,5

Another study published in the International Journal of Pediatrics investigating the long-term changes to facial structure caused by chronic mouth breathing noted that this seemingly ‘benign’ habit “has in fact immediate and/or latent cascading effects on multiple physiological and behavioral functions.” 29 Therefore, with this in mind, mouth breathing can have a tremendous impact on the mental and physical health of children; as it can be associated with the restriction of the lower airways, poor quality of sleep, reduced cognitive functioning and a lower quality of life. 5

3. Prevalence, Causes and Physical Manifestations of Mouth Breathing
Brazilian researchers investigating the prevalence of mouth breathing in children ages three to nine found that a 55% random selection of 370 subjects were mouth-breathers. 2 Reported causes of mouth breathing included: 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 the 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%). 3 Although allergic rhinitis is considered one of the leading causes of respiratory obstruction; it is of utmost importance to note that upon the first onset of nasal congestion, a feeling of air deprivation occurs, causing the individual to switch to mouth breathing. 4

Another study conducted by Pereira et al, demonstrated that orofacial changes were noted in mouth breathers such as: half-open lip and lower tongue position, lip, tongue and cheek hypo-tonicity, and tongue interposition between the arches during deglutition and phonation. 26

3.1 Effect of Low Tongue Position
A mouth breather carries the tongue in a low downward position, creating an airspace which allows the person to breathe more freely; and as a result it can lead to abnormal tongue activity. This abnormal tongue activity, can exert an excessive force upon the dentition during swallowing, contributing to malocclusions in children; and leading to periodontal disease and atypical myofascial pain in adulthood. 12,33 This displacing force and misdirection of the tongue, can additionally contribute to microscopic changes in the attachment apparatus; leading to increased tooth mobility and advancing periodontal disease.

Furthermore, this low tongue resting posture can contribute to various morphological changes to the orofacial structures; and consequently, Orofacial Myofunctional Disorders (OMDs) may develop as well. “OMDs are disorders pertaining to the face and mouth and may affect, directly and indirectly, chewing, swallowing, speech, occlusion, temporomandibular joint movement, oral hygiene, stability of orthodontic treatment, facial esthetics, and facial skeletal growth.” 25 The most common forms of OMDs include: oral breathing or lack of habitual nasal breathing; habitual open mouth posture, and lack of lip seal with patent nasal passages; reduced upper lip movement with or without a restricted labial frenum; restricted lingual frenum, from borderline to ankyloglossia; anterior or lateral tongue thrust at rest (static posture); low and forward tongue position at rest, usually accompanied by an increased verticle dimension; inefficient chewing (related or not) to temporomandibular joint (TMJ) disorders or malocclusion; atypical swallowing, with or without a tongue thrust (dynamic posture); oral habits; and forward position of the head at rest, during chewing and during swallowing to name a few. 25

The resting posture of the tongue plays a pivotal role since its effects are far more constant than atypical swallowing. Mouth breathing encourages incorrect positioning of the tongue (on the floor of the mouth), while nasal breathing naturally places the tongue in its proper resting position (on the roof of the mouth), and most important of all aides in achieving a lip seal.

A study conducted by Schmidt et al, indicated that correct tongue resting position (on the roof of the mouth) resulted in a significant activity in the temporalis and suprahyoid muscles as well as a significant reduction in heart rate variability when compared with a low tongue resting position (on the floor of the mouth). 27 In other words, a proper tongue resting posture is essential for achieving orofacial balance.

3.2 Postural Problems
In addition to abnormal swallowing patterns and facial characteristics, postural problems may also be present in those who habitually breathe through their mouth. Mouth breathers tend to assume a characteristic posture, carrying their heads forward in order to compensate for the restriction to their airways and make breathing possible.

A study conducted by Okuro et al, demonstrated how the respiratory biomechanics and exercise capacity were negatively affected by mouth breathing; and that the presence of moderate forward head posture acted as a compensatory mechanism in order to improve respiratory muscle function. 24 This forward head posture often leads to muscle fatigue, neck pain, tension in the temporomandibular joint area, spinal disc compression, early arthritis, tension headaches, and dental occlusal problems. 8

4. Multidisciplinary approach
In order to achieve proper oronasal balance, a patient must be examined as a whole in a multidisciplinary approach. “It is of fundamental importance to obtain information from the parents/guardians during the medical interview. Therefore, questions about the child’s sleep patterns, if he/she sleeps with the mouth opened, if there is noisy breathing, if the child lacks concentration at school, if the child feels sleepy during the day, if the pillow is wet in the morning; these questions should all be recorded, because they represent important elements in the diagnosis of oral breathing.” 38 Although there is no discernible test to identify mouth breathing, simply observing an individual’s resting breathing habits for at least three minutes can form part of a diagnosis for both children and adults.

It is important to note that an accurate diagnosis of mouth breathing cannot be done with data alone. Therefore, it is recommended to also carry out the Glatzel metal plate test and the time through which the child keeps water in her/his mouth with the lips sealed and without swallowing it, since the results may differ and complete each other. 38

A team of qualified professionals such as Pediatricians, Ear Nose and Throat Doctors, Orthodontists, Dentists, Dental Hygienists, Myofunctional Therapists, Buteyko Breathing Specialists, and Speech Pathologists to name a few; can help arrest the cascading effects associated with mouth breathing.

Management of Nasal Congestion
Proper management and early detection of nasal congestion is key to arresting mouth breathing in an individual. As previously stated, mouth breathing can be a result of various origins associated with respiratory obstruction; such as allergic rhinitis.

Therefore, with rhinitis being one of the leading causes of nasal obstruction, some of the most common treatments used for treating rhinitis include: trigger avoidance, decongestants, corticosteroids or allergy shots. While these offer some therapeutic benefits; for some, they may be effective only for as long as treatment continues. Meanwhile, the individual becomes accustomed to breathing through their mouth and will likely continue this habit even after their nasal airways have cleared, causing a vicious cycle of recurrent congestion. While it may seem counterintuitive nasal breathing is essential for decongesting the nose, along with breathing exercises designed to open the airways, such as the Buteyko Breathing Method.

The Buteyko Method, developed in the 1950s by Russian respiratory physiologist Dr. Konstantin Buteyko, was subject to a study investigating its effectiveness for the treatment of chronic rhinitis in asthma. The study validated evaluations, including the Sinonasal Outcome Test (SNOT); which showed a 71% reduction of rhinitis symptoms at the three month follow up. 1

The Buteyko Breathing Method features a measurement appraisal known as the Control Pause, a breath hold exercise to unblock the nose, and reduced breathing exercises to reset breathing volume towards normal. 19

Nasal Decongestion Exercise
The nose can be unblocked for both allergic and non-allergic rhinitis by performing a breath hold as follows:

  • Take a small, silent breath in and let a small, silent breath out through your nose;
  • Pinch your nose with your fingers to hold your breath;
  • Walk as many paces as possible with your breath held. Try to build up a feeling of air shortage, without overdoing it of course!
  • When you resume breathing, do so only through your nose; your breathing must be calmed immediately;
  • After resuming your breathing, your first breath is likely to be larger than usual. Calm your breathing as soon as possible by suppressing your second and third breaths;
  • You should be able to recover from this breath hold within two to three breaths. If not, you have held your breath for too long;
  • Wait for a minute or so and repeat the exercise;
  • Repeat this exercise five or six times until the nose is decongested.

Mouth Breathing

In conclusion, it is essential for medical and dental professionals to assess mouth breathing in children and adult patients. If mouth breathing is treated early, its negative effects on facial and dental development, along with the medical and social problems associated with it, can be reduced or averted. 14

As healthcare professionals, we are afforded the perfect opportunity to observe whether patients habitually breathe through their mouths, and to offer practical and effective life-changing recommendations. OH

Oral Health welcomes this original article.

References
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About the Authors
Martha Macaluso, MLT, RDH, BS, is a practicing Registered Dental Hygienist and Myofunctional Therapist. She received her degree in Dental Hygiene from Farmingdale State University and specialized in Myofunctional Therapy through the AOMT.

Martha is faculty at New York University College of Dentistry, where she teaches dental hygiene clinic. In addition to her published work, Martha has presented various continuing educational courses in the field of dentistry and myofunctional therapy.

She is extremely involved in the profession acting as editor to the Long Island Dental Hygiene Association, delegate to the Dental Hygienist Association of the State of New York and delegate to the American Dental Hygiene Association.

Buteyko practitioner and author Patrick McKeown completed his clinical training in the Buteyko Breathing Method at the Buteyko Clinic, Moscow, Russia in 2002 and was accredited by the late Professor Konstantin Buteyko.  Patrick has spent the last 15 years working with thousands of children and adults worldwide, who experience breathing pattern disorders, sleep disordered breathing and anxiety. To date, he has written eight books on the subject, and his latest book, The Oxygen Advantage, is an extension of this work, combining specifically-formulated exercises which empower athletes to improve their sports performance.


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18 Comments » for Mouth Breathing: Physical, Mental and Emotional Consequences
  1. Tarmon says:

    Um. I’m a Sleep Scientist… the reason people with apnoea mouth breath is because their airway is obstructed, resulting in them opening their mouth. Mouth breathing does NOT CAUSE sleep disordered breathing. This article has completely twisted the info to make it look like mouth breathing causes all these disorders which actually isn’t true at all. mouth breathing can be a SYMPTOM of other things, however. It’s misinformation like this that has patients with untreated severe apnoea come in and they’ve been taping their mouth closed resulting in them choking … potentially very dangerous! Do not tape your mouth closed, seek treatment for sleep apnoea (CPAP is best, in which masks can give you the option of breathing through nose or mouth – it does not matter which!!)

    • Jakabstore says:

      Please, use citations of the research which confirms your statement. And please read books on the topic from Dr. Artour Rakhimov.

      • Aaron says:

        Hello, do you see and link between this and the underage smoking, whether tobacco or marijuana since the smoke cause nasal congestion in many whom partake. Thus causing mouth breathing, contributing to some of these developmental issues and do you some of these issues manifesting in adults that smoke as well?

    • aysun says:

      I have read a lot about mouth breathing as my son suffers from it, and I can confirm that the article above is in line with current literature, as you can see is evidenced-based. The only criticism I can give to this article if I must is that, the severity of mouth breathing may have been put here gently. Mouth breathing causes systematic health problems and other dizzies such as dementia. I suggest you read first before contradicting scientific evidence. I find your comments very ignorant.

      • Robert says:

        I was feeling like I was gonna die from aggressive breathing through the nose and over the years of doing this I’ve naturally learned these exercises and everything here seems correct. If I breathe through the mouth I feel like I’m blacking out and getting to much of something or not enough of something therefore I start aggressively breathing through my nose which causes inflammation in my nose and rawness. So my conclusion was this; my collapsed nostrils interact with the slightest congestion which causes me to crave more oxygen and then I start to try to clear what micro particles that me be there to breathe even the slightest bit better through the nose. Going through this process leads to panic attacks and stress which again works against the problem only making it worse. It is until I do the exercises I naturally learned to calm myself down and get a gasp on my breathing only to be back to breathing through straws like I normally have to and eventually restarting the vicious cycle in a matter of minutes. This post was very helpful to me and I’m very thankful as I’ve looked long and hard for some sort of answer to my problems

    • aysun says:

      Dear Tarmon,
      I have read a lot about mouth breathing as my son suffers from it, and I can confirm that the article above is in line with current literature, as you can see is evidenced-based. The only criticism I can give to this article if I must is that, the severity of mouth breathing may have been put here gently. Mouth breathing causes systematic health problems and other dizzies such as dementia. I suggest you read first before contradicting scientific evidence. I find your comments very ignorant.

    • Michael K Atkinson says:

      Discusting advice Tarmon. Seriously, telling folks to not be aware of how they breathe and just buy a CPAP. Wow. Wtf is wrong with you? And putting a piece of tape on your mouth is not going to choke you. This post is old but needs to be disregarded by anyone stumbling onto it during their research. Tarmon….educate yourself before you disregard someone else’s science backed work. This dude has helped thousands without prescribing a machine hooked to your face to help you breathe….just simply use your nose instead of your mouth. We dont need your sleep clinic bs

      • Margaret says:

        Right on!

        • Dr. Ahmed obaid says:

          Thank for focusing on such an imporatant topic. As an orthodontic i can confirm the complications on facial devlopment including teeth crowding and high palat caused by mouth breathing.
          From my personal experiance as i suffered from teeth crowding due to decreased maxillary development as a consequence of mouth breathing.
          I HAVE SUFFERED FOR 20 YEARS from SEVERE ACNE ESPECIALLY ON THE SCALP WHIC HAS GONE IN ONE NIGHT I OBLIGATED My SELF TO SLEEP BREATHING FROM THE NOSE.
          thus I think researcher should focus on the systemic complications caused by mouth breathing and how it adversely affect immunity and general health.
          Best wishes.

      • Vincent S Benites says:

        I was reading some of these posts and You don’t seem to Read the type to just go along with something something. I need your advice regarding masks On kids at school. My son is 8 years old and Has all of a sudden Has developed a stuttering problem . We went to address it with his teacher and said something up to help him with that. It all seemed normal until leave brought up the subject of them finding it strange that he Just developed it. I guess if he was going to have problems it would have shown earlier. And I came across some information About masks and breathing in the breath you’re supposed to be breathing out Could have caused that exact thing. You don’t need to be a professor in college too knowledge to know that fresh air Is needed to survive. Wearing a mask over your mouth is one thing but when they make the kids put it over there knows also It’s very concerning and I have been opposed in on edge and Ready to act on The opportunity To get him out of that situation. And with them lifting the mandates on masks For everybody except children has put me over the edge To wear today I’m going to go to the school and demand demand explanations and action regarding getting getting the kids out of masks if not just my kid. I was wondering if you can educate me a little more on this subject. And let me know if I’m going down the right path. And of course I’m talking about besides my obvious fatherly instincts.

    • Ay says:

      I have done a lot of research about mouth breathing as a mother of a child who does mouth breathing. I found this article is very helpful as it is written in depth.

      I have tried so hard to resolve my child’s problem of mouth breathing but GP doctors in the UK are not aware the importance of nose breathing and the health and cosmetic complications of mouth breathing. They even said, nothing wrong with mouth breathing. After screaming from the top of my lungs, they made a referral to ENT specialist. Who, after seeing my devastation, to my fright said if his daughter was mouth breathing, he would not have been concerned about it what so ever, it is not a big deal. I was shocked. I went to the ortodontist, who was so ignorant of the implications of mouth breathing, his dental nurse in front of him shouted with excitement “I am a mouth breather”. I was horrified. Professionals like them have no idea.

      As a lay person, by the time I noticed of my son’s mouth breathing, it was already 2-3 years passed, so there were some damnaged to observe for them. But not to my surprise, they all used the expression that, nothing is wrong with him, and nothing is wrong with mouth breathing. But I knew that, his jaw hasn’t developed, his face is long, his lips are thinner, his teeth are crocket, he has gum recession especially on the lower front teeth, this was even noticed by ortodontists at the age of 16, his underdeveloped body, small slim posture. He was also not chewing food properly, after one chew he swallow food, I don’t know if this was caused by, or the cause of mouth breathing, knowing that mouth breathing causes underdevelop jaw. He is always very tired, very anxious, very nervous.

      Lastly, the only diagnosis was from ENT was, he is allergic to house dust mice (or something like this, apologies for not remembering such an important thing, but it was some sort of dust that every house had and not visible to the eyes). I do not know what to do about this dust other than vacuuming religiously.

      I took the measures to my hand and bought mouth strips (somnifix) to close his mouth, things to put in his nostrils to make it easier for air passage. When I told these well known methods to these health professionals they were petrified, looking at me as if I am crazy, they never heard of such a thing and totally unnecessary, as if I am abusing my child.

      These methods don’t work, because my son only tolarates the mouth strip which is deer to buy which doesn’t matter but it often gets undone at his sleep and his mount opens again. I still do it of course but I don’t know what else to do. The GP prescribed him antihistamine and cortiseroids which he doesnt like to use. I often as a night owl, and a worrying mother go to his room late night, and studied his breathing enough to tell the difference between mouth and nose breathing. When he is nose breathing, his breaths are longer deeper on inspiration and expiration (slightly longer on expiration); when mouth breathing, his breaths are shorter and lighter, unequal ratio, expiration is a lot shorter than inspiration (which is like a short sigh).

      Thank you for your article. I would like to hear your professional suggestions if you have any time.

      • DWalden says:

        Ay, I have had similar issues with my children. One thing I have found helpful is to start with mouth taping while they are doing something during the day. For instance, I’ll tape my children’s while they are coloring for 20-30mins or watching a movie. This also helps them get comfortable with it. Another suggestion would be to tape just half the mouth with a better quality of tape, this worked for me as well. Good luck!

  2. Adwoa Pokuaa says:

    Am Adwoa, from Ghana. I have been suffering from nasal decongestion and breathing through my mouth over years. I normally report to a doctor but is still not going.
    Please what should I do?

    • Kerrie says:

      I do a lot of yoga nasal breathing in and out, deep and slow. A good one for nasal and sinus congestion is ‘hummingbee’ breathing. You can find simple explanation and videos on YouTube if it is available to you. Or just ‘google’ it. Good luck

  3. Rachael says:

    Hello my son is 13 yrs and have been a mouth breather for sometime now. I went to the GP some years back , he was referred to the hospital and an adenoid surgery was done 3or4years ago but no changes. I am worried now because he is growing up and the way he breathes during sleep made me think he is not having enough sleep,also sometimes he wakes up with blood around his gum. Can you help or advice.

  4. Ankita Shah says:

    This blog has all the necessary information about Nasal breathing something which i was suffering for years but after realizing the cause I started to recover soon and I am happy that people are bringing this thing into light, Thank you o much for writing an article like this, really appreciate and looking forward for more information about it and sharing it with my friends.

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    Extraordinary post! I didn’t knowral of these assets and I will go look at them now!

  6. lol beans says:

    I’ll tape my children’s while they are coloring for 20-30mins or watching a movie. This also helps them get comfortable with it. Another suggestion would be to tape just half the mouth with a better quality of tape, this worked for me as well. Good luck!

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