Deficits in working memory, reading comprehension and arithmetic skills in children with mouth breathing syndrome: analytical cross-sectional study

Mouth breathing reduces oral function in adolescence

Although humans breathe naturally through the nostrils, mouth breathing in children has recently gathered attention. In this study, we hypothesized that tongue function and its related maxillofacial morphology would affect breathing in adolescence. To verify this hypothesis, we examined the association between breathing patterns, including mouth and nasal breathing; oral functions, including tongue motor function; and craniofacial morphology during adolescence, which has not been investigated till date. C3-H, which indicates the anteroposterior position of the hyoid bone in relation to the third cervical vertebra, was significantly smaller in mouth-breathers than in nasal-breathers. Lip-closing force, tongue pressure, and masticatory efficiency were lower in the order of nasal-breathers, oronasal-breathers, and mouth-breathers, and the values for mouth-breathers were significantly lower than those for nasal-breathers. Tongue pressure alone was identified as a significant independent variable, with an odds ratio of 1.063 (95% confidence interval, 1.006-1.123; p < 0.05). Our results indicate a relationship between mouth breathing and the lip-closing force, tongue pressure, and masticatory efficiency, as well as the significance of tongue pressure on mouth breathing in adolescents. The findings highlight the importance of clarifying the pathophysiology of mouth breathing and its underlying causes.

Mouth Breathing and Its Impact on Atypical Swallowing: A Systematic Review and Meta-Analysis

The aim of this systematic review is the assessment of the effect of mouth breathing on the prevalence of tongue thrust. The review was performed according to the PRISMA 2020 checklist guidelines, and the protocol was registered with PROSPERO (CRD42022339527). The inclusion criteria were the following: studies of clinical trials and cross-sectional and longitudinal descriptive studies that evaluate the appearance of tongue thrust in patients with mouth breathing; healthy subjects of any age, race or sex; and studies with a minimum sample group of five cases. The exclusion criteria were the following: studies with syndromic patients, articles from case reports, and letters to the editor and/or publisher. Searches were performed in electronic databases such as The National Library of Medicine (MEDLINE via PUBMED), the Cochrane Central Register of Controlled Trials, Web of Science and Scopus, including studies published until November 2023, without a language filter. The methodological quality of the included case-control studies was assessed using the Newcastle-Ottawa Scale (NOS), and the Joanna Briggs Institute (JBI) tool was used for descriptive cross-sectional studies and cross-sectional prevalence studies. A meta-analysis was conducted on studies that provided data on patients' classification according to mouth breathing (yes/no) as well as atypical swallowing (yes/no) using Review Manager 5.4. From 424 records, 12 articles were selected, and 4 were eligible for meta-analysis. It was shown that there is no consensus on the diagnostic methods used for mouth breathing and tongue thrust. The pooled risk ratio of atypical swallowing was significantly higher in the patients with mouth breathing (RR: 3.70; 95% CI: 2.06 to 6.66). These studies have several limitations, such as the heterogeneity among the individual studies in relation to the diagnostic tools and criteria for the assessment of mouth breathing and atypical swallowing. Considering the results, this systematic review shows that patients with mouth breathing presented higher risk ratios for atypical swallowing.

Malocclusion impairs cognitive behavior via AgRP signaling in adolescent mice

Introduction

Occlusal disharmony induced by deteriorating oral health conditions, such as tooth loss and decreased masticatory muscle due to sarcopenia, is one of the causes of cognitive impairment. Chewing is an essential oral function for maintaining cognitive function not only in the elderly but also in young people. Malocclusion is an occlusal disharmony that commonly occurs in children. The connection between a decline in cognitive function and malocclusion in children has been shown with chronic mouth breathing, obstructive sleep apnea syndrome, and thumb/digit sucking habits. However, the mechanism of malocclusion-induced cognitive decline is not fully understood. We recently reported an association between feeding-related neuropeptides and cognitive decline in adolescent mice with activity-based anorexia. The aim of the present study was to assess the effects of malocclusion on cognitive behavior and clarify the connection between cognitive decline and hypothalamic feeding-related neuropeptides in adolescent mice with malocclusion.

Methods

Four-week-old mice were randomly assigned to the sham-operated solid diet-fed (Sham/solid), sham-operated powder diet-fed (Sham/powder), or malocclusion-operated powder diet-fed (Malocclusion/powder) group. We applied composite resin to the mandibular anterior teeth to simulate malocclusion. We evaluated cognitive behavior using a novel object recognition (NOR) test, measured hypothalamic feeding-related neuropeptide mRNA expression levels, and enumerated c-Fos-positive cells in the hypothalamus 1 month after surgery. We also evaluated the effects of central antibody administration on cognitive behavior impairment in the NOR test.

Results

The NOR indices were lower and the agouti-related peptide (AgRP) mRNA levels and number of c-Fos-positive cells were higher in the malocclusion/powder group than in the other groups. The c-Fos-positive cells were also AgRP-positive. We observed that the central administration of anti-AgRP antibody significantly increased the NOR indices.

Discussion

The present study suggests that elevated cerebral AgRP signaling contributes to malocclusion-induced cognitive decline in adolescents, and the suppression of AgRP signaling can be a new therapeutic target against cognitive decline in occlusal disharmony.

Social anxiety and academic performance during COVID-19 in schoolchildren

The purpose of the present study was to determine the perception of schoolchildren whether their academic performance improved or worsened during the pandemic, analyzing their social anxiety, gender, use of masks in the classroom, and school year. The total sample was 107 primary school students (25 in the fourth, 40 in the fifth and 42 in the sixth grade), with a mean age of 10.51 years old (SD = 1). The gender were 58 girls and 49 boys, from a school in the province of La Coruña (Spain). The study was based on a quantitative methodology, and the design was cross-sectional, descriptive, observational and correlational. The social anxiety questionnaire (CASO-N24) was used to assess social anxiety, and an ad hoc self-report register was elaborated to evaluate sociodemographic variables. The results indicated that 44.8% of the schoolchildren considered that the pandemic had neither improved nor worsened their academic performance. Although 38.3% considered that high and very high social anxiety increased progressively as the school year progressed, both in boys and girls. Besides, the schoolchildren who presented very low and low social anxiety improved their grades in Physical Education, while those who presented high social anxiety worsened them. In conclusion, having a low social anxiety, lower grades before the pandemic and higher grades after, makes children perceive an improvement in their academic performance during the pandemic.

Resting-state Functional Connectivity During Controlled Respiratory Cycles Using Functional Magnetic Resonance Imaging

Introduction

This study aimed to assess the effect of controlled mouth breathing during the resting state using functional magnetic resonance imaging (fMRI).

Methods

Eleven subjects participated in this experiment in which the controlled "Nose" and "Mouth" breathings of 6 s respiratory cycle were performed with a visual cue at 3T MRI. Voxel-wise seed-to-voxel maps and whole-brain region of interest (ROI)-to-ROI connectome maps were analyzed in both "Nose>Mouth" and "Mouth>Nose" contrasts.

Results

As a result, there were more connection pairs in the "Mouth" breathing condition, i.e., 14 seeds and 14 connecting pairs in the "Mouth>Nose" contrast, compared to 7 seeds and 4 connecting pairs in the "Nose>Mouth" contrast (false discovery rate [FDR] of P<0.05).

Conclusion

The present study demonstrated that mouth breathing with controlled respiratory cycles could significantly induce alterations in functional connectivity in the resting-state network, suggesting that it can differently affect resting brain function; in particular, the brain can hardly rest during mouth breathing, as opposed to conventional nasal breathing.

Breathing Exercises for Improving Cognitive Function in Patients with Stroke

Patients with stroke may experience a certain degree of cognitive decline during the period of recovery, and a considerable number of such patients have been reported to show permanent cognitive damage. Therefore, the period of recovery and rehabilitation following stroke is critical for rapid cognitive functional improvements. As dysfunctional breathing has been reported as one of the factors affecting the quality of life post stroke, a number of studies have focused on the need for improving the breathing function in these patients. Numerous breathing exercises have been reported to enhance the respiratory, pulmonary, cognitive, and psychological functions. However, scientific evidence on the underlying mechanisms by which these exercises improve cognitive function is scattered at best. Therefore, it has been difficult to establish a protocol of breathing exercises for patients with stroke. In this review, we summarize the psychological, vascular, sleep-related, and biochemical factors influencing cognition in patients and highlight the need for breathing exercises based on existing studies. Breathing exercises are expected to contribute to improvements in cognitive function in stroke based on a diverse array of supporting evidence. With relevant follow-up studies, a protocol of breathing exercises can be developed for improving the cognitive function in patients with stroke.

Breathing pattern and muscle activity using different inspiratory resistance devices in children with MBS

Aim

The aim of this study was to evaluate the acute effects of different inspiratory resistance devices and intensity of loads via nasal airway on the breathing pattern and activity of respiratory muscles in children with mouth breathing syndrome (MBS).

Methods

Children with MBS were randomised into two groups based on inspiratory load intensity (20% and 40% of the maximal inspiratory pressure). These subjects were assessed during quiet breathing, breathing against inspiratory load via nasal airway and recovery. The measurements were repeated using two different devices (pressure threshold and flow resistance). Chest wall volumes and respiratory muscle activity were evaluated by optoelectronic plethysmography and surface electromyography, respectively.

Results

During the application of inspiratory load, there was a significant reduction in respiratory rate (p<0.04) and an increase in inspiratory time (p<0.02), total time of respiratory cycle (p<0.02), minute ventilation (p<0.03), tidal volume (p<0.01) and scalene and sternocleidomastoid muscles activity (root mean square values, p<0.01) when compared to quiet spontaneous breathing and recovery, regardless of load level or device applied. The application of inspiratory load using the flow resistance device showed an increase in the tidal volume (p<0.02) and end-inspiratory volume (p<0.02).

Conclusion

For both devices, the addition of inspiratory loads using a nasal interface had a positive effect on the breathing pattern. However, the flow resistance device was more effective in generating volume and, therefore, has advantages compared to pressure threshold.

In children with mouth breathing syndrome, adding inspiratory load using a nasal interface improves chest wall volumes and respiratory muscle activity, and a flow resistance device increases lung volume more than a pressure threshold devicehttps://bit.ly/3IzlayK

Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Children with Mouth Breathing

Aims and objectives

Persistent mouth breathing affects stomatognathic functions along with effects on the academics and social life of a child. Sleep-related problems and behavioral symptoms similar to that found in attention-deficit hyperactivity disorder (ADHD) can be present in mouth breathers. This study aims at assessing the sleep disturbances and pattern of symptoms of ADHD in children with mouth breathing.

Materials and methods

A cross-sectional study was carried out on 100 children of mouth breathing (consecutively selected) in 7–12 years of age using semi-structured proforma, children's sleep habit questionnaire (CSHQ), and diagnostic and statistical manual of mental disorders, version 5 (DSM 5). Statistical analysis was done using SPSS software version 21. Mean, standard deviation, Chi-square, and Pearson's correlation coefficient test were utilized during the analysis. p value of <0.05 was considered significant.

Results

Out of 100 children, 70 were males and 30 were females. On the CSHQ scale, the highest score was found on sleep-disordered breathing followed by sleep onset delay and daytime sleepiness. The commonest symptom of inattention was “failing to give close attention in school” (73%) whereas the commonest symptom of hyperactivity was “trouble waiting for his/her turn” (66%). Seven participants satisfied complete criteria for ADHD. Sleep duration and daytime sleepiness had a significant negative correlation with hyperactivity (p < 0.05). A positive correlation was observed between daytime sleepiness and inattention (p < 0.01).

Conclusion

Children with sleep disturbances or ADHD should be assessed for the presence of mouth breathing, as early identification and correction of mouth breathing may help to prevent unnecessary exposure to the medication.

Clinical significance

Children with ADHD or sleep disturbances should always be assessed for the presence of mouth breathing. Early identification and correction of mouth breathing may help in preventing unnecessary exposure to medication for treating ADHD.

How to cite this article

Kalaskar R, Bhaje P, Kalaskar A, et al. Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Mouth Breathing. Int J Clin Pediatr Dent 2021;14(5):604–609.

Nasal obstruction during the growth period modulates the Wnt/β-catenin pathway and brain-derived neurotrophic factor production in association with tyrosine kinase receptor B mRNA reduction in mouse hippocampus

There is accumulating evidence that nasal obstruction induces high‐level brain dysfunction, including memory and learning deficits. We previously demonstrated that unilateral nasal obstruction (UNO) during the growth period increases the expression of brain‐derived neurotrophic factor (BDNF). The expression of BDNF is regulated by the Wnt/β‐Catenin pathway, which is linked to neuronal differentiation, proliferation, and maintenance. However, little is known about whether Wnt3a protein expression could be an index for modulations analyses in the Wnt/β‐Catenin pathway caused by UNO during the growth period. This study aimed to investigate the effects of UNO during the growth period on the Wnt/β‐Catenin pathway in the hippocampus using combined behavioural, biochemical, and histological approaches. Male BALB/C mice were randomly divided into the control (CONT; n = 6) and experimental (UNO; n = 6) groups. Blood oxygen saturation (SpO₂) levels were measured, and a passive avoidance test was performed in mice aged 15 weeks. Brain tissues were subjected to immunohistochemistry, real‐time reverse transcription‐polymerase chain reaction, and western blot analysis. Compared with control mice, UNO mice had lower SpO₂ levels and exhibited memory/learning impairments during behavioural testing. Moreover, Wnt3a protein, BDNF mRNA, and tyrosine kinase receptor B (TrkB) mRNA expression levels were significantly lower in the hippocampus in the UNO group than in the CONT group. Our findings suggested that UNO during the growth period appeared to modulate the hippocampal Wnt/β‐catenin pathway and BDNF production in association with TrkB mRNA reduction, thereby resulting in memory and learning impairments.

Investigation on the Effect of Oral Breathing on Cognitive Activity Using Functional Brain Imaging

Oral breathing directly affects behavioral performance and dental health. Various relationships between oral breathing and periodontal disease have been well-described. However, the effect of oral breathing on cognitive performance remains unclear. This study aimed to investigate the effects of oral breathing on cognitive function using functional magnetic resonance imaging (fMRI). Twenty-two healthy participants (mean age, 22.27 ± 1.42 years) performed a two-back (2B) working memory fMRI task using a 3T MRI scanner while breathing through their oral or nasal passage. Functional activity analysis was performed using a statistical parametric mapping software package. One-sample group analyses were performed in 2B > Rest contrast. Functional connectivity analysis was conducted using MATLAB-based imaging software. Mixed ANOVA analysis was performed. The results showed more brain activation and connection during nasal breathing than during oral breathing. For Nasal > Oral contrast, various functional connections are known to have a significant relationship with working memory, including the left cerebellum, left and right inferior parietal gyrus. This can be significant evidence to demonstrate that oral breathing is an inappropriate method for intellectual activity using brain imaging techniques. Therefore, this study suggests that changing various habits related to oral breathing is important for cognitive function.

Identification of Breathing Patterns through EEG Signal Analysis Using Machine Learning

This study was to investigate the changes in brain function due to lack of oxygen (O₂) caused by mouth breathing, and to suggest a method to alleviate the side effects of mouth breathing on brain function through an additional O₂ supply. For this purpose, we classified the breathing patterns according to EEG signals using a machine learning technique and proposed a method to reduce the side effects of mouth breathing on brain function. Twenty subjects participated in this study, and each subject performed three different breathings: nose and mouth breathing and mouth breathing with O₂ supply during a working memory task. The results showed that nose breathing guarantees normal O₂ supply to the brain, but mouth breathing interrupts the O₂ supply to the brain. Therefore, this comparative study of EEG signals using machine learning showed that one of the most important elements distinguishing the effects of mouth and nose breathing on brain function was the difference in O₂ supply. These findings have important implications for the workplace environment, suggesting that special care is required for employees who work long hours in confined spaces such as public transport, and that a sufficient O₂ supply is needed in the workplace for working efficiency.

Risk assessment of orthodontic anomalies in children in suburban areas

Introduction: Orthodontic anomalies are very common both in the world and in our country. The etiology of orthodontic anomalies is multifactorial, complex and conditioned by numerous genetic and non-genetic factors: endogenous and exogenous. Prevention of orthodontic anomalies is possible if we have an insight into the most common etiological factors. Goal: To assess the frequency of individual etiological factors and assess the overall risk of orthodontic anomalies in children in suburban environments. Materials and methods: The research was conducted on 115 children, first grade elementary school pupils (28.68% of all 1st grade students), average age of 6.8 years, from 4 settlements around Novi Sad: Kisač, Kać, Veternik, and Futog. The research was conducted in the form of anonymous rounding surveys for parents with a preliminary explanation of the questions asked. The questions included etiological factors for the occurrence of orthodontic anomalies (diseases in pregnancy, childbirth, breastfeeding, supplementation and feeding, type of pacifier, position of the bottle when eating, bad habits, position when sleeping, position of arms when sleeping in relation to the jaw, pillow height, mouth breathing, orthodontic anomalies in parents). Results: Results indicate the following etiological factors as the most common: supplementary feeding and bottle feeding (in 41.74% of cases), breastfeeding from 0 to 6 months (40.87% of respondents) and mouth breathing (in 24.35% of children). In the examination of the total risk for orthodontic anomalies, low-risk was found in 95.65% of cases, medium-risk in 4.35% (in Kisac 9.38%, in Kać 2.94%, in Veternik 4.35%, in Futog 0% of children), while there were no high-risk respondents. Conclusion: Preventive measures should be aimed at educating mothers about the need and benefits of a natural way of breastfeeding and of using a spoon for supplementation and feeding.

Alterations in Oral-Nasal-Pharyngeal Microbiota and Salivary Proteins in Mouth-Breathing Children

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.

Investigation of Functional Connectivity Differences between Voluntary Respirations via Mouth and Nose Using Resting State fMRI

The problems of mouth breathing have been well-studied, but the neural correlates of functional connectivity (FC) still remain unclear. We examined the difference in FC between the two types of breathing. For our study, 21 healthy subjects performed voluntary mouth and nasal breathing conditions during a resting state functional magnetic resonance imaging (fMRI). The region of interest (ROI) analysis of FC in fMRI was conducted using a MATLAB-based imaging software. The resulting analysis showed that mouth breathing had widespread connections and more left lateralization. Left inferior temporal gyrus had the most left lateralized connections in mouth breathing condition. Furthermore, the central opercular cortex FC showed a significant relationship with mouth breathing. For nasal breathing, the sensorimotor area had symmetry FC pattern. These findings suggest that various FCs difference appeared between two breathing conditions. The impacts of these differences need to be more investigated to find out potential link with cognitive decline in mouth breathing syndrome.

Sleepiness, Neuropsychological Skills, and Scholastic Learning in Children

Excessive daytime sleepiness is a frequent condition among children and adolescents that may lead to several and significant daytime consequences, including impaired neurocognitive skills and scholastic performance. Here, we evaluated in one hundred and ninety-one unselected primary school children, the relationship between sleepiness and a wide range of cognitive and academic skills through a standardized neuropsychological test battery. In order to assess the statistical relationship, we performed a partial least squares path modelling, a non-parametrical approach which combined a model of paths between latent variables and the coefficients between indicators and dimensions. Results were validated through the bootstrap approach and suggest that sleepiness is not associated with all cognitive and scholastic abilities, but only with those relying on verbal abilities and complex cognitive functions (i.e., reading comprehension, oral/syntactic comprehension, spelling, and mathematic skills). Our data suggest the idea that sleepiness in children is associated mostly with “higher” (mainly verbal) cognitive function(s), while the visuospatial domain was not affected.

EEG signals during mouth breathing in a working memory task

Background: Continuous mouth breathing results not only morphological deformations but also poor learning outcomes. However, there were few studies that observed correlations between mouth breathing and cognition. This study aimed at investigating the changes in brain activity during mouth breathing while the participant simultaneously performed a cognitive task using electroencephalography (EEG).Methods: Twenty subjects participated in this study, and EEG electrodes (32 channels, 250-Hz sampling rate) were placed on their scalp. Brain waves during a resting state and n-back tasks (0-back and 2-back) and physiological parameters such as SpO2, ETCO2, and the airway respiratory rate were measured. The pre-processed EEG signals were analyzed based on their frequencies as delta waves (0.5 ∼ 4 Hz), theta waves (4 ∼ 8 Hz), alpha waves (8 ∼ 13 Hz), beta waves (13 ∼ 30 Hz) and gamma waves (30 ∼ 50 Hz) using fast Fourier transform (FFT).Results: When compared with nose breathing, theta and alpha powers were lower during mouth breathing at rest and alpha wave presented low power at 0-back and 2-back tasks. Furthermore, beta and gamma waves exhibited low powers at 2-back task. However, the behavioral results (accuracy and response time) have no significant difference between two breathing methods (mouth and nose). Mouth breathing showed different brain activity patterns, compared to nose breathing, and these changes are related to cognitive regions.Conclusion: The reason for this change seems to relate to the decreased oxygen saturation during mouth breathing, suggesting that when cognitive abilities are required, mouth breathing can act as one of the variables that cause different outcomes in brain activities.

Task Difficulty Modulates the Disrupting Effects of Oral Respiration on Visual Search Performance

Previous research has suggested that oral respiration may disturb cognitive function and health. The present study investigated whether oral respiration negatively affects visual attentional processing during a visual search task. Participants performed a visual search task in the following three breathing conditions: wearing a nasal plug, wearing surgical tape over their mouths, or no modification (oral vs. nasal vs. control). The participants searched for a target stimulus within different set sizes of distractors in three search conditions (orientation vs colour vs conjunction). Experiment 1 did not show any effect due to respiration. Experiment 2 rigorously manipulated the search efficiency and found that participants required more time to find a poorly discriminable target during oral breathing compared with other breathing styles, which was due to the heightened intercept under this condition. Because the intercept is an index of pre-search sensory processing or motor response in visual search, such cognitive processing was likely disrupted by oral respiration. These results suggest that oral respiration and attentional processing during inefficient visual search share a common cognitive resource.

Lingual and Maxillary Labial Frenuloplasty with Myofunctional Therapy as a Treatment for Mouth Breathing and Snoring

Chronic mouth breathing may adversely affect craniofacial development in children and may result in anatomical changes that directly impact the stability and collapsibility of the upper airway during sleep. Mouth breathing is a multifactorial problem that can be attributed to structural, functional, and neurological etiologies, which are not all mutually exclusive. While therapeutic interventions (myofunctional, speech and swallowing, occupational, and craniosacral therapy) may address the functional and behavioral factors that contribute to mouth breathing, progress may sometimes be limited by restrictive lingual and labial frenum that interfere with tongue and lip mobility. This case report explores the case of a three-year-old girl with mouth breathing, snoring, noisy breathing, and oral phase dysphagia that was successfully treated with lingual and labial frenuloplasty as an adjunct to myofunctional therapy. Within four days of the procedure, the patient had stopped snoring and demonstrated complete resolution of open mouth breathing. The patient was also observed to have increased compliance with myofunctional therapy exercises. This report highlights the effectiveness of surgical interventions to improve the efficacy of myofunctional therapy in addressing open mouth posture and low tongue resting position.

Growth and mouth breathers

OBJECTIVE

To assess the relationship between mouth breathing and growth disorders among children and teenagers.

DATA SOURCE

Search on MEDLINE database, over the last 10 years, by using the following terms: "mouth breathing", "adenotonsilar hypertrophy", "allergic rhinitis", "sleep disturbance" AND "growth impairment", "growth hormone", "failure to thrive", "short stature", or "failure to thrive".

DATA SUMMARY

A total of 247 articles were identified and, after reading the headings, this number was reduced to 45 articles, whose abstracts were read and, of these, 20 were deemed important and were included in the review. In addition of these articles, references mentioned in them and specific books on mouth breathing deemed important were included. Hypertrophy of palatine and/or pharyngeal tonsils, whether associated with allergic rhinitis, as well as poorly controlled allergic rhinitis, are the main causes of mouth breathing in children. Respiratory sleep disorders are frequent among these patients. Several studies associate mouth breathing with reduced growth, as well as with reduced growth hormone release, which are reestablished after effective treatment of mouth breathing (clinical and/or surgical).

CONCLUSIONS

Mouth breathing should be considered as a potential cause of growth retardation in children; pediatricians should assess these patients in a broad manner.

Association Between Breastfeeding and Childhood Breathing Patterns: A Systematic Review and Meta-Analysis

OBJECTIVES

This systematic review aimed to evaluate the association between breastfeeding and breathing patterns in children.

MATERIALS AND METHODS

We searched PubMed, EMBASE, Web of Science, CINAHL, and the Cochrane Central Register of Controlled Trials for publications from inception to October 1, 2017. The breastfeeding duration and period of exclusive breastfeeding were selected as primary outcomes. The odds ratio (OR) and 95% confidence interval (CI) were calculated. A meta-analysis was conducted to synthesize the evidence. The Newcastle-Ottawa Score was used for quality and comparability assessment.

RESULTS

Of the 54 articles identified, three observational studies met the inclusion criteria for this meta-analysis, representing 1,046 participants. The results of the meta-analysis revealed that the prevalence rate of mouth breathing (OR = 2.04; 95% CI, 1.26-3.31; p = 0.004) was significantly higher in subjects who were breastfed for less than 6 months, but no significant difference was observed within the periods of exclusive breastfeeding (6 months or less) (OR = 1.27; 95% CI, 0.73-2.21; p = 0.40).

CONCLUSION

We found only limited evidence about the association between breastfeeding and breathing patterns. However, the current evidence supports the association between breastfeeding and childhood breathing patterns. Based on this review, we found that the frequency of normal nasal respiration increases with the duration of breastfeeding. The methodological quality of the studies included was moderate. Thus, future studies should aim to correct the confounding factors related to breathing patterns, to use standardized diagnostic criteria of mouth breathing, and to conduct a prospective research to reduce the recall bias.

Common dental diseases in children and malocclusion

Malocclusion is a worldwide dental problem that influences the affected individuals to varying degrees. Many factors contribute to the anomaly in dentition, including hereditary and environmental aspects. Dental caries, pulpal and periapical lesions, dental trauma, abnormality of development, and oral habits are most common dental diseases in children that strongly relate to malocclusion. Management of oral health in the early childhood stage is carried out in clinic work of pediatric dentistry to minimize the unwanted effect of these diseases on dentition. This article highlights these diseases and their impacts on malocclusion in sequence. Prevention, treatment, and management of these conditions are also illustrated in order to achieve successful oral health for children and adolescents, even for their adult stage.

Impact of Breathing Patterns on the Quality of Life of 9- to 10-year-old Schoolchildren

Background

Mouth breathing can cause a set of changes in craniofacial growth and development, with esthetic, functional, and psychological repercussions.

Objective

To determine the impact of mouth breathing on the quality of life of schoolchildren.

Methods

A school-based, cross-sectional study was conducted with 1911 children ages 9 and 10 years in the city of Recife, Brazil. The children answered the Mouth Breather Quality of Life questionnaire and a questionnaire that addressed sociodemographic data and health-related aspects. Clinical examinations were performed by an examiner who had undergone a training and calibration process for the diagnosis of mouth breathing (kappa = 0.90). Descriptive statistics were conducted to characterize the sample. Statistical analysis involved the Student's t-test and the F test (analysis of variance) (alpha = 5%).

Results

The prevalence of mouth breathing was 54.81%. Children with oral breathing demonstrated a poorer quality of life in comparison with children with nasal breathing (p < 0.001). The following variables were significantly associated with a poorer quality of life among the children with mouth breathing: a younger age (p < 0.001) and the use of medication (p = 0.002).

Conclusion

Based on the present findings, children with the mouth-breathing pattern experience a greater negative impact on quality of life in comparison with those with the nose-breathing pattern. Thus, the early diagnosis and treatment of this clinical condition are fundamental to minimizing the consequences of mouth breathing on the quality of life of schoolchildren with respiration disorders.

Factors associated with mouth breathing in children with -developmental -disabilities

OBJECTIVE

To investigate the prevalence and factors associated with mouth breathing among patients with developmental disabilities of a dental service.

METHODS

We analyzed 408 dental records. Mouth breathing was reported by the patients' parents and from direct observation. Other variables were as -follows: history of asthma, bronchitis, palate shape, pacifier use, thumb -sucking, nail biting, use of medications, gastroesophageal reflux, bruxism, gender, age, and diagnosis of the patient. Statistical analysis included descriptive analysis with ratio calculation and multiple logistic regression. Variables with p < 0.25 were included in the model to estimate the adjusted OR (95% CI), calculated by the forward stepwise method. Variables with p ​​< 0.05 were kept in the model.

RESULTS

Being male (p = 0.016) and use of centrally acting drugs (p = 0.001) were the variables that remained in the model.

CONCLUSION

Among patients with -developmental disabilities, boys and psychotropic drug users had a greater chance of being mouth breathers.