Mouth breathing

Mouth breathing refers to the act of breathing through the mouth (as a temporary backup system) if there is an obstruction to breathing through the nose, which is the designated breathing organ for the human body.

Mouth breathing
Other namesOpen-mouth breathing, mouth breathing habit
SymptomsSnoring, congestion, dry mouth, ADHD, hoarse voice, stuffy nose, bad breath, fatigue
Preventionnasal breathing

Definition

The Macmillan Dictionary defines the pejorative term "mouth breather" as "a stupid person."[1] Research indicates that mouth breathing decreases cognitive ability.[2][3]

Background

Chronic mouth breathing (as opposed to occasional use of the mouth for breathing) can lead to illness.[4][5][6][7][8] It is an area of research interest in Orthodontics (and the related field of Myofunctional Therapy)[9] and for biological anthropologists.[10] It is classified into three types: obstructive, habitual, and anatomic.[11]:281

There are a number of reasons why an individual may breathe through the mouth rather than the nose, and in about 85% of cases, mouth breathing is an adaptation to nasal congestion[6] [11]:281 Mouth breathing frequently occurs during sleep if there is some form of nasal obstruction.[5]

While mouth breathing may also occur during exercise, a 2018 study published in the International Journal of Kinesiology and Sports Science, indicates that nasal breathing offers a greater advantage over mouth breathing during exercise. This is due to the fact that "breathing through the nose releases nitric oxide, which is necessary to increase carbon dioxide (CO2) in the blood, which, in turn, is what releases oxygen. Mouth breathing does not effectively release nitric oxide, which means the cells are not getting as much oxygen as through nasal breathing, which could lead to fatigue and stress."[12] Professor Michael Flanell makes a similar argument in the 2019 article "The Athlete's Secret Ingredient: The Power of Nasal Breathing." He refers to nasal breathing as "the secret to improved health and athletic performance and recovery" since "for the athlete the ability to consume more O2 into their muscles while keeping carbon dioxide levels low is the difference between mediocracy and greatness in athletes."[13]

More specialized causes of nasal obstruction that have been linked to mouth breathing include: antrochoanal polyps;[14]:350 a short upper lip which prevents the lips from meeting at rest (lip incompetence);[11]:281 and pregnancy rhinitis which tends to occur in the third trimester of pregnancy.[15]:435

Potential effects

Conditions associated with mouth breathing include cheilitis glandularis,[14]:490 Down syndrome,[16]:365 anterior open bite,[15]:225 tongue thrusting habit,[15]:225 cerebral palsy,[17]:422, ADHD,[18][19] sleep apnea, and snoring. In addition, Gingivitis,[15]:85 gingival enlargement,[15]:85 and increased levels of dental plaque[15]:108 are common in persons who chronically breathe through their mouths. The usual effect on the gums is sharply confined to the anterior maxillary region, especially the incisors (the upper teeth at the front). The appearance is erythematous (red), edematous (swollen) and shiny. This region receives the greatest exposure to airflow during mouth breathing, and it is thought that the inflammation and irritation is related to surface dehydration, but in animal experimentation, repeated air drying of the gums did not create such an appearance.[15]:85

Chronic mouth breathing in children may affect dental and facial growth.[8][3] It may also lead to the development of a long, narrow face, sometimes termed long face syndrome, when the mouth breathing is related to adenoid hypertrophy. Malocclusion of the teeth (e.g., crowded teeth) is also suggested to result from chronic mouth breathing in children. Conversely, it has been suggested that a long thin face type, with corresponding thin nasopharyngeal airway, predisposes to nasal obstruction and mouthbreathing,[6] i.e., a long thin face may cause mouth breathing rather than the other way around. Facial form is also strongly influenced by genetic factors.

Potential impact on Covid-19

Studies and trials are currently underway that examine the possible benefits of nitric oxide in the treatment of Covid-19.[20][5] This research is based on the fact that nitric oxide was investigated as an experimental therapy for SARS.[21]

Just as Nitric Oxide (NO) is developed and increased in the human body through nasal breathing, it is likewise decimated by mouth breathing. A May 2020 study notes that in the same way that “mouth breathing has been associated with many health issues, including abnormal facial and dental development, cardiovascular disease, fatigue, halitosis, headaches, hypertension, inflammation, sleep apnea, snoring, stress, and tooth decay,” mouth breathers also were found to have “lower levels of NO within the respiratory tract compared to nasal breathers.”[5] The researchers thus conclude that replacing mouth breathing with nasal breathing is a “lifestyle change” that “may also help to reduce SARS-CoV-2 viral load and symptoms of COVID-19 pneumonia by promoting more efficient antiviral defense mechanisms in the respiratory tract.”[5] In addition, Brian Strickland, MD, a fellow in Wilderness Medicine at Massachusetts General Hospital who studies “acute respiratory distress” in high altitudes, is applying this research towards Covid-19.[22][23] He is currently involved in clinical trials which apply the use of inhaled nitric oxide as a treatment for Covid-19.[24] This approach was inspired by the work of Associate Professor of Emergency Medicine at the Harvard Medical School N. Stuart Harris, who has been studying the effects of altitude sickness on mountain climbers, such as those who climb Mount Everest. Harris noticed that the consequences of high level altitude sickness on the human body mirrored Covid -19’s dysfunctional impact on the lungs. His focus on nitric oxide comes from its role in being able to breathe in high altitudes.[22]

The Johns Hopkins School of Medicine’s handbook, Bouncing Back From Covid-19: Your Guide to Restoring Movement, offers a series of breathing exercises that require the inhalation and exhalation of breath through the nose only, with closed lips and with the tongue on the roof of the mouth.[25][26]

Yoga

Yogis such as B. K. S. Iyengar advocate both inhaling and exhaling through the nose in the practice of yoga, rather than inhaling through the nose and exhaling through the mouth.[27][28][29] They tell their students that the "nose is for breathing, the mouth is for eating."[28][30][31][27]

See also

Further reading
  • Nestor, James (2020). Breath: The New Science of a Lost Art. Riverhead Books. p. 304. ISBN 978-0735213616.

References
  1. "Macmillan Dictionary: Mouthbreather". The Macmillan Dictionary. Retrieved 2020-05-31.
  2. Wollan, Malia (2019-04-23). "How to Be a Nose Breather". New York Times. Retrieved 2020-05-31.
  3. Vinopal, Lauren (2019-07-19). "Undiagnosed Mouth Breathing Creates Unhealthy Kids". Fatherly. Retrieved 2020-05-31.
  4. Dahl, Melissa (2011-01-11). "'Mouth-breathing' gross, harmful to your health". NBC News. Retrieved 2020-06-28.
  5. Martel, Jan; Ko, Yun-Fei; Young, John D.; Ojcius, David (2020-05-06). "Could nasal nitric oxide help to mitigate the severity of COVID-19?". Microbes and Infection. doi:10.1016/j.micinf.2020.05.002. Retrieved 2020-05-06.
  6. Rao A, ed. (2012). Principles and Practice of Pedodontics (3rd ed.). New Delhi: Jaypee Brothers Medical Pub. pp. 169, 170. ISBN 9789350258910.
  7. Nall, Rachel (September 22, 2017). "What's wrong with breathing through the mouth?". Medical News Today. Retrieved 2020-05-31.
  8. Valcheva, Zornitsa (January 2018). "THE ROLE OF MOUTH BREATHING ON DENTITION DEVELOPMENT AND FORMATION" (PDF). Journal of IMAB. Retrieved 2020-05-31.
  9. Frey, Lorraine (November 2014). "THE ESSENTIAL ROLE OF THE COM IN THE MANAGEMENT OF SLEEP-DISORDERED BREATHING: A LITERATURE REVIEW AND DISCUSSION". Int J Orofacial Myology. Retrieved 2020-06-21.
  10. Gross, Terry (2020-05-27). "How The 'Lost Art' Of Breathing Can Impact Sleep And Resilience". National Public Radio (NPR)/Fresh Air. Retrieved 2020-06-23.
  11. Phulari BS, ed. (2011). Orthodontics : principles and practice. New Delhi: Jaypee Bros. Medical Publishers. ISBN 9789350252420.
  12. Berman, Joe (2019-01-29). "Could nasal breathing improve athletic performance?". Washington Post. Retrieved 2020-05-31.
  13. Flanell, Michael (2019-06-06). "The Athlete's Secret Ingredient: The Power of Nasal Breathing" (PDF). EC Pulmonology and Respiratory Medicine. 8 (6): 471–475. Retrieved 2020-05-08.
  14. Barnes L, ed. (2009). Surgical pathology of the head and neck (3rd ed.). New York: Informa healthcare. ISBN 978-1-4200-9163-2.
  15. Newman MG, Takei HH, Klokkevold PR, Carranza FA, eds. (2012). Carranza's clinical periodontology (11th ed.). St. Louis, Mo.: Elsevier/Saunders. ISBN 978-1-4377-0416-7.
  16. Regezi JA, Sciubba JJ, Jordan RK (2011). Oral pathology : clinical pathologic correlations (6th ed.). St. Louis, Mo.: Elsevier/Saunders. ISBN 978-1-4557-0262-6.
  17. Cawson RA, Odell EW (2008). Cawson's essentials of oral pathology and oral medicine (8th ed.). Edinburgh: Churchill Livingstone. ISBN 978-0-7020-4001-6.
  18. Won, Dana (February 2017). "It Is Just Attention-Deficit Hyperactivity Disorder…or Is It?" (PDF). J Dev Behav Pediatr. Retrieved 2020-05-31.
  19. Sano, Masahiro (October 2013). "Increased oxygen load in the prefrontal cortex from mouth breathing: a vector-based near-infrared spectroscopy study" (PDF). Neuroreport. Retrieved 2020-05-31.
  20. "Nitric Oxide Investigated as COVID-19 Treatment". WebMD. Retrieved 10 April 2020.
  21. Åkerström, Sara; Mousavi-Jazi, Mehrdad; Klingström, Jonas; Leijon, Mikael; Lundkvist, Åke; Mirazimi, Ali (1 February 2005). "Nitric Oxide Inhibits the Replication Cycle of Severe Acute Respiratory Syndrome Coronavirus". Journal of Virology. 79 (3): 1966–1969. doi:10.1128/JVI.79.3.1966-1969.2005. PMC 544093. PMID 15650225.
  22. Powell, Alvin (2020-05-06). "Applying wisdom from the Himalayas to the ER's COVID battle". The Harvard Gazette. Retrieved 2020-06-25.
  23. "Lessons from the Backcountry in Finding a Potential COVID-19 Treatment". Massachusetts General Hospital. 2020-06-24. Retrieved 2020-06-25.
  24. "Inhaled Nitric Oxide Therapy for Emergency Room COVID-19 Patients". Massachusetts General Hospital. 2020-06-24. Retrieved 2020-06-25.
  25. "Bouncing Back from COVID-19: Your Guide to Restoring Movement" (PDF). Johns Hopkins School of Medicine. 2020. Retrieved 2020-06-27.
  26. "Helping Covid-19 Patients Recover". Johns Hopkins School of Medicine. 2020. Retrieved 2020-06-27.
  27. Yoga Journal Editors (2017-04-12). "Q&A: Is Mouth Breathing OK in Yoga?". Yoga Journal. Retrieved 2020-06-26.
  28. Payne, Larry. "Yogic Breathing: Tips for Breathing through Your Nose (Most of the Time)". Yoga For Dummies, 3rd Edition. Retrieved 2020-06-26.
  29. Himalayan Institute Core Faculty, Himalayan Institute Core Faculty (2017-07-13). "Yogic Breathing: A Study Guide". Himalayan Institute of Yoga Science and Philosophy. Retrieved 2020-06-26.
  30. Krucoff, Carol (2013). "Yoga Sparks". New Harbinger Publications. Retrieved 2020-05-31.
  31. Jurek, Scott (2012). "Eat and Run". Houghton Mifflin. Retrieved 2020-05-31.
Classification
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