mouth breathing, snoring

by Marc F. Goldstein, MD

What is mouth breathing?

Mouth breathing is when a person habitually breathes through their mouth instead of their nose. Mouth breathing often develops gradually and many individuals are usually unaware that they are doing it, especially in their sleep. Acute mouth breathing can occur during a cold or respiratory allergies. Chronic mouth breathing is oftentimes a sign of underlying issues in the nose related to either allergies, non-allergic swelling of the nose, enlarged adenoids and/or tonsils or other structural problems in the nasal airway. 

Are there long term risks and complications to mouth breathing?

Studies over the years have shown that chronic mouth breathing can significantly affect overall health, including dental development and facial structural development. However, recent studies have shown that mouth breathing causes significant cardiovascular effects as well. Normally, nose breathing slows our breathing and improves lung capacity. If one is chronically mouth breathing, they are disrupting and bypassing several natural functions of the nose and puts people at risk for developing a variety of complications.

Patients who mouth-breathe often experience: 

1. Snoring at night
2. Snoring and sleep apnea, which causes an individual stop breathing in their sleep, leading to nighttime awakenings, disruption in normal sleep architecture, drop in oxygenation during times when you do not breath (apnea) – latter may have long-term consequences on brain, heart, lung, and kidneys
3. Severe nasal obstruction, which can also put people at risk for a variety of cardiovascular problems including increase in blood pressure and decrease in oxygenation in the blood
4. Chronic sore throat, particularly in the morning
5. Hoarse voice
6. Misalignment of the teeth called malocclusion, typically in children who are developmentally growing
7. Dry mouth and chronically chapped lips
8. Drooling in sleep
9. Disruptive facial development in children producing elongated features or receding jaw and development of high arch palate
10. Mental fatigue
11. Possible misdiagnosis of Attention, Deficit, Hyperactivity Disorder (ADHD
12. Chronic bad breath due to bacterial overgrowth and dryness in the mouth

Does mouth breathing impact my teeth and smile? Effects of mouth breathing on dental and facial development

There are several dental problems that are associated with mouth breathing as well including:

1. Grinding or bruxism, where clenching of teeth causes wear and tear of teeth enamel and occasionally dental fracture
2. Enlarged tonsils
3. Enlarged adenoids 
4. Disorders of the joints in the jaw called TMJ disease
5. Dental erosion
6. Misalignment of teeth with teeth crowding or crooked teeth
7. Gum disease or inflamed gums
8. Tooth decaying
9. Impacted teeth. 

Dentists are often the first one to identify mouth breathing as a chronic problem, as they see the dental consequences. People who suffer from sleep apnea, which may or may not be related to chronic mouth breathing, will also experience issues in regard to daytime fatigue, excessive sleepiness during the day, low energy, brain fog consistent with difficulty concentrating, poor memory, decrease in mental clarity, and in some children increase in activity. In children, structural problems can also occur because of chronic mouth-breathing and abnormal growth in the jaw. A child who is a chronic mouth breather may develop an elongated facial shape with a receding chin and a narrow jaw. Children will also habitually keep their mouth open slightly, even when they are relaxed or focused on a task, leading to frequent chapped lips, lip smacking, dermatitis around the lips, noisy eating, and speech difficulty. 

When should I see a doctor if I mouth breathe? Should I see an allergist for mouth breathing?

Mouth breathing should be evaluated by a physician who has expertise in upper airway disease. Qualified Allergists are best equipped to handle many of the non-dental issues, including airway obstruction due to enlargement of lymphoid tissue in the tonsils, adenoids, sleep apnea, chronic allergies, and nasal polyp disease. Evaluation by an allergist would include (1) evaluating and managing the possibility of upper respiratory allergies producing nasal obstruction and mouth breathing, and (2) an a physical exam focusing on the nasal airway to look for structural problems like septal deviations, nasal polyps, mucus secreting tumors, cancers, tonsil and adenoid enlargement in the upper airway. Treatment of such disorders often significantly improve mouth breathing and subsequently improve many of the complications associated with mouth breathing as described above.