CONFLICT OF INTEREST STATEMENT
It is the policy of the Ontario Dental Association that all practice-related speakers at any program sponsored by the Ontario Dental Association shall complete a conflict of interest statement regarding any interest in a company or a product related to the program as a part of the Speaker’s Agreement with the Ontario Dental Association. Further, any portion of the following information can be shared with the membership and/or attendees to gain perspective of the program.
In accordance with this policy, I, Ms. Trisha O’Hehir, declare that I have no proprietary, financial or other personal interest of any nature or kind in Mouth Breathing Leads to more then the product, service and/or company that will be discussed or considered during the proposed program, except the following:
• O’Hehir University – The Toothpaste Secret Book Anterior Gingivitis I declare that I have no proprietary, financial or other personal interest of any nature or kind in any firm beneficially associated with any product and/or service that will be discussed or considered during the proposed program.
I declare that I have no past or present financial interest, consulting position or other involvement of any nature or kind related to the program that could give rise to even a suspicion of a conflict of interest, except the following:
• Xleur/Spry, Sunstar Butler, Sonicare, Waterpik, Rowpar, PDT Instruments.
Furthermore, I understand and agree that as a condition for participating as a speaker at an Ontario Dental Association sponsored program, I will exercise particular care that no detriment to the Ontario Dental Association will result from conflicts between my interests and those of the Ontario Dental Association.
Trisha O’Hehir, RDH, MS Please note that in accordance with ADA CERP, we are required to publish any declared commercial affiliations.
Having read and understood the Ontario Dental Association’s policy and having completed this statement to the best of my knowledge and belief, I agree to be bound by the terms hereof.
1 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 2 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Course Objectives for this Morning Course Objectives for this Morning
Understand oxygen absorption differences Understand oxygen absorption differences
Explain mouth breathing and long face syndrome Explain mouth breathing and long face syndrome Introduction Describe early habits and mouth breathing Describe early habits and mouth breathing
Understand tongue function and ankyloglossia Understand tongue function and ankyloglossia
Describe 3 steps to help mouth breathers switch back Describe 3 steps to help mouth breathers switch back • •
3 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 4 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
I apologize in advance Anyone in your family a mouth breather? Close Your Mouth!
5 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 6 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 My brother Tim - classic mouth breather Marketing promotes Open mouth Flaccid lips open mouth, lips apart Shortened upper lip Shiners under the eyes Flat cheeks under the eyes Visible white under the eye Slouched posture ! Marketing uses open mouth for sex appeal Other signs: Snoring Gingivitis ! Lip product advertisements Cross-bite
! Celebrities
! “Desirable” look
7 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 8 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
9 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 10 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
11 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 12 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 13 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 14 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
15 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 16 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Sexy… NOT So Sexy!
17 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 18 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 19 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 20 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
21 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 22 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Physical Culture March, 1922 Try this now
open lips, close lips www.Modernmechix.com repeat several times
23 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 24 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Physical Culture, August 1930 Physical Culture, August 1930
25 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 26 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Chin Strap Torture Chin Straps Sold Today
27 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 28 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Micropore paper tape
29 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 30 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Besides Micropore paper tape open mouth, where is the tongue?
This is not child abuse
31 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 32 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Red Swollen Gums Mouth Breathing is not just about anterior gingivitis
Remedy: Vaseline
33 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 34 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Red Swollen Gums Red Swollen Gums
35 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 36 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Mouth Breathers The topic of mouth breathing must include: are Prone to: • nasal congestion swallowing / tongue rest position & over breathing • watery and itchy eyes • runny nose • allergies • asthma • enlarged tonsils • bad breath • dry cough • sleep disturbances • snoring • tongue thrust • abnormal swallowing habits • poor palate development • crooked teeth • ortho relapse • altered speech patterns • weak, flaccid lips • low energy level • high stress level • addiction to Chap Stick or lip gloss • chewing with the mouth open • drinking water or liquid after every bite • gingivitis / periodontitis
37 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 38 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Mouth Breathers Trisha’s Clues Many benefits of nasal breathing are Prone to: • nasal congestion • watery and itchy eyes more oxygen, filtration • runny nose • allergies • asthma • enlarged tonsils brain development in kids • bad breath • dry cough • sleep disturbances adequate saliva • snoring • tongue thrust • abnormal swallowing habits fresh breath • poor palate development • crooked teeth • ortho relapse • altered speech patterns optimal palatal development • weak, flaccid lips • low energy level • high stress level increased stamina/endurance • addiction to Chap Stick or lip gloss • chewing with the mouth open • drinking water or liquid after every bite lower pulse rate/stress reduction • gingivitis
39 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 40 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Course Objectives for this Morning Why Do We Breathe?
Understand oxygen absorption differences 10% - 18% more oxygen absorbed with nose breathing
Explain mouth breathing and long face syndrome • Deliver oxygen to body cells
Describe early habits and mouth breathing • Remove excess carbon dioxide (CO2)
• Faster / greater breaths >> reduced cell oxygenation Understand tongue function and ankyloglossia • Slower / fewer breaths >> increased cell oxygenation
Describe 3 steps to help mouth breathers switch back •
41 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 42 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 How do we breathe? What Makes Us Breathe?
• Breathing is subconscious • In and out through the nose • Inhale determined chemically • Belly breathing, no chest movement • Blood pH change triggers brain to take a new breath
www.annapereira.com
43 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 44 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Oxygen Absorption in Role of CO2 Nasal Breathing
• Facilitates release of oxygen from hemoglobin
• Triggers breathing pattern • O2 absorbed on exhale • Maintains and balances pH of blood • Nostrils smaller than mouth • Prevents smooth muscle spasm • Back pressure in lungs created on exhale - slows release of air through the nostrils
• More time for lungs to transfer oxygen to blood
45 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 46 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Oxygen Absorption Oxygen Absorption
• Nasal respiration→ Sinuses→ Produces nitric oxide • Nasal respiration→ Sinuses→ Produces nitric oxide (NO) (NO)
• Inhalation NO = ↑ O2 exchange efficiency • Inhalation NO = ↑ O2 exchange efficiency • bronchodilator • antibacterial agent • Increases blood O2 by 10-18% • vasodilator
• Increases blood O2 by 10-18% • Improves O2 absorption in lungs
• Improves O2 absorption in lungs
47 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 48 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Oxygen Absorption Nasal Filtration
• Nasal respiration→ Sinuses→ Produces nitric oxide (NO) • Filters O2- removes 98-99% allergens, bacteria, viruses • Inhalation NO = ↑ O2 exchange efficiency • Warms, moisturizes, dehumidifies, smells
• Increases blood O2 by 10-18% • Mouth breathing = No filtering, no warming
• Improves O2 absorption in lungs
49 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 50 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Nasal Filtration Respiratory System Exchange of oxygen and carbon dioxide
! Each nostril functions independently and synergistically O2 and CO2 Nostril dominance switches every 50 to 90 minutes
• Nose breathing - ideal exchange of O2 and CO2
• Ideal exchange maintains balanced pH of blood
• Nose breathing produces nitric oxide, increases O2 levels
SUMMARY
51 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 52 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Respiratory System Normal Breathing Exchange of oxygen and carbon dioxide
O2 and CO2 ! Gentle wave pattern
! Eight to ten breaths per minute
• Mouth breathing expels CO2 too quickly ! Breathing in and out through nose
Mouth breathing decreases O2 absorption • ! About one breath every six seconds
• Mouth breathing leads to a drop in pH of blood
SUMMARY
53 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 54 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Mouth Breathing Breathing ! Constant decrease in CO2 levels should be ! Brain trigger resets itself, activates earlier, more often
! Causes over breathing / hyperventilation ! One breath every three seconds invisible and silent
55 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 56 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Talking and Smiling The only time the mouth should be open is…
57 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 58 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Biting (not chewing!) Kissing
59 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 60 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Oral Hygiene Untrue Assumptions about Mouth Breathing
•No difference between nose and mouth breathing
•You get more oxygen when mouth breathing
•That mouth breathing and sleep apnea are not connected
61 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 62 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Course Objectives for this Morning
Understand oxygen absorption differences
Explain mouth breathing and long face syndrome Long
Describe early habits and mouth breathing Face Syndrome Understand tongue function and ankyloglossia
Screen patients for tongue rest position •
63 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 64 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
• long, narrow face • vacant stare 10-18% • mouth open • tongue down less • flat under eyes oxygen to • dark circles the brain • shortened upper lip • flaccid lips
65 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 66 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Palatal development depends on the tongue resting in the palate
SMALL PALATE BICUSPIDS EXTRATED
www.mkdentalcare.com 67 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 68 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Palatal development depends on Palatal development depends on the tongue resting in the palate the tongue resting in the palate
NARROWER PALATE BICUSPIDS EXTRATED
www.mkdentalcare.com www.mkdentalcare.com 69 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 70 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Narrow palate Palatal development
www.suortho.com 71 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 72 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Palatal development Facial growth changes
73 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 74 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Facial growth changes Facial growth changes
Dr Mew’s patient: David
Ten-year-old boy is a nose breather and has a good-looking, broad face with everything in proportion.
At age 17, his face had changed its shape considerably Jefferson, DMD, MAGD 75 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 76 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Facial growth changes Facial growth changes
Kelly 7 years Samantha 8 ½ years
his face had changed its shape considerably Yosh Jefferson, DMD, MAGD 77 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 78 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Facial growth changes
Kelly Samantha
Yosh Jefferson, DMD, MAGD Chris Norton D.D.S. 79 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 80 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Tongue drops down and forward Body Posture
Joy Moeller, RDH, OM
81 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 82 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
More Comfortable Straining To Close With Lips Apart Their Lips
83 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 84 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 85 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 86 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Chronic Mouth Breathing Early Leads to Chronic Mouth Breathing Early In Life Can Crooked Teeth Lead To Facial Deformities
In the 1960s, Dr. Harvold noticed that many patients seeking orthodontic treatment were also mouth breathers. 1981 Age 4- Facial skeleton 60% of adult size
Malocclusion Silicon nose Age 12- Facial skeleton 90% of adult size plugs
Block in roof of the mouth
87 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 88 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Course Objectives for this Morning Muscles of face, jaw, tongue and neck
Understand oxygen absorption differences Abnormal pull of muscles on bones of face
Explain mouth breathing and long face syndrome Jaw deforms
Describe early habits and mouth breathing Malocclusion develops
Understand tongue function and ankyloglossia
Describe 3 steps to help mouth breathers switch back •
89 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 90 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Bottle feeding encourages tongue down and forward Breast feeding encourages tongue up position
Tongue down versus tongue up Tongue up versus tongue down
91 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 92 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Sippy cups and pacifiers Thumb and Digit Sucking hold tongue down and forward
93 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 94 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Thumb Sucking Thumb Sucking with pressure on the nose adults as well
95 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 96 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 What switches someone from nose breathing to mouth Colds breathing? Allergies Asthma
97 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 98 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Mouth Breathing Causes Nasal Congestion Mouth Breathing (breathing mechanism) ! Mouth breathing sends wrong message to brain
+ ! CO2 being lost too quickly
! Goblet cells stimulated: Brain -Produce mucous in nose (mucous trigger) -Slow breathing
-Constrict blood vessels =
99 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 100 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Possible Reasons For Open Mouth Breathing
Airway blockage, enlarged tonsils / adenoids
Nasal septum deviations
Ankyloglossia - ”Tongue Tied”
Allergic rhinitis - allergies
Nasal congestion
Habitual
101 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 102 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Course Objectives for this Morning Many problems with mouth breathing
dry mouth Understand oxygen absorption differences bad breath
Explain mouth breathing and long face syndrome infected tonsils
Describe early habits and mouth breathing snoring, sleep apnea
narrow palate Understand tongue function and ankyloglossia
fatigue, poor brain
Describe 3 steps to help mouth breathers switch back • open mouth chewing
103 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 104 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Many problems with mouth breathing Dry Mouth / Xerostomia
dry mouth ! Saliva is a natural lubricant and immune defense
bad breath ! Open mouth posture / breathing dries out oral tissues
infected tonsils
snoring, sleep apnea
narrow palate
fatigue, poor brain
open mouth chewing
105 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 106 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Dry Mouth / Xerostomia Many problems with mouth breathing
! Dry mouth can lead to dental complications: dry mouth
- Drop in oral pH causing new or recurrent decay bad breath - Red, swollen, bleeding gums infected tonsils - Bad breath
snoring, sleep apnea
narrow palate
fatigue, poor brain
open mouth chewing
107 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 108 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Bad Breath Bad Breath
109 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 110 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Bad Breath – The Truth Bad Breath – Old Wives Tales Every Day: !Bad Breath DOES NOT come from indigestion • Coatings build on the tongue, teeth, gums and throat !Bad Breath DOES NOT come from constipation
• Bacteria break down proteins in these coatings !Bad Breath DOES NOT come from worms • Bacteria release waste compounds called Volatile Sulphur Compounds: the smells of Bad Breath
111 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 112 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Who Has Bad Breath What causes bad breath? Dental Studies
!50% of people have bad breath sometimes 1 Intraoral factors - 90% - mouth !Majority of people have morning breath 2 !25% of people have chronic bad breath 3 Extraoral factors - 10% - lungs !3rd most common dental complaint after caries and gum disease 4 Imaginary - Halitophobia
1. Tonzetich J, Ng SK. Reduction of malodor by oral cleansing procedures. Oral Surg Oral Med Oral Pathol 1976;42:172–81 2. Tonzetich J. Oral malodour: an indicator of health status and oral cleanliness. Int Dent J 1978;28(3):309–19 3. Bosy A. Oral malodor: philosophical and practical aspects. J Can Dent Assoc 1997;63:196–201 4. Loesche WJ. The effects of antimicrobial mouthrinses on oral malodor and their status relative of U.S. Food and Drug Administration regulations. Quintessence Int 1999;30:311–8
113 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 114 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Lifestyle Causes Bad Breath Medications lead to bad breath
! Blood Pressure Medication ! Allergy and Sinus Medication ! Anti Depressant Medication ! Heartburn and Indigestion Medication ! Sedative and Relaxant Medication
115 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 116 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
What causes bad breath? Bad Breath VSC (volatile sulfur compounds) methylmercaptan, hydrogen sulfide, dimethyl sulphide Smells
Released with the Perio breakdown of: Tongue Coating • Food particles Perio • Saliva • Blood • Epithelial Cells • Bacteria
117 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 118 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Many problems with mouth breathing Bad Breath Smells dry mouth
bad breath
Perio infected tonsils Tongue Coating
Perio snoring, sleep apnea
narrow palate
fatigue, poor brain
open mouth chewing 119
119 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 120 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Infected Tonsils Enlarged Tonsils
! Palatine Tonsils
! Back of throat
! Bilateral
! Lymph tissue
! Immune defense in early years of life
121 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 122 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Enlarged Tonsils Kissing Tonsils
www.kidshealth.org National Institute of Health 123 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 124 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Many problems with mouth breathing Tonsillolith or Tonsil Stones dry mouth
bad breath
infected tonsils
snoring, sleep apnea
narrow palate
fatigue, poor brain
open mouth chewing
125 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 126 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 In sleep apnea the airway closes mechanically by more Snoring then 50% when the mouth is open. Also notice the position of the tongue in both cases.
www.sleep4health.com 127 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 128 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
In sleep apnea the airway closes mechanically by more then 50% when the mouth is open. Also notice the Kids snore too… position of the tongue in both cases. but they shouldn’t!
www.sleep4health.com 129 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 130 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Snoring in kids In this study of 11,000 kids 6 months to 7 years, SDB symptoms had strong, persistent statistical effects on subsequent behavior in childhood. Findings suggest that SDB symptoms may require attention as early as the first year of life.
SDB = Mouth Breathing
Bonuck K, et al. "Sleep-disordered breathing in a population-based cohort: Behavioral outcomes at 4 and 7 years"Pediatrics 2012; 129: 1–9.
131 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 132 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 In sleep apnea the airway closes mechanically by more Bed Wetting and Mouth Breathing then 50% when the mouth is open. Also notice the sleepposition apnea of the tongue insleep both with cases. closed mouth
www.sleep4health.com 133 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 134 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Sleep Disturbances Sleep Disturbances
• There is NO such thing as ADHD • These kids are simply sleep deprived • ADHD behavior is simply the child trying to keep themselves awake • According to Dr. Stephen H. Sheldon, Northwestern University and director of the largest children’s sleep apnea clinic in the USA
135 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 136 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Sleep Disturbances Sleep Disturbances
• Author: Richard Saul, MD Psychiatrist Leon Eisenberg - scientific father of ADHD said a few months before his death: “ADHA is a 1922-2012 prime example of a fictitious disease.”
137 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 138 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Sleep Disturbances Sleep Disturbances • Poor sleep may lead to: Author: Phillip W. Cooper, Jr., DDS Savannah, GA • Problems paying attention in school • Frequently tired • Irritability • Behavior problems • Poor brain development
139 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 140 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Many problems with mouth breathing Palatal development depends on the tongue resting in the palate dry mouth
bad breath
infected tonsils SMALL PALATE
snoring, sleep apnea BICUSPIDS EXTRATED
narrow palate
fatigue, poor brain
open mouth chewing www.mkdentalcare.com 141 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 142 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Palatal development depends on Palatal expansion the tongue resting in the palate
www.mkdentalcare.com 143 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 144 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Many problems with mouth breathing Fatigue dry mouth • Decreased oxygen absorption in lungs bad breath
Decreased oxygen in blood infected tonsils •
snoring, sleep apnea • Lack of energy
narrow palate • May fatigue easily during exercise fatigue, poor brain
open mouth chewing
145 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 146 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Many problems with mouth breathing Chewing with mouth open
dry mouth • Inadequate palatal seal for bad breath swallowing
infected tonsils • Using liquids to aid swallowing
snoring, sleep apnea
narrow palate
fatigue, poor brain
open mouth chewing
147 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 148 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Chewing and Swallowing Chewing
• Collecting and gathering of food difficult • With lips closed
• Creating a bolus difficult • Tongue gathers, collects, and creates a bolus of food prior to swallowing • Inadequate palatal seal for swallowing
• Often chewing with the mouth open • Bilateral chewing
• Using liquids to aid swallowing
149 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 150 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 151 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 152 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Swallowing Swallowing
• Tongue up on the spot
• Middle of the tongue on the roof of the mouth
• Back of the tongue creating closure with soft palate and throat
153 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 154 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Recognize Improper Tongue Position With Swallowing
Activated mentalis muscle during swallowing
www.americandysphagianetwork.org 155 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 156 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Activated Mentalis Muscle Watch For A Facial During Swallow Grimace When Swallowing
157 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 158 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Swallow Air With Food Myofunctional Research CO.- MRC
Dr. Chris Farrell BDS- Founder
www.myoresearch.com
159 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 160 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Swallow Air With Food Speech Sounds
• Mumbling
• Tongue visible when speaking
• Lisping
• Difficulty hearing them speak
• • Talking too fast
161 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 162 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Speech Sounds Many problems with mouth breathing
• Have patient say “Sister Sally said something dry mouth silly” or count from 60-70.
bad breath • Note tongue position and any shifting
• Tongue may come outward and between teeth infected tonsils
snoring, sleep apnea
narrow palate
fatigue, poor brain
open mouth chewing
163 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 164 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Many benefits of nasal breathing We are meant to Nose Breathe more oxygen, filtration, restorative sleep
brain development in kids
adequate saliva
fresh breath
optimal palatal development
increased stamina/endurance
lower pulse rate/stress reduction
165 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 166 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Many benefits of nasal breathing
more oxygen, filtration
brain development in kids
adequate saliva
fresh breath Sanya Ross optimal palatal development Richards Increased stamina and increased stamina/endurance endurance lower pulse rate/stress reduction
167 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 168 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Course Objectives for this Morning Course Objectives for this Morning
Understand oxygen absorption differences Understand oxygen absorption differences
Explain mouth breathing and long face syndrome Explain mouth breathing and long face syndrome
Describe early habits and mouth breathing Describe early habits and mouth breathing
Understand tongue function and ankyloglossia Understand tongue function and ankyloglossia
Describe 3 steps to help mouth breathers switch back Describe 3 steps to help mouth breathers switch back • •
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Tongue Functions
171 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 172 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
173 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 174 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 175 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 176 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Tongue Functions
177 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 178 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Sticking The Tongue Out Sticking The Tongue Out
179 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 180 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Tongue Rest Position • Tongue rest position is Tongue in the palate, just behind upper anterior teeth - rest The Spot position • Important in palatal development
• Allows for proper breathing, chewing, and swallowing
181 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 182 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Tongue On The Spot Breathing
• Area distal to incisive papilla • Tongue position up on the spot
• On the rugae of hard palate • Lips together, teeth apart
• Not touching the anterior teeth • Allows for nasal breathing - if airway adequate
• Top of tongue, NOT just tongue tip • Cannot breathe through mouth if tongue rest www.agaveclinic.com position correct
183 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 184 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Tongue posture – up or down or middle Muscles of the tongue
Extrinsic Muscles: Genioglossus - protrudes Hyoglossus - depresses Styloglossus - elevates and retracts Palatoglossus - depresses the soft palate and elevates the back of the tongue
Intrinsic Muscles: Superior Longitudinal Muscle - elevates the tongue Inferior Longitudinal Muscle - sides of the tongue Vertical Muscle - connects superior and inferior Transverse Muscle - divides the tongue in the middle •
185 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 186 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 TMD Neck Lift with Tongue Activated
Sandra Coulson Myofunctional Therapist Tongue up Lips together Teeth apart •
187 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 188 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Ankyloglossia Signs/Symptoms
What if the tongue • Cannot stick tongue out past lips • V-shaped notch at tip of tongue cannot reach the • Tongue curves downward / extended palate? • Trouble swallowing pills • Improper swallow pattern • Speech problem
189 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 190 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Ankyloglossia
• Unable to latch onto the breast
• Failure to thrive
• Males affected more often
Photo by Janelle Abby MD. www.newborns.stanford.edu 191 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 192 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Breast Feeding Breast Feeding
Tongue up against the roof of the mouth
193 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 194 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Breast Feeding
www.BrianPalmerDDS.com
Nose
Tip of tongue
Gum pad
Habitual tongue posture of newborn infant
Tip of tongue extends over and past the gum pad
195 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 196 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Breast Feeding Don Eberhart, DDS Ankyloglossia - Tongue Tied
197 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 198 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Ankyloglossia - Tongue Tied Frenum Length - Ok or Tight
www.blueskydentaloffice.com 199 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 200 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Restricted Frenum Cannot Stick Tongue Out Past the Lower Lip
www.BrianPalmerDDS.com
201 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 202 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Don Eberhart, DDS Frenectomy
• Definition: Removal of a frenulum, small fold of tissue that prevents an organ of the body from moving too far.m
• Lingual Frenectomy - for ankyloglosia
• Labial Frenectomy - for upper, lower lip
203 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 204 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Don Eberhart, DDS
Don Eberhart, DDS 205 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 206 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Don Eberhart, DDS
Don Eberhart, DDS
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Cannot Stick Tongue Out Able To Stick Tongue Out After Frenectomy After Frenectomy Before Frenectomy Before Frenectomy
Dr. Albert B. Boholst, DMD, PA Dr. Albert B. Boholst, DMD, PA
209 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 210 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Tongue Exercises Needed Cade Cory Before Frenectomy After Frenectomy
211 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 212 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
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Labial Frenums prevent lip closure
215 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 216 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Course Objectives for this Morning Course Objectives for this Morning
Understand oxygen absorption differences Understand oxygen absorption differences
Explain mouth breathing and long face syndrome Explain mouth breathing and long face syndrome
Describe early habits and mouth breathing Describe early habits and mouth breathing
Understand tongue function and ankyloglossia Understand tongue function and ankyloglossia
Describe 3 steps to help mouth breathers switch back Screening and three steps to help mouth breathers • •
217 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 218 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Open Wide! Screening Exam
1) Lips Together At Rest - yes or no
2) Nasal Breathing – yes or no
3) Tongue Posture – up, down, middle
4) Frenum Length - adequate or tight
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Step One: Questions To Ask Lips Together At Rest- yes or no Do they wake up in morning with dry mouth?
Do they ever drool? During daytime? While sleeping?
Do they notice times during the day when mouth is open?
Watching TV? Working on the computer? Driving? Reading?
221 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 222 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Questions To Ask Step Two:
Do they suffer from seasonal allergies? Allergic rhinitis? Nasal Breathing – yes or no
Frequent colds?
Tonsils and/or adenoids removed?
Asthma? Inhaler use?
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Step Three: Questions To Ask Ask patient to pay attention to what their tongue does Tongue Posture – up or down or middle throughout the day…
Do they notice times during the day when their tongue is not up on the spot?
Is tongue down low in the jaw?
Is tongue between teeth as a cushion? Bracing against the teeth?
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Step Four: Questions To Ask
Can they stick their tongue out past their lower lip? Frenum Length - Ok or tight
Trouble licking ice cream cone?
three fingers - full open mouth two fingers - tongue on the spot Difficulty with certain speech sounds?
227 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 228 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Always Remember… Screening Exam
Do not “tell” patient what you are looking for during screening exam, “see” it. 1) Lips Together At Rest - yes or no
2) Nasal Breathing – yes or no Observe true breathing, swallowing, rest posture patterns. 3) Tongue Posture – up, down, middle
4) Frenum Length - adequate or tight If scripted, they may “perform” correctly three fingers - full open mouth two fingers - tongue on the spot
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Three steps to convert mouth breathers to nose breathers Three steps to convert mouth breathers to nose breathers
Awareness of nasal vs mouth breathing Awareness of nasal vs mouth breathing
Unclog the nose exercise Unclog the nose exercise
Tape the mouth during sleep Tape the mouth during sleep
231 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 232 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Xlear Nasal Spray
How to unplug the nose If you wash your hands everyday, wash your nose everyday!
• Close your mouth, finger on the lips • Small breath in and small breath out • Pinch your nose to hold your breath • Move head up and down as long as you can • Repeat as needed up to six times
233 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 234 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Look at your Toes Xylitol is a mucolytic substance Squirt your Nose thins out mucous
Improved outcomes post surgery for CRSsNP (chronic rhinosinusitis with and without nasal polyps)
Laryngoscope. 2011 Nov;121(11):2468-72.
235 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 236 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Three steps to convert mouth breathers to nose breathers
Awareness of nasal vs mouth breathing
Fold the edges
Unclog the nose exercise This is not child abuse
Tape the mouth during sleep
237 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 238 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Only use micropore paper tape! Never duct tape!
239 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 240 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 Dr. Sue, Orthodontist, Honolulu, HI Dr. Sue, Orthodontist, Honolulu, HI http://nosebreathe.com $135.00
241 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 242 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Three steps to convert mouth breathers to nose breathers
Awareness of nasal vs mouth breathing
Unclog the nose exercise
Tape the mouth during sleep
243 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 244 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015
Additional Training for RDHs: Course Objectives for this Morning
Myofunctional Therapy - four-day introductory course Understand oxygen absorption differences
Joy Moeller, RDH, COM Explain mouth breathing and long face syndrome http://www.myofunctional-therapy.com
Describe early habits and mouth breathing
Buteyko Breathing - seven-day course for RDHs Understand tongue function and ankyloglossia Patrick McKeown
http://www.buteykoclinic.com Screen patients for tongue rest position •
245 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 246 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 We are meant to Nose Breathe
247 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015 248 Current Trisha O'Hehir Mouth Breathing ODA 2015 - May 12, 2015