Snoring - Problem Caused by Mouth Kids snore too… but they shouldn’t!

Trisha O’Hehir, MS, RDH [email protected] 520-444-2279

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 = /Snoring

Bonuck K, et al. "Sleep-disordered breathing in a population-based cohort: Behavioral outcomes at 4 and 7 years"Pediatrics 2012; 129: 1–9. Sexy Not so sexy

I want to apologize in advance. You will notice mouth breathers now — everywhere!

nose breather

mouth breather For most of you, this is about patients Anyone in your family a mouth breather?

For a few of you, it’s all about family

My brother Tim - classic mouth breather My brother Tim - classic mouth breather

Open mouth Flaccid lips Shortened upper lip Shiners under the eyes Flat cheeks under the eyes Visible white under the eye Slouched posture Other signs: Snoring Gingivitis Cross-bite

• aerophagia (swallowing air) What can go wrong… • • • nasal congestion • • watery and itchy eyes Healthy breathing • flatulence • runny nose • acid reflux • allergies • chewing with the mouth open • should be invisible • drinking liquid after every bite • enlarged tonsils, tonsil stones • dry mouth • • gingivitis / periodontitis • dry and silent • • sleep disturbances • bed wetting • ADHD, ADD • failure to thrive • snoring • gummy smile • sleep • Long Face Syndrome • tongue thrust • recessive chin • abnormal swallowing habits • heart burn • poor palate development • silent aspiration • crooked teeth • fibromyalgia • ortho relapse • slouched posture • altered speech patterns • frequent urination at night • weak, flaccid lips • pneumonia • low energy level • chronic fatigue syndrome • high stress level • addiction to Chap Stick or lip gloss Normal Breathing Humans are meant to

• Gentle wave pattern nose breathe.

• Eight to ten breaths per minute The only time the mouth • Breathing in and out through nose should be open is… • About one breath every six seconds

• Breath starts at diaphragm - focus on tummy

Talking and Smiling Biting (not chewing!)

Swimming Kissing Oral Hygiene Nose Breathing Message

Lips together

Teeth apart

Tongue up

Breath starts at diaphragm - focus on tummy

Physical Culture August 1930

Physical Culture March 1922

Physical Culture August 1930 of Obstructive Sleep Apnea In sleep apnea the airway closes mechanically by Signs and Symptoms of Mouth Breathing more then 50% when the mouth is open. Also notice the position of the tongue in both cases.

www.sleep4health.com

Signs and Symptoms of Mouth breathing: Obstructive Sleep Apnea (OSA)

1. High body mass

• Air hits back of the throat 2. Smoking • Airway dries out tissues 3. Neck circumference

• Elasticity is lost • More than 16 inches for women • Collapses easily • More than 17 inches for men

www.sleep4health.com

Signs and Symptoms of Sleep Apnea What it Sounds Like When Breathing Stops Obstructive Sleep Apnea (OSA)

1. High body mass

2. Smoking

3. Neck circumference

• More than 16 inches for women

• More than 17 inches for men Apnea - full blockage - partial blockage Treating Sleep Apnea Nasal Mouth Airway Sleep Breathing Breathing Issues Apnea Assumption - there is no difference between nose and mouth breathing Cause of Mid-Stage End-Stage Health Disease Disease Disease Ignores that we breathe all day, not just while sleeping

www.sleep4health.com

Mouth Breathing vs Nasal Breathing What Makes Us Breathe?

Why Do We Breathe? • Breathing is subconscious

• Inhale determined chemically

• Deliver oxygen to body cells • Blood pH change triggers brain to take a new breath • Remove excess carbon dioxide (CO2)

Oxygen Absorption in Nasal Breathing Role of CO2

• 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 Oxygen Absorption Role of CO2

• Nasal respiration→ Sinuses→ Produces nitric oxide • Facilitates release of oxygen from hemoglobin (NO)

• Triggers breathing pattern • Inhalation NO = ↑ O2 exchange efficiency • Maintains and balances pH of blood

Increases blood O2 by 10-18% • Prevents smooth muscle spasm •

• Improves O2 absorption in lungs

Oxygen Absorption Oxygen Absorption

• Nasal respiration→ Sinuses→ Produces nitric oxide • Nasal respiration→ Sinuses→ Produces nitric oxide (NO) (NO) • Inhalation NO = ↑ O2 exchange efficiency • bronchodilator • Inhalation NO = ↑ O2 exchange efficiency • antibacterial agent • vasodilator • Increases blood O2 by 10-18% • Increases blood O2 by 10-18%

• Improves O2 absorption in lungs • Improves O2 absorption in lungs

Nasal Filtration Advantages of greater oxygen absorption Each nostril functions independently and synergistically Nostril dominance switches every 50 to 90 minutes 1. More restful and regenerative sleep 2. Human growth hormone release 3. Increased stamina and endurance Mouth Breathing Causes Mouth Breathing

Nasal Congestion (breathing mechanism)

Mouth breathing sends wrong message to brain +

CO2 being lost too quickly

Goblet cells stimulated: -Produce mucous in nose Brain

-Slow breathing (mucous trigger) -Constrict blood vessels =

Respiratory System Exchange of oxygen and carbon dioxide

O2 and CO2

•Nose breathing - ideal exchange of O2 and CO2

•Ideal exchange maintains balanced pH of blood

•Nose breathing produces nitric oxide, increases O2 levels

SUMMARY

Respiratory System An unexpected outcome Exchange of oxygen and carbon dioxide from nasal breathing - weight loss O2 and CO2

•Mouth breathing expels CO2 too quickly

•Mouth breathing decreases O2 absorption

•Mouth breathing leads to a drop in pH of blood

SUMMARY • aerophagia (swallowing air) What can go wrong… What can go wrong • burping • hiccups • nasal congestion with • bloating • watery and itchy eyes • flatulence • runny nose • acid reflux • allergies mouth breathing • chewing with the mouth open • asthma • drinking liquid after every bite • enlarged tonsils, tonsil stones • bad breath • dry mouth sleep problems • gingivitis / periodontitis • dry cough • bronchitis • sleep disturbances • bed wetting • ADHD, ADD • failure to thrive • snoring ADHD • gummy smile • sleep apnea • Long Face Syndrome • tongue thrust • recessive chin • abnormal swallowing habits infected tonsils • heart burn • poor palate development • silent aspiration • crooked teeth • ortho relapse • fibromyalgia snoring, sleep apnea • slouched posture • altered speech patterns • frequent urination at night • weak, flaccid lips • pneumonia • low energy level • chronic fatigue syndrome • high stress level narrow palate • addiction to Chap Stick or lip gloss

Sleep Disturbances Sleep Disturbances Poor sleep may lead to: • There is NO such thing as ADHD

• These kids are simply sleep Problems paying attention in school deprived Frequently tired • According to Dr. Stephen H. Sheldon, Northwestern University Irritability and director of the largest children’s sleep apnea clinic in Behavior problems the USA Poor concentration

Sleep Disturbances Human Growth Hormone

• Secreted by the pituitary gland

ADHD behavior is linked to awake • Released during sleep sleeping - the brain goes to sleep • Highest levels in children and young repeatedly, but just for a fraction of a second while the child is awake. adolescents • Increases bone and muscle development Mouth breathing leads to Human Growth Hormone premature aging

• Stimulates growth of all internal organs except the brain • Stimulates the immune system • In adults, keeps you looking and feeling young (supplements) • Sleep depravation suppresses release of HGH

Nathan Nathan

Lips together Lips together

Teeth apart Teeth apart

Tongue up Tongue up

7 years old 7 years old squirted 3 days morning and night • •

Nathan Nathan

Lips together Lips together

Teeth apart Teeth apart After he fell asleep, gently pinched his Tongue lipsup for 1 hour, three Tongue up

7 years old Squirted 3 days nights - he slept 7 years old 8 years old 9 years old morning and night through the night! • • Enlarged Tonsils Tonsillolith or Tonsil Stones Infected Tonsils

Snoring Mouth open Snoring air flow with tongue down - soft palate vibrates

Mouth closed air flow with tongue down - soft palate vibrates

www.sleep4health.com

Palatal development depends on the tongue resting in the palate

Even sitting up, the mouth should be closed when sleeping Airline passengers sitting next to me.

www.mkdentalcare.com Palatal development depends on the tongue resting in the palate Narrow palate

NARROWER PALATE BICUSPIDS EXTRATED

www.mkdentalcare.com Dr Rubens Demicheri, D.D.S., M.D.

Palatal development My brother Tim - classic mouth breather

www.suortho.com

10-18% Long less Face oxygen to Syndrome the brain • long, narrow face Facial growth changes

• vacant stare

• mouth open

• tongue down

• flat under eyes

• dark circles

• shortened upper lip

• flaccid lips

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 Yosh Jefferson, DMD, MAGD

Facial growth changes Facial growth changes

Kelly 7 years Samantha 8 ½ years

his face had changed its shape considerably Yosh Jefferson, DMD, MAGD Facial growth changes

Kelly Samantha

Yosh Jefferson, DMD, MAGD

Body Posture

Joy Moeller, RDH, OM

Chris Norton D.D.S.

Chronic Mouth Breathing Early Leads to Crooked Teeth Four Bicuspid Extractions

In the 1960s, Dr. Harvold noticed that many patients seeking orthodontic treatment were also mouth breathers. 1981

Malocclusion

Silicon nose plugs 5th round of Block in roof of the mouth orthodontics Bicuspid Extractions Appliances to expand the palate and Retraction… Vivos Appliance - Dr. David Singh

• Crowds the airway

• Tongue is too big for the palate, low posture

• Often cross bites

• Teeth may be straight, but face is pinched Open extraction sites and place implants

We are meant to Nose Breathe What switches someone from nose breathing to mouth breathing?

Colds Allergies Asthma Thumb and Digit Sucking

Breathing TMD

• Tongue position up on the roof of the mouth

• Lips together, teeth apart

• Allows for nasal breathing - if airway adequate Tongue up Lips together • Cannot breathe through mouth if tongue rest position correct - try this now Teeth apart Muscles of the tongue

Extrinsic Muscles: Genioglossus - protrudes Hyoglossus - depresses What if the tongue Styloglossus - elevates and retracts Palatoglossus - depresses the soft palate and elevates the back of the tongue cannot reach the

Intrinsic Muscles: palate? 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

Ankyloglossia Labial Frenum Restricts Breast Feeding

• Unable to latch onto the breast • Failure to thrive • Males affected more often

Photo by Janelle Aby MD. www.newborns.stanford.edu

Frenum Length - OK or Tight Don Eberhart, DDS Ankyloglossia - Tongue Tied Ankyloglossia - Tongue Tied

Don Eberhart, DDS Don Eberhart, DDS

YouTube.com - search my name and myofunctional Myofunctional Exercises Nose Breathing Message Three steps to convert mouth breathers to nose breathers

Lips together Awareness of nasal vs mouth breathing

Teeth apart Unclog the nose exercise

Tongue up

Tape or gel the lips during sleep Neural Stimulation for infants

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 or gel the lips during sleep Tape or gel the lips during sleep Neural Stimulation for infants Neural Stimulation for infants

Xlear Nasal Spray How to unplug If you wash your hands everyday, your nose 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 Look at your Toes Three steps to convert mouth breathers to nose breathers Squirt your Nose Awareness of nasal vs mouth breathing

Unclog the nose exercise

Tape or gel the lips during sleep Neural Stimulation for infants

Micropore paper tape

Insure nasal breathing

before using tape

Micropore paper tape

Fold the edges Micropore paper tape Never use duct tape!

This is not child abuse

Nasal Breathing - Neural Stimulation Only use micropore paper tape!

Rub the tongue 3 times, rub the palate 3 times

Repeat 3 times - Tongue will go to the palate

Dr. Sue, Orthodontist, Honolulu, HI https://sleepqplus.com/ Three steps to convert mouth breathers to nose breathers

Awareness of nasal vs mouth breathing

Unclog the nose exercise

Dr. Sue, Orthodontist, Honolulu, HI http://nosebreathe.com Tape the mouth during sleep Neural stimulation for infants

Time for a test… LipZip: Breathe Better to Live Better

Nose breathing while awake & asleep Do you know more than doctors on TV?

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Welcome to LipZip Breathe Better to Live Better