Association between Mouth Breathing Habit and Dental Caries-A Retrospective Study

Ushanthika T and Sowmya K^*

^*Correspondence: Sowmya K, Department of Conservative Dentistry and Endodontics, Saveetha Institute of Medical and Technical Sciences Saveetha University, India, Email:

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Introduction

Oral habits are learned patterns of muscular contraction. Abnormal habits such as finger sucking, lip sucking, tongue thrusting, abnormal muscle habit can interfere with regular patterns of facial growth [1,2]. But psychologists believe that these habits can become "Bad Oral Habits", if continued longer than normal may cause physical damage to social or cognitive development [3,4]. Mouth breathing refers to the state of inhaling and exhaling through the mouth. The literature describes the prevalence of mouth breathing as ranging from 5 to 75% of tested children [5]. Excessive mouth breathing is problematic because of different disturbances. The air is not filtered and warmed as much as when inhaled through the nose, as it bypasses the nasal canal and Paranasal sinuses, and dries out the mouth, among other mechanisms. Mouth breathing is often associated with congestion, obstruction, or other abnormalities of the upper respiratory tract as well as other oral and medical conditions.

Dental caries is described as a multifactorial disease, in which the anatomy of the oral cavity, strength of the dental tissue, salivary composition, crevicular fluid, and diet are as important as the formation of bacterial plaque and the microorganisms that cause the disease. Since 1970, there has been a considerable reduction in the prevalence of dental caries in the majority of developed countries [6]. While a number of authors report improvements in oral health status in recent decades [7,8].

Saliva has many important functions. Among them are self-cleaning of the mouth, buffering and clearing acids, acquired pellicle formation, antimicrobial actions, and provision of ions for remineralization of demineralized enamel.

It protects the teeth from organic acids produced by bacteria which cause dental caries, and the extrinsic and intrinsic acids that initiate dental erosion. The depressed resting salivary flow is associated with lower plaque pH, increased numbers of lactobacilli and candida species, and greater caries risk.

This could have serious consequences for caries activity, and will also increase the risk of tooth loss via dental erosion [9]. When the subject breathes through the mouth, there is loss of saliva and dryness of the mouth and this can increase the risk of tooth decay and inflammation of the gingiva.

As mouth breathing causes water loss it is a potential factor which could contribute to oral dryness. Some studies have failed to find associations between mouth breathing and caries risk or salivary patterns.

The aim of the study is to find the association between mouth breathing and dental caries experience. Our team has extensive knowledge and research experience that has translated into high quality publications [10-29].

Materials and Methods

Study design: Retrospective study.

Study population: A retrospective study was carried out among young adults reporting to Saveetha Dental College and Hospital. The study was conducted between June 2020-March 2021. The study population consisted of patients who reported mouth breathing habit.

Ethical approval: Ethical approval was obtained from the Institutional Ethical Committee and Scientific Review Board [SRB] of Saveetha Dental College.

Data collection: The data were collected by analyzing the records of 86,000 patients between June 2020-March 2021. The data included the patient's demographic details, history of mouth breathing and caries status.

Data analysis: The collected data were entered in an Excel sheet and subjected to statistical analysis using SPSS software. Bar charts were made on the number of caries for the tooth number 11, 21 and 31.

Results

In this study the patients seen in the 10-15 years age group were (29.15%), (20.18%) in the age group of 14-16 years and 50.67% in the 17-20 age group (Figure 1) and this study showed there were more number of male patients (58.65%) reported having mouth breathing when compared to female patients (41.35 %) (Figure 2). The association of mouth breathing and dental caries has been presented in Figures 3 to Figure 5.

Figure 1. Bar graph depicts the distribution of the study population based on age. It shows that the most number of patients with mouth breathing were seen among the 10-15 years age group (29.15%), 14-16 age group (48.08%) and in the 17-20 years age group (50.67%).

Figure 2. Depicts the distribution of the study population based on gender. It shows there were more males (58.65%) when compared to females (41.35 %).

Figure 3. Graph depicts the association between mouth breathing and caries status in 11. Where x axis denotes mouth breathing status and y axis denotes number of patients. Blue denotes that caries is absent and green denotes that caries present. 1.79% of the population with mouth breathing habit had caries and 5.8% of the population with no mouth breathing habit had caries in relation to 11. However the association was not found to be significant (Chi square test; p value=0.057>0.05, not significant).

Figure 4. Graph depicts the association between mouth breathing and caries status in 11. Where x axis denotes mouth breathing status and y axis denotes number of patients. Blue denotes that caries is absent and green denotes that caries present. 3.1 % of the population with mouth breathing habit had caries and 8.07% of the population with no mouth breathing habit had caries in relation to 21. However the association was not found to be significant (Chi square test; p value=0.057>0.05, not significant).

Figure 5. Graph depicts the association between mouth breathing and caries status in 31. Where x axis denotes mouth breathing status and y axis denotes number of patients. Blue denotes that caries is absent and green denotes that caries present. 0.45% of the population with mouth breathing habit had caries and 0.90% of the population with no mouth breathing habit had caries in relation to 31. However the association was not found to be significant (Chi square test; p value=0.642>0.05, not significant).

Discussion

In this study the age group taken was 10-15 years age group (51.92%) and (48.08%) in the 16-20 years age group. There were more number of male patients (58.65%) reported having mouth breathing when compared to female patients (41.35 %). The tooth number taken to assess the caries was 21, 11 and 31 and the caries status. However, Al-Awadi et al. found lower salivary flow rate among male patients 18-22 years old with mouth breathing associated with nasal obstruction in comparison to nose breathers. Mouth breathing was also associated with lower salivary pH, higher plaque index and increased salivary mutans streptococci counts. Other studies also report association between mouth breathing and dental caries [30,33].

In our study caries status were given to the mouth breathing patients for 11 (tooth number). 44.84% of the people with mouth breathing habit had caries and 47.53% of the patients without mouth breathing had caries present in relation to 11. The results were found to be not significant and hence proving no significant relationship between mouth breathing and dental caries. Similar results was found in a study by Koga-Ito et al. [30] found no differences in caries risk between treated and untreated children for mouth breathing syndrome, although the level of IgG antibodies to S. mutans (cariogenic bacteria) was higher in the treated group. Another study did not find differences in flow rates or buffering capacities of resting and stimulated saliva between mouth- or nose-breathers adolescents aged 10-19 years.

The results of this study should be considered in highlighting its limitations. As this was a nonrepresentative descriptive study of the mouth-breathers only, the results could not be generalized for the whole population. The factors like family income and level of parental education that could be associated with a child's oral health practice were not assessed in this study.

It also remains uncertain whether mouth breathing has a causal relationship with gingival inflammation or dental caries. Prospective cohort studies including both mouth breather children and children without mouth breathing strongly suggested to fully clarifying the mechanism between mouth breathing and oral health by performing multivariate analyses like logistic regression.

Limitations

The main of this study is limited sample size and confined to a single source for data. Further descriptive studies on a larger scale can help us to give comprehensive data for arriving at a conclusion and to plan health oral health programs for the population studied.

Conclusion

Within the limitations of the current study, The effect of mouth breathing on the oral cavity remains controversial, and research about this topic is scarce. This study investigated the effect of mouth breathing on the levels of dental caries and it was found that there was no significant relation. However further studies are recommended on this topic after examining the individuals while possibly assessing more segments of the mouth to give an overview of the general dental to find an association as these were the main limitations in this study.

Acknowledgement

The authors sincerely acknowledge the faculty Medical record department and Information technology department of SIMATS for their tireless help in sorting out datas pertinent to this study.

Authors Contribution

Ushanthika T: Literature search, data collection, data analysis, manuscript writing.

Dr. Sowmya K: Study design, data verification, manuscript drafting.

Funding

The authors declare that the present project is funded by Saveetha Institute of Medical and Technical Sciences, Saveetha Dental college and hospitals, Saveetha university.

Conflict of Interest

The authors declare that there were no conflicts of interest in the present study.

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