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. 2025 May;18(5):514-521.
doi: 10.5005/jp-journals-10005-3109. Epub 2025 Jul 25.

Clinical and Cephalometric Correlation between Mouth-breathing and Nasal-breathing Children

Priyanka Balakrishnan  1 , Daya Srinivasan  2 , Ar Eagappan Senthil  3 , Krithika Priyadharshini Arunagiri  4 , Shashank Kannan  4 , Cyril Benedict  5
Affiliations

Clinical and Cephalometric Correlation between Mouth-breathing and Nasal-breathing Children

Priyanka Balakrishnan et al. Int J Clin Pediatr Dent. 2025 May.

Abstract

Introduction: Pediatric sleep-disordered breathing encompasses conditions from upper airway resistance syndrome to obstructive sleep apnea. Mouth-breathing in children causes severe dentoalveolar deformities. Adenotonsillar hypertrophy exacerbates mouth-breathing, greatly influencing dentofacial development. Early detection of mouth-breathing habit is crucial to prevent the development of malocclusion. Mouth-breathing also alters the salivary pH of the saliva and has an impact on gingival health.

Aim: The study aims to compare and correlate the clinical and cephalometric parameters between nasal-breathing children (NBC) and mouth-breathing children (MBC) among the age-group of 6-12 years.

Materials and methods: A cross-sectional study was conducted to analyze the clinical and cephalometric variables between NBC and MBC among the age-group of 6-12 years who reported to the Department of Pediatric and Preventive Dentistry with the chief complaint of malocclusion. Sixty-six children were assessed for the breathing pattern and categorized into NBC and MBC based on the clinical history and assessment test. After initial screening and examination, the children were referred to the Department of ENT for otolaryngology assessment. Both the groups were assessed for clinical parameters such as malocclusion, salivary pH, tonsillar hypertrophy, and gingival inflammation. Lateral cephalometric assessment was done for both the groups and all the values were tabulated. All the data were analyzed statistically using Statistical Package for the Social Sciences (SPSS) software version 20.

Results: MBC exhibited narrower dental arches (intermolar width: p < 0.001, intercanine width: p < 0.035), increased mouth opening (p = 0.001), and higher tonsillar hypertrophy grades (p < 0.05). Class II molar occlusion was more common among MBC compared to NBC (p = 0.002). MBC (mean = 6.68) also had a reduced salivary pH compared to NBC (mean = 6.36). The maximal mouth opening was also reduced among MBC (p = 0.001). Cephalometrically, MBC displayed a stronger tendency towards skeletal class II occlusion [FMA (p = 0.001)] compared to NBC.

Conclusion: MBC show increased prevalence of malocclusion, tonsillar hypertrophy, gingival inflammation, and decreased saliva pH, impacting dentofacial development, which needs early intervention.

How to cite this article: Balakrishnan P, Srinivasan D, Senthil ARE et al. Clinical and Cephalometric Correlation between Mouth-breathing and Nasal-breathing Children. Int J Clin Pediatr Dent 2025;18(5):514-521.

Keywords: Breathing; Malocclusion; Mouth-breathing; Nasal obstruction; Saliva.

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Conflict of interest statement

Source of support: Nil Conflict of interest: NoneConflict of interest: None

Figures

Fig. 1:
Fig. 1:
Schematic representation of the study proceedings
Figs 2A to C:
Figs 2A to C:
(A) Mouth mirror test (fog test); (B) Lip posture assessment; (C) Massler's water holding test
Fig. 3:
Fig. 3:
Measurements on dental study models
Fig. 4:
Fig. 4:
Cephalometric points and planes
See this image and copyright information in PMC

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