This article Zhuo Zheng: Zhang Wenjuan Wu Yin
If there is any advice to parents as an otolaryngologist who sees many children every day, the most important point must be - "don't search for 'mouth breathing' on the Internet".
Any search engine or short video platform, enter "mouth breath" in the search box and press the enter key, it is like opening Pandora's box, you will see this.
This one
And this
No matter how calm parents are, all they can see are these shocking "adenoid face" photos, and the words "ugly" and "harmful" also hit the pain points of parents, and it is inevitable that they will have apprehension...
Looking back at the baby next to him, it was a thunderbolt: this little mouth seems to be more and more upturned the more you look at it, and this tooth seems to be a little protruding... Finished! Isn't this the adenoid face?! Curious to search my mouth and breathe, I never expected that the clown was myself?!
Parents, don't panic, "mouth breathing" is not so scary. Let's arm ourselves with science, relieve anxiety with popular science, and talk about "mouth breathing" together.
Too long to look at the version
1. Not all mouth openings are mouth breathing;
2. First judge whether there is a problem with the child's nose ventilation, and abnormal nasal ventilation needs to see an otolaryngology department;
3. After eliminating or solving the problem of nasal ventilation, you can see the stomatology.
What exactly is mouth breathing?
Does opening your mouth necessarily mean mouth breathing?
First of all, the term "mouth breathing" is not particularly accurate, and it is more appropriate to call it "nasal breathing".
For everyone, even if they are particularly healthy, they will not continue to breathe only through the nose, and in some physiological states, such as when people exercise vigorously, temporary mouth breathing is required to meet the increased lung capacity.
In a quiet state, such as sleeping, the airflow should indeed pass through the nasal cavity, and this breathing state is normal breathing.
If a child breathes in a quiet state when the airflow also passes through the mouth, and the airflow through the mouth exceeds a certain proportion (generally 25%~30%), such a breathing state accounts for more than 80% of the child's overall breathing time, which is the "mouth breathing" that we need to pay attention to in medicine, which is an abnormal breathing state. If a child breathes most of the time through the mouth, it is severe mouth breathing.
Opening your mouth while breathing is not the same as breathing through your mouth, and you don't necessarily need intervention.
When we breathe through the nose with our mouth closed, normally the tongue is close to the hard palate, and there is no obvious air flow through the mouth. When the real "mouth breathing", there will be too much air flow through the mouth, at this time the child not only opens the mouth, showing teeth, the position of the tongue is also relatively low, mouth breathing children, breathing the tip of the tongue is generally against the inside of the lower front teeth, this tongue position has the possibility of mouth breathing.
If a child has an open mouth and bared teeth, and the position of the tongue is normal, the mouth cannot produce airflow channels and is not easy to produce mouth breathing (see figure below).
Figure: Schematic diagram of the direction of airflow when a person with an open lip and a tooth is breathing
A: The tongue position is normal, and the back of the tongue is in contact with the upper palate without mouth breathing; B: Those with low tongue position are more likely to breathe through the mouth
In fact, among those children who always have their mouths open and their teeth exposed, more than half are actually breathing through the nose normally, and it is generally normal to check the position of the child's tongue, and there is no air flow through the mouth. This simple open lip and toothy situation, not accompanied by mouth breathing, is not strictly speaking, called adenoid face.
The child always has his mouth open,
What are the possible reasons?
Children who always open their mouths are partly related to poor nasal ventilation and compensatory ventilation through the mouth, which belongs to pathological mouth breathing ("true mouth breathing"); And some children have normal nose ventilation, and the mouth opening phenomenon needs to be found from a place other than nose ventilation.
Pathological mouth breathing
It is mainly due to various reasons that the child's nose is not breathing smoothly, so that the child is forced to breathe with his mouth open to compensate for ventilation.
We adults sometimes have this experience:
During a cold or rhinitis attack (remember the feeling of "cement nose" during "yang"? ), nasal congestion is particularly severe, can not breathe, we will also involuntarily open the mouth "gasping" (mouth breathing), sometimes a night of mouth breathing will also lead to dry mouth in the morning.
In children, a variety of causes can cause mouth breathing as long as they can affect the child's nose ventilation, such as various types of rhinitis, sinusitis, adenoid hypertrophy and so on.
This pathological mouth breathing needs our attention, because when the child's nose is poorly ventilated and breathes by the mouth, often the total ventilation is still not enough, and long-term insufficient ventilation may cause chronic hypoxia, which will have an impact on the health state, growth and development of the child's whole body.
In addition, the disease itself that causes poor ventilation, whether it is rhinitis, sinusitis or adenoid hypertrophy, some symptoms of these diseases themselves, such as nasal congestion, nasal discharge, nasal itching, sneezing, etc., will also make the child feel very uncomfortable, which greatly affects the child's quality of life.
What is the cause of "open lip and toothless" with normal nasal ventilation
It is common for people to have their lips slightly open when they are relaxed (e.g., asleep, fatigued, infants and toddlers playing); If there is no smile, it is difficult to complete the closure of the lips in a normal state, which is called "open lip and toothless". When the child always has the phenomenon of opening the lip and showing his teeth, "always opening the mouth", but the nose ventilation is normal, this situation will have to find a cause other than the nose.
In this part of the children, some children do not have air flow through their mouths, just open their mouths; Some children also have some air flow through the mouth that should not be there. This can be evaluated by the dental clinic, weak lip muscles, respiratory problems, hereditary bite problems, short upper lip, eating hands and other bad habits may cause children to open lips and show teeth.
For example, in some children who eat pacifiers for a long time, or children who are used to frequent finger sucking, lip biting, and tongue sticking, parents may often find the phenomenon of opening their lips and showing teeth, and the child's nose ventilation may be no problem. Some children do have problems such as adenoid hypertrophy and other problems of poor nose ventilation, but the adenoids are cut, rhinitis is better, the nose ventilation is smooth, and the situation of opening the mouth still exists.
Once nasal ventilation problems have been ruled out, it is recommended that the stomatologist assess the severity, age of the child, and cooperation before deciding whether to intervene and how to intervene.
Generally, early treatment is mainly to break bad habits, most children will gradually reduce or quit some bad habits after the age of 3-4 years old, some bad habits can not be corrected by themselves can use simple function correctors or muscle function training under the guidance of a doctor.
For patients over 10 years of age, malformed deformities have developed due to the long duration of bad habits, and orthodontic treatment is generally required.
When you are afraid of your child's mouth breathing,
What are you worried about?
Worried that if the mouth breathes for a long time, the child will become ugly?
There is some truth to this concern.
Long-term mouth breathing, if the degree is heavy enough, whether it is pathological mouth breathing or habitual mouth opening, can have some adverse effects on the normal growth and development of the child's craniomaxillofacial area, and there have been many studies in the orthodontic community.
However, children's craniomaxillofacial growth is affected by many factors, among which genetic factors dominate, abnormal breathing patterns, bad habits, etc. cause different degrees of facial changes on the basis of heredity.
That is to say, if the child does have a long period of mouth breathing, then the face will be affected to a certain extent; But not all "not so good-looking" faces are related to mouth breathing, and not every child who finds that the lips are upturned and the teeth are protruding forward, it must be caused by mouth breathing.
Does worrying about mouth breathing mean that there is adenoid hypertrophy, which will cause an adenoid appearance? Is surgery needed?
Adenoid hypertrophy is only a possible cause of mouth breathing, and adenoid facial appearance does not mean that adenoid hypertrophy directly causes facial changes, but mainly when adenoid hypertrophy hyperplasia, it will block the child's hind nostrils, making the child's nose ventilation poor.
Because the child's nose ventilation is very critical, poor nose ventilation when breathing will make the child's overall ventilation decrease, and during sleep due to the feeling of insufficient ventilation, it will subconsciously be forced to open the mouth to breathe hard to compensate for ventilation, and adenoid hypertrophy related mouth breathing is how it comes.
Under the influence of this abnormal breathing pattern of forced mouth breathing, the child's facial features will be pulled by some abnormal forces, and after a long time, it will affect the development of the child's five senses, resulting in the performance of "adenoid face" such as protruding teeth, upturned lips, and high arch of hard palate.
It can be seen that the "culprit" of "adenoid face" is not only adenoid hypertrophy, including rhinitis, sinusitis, etc. If various reasons affect the child's nose ventilation, long enough and heavy enough, can have a similar impact on breathing patterns, specific to each child, the main causes may be different. The problem of facial appearance and malocclusion also has a key cause - genetics, if the cause is not found correctly, the direction of treatment may be biased.
However, even if an adenoid hypertrophy is diagnosed, not every child needs immediate surgery. A professional otolaryngologist will evaluate your child's condition, and sometimes conservative treatment with medication may be considered first.
Even if surgery is indeed required, adenoidectomy itself is a very mature and low-risk, high-safety minor surgery, and even a "go-and-go" day surgery with low postoperative discomfort and quick recovery.
Self-assessment of "mouth breathing"
Since some children breathe with "real" mouths, and some children just breathe with their mouths open and noses, how can we distinguish judgments at home?
Severe mouth breathing can be detected by self-assessment. Mild mouth breathing, mouth and nose have airflow, it is difficult to judge whether it is pathological, need to be judged by a doctor.
The double-sided mirror method commonly used in clinical practice is simple and easy (as shown in the figure).
We can use a larger metal spoon instead at home, put the spoon between the child's nostrils and upper lip, and observe the fogging on the spoon, which should normally be more foggy on the spoon on this side of the nose.
If you notice a lot of fog on the side of your mouth, you may be breathing through the mouth. Sometimes the child is not very cooperative and deliberately exhales through the mouth, which is not necessarily accurate, so it is best to test after the child has fallen asleep.
However, this method can only roughly determine the presence of mouth breathing, but it cannot diagnose the severity of mouth breathing. In most cases, we do not need to do this quantitative diagnosis, not necessarily to understand the severity of mouth breathing, only to know whether there is mouth breathing.
If the child is found to have mouth breathing, you can seek a professional doctor's assessment and individualized and targeted intervention: if the child has nasal hypoventilation, it is necessary to find the cause and improve nasal ventilation.
Regardless of whether there is a problem of nose ventilation, if parents feel that the child always has an open mouth and does not look good, then after excluding/solving the problem of nose ventilation, it is necessary to discuss with the dentist whether to correct the mouth itself.
Suspect that the child really breathes,
What's next?
Ask a professional doctor for an assessment.
As we mentioned earlier, real mouth breathing and habitual mouth opening, the direction of treatment is not the same.
Real mouth breathing needs to ask a professional otolaryngologist to conduct a comprehensive assessment of the child, the otolaryngologist will carefully ask the child's medical history, check the child's nasal cavity, throat, and sometimes need to do some special examinations to help judge, such as electronic nasopharyngoscopy (nasal endoscopy), sleep monitoring, cranial lateral radiographs, etc., according to the results of the examination to assess whether the child has the problem of unsmooth ventilation of the upper respiratory tract, find the corresponding cause, carry out targeted treatment, and help the child improve ventilation. Remove the underlying factors that cause mouth breathing from the source.
Habitual mouth opening requires oral evaluation and treatment by a professional pediatric stomatologist and orthodontist.
How do you know if your child is really breathing?
Which specialty should I see?
Indeed, because different doctors have different understandings and treatment concepts of "mouth breathing", the focus of attention may be different, for example, otolaryngologists may pay more attention to the child's breathing, while stomatologists may pay more attention to oral health, such as whether the teeth bite and alignment are normal. The same child may receive different opinions when visiting different specialties.
Different parents are worried about different points, which requires full communication with the doctor, according to the medical history and symptom characteristics of each child, the doctor and parents discuss and make individualized diagnosis and treatment decisions.
I have encountered parents who complain helplessly:
Take the child to see the teeth, the stomatologist recommends seeing the otolaryngologist to remove the adenoids, the otolaryngologist has seen it and feels that the teeth can be corrected directly without treatment, and the dentist said that the adenoids must be removed to correct the teeth...
I went back and forth between the two departments several times, and the more I looked at it, the more confused I became. If it involves joint decision-making between doctors and patients, it is more difficult to clarify the direction of diagnosis and treatment in just a few minutes of communication.
Oral breathing problem is actually an interdisciplinary discussion hot spot for many years, otolaryngologists, stomatologists have conducted special discussions on this issue, reached a consensus, and continue to work closely together in practical work, and strive to provide scientific and reasonable diagnosis and treatment for every oral breathing child.
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