Search

A system for quantitatively introducing cigarette smoke into the respiratory tract of spontaneously breathing laboratory animals has been developed. At the present time, its use is restricted to animals either with tracheotomies or capable of mouth breathing. The volume, frequency, and duration of cigarette puffing is programmed and not determined by the animal’s respiratory activity. Smoke is loaded into a holding tube and inhaled during normal inhalation. To prevent anoxia, animals are allowed fresh air between puffs. The system can be automated for simultaneously exposing four to eight animals. Except for modest loss of particulate material, the composition of smoke does not appear to be altered materially.

The purpose of the present study was to determine whether adenoidectomy (and hence a change to nose breathing) is followed by: (1) a change in the inclination of upper and lower incisors. (2) a change in the width of the upper arch, and/or (3) an effect on the sagittal depth of the bony nasopharynx. The clinical material comprised the children in a previous study who were at least 8 years old and in whom the upper and lower incisors had erupted before the initial examination, which was followed by adenoidectomy. A second examination was made 1 year later. The group undergoing adenoidectomy numbered thirty-seven children, and there were thirty-seven controls. All the children were examined with respect to forty-six variables, grouped under the headings of anamnesis, adenoids, dentition, airflow, and skeleton. Measurements were obtained for each child from lateral radiographs and casts, and the nasal airflow was recorded in liters per minute. Group means for the two examinations have been compared and relationships have been studied with the aid of simple correlation analysis and multiple regression analysis. It was found that in the year between the examinations, the children who underwent adenoidectomy had undergone a significantly greater increase than the controls in the angle of the upper and lower incisors, respectively, to the nasion-sella and the mandibular lines. The adenoidectomy group also had a significantly greater increase in the mean width of the upper arch between the first molars, this width being enlarged most in the children who had switched from mouth to nose breathing after adenoidectomy. Furthermore, the mean sagittal depth of the nasopharynx had increased only for the children who underwent adenoidectomy, the increment in this group being significantly different from 0. The study accordingly demonstrates that dentitional changes occur after adenoidectomy in children who were mouth breathers preoperatively because of nasal obstruction. The size of the nasopharyngeal cavity also changed in the children who switched from mouth to nose breathing after adenoidectomy. Since the dentition seems to be affected to some extent by the combined occurrence of adenoids and mouth breathing, an assessment of indications for adenoidectomy should include orthodontic evaluations.

The Copenhagen Municipal School Dental Service examines and treats about 50,000 children each year. As from (he beginning of the 1967/68 school year, a special registration form for traumatic dental injuries was introduced with this School Dental Service. During the 5-year period from 1967–1972 a total of 9,965 traumatic injuries was registered in the school population. The boy/girl ratio was 1.6:1 and the largest number of injuries for both sexes is found in the age 8–9 years. About 25–30 % of the traumatized children sustained traumata more than once. By means of computation it was discovered that 34.9 % of boys and 23.1 % of girls may be assumed to have sustained a trauma before leaving school in the 9th grade. In 25 % of the cases the injury was treated no later than 2 hours after the accident and 40 % were treated on the same day. A very clear connection between the number of injuries and the school year was observed. Generally one tooth was involved and it was extremely rare for a trauma to involve more than four teeth. There were a total of 12,989 injuries to 11,767 teeth. The majority of cases involved the maxillary central incisors (70 %). Soft tissue injury was the only reason for the examination in 15 % of the cases. The relation between lip closure and trauma was also examined. One-fourth of those examined had an incomplete lip closure.

Gingivitis, dental caries and malocclusion are often seen associated with mouth breathing. The purpose of this study is to reveal relation between mouthbreathing signs and nasal obstruction. Clinical observation was carried out on mouth breathing signs and on nasal obstruction in cases of 136 school children (11-12 years old).(1) Mouthbreathing signs were seen about half of children and correlated with each other except lack of uvular reflex.(2) 50.7% had some nasal and pharyngeal obstruction. 11.0% were nasal respiration stopped at the time examined and 39.7% had nasal and pharyngeal diseases tending to cause stop of nasal respiration.(3) Nasal and pharyngeal obstruction and oral signs of mouthbreathing were related each other. However correlation between lip-seal insufficiency and oral signs of mouthbreathing was seen more closely.

A case of I-cell disease, characterized by massive gingival hyperplasia preceding deciduous tooth eruption, maxillofacial and other skeletal malformations in growth and maturation, and absence of enamel formation, is presented. The syndrome is characterized by maturational defects appearing soon after birth and by early psychomotor retardation, progressive skeletal deformities, and facial abnormalities. Differentiation between I-cell disease and other members of the Hurler's syndrome group (G M1 -gangliosidosis, lipomucopolysaccharidosis, mucopolysaccharidosis I) can be made on the basis of both clinical and laboratory studies. The consistent feature of I-cell disease is the presence of intracytoplasmic inclusion bodies in cultures of fibroblasts from the skin. This case report indicates the early onset and marked severity of the gingival involvement, suggesting its importance to the dental profession.

Summary 1. Measurements of airway resistance at different lung volumes in newborn babies have been shown to be in general agreement with the extrapolated findings of Briscoe and DuBois in older subjects. The difference, if any, between the airway resistance during nose and during mouth breathing should be investigated in infants. 2. The derived values for conductance frequently lay above the extrapolated portion of the regression line representing the upper limit of the normal range of Briscoe and DuBois. This may be related to a larger ratio of airway cross-section area to lung volume in the newborn. 3. The hypothesis is advanced that in those newborn infants who have higher airway conductance for a given lung volume than do the majority of infants the corresponding intrathoracic pressure may have been more negative.

WAXMOLDS OFPOSTNARESOPENINGS. Presented byDR.AUSTINA.HAYDEN. Dr. Hayden made a preliminary report on the use of wax molds for determining the size and shape of the postnares openings, and presented a boy, aged 14, who had been operated on twice for the correction of mouth breathing. The tonsils and adenoids had been removed. The turbinates did not cause obstruction at any point, but there was complete obstruction of the right anterior nasal opening, due to traumatic deflection of the septum. The boy had been referred to Dr. Hayden for correction of this defect. Some tonsillar tissue had reformed, and when the patient was anesthetized for its removal it was discovered that he had small postnasal choanal openings. Dr. Hayden believed that many of these cases are missed during the usual examination made digitally or by a mirror. Subsequently, he made casts of these

Mouth breathing in the infant and child is frequently secondary to chronic nasal allergy. Malocclusion and V-shaped dental arch are commonly found in children who are decided mouth breathers. The anatomic, pathogenctic, prophylactic, and prognostic considerations are discussed. It is hoped that further investigations will be conducted through the cooperative efforts of the orthodontist, the pediatrician, and the allergist.

1 n contrast to the vast array of metric observations on human skulls during the growth period, there is a paucity of information regarding the physiologic correlates: the factors controlling growth at the mandibular condyles, the pressure and tension systems determining bone apposition and modeling on the surfaces of the jaws, and the functional systems regulating tonus in the musculature which positions the mandible relative to the maxilla. Pilot studies1 have demonstrated that the rhesus monkey can serve as an experimental model in research on the etiology of dental malocclusions. With the use of this model, it has been possible to test certain hypotheses on the interrelationships of muscle function, skeletal form, and dental malocclusion by inductive inference rather than by surveillance. Alternative hypotheses are formulated and subjected to testing. Recent experiments have been designed to test certain theories regarding functional factors which affect the suspension of the mandible as well as the position of the teeth. The relationship of factors which influence the establishment of dental occlusion is illustrated in Fig. 1, in which A and B represent the maxilla and the mandible; C, the tongue; D and E, the muscles suspending the jaw; and P and G, the erupting or extruding teeth. The model illustrates the possible effects of changes in the relative tonus of the muscle groups (D and E) upon the distance between the jaws (A and B) as well as the space available for the tongue (C) and the extruding teeth (P and G). The question becomes: Can significant changes in muscle tonus occur in response to common environmental stimuli ? Obviously, strong orthodontic forces, muscle exercises, and selective destruction of neuromuscular components

The effects of tracheostomy in 27 patients with severe respiratory difficulty are described in terms of arterial blood gas values and clinical observations. Postoperatively, mouth breathing was compared with tracheostomy breathing. Obstruction of the lower respiratory tract from accumulated secretions leads to hypoventilation, ineffective coughing, carbon dioxide retention, anoxia and coma. In such cases, tracheostomy may be life-saving because it provides a reliable pathway: a) for suctioning the secretions (which may be unusually abundant in emphysema with bronchitis), and b) for the administration of artificial respiration. An important factor in the outcome of tracheostomy is meticulous postoperative care. Attention to such things as proper tube alignment and proper suctioning techniques goes a long way toward preventing possible mucosal damage and infection. Tracheostomy provides therapeutic relief even to patients who are gravely ill (narcosis, coma) with emphysema and bronchitis.

A REVIEW of the opinions expressed during the last fifty to eighty years concerning the nature and treatment of distoclusion will lead one to the conclusion that these opinions have been subject to constant change and that purely mechanical considerations regarding the form and manufacture of appliances have carried more weight than differential diagnosis or pathogenic knowledge. I will not go into the details of this repeated change in suggestions for treatment, but I would like to point out that from an exchange of correspondence between Angle and Oppenheim2 in 1929, which was published in American and German professional journals, it becomes evident that during the later years of his life Angle, too, was convinced of the need to classify distoclusion cases according to their various characteristics in order to obtain a, clearer idea of the type of treatment that should be employed. In other words, Angle also required a differential diagnostic examination. The method of treatment must be correlated to the result of this examination, which can be carried out by studying the relationship between the face and the jaws by means of photographs or teleradiographs. If we consider the various methods of t,reatment, it can be said that, on the whole, with the methods which have been in use up to now, alveolar movement of the teeth to correct occlusal anomalies was generally considered a more reliable way to obtain a durable result than movement of the entire mandible. Kingsley ‘sz8 method of “jumping the bite” proved to be reliable only in distoclusion cases which were not too pronounced and which did not exceed onehalf of one premolar in breadth. All other methods relying on the aid of an extraoral anchorage (headgear) or inter-maxillary elastics compensated for the occlusal anomaly chiefly through alveolar movements of the teeth. With these methods the movements are usually distributed between both dental arches, with a distal movement of the upper teeth and a corresponding alveolar mesial movement of the lower teeth. Functional orthopedics (1989) brought into the treatment of distoclusion a new development which must be considered extremely valuable. In this

1. 1. The anterior space between the gum pads at birth has no bearing upon the deciduous dentition. 2. 2. Babies at birth have a posterior relationship of the jaws ranging from 0 to 8 mm. The mandible must grow forward, move forward, or both, to the extent of 2 to 13 mm. more than the maxilla. It is my present opinion that we can foretell malocclusion in the permanent dentition during this developmental period. 3. 3. Up to the age of 5 years, the type of delivery, method of feeding, and mouth breathing do not appear to be factors in malocclusion. The factor of disease needs further investigation. 4. 4. Irregularities of the teeth due to sucking were spontaneously corrected soon after the habit was stopped. In the event that sucking continues after the fourth year, the child should be helped to stop this habit. 5. 5. Heredity seems to be the most important factor in irregularities and malocclusion in the deciduous dentition.

1. Abnormal postural positions are frequently due to pain or some interference with normal function that makes it more comfortable to cultivate a new postural position. Abnormal postural position of the lips is often associated with inferior postnormal arch relationship with labio-clination of the upper incisors. After having established, it will persist even when mouth breathing is removed, unless some effort is made to restore normal postural position.

The following case report of a death after tonsillectomy is presented largely because it serves to emphasize a number of important features in the immediate postoperative management of patients subjected to tonsillectomy under general anesthesia. REPORT OF A CASE E. C., a Negro child aged 7, female, was admitted to the hospital from the otolaryngology outpatient department with a history of frequent colds and sore throats for the past two years, snoring, mouth breathing and occasional cough. The most recent acute episode was said to have been about six weeks prior to her admission to the hospital. Physical examination revealed a thin, lethargic child but no obvious abnormalities of the heart, lungs or abdominal system. The tonsils were enlarged with considerable debris in the crypts and injection of the anterior pillars. The ears and nose showed no significant abnormalities. The adenoids were grossly enlarged to palpation. The laboratory data indicated

n/a

Simultaneous extrathoracic and intrathoracic flow resistance was measured in 19 unanesthetized subjects during mouth breathing. Lateral intratracheal pressure was recorded from a needle introduced 2 cm below the larynx. The intratracheal-oral pressure gradient was recorded during various respiratory maneuvers. The pressure drop from esophagus to trachea was also recorded. The extrathoracic pressure-flow relationships were alinear. Large inter- and intrasubject variability in upper airway resistance was encountered. Some factors contributing to this variability were defined. The upper airway accounted for approximately 45% of the total airway resistance in nine normal and 20% in 10 emphysematous human subjects. Upper airway resistance decreased with increasing lung inflation in four normal subjects. The magnitude and potential variability of the upper airway resistance must be considered in evaluating maneuvers designed to alter intrathoracic flow resistance, especially in normal human beings. It appears that during mouth breathing the major component of the upper airway resistance is located in the larynx. Submitted on September 14, 1960

Six commercially available devices were tested to determine the alveolar oxygen concentration that is achieved and the volume of rebreathing that can occur in conditions simulating clinical use. All were tested at zero oxygen flow, since failure and interruption of the oxygen supply to such devices can occur in clinical use. In patients whose cardiorespiratory reserve is exhausted, any increase in dead space will be detrimental; for such patients devices should be selected which cannot cause rebreathing under any circumstances. Three of the devices tested could cause appreciable rebreathing, i.e., Oxyaire (B.L.B. pattern), Pneumask, and the M.C. mask. Claims made for the Pneumask and the M.C. mask were not substantiated in this study. With administration by nasal catheter changes in alveolar oxygen concentrations were found to be dependent on the percentage of mouth breathing by the subject. The Ventimask produced a consistent elevation of the alveolar oxygen percentage and did not cause any increase in the dead space.

The normal, or resting, potential that exists between the enamel and soft tissues can be displaced in magnitude and sign by changes in solution concentration and pH. Such displaced potentials return to the resting range. Mouth breathing caused regular variation in the potential across an anterior tooth, which was considered to be associated with pulpal reaction to the cooling effect. The impedance of enamel, dentin, and the whole tooth was determined, and wide variations were found.

4. Treatment of mouth breathing is the joint concern of the pediatrician, the rhinologist, the orthodontist and the pedodontist. Each child should have a complete pediatric appraisal. Actual treatment is divided into three parts: removal o f the nasal or pharyngeal ob ­ structions by surgery or appropriate m ed­ ication by the rhinologist; interception o f the habit with an oral screen by the pedodontist; and correction o f the mal­ occlusion by the orthodontist.

The upper airway resistance may be considered as consisting of two components: the oral component between the oral aperture and the pharynx, about one centimetre above the top of the epiglottis; and the laryngeal component, between this part of the pharynx and the sub-glottic space. These two components of the upper airway resistance were measured by introducing an additional point of measurement in the pharynx to the two used for determining the upper airway resistance as a whole.The mean oral resistance for 8 subjects at a flow of 0.5 1/sec was 0.5 cm H2O/1/sec. The mean laryngeal resistance for 6 subjects at the same flow rate was 0.3 cm H2O/1/sec. The value was the same for the 4 normal men and 2 male cases of unilateral cord paralysis composing this group. For 2 cases of bilateral cord paralysis the mean was 24 cm H2O/1/sec.In view of the high oral resistance it would seem to be important in all kinds of examinations of the ventilatory capacity to standardize the space between the dental arches, and ...

Every physician sees many patients whose chief complaint is a "stuffy nose." The degree of nasal respiratory impediment may vary from occasional stuffiness to almost complete obstruction for a long period. The vasomotor control of the nasal mucous membrane is most active in the second decade of life and is closely associated with, and influenced by, the physiologic changes incident to puberty. This activity often continues into the third or fourth decade of life, with all of the ill effects of mouth breathing and aprosexia due to insufficient nasal ventilation. In addition to recognizing these physiologic changes, one must properly study and evaluate the physical condition of the nasal fossae, such as septal deformities and the position and contour of the inferior turbinates. Today there is a great tendency for physicians, when called on to treat these conditions, to begin at once to look for an intrinsic or extrinsic

The stress of forced mouth breathing and the superimposition of cigarette smoking on this stress cause losses in oxidative phosphorylation efficiency in guinea pig lung mitochondria in vivo. The loss of efficiency is greater in the mouth-breathing, air-inhaling animals than in cigarette smokers under the same conditions. The “tightness” of phosphorylation coupling at mitochondrial sites 2 and 3 was rneasured in these experiments, using artificial electron generators or acceptors. The mouth-breathing, nonsmoking animals lost efficiency at two phosphorylation locisites 2 and 3. Mouth-breathing smokers lost efficiency only at phosphorylation transfer site 3. These stress and cigarette smoke effects at sites 2 and 3, respectively, suggest that the losses of oxidative phosphorylation efficiency are due to different mechanisms acting at specific loci within the mitochondrion.

To induce artificial mouth breathing on experimental animals has extremely been difficult because of its immediate death following nasal sealing treatment, and we could find only an imitating experiment reported by Butcher et al (J. Periodont. 32: 38, 1961). The purpose of this study is to induce absolute mouth breathing in rats and to investigate histopathological changes of their gingival tissues. Thirty six of Wister strain rats were equally divided into control and experimental groups. To induce absolute mouth breathing artificially, the nose of all experimental animals were sutured using thin wire and metallic buttones. After two weeks of experimental period, animals were sacrificed and materials were obtained.Consequently, we could find much more remarkable hyperkeratinization of epithelial layers in the experimental animals than the control. Inf lammatoric changes, however, were found in both groups of animals, but less in control. As the conclusion of this investigation, absolute mouth breathing may induce hyperkeratinization of the epithelial tissues, but does not initiate gingival inflammation following two weeks of experiment.

The upper airway—subglottic to mouth—resistance was measured as the relationship between the pressure drop across, and flow through, this part of the respiratory tract in 10 male and 5 female cases of unilateral and 1 male and 9 female cases of bilateral paralysis of the recurrent nerve. The pressure-flow relationship was curvilinear during both inspiration and expiration and both resting and hyperventilation. All curves could be represented in terms of second degree polynomials. Means of upper airway resistance at a flow rate of 0.51/sec were 1.0 and 0.9 cm H2O/1/sec at rest and during hyperventilation, respectively, in male cases of unilateral paralysis of the recurrent nerve. Corresponding values for female cases were 4.1 and 2.0 cm H2O/1/sec. In cases of bilateral paralysis the mean upper airway resistance at a flow of 0.51/sec at rest was 21.5 cm H2O/1/sec. The mechanical work performed in moving air through the upper airway was determined as the cumulative product of ventilated volume and pressure d...

1. 1. Eighty-four (39 per cent) of the 214 preschool children in this study had a tongue-thrust pattern for saliva swallowing; 117 (55 per cent) for liquid swallowing; and 146 (68 per cent) for swallowing solids, according to the conservative definition of tongue-thrust. 2. 2. One hundred sixty-four (77 per cent) had a thrust for saliva swallowing; 181 (85 per cent) for liquid swallowing; and 190 (89 per cent) for solid swallowing, according to the liberal definition. 3. 3. With the liberal definition of tongue-thrust, a significant χ 2 was obtained comparing large tonsils and small tonsils for liquid and solid swallows, lack of mentalis contraction, or some degree of contraction for saliva swallows. 4. 4. With the conservative definition of tongue-thrust, a significant χ 2 result was obtained comparing large tonsils with small tonsils for solid and liquid swallows, comparing nasal breathing with mouth breathing, and comparing high, narrow palate arches with normal arches. 5. 5. Among these subjects there was a considerable variability of swallowing patterns. This variability was noted in terms of the medium being swallowed. 6. 6. Most of the variables which have been reported in the literature as being causally related to tongue-thrust (feeding patterns, masseter muscle activity, thumb-sucking habits, rugae roughness, and, to a certain degree, mentalis muscle contraction) were not found to be significantly related in these subjects.

The function of the soft palate is to provide at the pharyngeal crossroad of airway and foodway a mobile separation between the nasal and the oral passage. In respiration through the nose the air can pass freely between the soft palate and the pharyngeal wall, while in swallowing the soft palate closes off this passage so that no food or drink may reach the nose. In addition to this function the soft palate contributes to the faculty of speech as developed in the human race. The lowering of the larynx below the oral level in the evolution of biped man entails not only mouth breathing but also oral speech. (cf. Negus: "The larynx is pushed down the throat as posture became erect!") In various animals (horse, dog, etc.) in which the larynx is situated more in line with the oral cavity or even higher (in the nasopharynx), mouth breathing and

Airways conductance (Gaw) at different lung volumes (Vtg) was determined by a body plethysmograph in 29 normal males and 27 normal females. All but three showed significant (P < 0.05) linear regressions of Gaw on Vtg. The same mean relationship that described the effect on Gaw of an induced volume change within one subject was also valid for comparison of Gaw between subjects with different lung sizes (range of TLC: 4.3–10.5 1). When this volume dependence of Gaw was considered, no further difference in mean Gaw between subjects of different sex, weight, or height was found. The present Gaw values were notably higher than previously reported. This was ascribed to the low mouth resistance (0.09 cm H2O/(l/s)) with the present mouthpiece. FEV % showed the best correlation to Gaw/Vtg determined below FRC.

Another common irritant to the gingiva is dryness during mouth breathing. All the oral tissues are normally moistened with saliva. Whenever the patient is un­ able to breathe properly through the nose, breathing through the mouth causes the gingiva to become inflamed, edematous and hemorrhagic. One meth­ od of approach would be to eliminate the cause of mouth breathing by having the patient consult an otolaryngologist. To treat the condition palliatively by dental means, it would be necessary for the patient to apply an emollient, such as cocoa butter or petroleum jelly, over the dried gingiva prior to retiring and as many times a day as necessary. This pro­ M O U T H B R E A T H IN G A S A N IR R IT A N T tective layer prevents the drying of the gingiva.

Fifty-five 6 to 12 year-old adenoid children were compared with forty healthy children of the same age to establish a positive correlation between mouthbreathing and gingival inflammation existed. The test group was composed of children with a history of medical complications due to enlarged adenoids. Gingival Index and Plague Index were used and, in addition, adenoid size and breathing habits were registered in both groups. Mouthbreathers were found to have higher GI- scores than nosebreathers (p

WHILE many improvements in surgical and anesthetic techniques have made the tonsillectomy and adenoidectomy an even safer procedure than in previous years, fatal complications still occur. Each year in the United States, about 300 persons die during the operation or as a direct result of it.1Many of these deaths are preventable. The following case report demonstrates an unusual complication which may be anticipated by a more comprehensive preoperative evaluation. Report of a Case A 7-year-old Negro girl was admitted to Charity Hospital of Louisiana at New Orleans on Jan 28, 1964, for a tonsillectomy and adenoidectomy. She had a three-year history of recurrent tonsillitis, chronic otitis media, and mouth breathing. In July 1961, this operation was considered but was deferred because of a 31% hematocrit value. In December 1961, the patient had a positive sickle cell preparation. She was next seen at Charity Hospital on Nov 5, 1963