Mouth Breathing Can Cause Major Health Problems

Dentists May Be First to Diagnose Patients Who Mouth Breathe



For some, the phrase “spring is in the air” is quite literal. When the winter snow melts and flowers bloom, pollen and other materials can wreak havoc on those suffering from seasonal allergies, usually causing a habit called “mouth breathing.” The physical, medical and social problems associated with mouth breathing are not recognized by most health care professionals, according to a study published in the January/February 2010 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD). Dentists typically request that their patients return every six months, which means that some people see their dentist more frequently than they see their physician. As a result, dentists may be the first to identify the symptoms of mouth breathing. And, because dentists understand the problems associated with mouth breathing, they can help prevent the adverse effects.

“Allergies can cause upper airway obstruction, or mouth breathing, in patients,” said Yosh Jefferson, DMD, author of the study. “Almost every family has someone with mouth breathing problems.”

Over time, children whose mouth breathing goes untreated may suffer from abnormal facial and dental development, such as long, narrow faces and mouths, gummy smiles, gingivitis and crooked teeth. The poor sleeping habits that result from mouth breathing can adversely affect growth and academic performance. As Dr. Jefferson notes in his article, “Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity.” In addition, mouth breathing can cause poor oxygen concentration in the bloodstream, which can cause high blood pressure, heart problems, sleep apnea and other medical issues.

“Children who mouth breathe typically do not sleep well, causing them to be tired during the day and possibly unable to concentrate on academics,” Dr. Jefferson said. “If the child becomes frustrated in school, he or she may exhibit behavioral problems.”

Treatment for mouth breathing is available and can be beneficial for children if the condition is caught early. A dentist can check for mouth breathing symptoms and swollen tonsils. If tonsils and/or adenoids are swollen, they can be surgically removed by an ear-nose-throat (ENT) specialist. If the face and mouth are narrow, dentists can use expansion appliances to help widen the sinuses and open nasal airway passages.

“After surgery and/or orthodontic intervention, many patients show improvement in behavior, energy level, academic performance, peer acceptance and growth,” says Leslie Grant, DDS, spokesperson for the AGD. “Seeking treatment for mouth breathing can significantly improve quality of life.”

At this time, many health care professionals are not aware of the health problems associated with mouth breathing. If you or your child suffers from this condition, speak with a health care professional who is knowledgeable about mouth breathing.

To learn more about oral health, visit www.KnowYourTeeth.com.

Three Out of Four Disadvantaged Kids in LA Have Untreated Dental Disease

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A huge percentage of underprivileged kids in Los Angeles County have infectious dental disease that’s gone unchecked, according to a study led by the Herman Ostrow School of Dentistry of the University of Southern California.

In the report, “The Children’s Dental Health Project of Los Angeles County,” researchers Roseann Mulligan and Hazem Seirawan reveal that a staggering 73 percent of disadvantaged kids have untreated caries, the bacterial disease responsible for tooth decay. Dentists screened more than 2,300 children at 59 Head Start centers, Women, Infants and Children (WIC) centers, and elementary and high schools throughout the county.

This groundbreaking study is the most comprehensive study on oral health in underprivileged children ever conducted in Los Angeles County, surveying children of a wide range of ages, races and degrees of caries infection.

A “silent epidemic” with five times the prevalence of asthma, caries is the most common chronic disease in children and can result in serious pain and illnesses affecting parts of the body beyond the mouth, says Mulligan, Chair of the Division of Dental Public Health and Pediatric Dentistry at the Ostrow School of Dentistry. The disease is an infectious process, with bacteria passed between individuals via shared eating utensils, kissing and other forms of contact. The pain caused by the disease is a huge contributor to school absences throughout the county.

The study also explains many of the complex social, logistical and economic factors that make disadvantaged kids more likely to suffer from untreated dental caries. One significant barrier is dental insurance; many kids aren’t covered by Denti-Cal, California’s public dental insurance program, and the parents of those kids that are covered may still have trouble regularly seeing a dentist since only about half of the dentists in Los Angeles County accept Denti-Cal, says Seirawan, research assistant professor at the Ostrow School of Dentistry. Other factors include poor oral hygiene habits, inadequate nutrition, the consumption of bottled versus fluoridated tap water, and more.

The study proposes several suggestions for lessening the impact of dental disease among the county’s underprivileged children. From encouraging better oral health education at the school and community level and supporting the organizations providing care to disadvantaged kids, to helping more dentists serve lower-income communities after they graduate and campaigning for policy changes within local and state government, there’s plenty that members of the community can do to help Los Angeles kids fight dental caries, Mulligan says.

The project was conducted with the help of faculty from the University of California, Los Angeles School of Dentistry and was supported by First 5 LA, the Annenberg Foundation, the California Endowment and the California Wellness Foundation.

Learn more about the study.



See the full report.

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Periodontal pathogens enhance HIV-1 promoter activation in T cells

Although oral co-infections (e.g. periodontal disease) are highly prevalent in HIV-1 patients and appear to positively correlate with viral load levels, the potential for oral bacteria to induce HIV-1 reactivation in latently infected cells has received little attention. The researchers involved in this study have proved that periodontal pathogens enhanced HIV-1 promoter activation in T-cells, monocytes/macrophages and dendritic cells; however the mechanisms involved in this response remain undetermined.

The objective of this study was to determine the role of Toll-like receptors (TLR) in HIV-1 reactivation induced by periodontal pathogens. The oral Gram-negative but not Gram-positive bacteria enhanced HIV-1LTR activation in BF24 cells. TLR9 activation by F. nucleatum and TLR2 by both Gram-negative bacteria were involved in this response, however TLR4 activation had no effect. Use of NFkB or Sp1 specific chemical inhibitors suggested that these transcription factors are positive and negative regulators of bacterially-induced HIV-1LTR activation, respectively. HIV-1LTR activation and viral replication were similarly induced in THP89GFP cells.

Finally, production of TNFa was enhanced by Gram-negative bacteria and its neutralization reduced HIV-1 reactivation. These results suggest that TLR2 and TLR9 activation by P. gingivalis and F. nucleatum, as well as TNFa produced in response to challenge enhance HIV-1 reactivation in monocytes/macrophages. Increased bacterial growth and emergence of periodontopathogens or their products accompanying chronic oral inflammatory diseases could be risk modifiers for viral replication and transmission, systemic immune activation and AIDS progression in HIV-1 patients.

Successful treatment of periodontal disease lowered preterm birth incidences

Previous studies have explored the effect of periodontal treatment, irrespective of efficacy of treatment, in reducing infant prematurity. In a study titled "Risk of Preterm Birth Is Reduced with Successful Periodontal Treatment," lead researcher M. Jeffcott, and colleagues S. Parry and M. Sammel (all from the University of Pennsylvania, Philadelphia) and G. Macones (Washington University, St. Louis, Missouri) determined whether a reduction in infant prematurity was associated with successful periodontal treatment.

Pregnant subjects between 6 and 20 weeks gestation (using standard pregnancy dating criteria) were eligible for screening and enrollment. Eight hundred and seventy-two subjects with and without periodontal disease were followed. One hundred and sixty subjects with periodontal disease were treated with scaling and root planing. Subjects received periodontal examinations before and after scaling and root planing. Subjects were classified post-hoc according to the results of periodontal treatment: successful treatment ("non-exposure") or unsuccessful treatment ("exposure").

Groups were compared using standard bivariate statistics, odds ratios, and logistic regression analysis. Dichotomous outcomes were compared with chi-square where appropriate.

The primary study outcome for this clinical trial was the occurrence of spontaneous preterm birth <35 weeks. Subjects without periodontal disease had 7.2 percent rate of prematurity less than 35 weeks gestation; subjects with periodontal disease had 23.4 percent rate of prematurity <35 weeks gestation. Pregnant women who were refractory to scaling and root planing were significantly more likely to have preterm infants. Subjects who were successfully treated for their periodontal disease had a significantly lower incidence of preterm birth less than 35 weeks gestation.

Mayo oral cancer study shows full tumor genome

Mayo Clinic researchers along with collaborators from Life Technologies are reporting on the application of a new approach for sequencing RNA to study cancer tumors. Their findings from a proof-of-principle study on oral carcinomas appear in the current issue of PLoS One, the online science journal.

To explore the advantages of massively parallel sequencing of genomic transcripts (RNA), the researchers used a novel, strand-specific sequencing method using matched tumors and normal tissues of three patients with the specific cancer. They also analyzed the genomic DNA from one of the tumor-normal pairs which revealed numerous chromosomal regions of gain and loss in the tumor sample.

The key finding of this work was that alterations in gene expression which can arise from a variety of genomic alterations frequently are driven by losses or gains in large chromosomal regions during tumor development.

In addition to the specific tumor findings, this study also demonstrated the value of this RNA sequencing (RNA-Seq) method. It will allow researchers to measure strand-specific expression across the entire sample's transcriptome. This technology reveals far more detail about genome-wide transcription than traditional microarrays.

"This method allows us to investigate genetic changes at a level that we were never able to see before," says David Smith, Ph.D., Mayo Clinic genomics researcher and corresponding author of the study. "This provides us with much more information about alterations during cancer development that could reveal important therapeutic targets. We can more completely understand the relationship between an individual's genome and the alterations to that which result in disease.

This is a huge step in speed, detail and diagnostic power for the field of individualized medicine. This transforms how we are going to study cancer -- and how we're going to practice medicine -- in the very near future."

The urgency of this condition points to the need for more efficient technologies and methods. Head and neck cancers are the sixth most prevalent carcinomas in the world. Advanced stage oral and throat cancers have a five-year survival rate of only 50 percent in the United States. Information provided by these and continued studies will help to better characterize the molecular basis of cancer development. That information can hopefully define better therapeutic strategies for treating an individual's specific cancer.

SIBLING proteins may predict oral cancer

IMAGE: Dr. Kalu Ogbureke is an oral and maxillofacial pathologist in the MCG School of Dentistry.


The presence of certain proteins in premalignant oral lesions may predict oral cancer development, Medical College of Georgia researchers said.

SIBLINGs, or Small Integrin-Binding Ligand N-linked Glycoproteins, are a family of five proteins that help mineralize bone but can also spread cancer. SIBLINGs have been found in cancers including breast, lung, colon and prostate.

"Several years ago we discovered that three SIBLINGs—osteopontin, bone sialoprotein and dentin sialophosphoprotein—were expressed at significantly high levels in oral cancers," said Dr. Kalu Ogbureke, an oral and maxillofacial pathologist in the MCG School of Dentistry. "Following that discovery, we began to research the potential role of SIBLINGs in oral lesions before they become invasive cancers."

The study, published online this week in the journal Cancer, examined 60 archived surgical biopsies of precancerous lesions sent to MCG for diagnosis and the patients' subsequent health information. Eighty-seven percent of the biopsies were positive for at least one SIBLING protein—which the researchers discovered can be good or bad, depending on the protein. For instance, they found that the protein, dentin sialophosphoprotein, increases oral cancer risk fourfold, while bone sialoprotein significantly decreases the risk.

"The proteins could be used as biomarkers to predict [the potential of a lesion to become cancerous]," said Dr. Ogbureke, the study's lead author. "That is very significant, because we would then be in a position to modify treatment for the individual patient's need in the near future."

Precancerous oral lesions, which can develop in the cheek, tongue, gums and floor and roof of the mouth, are risk factors for oral squamous cell carcinoma, which accounts for over 95 percent of all oral and pharyngeal cancers. Oral cancer, the sixth most common cancer in the world, kills about 8,000 Americans annually, Dr. Ogbureke said.

Treatment has been stymied up to this point because of clinicians' inability to predict which lesions will become cancerous. Surgery is standard for oral cancer, but treatment methods vary for precancerous lesions.

"When we treat these lesions now, there's an implied risk of under- or over-treating patients," Dr. Ogbureke said. "For example, should the entire lesion be surgically removed before we know its potential to become cancer, or should we wait and see if it becomes cancer before intervening?"

Further complicating the matter is that the severity of dysplasia, or abnormal cell growth, in a lesion can be totally unrelated to cancer risk. Some mild dysplasias can turn cancerous quickly while certain severe dysplasias can remain harmless indefinitely. The protein findings, which help eliminate the guesswork in such cases, "are fundamental," Dr. Ogbureke said. "If we're able to recognize these lesions early and biopsy them to determine their SIBLING profile, then oral cancer could be preventable and treatable very early."

Dr. Ogbureke's next step is to design a multi-center study that incorporates oral cancer risk factors, such as smoking and alcohol consumption, to further investigate their relationship with SIBLING protein expression.

Comments by American Dental Association

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On the Pew Center on the States’ report
‘The Cost of Delay: State Dental Policies Fail One in Five Children’

President Dr. Ron Tankersley:

“We welcome the Pew organization to our longstanding fight to improve the lives of American children by helping more of them enjoy the good oral health that too many of them now lack. Pew’s presenting its information in the form of a report card makes it easy for anyone to understand that too many kids in too many states are suffering. And we face huge challenges in changing that.

“Even in states to which Pew awarded an A, countless children lack access to dental care and suffer as a consequence. These children are just like your children. Except these children can’t eat or sleep properly, can’t pay attention in school, can’t even smile, because of untreated dental disease.

“We don’t agree with everything in the report. But certainly, it highlights some of the major policy areas that the American Dental Association and state dental societies have advocated for years—things like increased Medicaid funding, school sealant programs and community water fluoridation. It also highlights the urgent need for reliable routine data collection so that policies are well-informed and kids are not left suffering.

“The report does omit some policy areas that we believe are equally important to improving children’s access to care. For instance, some states have innovative programs—like student loan forgiveness and tax incentives—to help dentists establish practices in underserved areas or practice in community health centers. And when it comes to fixing Medicaid, money is a huge issue, but it isn’t the only issue. Patients and parents need oral health education to help them take care of themselves and their families to prevent disease. Many of them need additional services, like transportation, in order to be able to get to dental appointments. If Medicaid did a better job of these things, treatment costs would decrease, because we would be preventing more disease and treating less.

“The ADA and state dental societies have a long history as the nation’s leading advocates for oral health. ADA members donated some $2.16 billion in free care to disadvantaged children and adults, both as individuals and through such programs as Give Kids A Smile and Missions of Mercy, in 2007 alone. . But we’re the first to admit that we can’t do this alone, and charity is no substitute for an effective, equitable oral health delivery system. We’re grateful for assistance from the Pew Center and others who are willing to lend a hand in what undoubtedly will remain a long, tough fight.”