Is Open-Mouth Posture/ Mouth Breathing Ever Okay? No Way!

IS OPEN MOUTH POSTURE/MOUTH BREATHING EVER OK?  NO WAY!

As Richard F. Liao, DDS states, “your mouth is the source of your energy and the gateway to your whole-body health.”

We have all seen it – and once you see it, you can’t “un-see” it! It’s mouth breathing or open mouth posture. As speech professionals, are we more aware as we are learning more about this – or are there more people with open mouth posture?

MOUTH BREATHING IS SERIOUS STUFF AND CAN LEAD TO LONG-TERM ISSUES:

• High Blood pressure and other cardiovascular problems
• Poor growth 
• Hyperactivity/Inattention (movement to stay awake or meltdowns, unregulated)
• Behavioral Difficulties 
• Anxiety, Depression
• Increased risk of neurocognitive issues 
• Metabolic disease 

WHAT ARE SOME OF THE RED FLAGS CAREGIVERS CAN OBSERVE:

1. Audible breathing, snoring, gasping
2. Tossing, turning, sleeping in odd positions
3. Sweating 
4. Teeth grinding 
5. Bedwetting 
6. Night terrors 
7. Waking frequently 
8. Tired or wired throughout the day 
9. Concerns with behavior, emotional regulation, anxiety
10. Concerns with learning, school performance
11. Poor concentration and attention

WHAT MIGHT BE THE CAUSES? 

• Medical
  • Allergies
  • Enlarged Tonsils/Adenoids
  • Enlarged Turbinates 
• Structural
  • Tethered Oral Tissue (lips, tongue)
  • Obstruction
  • Deviated Septum
  • Recessed Jaw 
  • Nasal Growth

“Small” Nose

• Musculature (weakness)
  • Jaw instability
  • Lack of tongue retraction
  • Lip weakness
  • Eating Soft Foods
• Habitual
  • Thumbsucking
  • Sippy Cup Use
  • This is all I know
• Low Tone

WHERE DO YOU START? DO NOT UNDERESTIMATE OBSERVATION!

• What should I be observing?
  • Body Posture – head forward, pelvis titled, one shoulder higher than the other
  • Pooling in the veins
  • Lips are chapped, cracked, open
  • Dimpling in the mentalis
  • Small teeth due to grinding
  • Gummy smile
  • Jaw misalignment
  • Tongue not resting correctly inside the mouth
• What if client can breathe through their nose but still has open-mouth posture?
  • Mirror test – place small mirror under client’s nose – does it “fog up”?
  • Listen to speech – hyponasal speech might indicate obstruction or blockage
  • Can they close lips between talking? Do they close their lips when watching TV, reading, playing games?
  • Are lips closed when they are eating?
  • Duration of breathing through nose?

GETTING YOUR CLIENT FROM MOUTH BREATHER TO NOSE BREATHER

1. Nasal Breathing Activities:
   1. Add a tactile cue (nasal flute)
   2. mirror test
   3. sniffing like a bunny
   4. olfactory cue – breathe essential oils or stickers
   5. Alternate nasal breathing
2. Acupressure (if nostril(s) are blocked):
   1. Place tongue to palate and push tongue into palate
   2. Put index finger between eyebrows and apply light to medium pressure
   3. Hold for 20-30 seconds
3. Diaphragmatic Breathing
   1. Have client lie flat on a couch or the floor
   2. Place a book on client’s stomach for sensory input (therapists or client’s hands can be placed on book to stabilize book and add more sensory input if needed)
   3. Clients lips/mouth remain closed
   4. Prompt client to inhale a deep breath THROUGH NOSE
   5. Prompt client to fill belly with air in increments: “small belly” “big belly”
   6. Prompt client to exhale THROUGH NOSE
4. Oral Motor and Myo Activities:
   1. Lip Closure:
      1. Lip Seal: have client close lips gently – add a tactile cue (tongue depressor or folder paper) if necessary – and maintain lip seal for a determined number of seconds. This will increase muscle memory and strengthen lip muscles.
      2. TalkTools® Straw Drinking Hierarchy™
      3. TalkTools® Horn Blowing Hierarchy
      4. Make kisses
      5. Smack lips together
      6. Make humming sounds
   2. Jaw Instability:
      1. TalkTools® Bite Block Exercises
      2. Chewing/Eating Observation
      3. TalkTools® Chew Tube Hierarchy
      4. Gum Chewing Exercises
      5. TalkTools® Slow Feed Activity
      6. TalkTools® Jaw Exerciser
   3. Tongue placement:
      1. Tongue lateralization observation during eating – solid cube placement
      2. Tongue-tip elevation exercises: elevate tongue tip to “spot” on top palate behind front teeth (may need to use a tool to elevate the tongue unless client can do this on their own)
      3. Tongue clicks
      4. Gum chewing Exercises
      5. TalkTools Slow Feed activity
      6. Tongue extension/retraction exercises
      7. Lollipop squeezes and rolls
5. Swallowing Activities:
   1. Lip closure activities listed above
   2. Chin tuck against resistance
   3. Dry swallow (no additional liquids).
6. Body Posture Awareness:
   1. encourage correct seated body posture with trunk upright, forearms and knees parallel to the floor, hands at rest on laps or tray, feet firmly on floor
   2. Chin tuck exercises can help with forward head posture
7. Consistent Practice and Reinforcement:
   1. Encourage regular practice of exercises and techniques both during therapy sessions and in daily activities. 
   2. Consistency and repetition are key to reinforcing new habits and achieving lasting improvements in oral posture.

ADDITIONAL TIPS:

• Always conduct a thorough assessment of the WHOLE CHILD, as well as their specific needs and circumstances to create an effective treatment plan
• Do not assess and treat in a bubble! Collaboration with other professionals is essential in determining the best treatment plan, as well as if and when to refer!