Title Caries Risk Is Increased in Mouth-Breathing Patients
Clinical Question Do patients with mouth breathing-induced xerostomia have an increased susceptibility to caries?
Clinical Bottom Line Mouth-breathing patients are at a greater risk for the development of caries. As oral healthcare providers, it is important to factor a patient's breathing habits into their caries risk profile in order to make better clinical judgments.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
15528914Nascimento/200490 Children aged 3-5 years (60 nose breathers, 30 mouth breathers)Cross-Sectional Study
Key resultsMouth-breathing children were at a significantly higher risk for the development of posterior initial carious lesions (P=<.005) and total initial lesions (P=<.009). Total initial lesions were 12.3 for mouth breathers and 7.9 for nose breathers.
26666708Choi/201610 Healthy adultsRandomized Controlled Trial
Key resultsNight time mouth breathing was found to be linked to a lower (6.6) oral pH compared to (7.0) normal breathing (difference = −0.40; 95% CI, −0.65; −0.16; P<.01).
21231815Stensson/201120 young adults with controlled asthma and 20 healthy young adultsCross-Sectional Study
Key results65% of asthma group reported frequent mouth breathing. The asthmatic group was significantly more likely (mean DFS [SD] = 6.0 [8.1]) to have initial carious lesions compared to the non-asthmatic (mean DFS [SD] = 1.3 [2.0]) group (P= .02).
Evidence Search ("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields] OR "caries"[All Fields]) AND ("mouth breathing"[MeSH Terms] OR ("mouth"[All Fields] AND "breathing"[All Fields]) OR "mouth breathing"[All Fields])
Comments on
The Evidence
Validity: All studies had similar groups at the start who were treated the same. The completion rate was >80% in the Choi trial with adequate follow-up. Recall bias could play a role in the Nascimento and Stensson studies due to self-reporting of mouth breathing. No competing interests were noted. The spectrum of mouth breathing was not taken into account during these studies but that would be difficult to quantify and apply to a study. Each study had relatively small numbers of participants, which decreases the strength of the evidence. Though the asthma study did not directly look at mouth breathing I believe that, because a majority of the asthmatic patients reported it as a symptom, the results can be applied. Perspective: I believe that this evidence supports the theoretical conclusion that because mouth breathing dries the mouth, it will decrease the ability of saliva to buffer acids and increase a patient’s chance of getting caries.
Applicability The findings of this study are applicable to mouth-breathing patients. Whether it is caused by asthma, a nasal obstruction, or another factor, clinicians must recognize mouth breathing as an additional risk factor for caries. The patient must also be informed of the effects of their condition so that they may understand and better take responsibility for the maintenance of the oral health.
Specialty (Public Health) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords Mouth Breathing, Xerostomia, Caries Risk, Nasal Obstruction, obstructive sleep apnea
ID# 3166
Date of submission 04/28/2017
E-mail tateaw@uthscsa.livemail.edu
Author Andrew Tate
Co-author(s) e-mail
Faculty mentor Jeffrey Paz, DDS
Faculty mentor e-mail Drjeffpaz@gmail.com
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available