National Smile Week 2005
71% of snorers have bad breath in the morning
The Sweet Smell Of Success
In response to a questionnaire to discover how many snorers are troubled by oral malodour, more than half of them admitted to having bad breath in the morning.
A total of 3,310 anonymous participants, 1929 men and 1381 women took part in this short questionnaire conducted by the British Snoring & Sleep Apnoea Association.
Respondents were asked a total of 7 questions pertaining to their nocturnal breathing habits, in particular `mouth breathing' and its consequences.
When considering the deleterious effects that snoring can cause, it is not only the 15 million snorers in the UK who are affected. The 15 million bed partners of snorers are affected greatly, not least by the chronic sleep deprivation that snoring causes and the consequent effects on their health and quality of life. Literature from previous epidemiological studies confirms that 80% of snorers snore every night, with just under half of all snorers having always snored. As one of the respondents to this present survey acknowledged `It is a stigma to admit that you have a snoring problem'.
`MOUTH BREATHERS' & `SNORERS'
There are many reasons why people snore and a common cause is `mouth breathing'. When we sleep, we are designed to breathe through the nose where the air can be filtered and warmed before it reaches the lungs. Sleeping with the mouth open causes air turbulence at the back of the throat resulting in the noise we know as snoring. A massive 85% of respondents to this present survey sleep with their mouth open always or some of the time. One respondent to the survey commented: `I suffer from hayfever which means most of the time my nose is blocked causing me to breathe through my mouth'.
Mouth breathing is abnormal and is caused by a multitude of conditions: nasal stuffiness due to allergy or seasonal allergic rhinitis, small or collapsing nostrils, abnormalities of the nose such as polyps, tonsil & adenoid hypertrophy, hypertrophic and morphological abnormalities of the soft palate and palatine uvula, low set soft palate, micrognathia, macroglossia, obesity, tongue root depression or simply a consequence of a lack of muscle tone needed to prevent the jaw from dropping open during sleep (Nishimura & Suzuki 2003). One respondent said `If I have sinus problems, which I do, I breathe through my mouth which leads to snoring'. Results from this present survey found 65% of respondents have trouble breathing through the nose at night with 20% of them suffering this condition every night.
UNDESIRABLE EFFECTS OF MOUTH BREATHING
It is common for snores who mouth breathe to complain of dry mouth, sore throat and bad breath in the morning. Results from this present survey found 96% of snorers wake with a dry mouth and 75% of them wake with a sore throat every morning or some mornings. One respondent said `The back of my mouth is dry in the morning!' and another said `I usually wake up with dry mouth and a horrible taste in my mouth'.
Mouth breathing also has other undesirable effects such as bad breath, dry mouth & throat, nasal crusting/blockage, upper respiratory tract & sinus infections, post nasal drip, dental plaque build-up, gum disease and tooth decay. Urschitz et al (2004) suggest that regular mouth breathers have a higher incidence of sore throats. The results of their study also found that parental smoking and frequent infections were significantly associated with snoring in children. Sore throats and snoring were higher in girls than in boys. The authors concluded that obesity, signs of nasal obstruction and pharyngeal problems were risk factors for snoring in children.
Kanehira et al (2004) in their study of 119 participants found mouth breathing was a `factor contributing to oral malodour, with 8% of the participants having a sulfide level in the mouth air above the socially acceptable limit of 75ppb (parts per billion)'. However, bad breath was not found to be significantly correlated with plaque index, history of caries or frequency of toothbrushing.
Bad breath is a very common problem and other people generally notice bad breath before the individual does. Results from the present research found that over half of all snorers suffer from bad breath occasionally, but 15% of them say they always suffer from bad breath. One respondent to the survey said 'I wake up with "dog breath"' whilst another said 'Although I have not been told about bad breath in the morning, I have been aware of it!'.
TACKLING THE PROBLEM
Bad breath or halitosis as it is sometimes known, is socially incapacitating, physically damaging and difficult to discuss. However, the underlying causes can be damaging and require diagnosis and management. Any delay in diagnosis and treatment may cause prolonged problems in the future. In his research of 2003, Defabjanis suggests that sleeping with the mouth open is a good indicator of airway obstruction which, if left unaddressed, can lead to sleep disturbances such as snoring and sleep apnoea.
Defabjanis believes these conditions always include a functional maxillofacial disorder and the earlier treatment is initiated the more effective, simple and unobtrusive it will be. Nishimura & Suzuki (2003) also believe that by monitoring the anatomical changes that occur during mouth breathing in patients who suffer from sleep disorders, useful information may be provided for evaluating the pathology of the conditions of snoring and sleep apnoea.
As one respondent remarked: `Your small survey makes me realise how bad my snoring has become, almost all my answers were "always". I think it's time to do something about it'.
Perhaps we should focus our attention on the early diagnosis and prevention of these pathologies if we are to taste the sweet smell of success!
5 facts about mouth breathing:
- Mouth breathing is abnormal.
- Mouth breathing causes bad breath, snoring and other undesirable and anti-social effects.
- Mouth breathing causes sleep disturbances in many children and adults.
- Mouth breathing is a sign of underlying abnormalities related to the head, neck, face, and jaw in children and adults which can be difficult to correct if not treated early.
- Mouth breathing can be associated with high blood pressure and coronary heart disease in adults especially if they have a history of snoring and/or sleep apnoea.
Defabjanis P (2003) Impact of nasal airway obstruction on dentofacial development and sleep disturbances in children. Journal of Clinical Pediatric Dentistry 27 (2) 95-100.
Kanehira T et al (2004) Prevalence of oral malodor and the relationship with habitual mouth breathing in children. Journal of Clinical Pediatric Dentistry 28 (4) 285-8.
Nishimura T & Suzuki K (2003) Anatomy of oral respiration: morphology of the oral cavity and pharynx. Acta Oto-Layngologica Supplement (550) 25-8.
Urschitz MS et al (2004) Risk factors and natural history of habitual snoring. Chest 126 (3) 790-800.