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Mouth breathing: second best is not good enough

Mouth breathing: second best is not good enough

If breathing through the nose is difficult, it's natural to subconsciously breathe through the mouth. But mouth breathing becomes a habit for those with structural defects or nasal inflammations
Mouth breathing: When you breathe where you should eat
Photo by Anantha Subramanyam K

“Noses are for breathing and mouths are for eating,” says Patrick McKeown, breathing instructor and author of The Oxygen Advantage. But, when the nose is blocked (due to the common cold, or a sudden allergy), one automatically resorts to breathing through the mouth (oral breathing).

Occasional mouth breathing is natural and unconscious, says Dr Nimish Shah, a pulmonologist at Jaslok Hospital and Research Centre, Mumbai. “Humans occasionally resort to mouth breathing either during the day or in sleep. But, if it is frequent, it suggests a blocked nose.”


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Naveen Uppot Payyanadan (59), a businessman from Kozhikode, experienced frequent nose blockage. He faced a blocked nose mostly in winter and sometimes during summer, leading him to breathe through his mouth. “As it worsened, I underwent an endoscopy – a test to examine the internal body parts – in September 2022,” he said.

How do you know if you are a habitual mouth breather

Dr Sivaresmi Unnithan, a pulmonologist at Fortis Hospital, Kolkata, outlines the typical symptoms of habitual mouth breathers:

  • Adenoid facies (Open-mouth appearance during the day and while sleeping)
  • Dry or parched mouth
  • Cracked lips
  • Snoring
  • Tooth decay or frequent cavities
  • Poor concentration
  • Physical fatigue just after waking up

Mouth breathing and its causes

The main reason for mouth breathing is nasal (upper airway) obstructions. Dr Shah says that obstruction can be due to nasal inflammation or deformities.

Some types of nasal inflammations include:

  1. allergic rhinitis – an allergic inflammation due to dust, pollen, mites or other air-borne elements
  2. sinusitis (sinus inflammation)
  3. common cold

Nasal deformities include the following:

  1. Deviated nasal septum (displacement of the nasal wall)
  2. Nasal polyps (painless, non-cancerous growth in the nasal passage lining)
  3. Enlargement of adenoid and/or tonsils

Payyanadan’s endoscopy revealed deviated nasal septum and nasal polyps in the right nasal cavity.

In children, the common reason for mouth breathing is adenoid/tonsils enlargement; and in the elderly, it is due to allergic rhinitis caused by nasal muscle degeneration, says Dr Unnithan.

Mouth breathing, obesity and obstructive sleep apnea

Obesity, combined with obstructive sleep apnea, is another leading cause of mouth-breathing in children. Dr Karunakar Prabhu, an oral surgeon at East Suffolk and North Essex NHS Foundation Trust (ESNEFT), Ipswich, explains, “Obesity leading to obstructive sleep apnea causes accumulation of fat around the neck and an upper airway collapse.”

Dr Unnithan recalls meeting 7-year-old Shouvik in Kolkata in April 2016.  “The boy was evidently overweight. His mother complained that he snored while sleeping, dozed off in class and had poor concentration. Tests indicated enlarged adenoids.”

Adverse consequences

When mouth breathing interrupts the day-to-day functioning, and breathing through the nose becomes a rare phenomenon, one should seek help, say doctors.

Lowers immunity: Dr Shah explains, “Mouth breathing exposes people to lung, throat and dental infections as the mouth cannot filter dust, allergens, bacteria, or viruses in the air, unlike the nose.”

Dr Unnithan explains that lack of humidification is also a reason. “In humidification, the sinuses in the nose transform the dry air into moisture and fight the bacteria or viruses in the respiratory tract.  But, in mouth breathing, one inhales and exhales dry air. So, the lung or respiratory tract is easily infected.”

Develops dental-facial deformity: A child who is a mouth breather is very likely to develop facial deformities in adulthood which include increased facial height, narrow jawbone, a high palate, poor definition of cheekbones, a receded lower jaw and forward head posture in most cases, says Dr Prabhu.

Affects dental health: Habitual mouth breathers often develop tooth cavities or pigmentation. Mouth breathing increases the acidic reaction, causes tooth plaque (a sticky film comprising bacteria) and eventually creates tiny holes or decay. Most common dental issue in children, says Dr Prabhu, is the malalignment or overcrowding of teeth.

Impairs functioning: Mouth breathers lack concentration and energy due to the lack of humidification (add reminder explanation) which causes less oxygen absorption, says Dr Unnithan.

Managing mouth breathing

“It is vital to identify the cause of obstruction to resolve mouth breathing,” says Dr Prabhu. “In some cases, surgery is the apt solution.”

  1. Adenoidectomy – the surgical removal of the adenoid and septoplasty. Surgically straightening the deviated nasal septum will resolve long-term facial deformity.
  2. Orthognathic surgery corrects the malalignment of teeth.

Dr Shah adds, “Antihistamine drugs can treat allergic rhinitis to a great extent. Nasal sprays and steroids are also other alternatives.”

First, Shouvik became physically active to tackle obesity. For the next 5 years he used nasal sprays, steroids and CPAP (continuous positive airway pressure) to regularly clear nose blockages. When he turned 12, this problem was resolved through adenoidectomy.

In Payyanadan’s case, drugs were given to shrink the nasal polyps and resolve the issue.


  • Identify the root cause of mouth breathing by consulting the doctors.
  • Do not resort to mouth taping unless the nasal block is cleared.
  • Mindful breathing through the nose helps.
  • Living in a dust-free or allergen-free environment helps.

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