Mouth breathing is rarely discussed in routine oral health education, despite being widely recognised in medicine, sleep science and orthodontics as a factor that can influence both oral and general health. This raises an important question for dental teams: should mouth breathing be mentioned in oral health education, and if so, how far does our role go?
What is mouth breathing and why does it matter?
Mouth breathing refers to habitual breathing through the mouth rather than the nose, either during the day, at night, or both. This pattern can occur in children and adults and does not always relate to an obvious nasal obstruction.
From an oral health perspective, mouth breathing matters because it is associated with:
- Dry mouth and reduced salivary flow.
- Increased plaque accumulation.
- Gingival inflammation.
- Higher caries risk.
- Halitosis.
- Oral discomfort or dryness on waking.
Saliva plays a key protective role in buffering acids, controlling bacterial levels and maintaining oral tissue health. Persistent mouth breathing, particularly overnight, can reduce these protective effects at a time when salivary flow is already naturally lower.
What does the evidence say?
The relationship between mouth breathing and oral health is increasingly supported by peer-reviewed research, particularly in relation to dryness, plaque accumulation and gingival health.
A study published in the British Dental Journal by Kaur et al. (2018) examined the influence of mouth breathing on the outcome of periodontal treatment. The authors reported that mouth breathing was associated with oral tissue dehydration and initially higher levels of gingival inflammation. Crucially, the study found that even with professional cleaning, mouth breathers showed significantly less improvement in gum health at palatal sites, highlighting how reduced oral moisture may compromise the protective role of saliva and hinder the healing of periodontal tissues.
More recently, Popa et al. (2025) investigated salivary flow and morning oral health indicators in mouth breathers. Their findings showed that mouth breathing was associated with reduced salivary flow, increased tongue coating burden and markers linked to morning oral dryness and halitosis. This supports common clinical observations reported by patients who wake with a dry mouth or unpleasant taste.
In children and adolescents, the implications may be broader. A systematic evidence review by Kimura et al. (2025) examined caries and periodontal outcomes in mouth breathers and found associations with increased plaque levels, gingival bleeding and early and advanced caries lesions. While the authors emphasised that mouth breathing should be considered alongside other risk factors, the review supports its relevance within a wider oral health risk profile.
Taken together, this growing body of evidence suggests that mouth breathing can influence the oral environment in ways that are directly relevant to everyday oral health education.
Why is mouth breathing rarely mentioned in oral health education?
There are several reasons this topic has traditionally received limited attention:
- Scope of practice concerns, with dental teams understandably cautious about straying into medical diagnosis.
- Lack of explicit inclusion in national oral health education guidance, which tends to focus on plaque control, diet, fluoride and smoking.
- Uncertainty around language, particularly how to raise the issue without alarming patients.
As a result, mouth breathing is often observed clinically but not openly discussed.
Should dental teams mention mouth breathing?
Oral health education is not limited to brushing technique and sugar intake. It also involves helping patients understand factors that influence the oral environment. Mouth breathing clearly falls within this remit.
Dental nurses should not diagnose the cause of mouth breathing or recommend medical treatments. However, they can:
- Document patient-reported dry mouth on waking.
- Explain how oral dryness can affect plaque control and gingival health.
- Ask neutral, non-leading questions, such as:
- “Do you often wake up with a dry mouth?”
- “Do you tend to breathe through your mouth at night?”
- Signpost appropriately where concerns are identified.
This mirrors how dental teams already approach issues such as reflux, smoking or suspected bruxism.
How could this be included in oral health education?
Mouth breathing does not need to be treated as a standalone topic. It can be introduced naturally when discussing:
- Dry mouth and saliva.
- Gingival inflammation.
- Caries risk.
The key is to keep the language informative rather than diagnostic.
Children, prevention and early conversations
In children, early awareness of mouth breathing patterns may be particularly important. Dental teams often see children regularly over long periods and are well placed to notice changes in oral health and development.
Raising the topic carefully with parents, without causing alarm, can support earlier assessment where appropriate and reinforce the preventative role of oral health education.
Staying within professional boundaries
Mentioning mouth breathing does not mean stepping outside scope. It means recognising a factor that can influence oral health, explaining its oral implications and signposting when appropriate. This aligns with a preventative, patient-centred approach to dentistry.
My personal experience
On a personal note, this is an area I have become increasingly aware of myself. I come from a family of habitual mouth breathers, and in my case this is not linked to any obvious nasal obstruction. More recently, I have been using simple mouth strips at night to encourage nasal breathing during sleep. I have noticed a clear difference on waking, particularly in terms of morning dry mouth and oral freshness. General guidance suggests these strips are often used short-term to help retrain breathing patterns rather than indefinitely. Whether that proves to be the case for me remains to be seen, but the experience has highlighted just how much breathing patterns can influence the oral environment. This reflects my personal experience rather than a clinical recommendation.
The role of mouth breathing in oral health education
Alongside individual patient conversations, mouth breathing also raises questions about how dental teams discuss and manage emerging oral health risk factors. Mouth breathing is not a fringe concept, and it is not speculative. It is a recognised factor that can influence oral health, yet it remains largely absent from routine oral health education.
Many clinicians, including dentists, may feel unsure how to respond if a colleague raises observations such as snoring, mouth breathing at night, or persistent morning dry mouth. Without shared understanding, this uncertainty can discourage conversations altogether.
Using team meetings or peer discussion forums to explore how mouth breathing relates to oral health, and to agree simple, consistent approaches to observation, explanation, and signposting, can help build confidence across the team. This supports a collaborative preventative approach without placing diagnostic or treatment expectations on any individual team member.
References
Kaur, M., et al. (2018) Influence of mouth breathing on gingival inflammation and plaque. British Dental Journal.
Popa, M., et al. (2025) Salivary flow, tongue coating burden, and morning oral health indicators in mouth breathers. Journal of Clinical Medicine.
Kimura, A.C.R.S., et al. (2025) Dental caries and periodontal outcomes in mouth breathers: a systematic evidence review. Journal of Pediatric Dentistry.
