Replacement of Missing Anterior Teeth in a Patient with Chronic Mouth Breathing and Tongue Thrusting

The loss of anterior teeth has serious functional, esthetic disabilities, in addition to compromising the patients' quality of life. Various etiologies can be attributed to the anterior tooth loss, including trauma, caries, and periodontal diseases. The chronic mouth breathing due to nasal adenoids is known to enhance the gingival and periodontal diseases. The dental literature proves the association of nasal breathing, tongue thrusting, and anterior open bite. Arch shape and tooth position are primarily determined by the equilibrium of the forces from tongue and perioral musculature. Increased force from tongue musculature in the tongue thrusting patient leads to flaring of anterior teeth, making them susceptible for periodontal and traumatic tooth loss. Replacement of the anterior teeth in this patient will also help in restoration of anterior guidance, which is critical for the health of temporomandibular joint, posterior teeth, and musculature. 1. Introduction Loss of anterior teeth has major detrimental social implications for the sufferer and significantly affects the normal social integration. Loss of anterior teeth is from multifactorial origin ranging from trauma, periodontal disease, dental caries, and persisting oral habits. If preventive treatment is not provided at an early age, they continue to persist up to adult age. Potential detrimental effects and management of these persisting oral habits are often overlooked by the oral health professionals. The excessive lymphoid tissue proliferation with chronic allergy and infection lead to obstruction of the nasal airway, resulting in chronic mouth breathing [1]. Studies have shown the strong correlation between mouth breathing as an etiological factor for tongue thrusting and anterior dental open bite [2]. The long existing malocclusion leads to having the tongue filling the space and results in loss of lip and muscle tonus. The disturbed balance between the force of the tongue and oral musculature leads to anterior migration of teeth. The exposed, flared teeth are highly susceptible for traumatic damage. The mouth breathing is also considered as one of the predisposing factors for initiation of periodontal disease [3, 4]. The chronic mouth breathing patient with high incidence of periodontal disease tend to lose the anterior teeth in their early age. Anterior dental open bite and loss of anterior teeth impede the emission of dental-alveolar sounds [5, 6]. The absence of anterior guidance prolongs the disocclusion time and predisposes the patients for temporomandibular disorders [7]. There is a