Mask Mouth and Mouth Breathing: What's Changed Post-Pandemic? - Dr Nalini Nagalla

In the years after the pandemic began, the medical world has grown accustomed to watching COVID-19's long-term consequences, which range from weariness and brain fog to lung scarring. However, another subtle trend that has received less attention is the increase in mouth breathing and its impact on oral and airway health.

During the pandemic, prolonged mask use, anxiety-driven breathing patterns, and lifestyle changes brought mouth breathing to the forefront in an unanticipated way.

Years later, many doctors are observing an unexpected increase in patients presenting with dry mouth, throat discomfort, nasal congestion, and even airway hypersensitivity.

Could they be linked? The increasing evidence implies that they may be.

What is "Mask Mouth"?

The term "mask mouth" first gained popularity among dentists. Patients using masks for extended hours, particularly healthcare personnel and students, began reporting symptoms such as:

• Dry mouth
• Bad breath
• Increased dental plaque or deterioration
• Gum inflammation

The main concern was not the mask itself, but how it gently affected breathing habits. When the mouth is uncovered, nasal breathing is the default. However, when a mask is worn, many people reflexively switch to mouth breathing, especially when speaking or exerting effort.

Why Mouth Breathing Matters

Breathing through the mouth bypasses the nose's natural filtration, humidification, and temperature regulation capabilities. Over time, this may lead to:

• Dry oral mucosa
• Changed oral microbiome
• dehydrated airway lining
• Increased sensitivity to allergens and irritants

More importantly, it may sensitize the airway, increasing the likelihood of throat discomfort, recurrent coughs, or even chronic nasal congestion.

A Shift in Airway Sensitivity?

Clinically, there is increasing anecdotal evidence of patients, particularly young adults and adolescents, who now report:

• Frequently need to clear their throat
• Sense of "tight" or "ticklish" airway
• Nasal congestion without infection
• Voice tiredness or pain while speaking

These are not typical allergy or infection symptoms. Rather, they suggest a change in the upper airway's baseline sensitivity, which could be altered by postural breathing changes and low-level inflammation.

Role of Nasal Disuse

Disuse of nasal passageways has been shown in ENT literature to make nasal breathing more difficult. The turbinates enlarge, ventilation becomes restricted, and people may learn to avoid nasal breathing entirely.

When a person develops a habit of mouth breathing, whether due to mask use, persistent sinus problems, or stress, the nose is not used properly. This neglect causes a feedback loop in which the nose seems "blocked," thus the person continues to mouth breathe, exacerbating the condition.

Is This The New Normal?

Not quite, but it's something we should be more conscious of.

In the post-pandemic era, we have noticed increases in respiratory sensitivity that are not directly related to infection or structural disease. While much of the attention is still focused on long-term COVID, there is a parallel story unfolding that revolves around behaviourally acquired airways changes.

And these alterations may not be purely physical. Mouth breathing has been associated to tongue posture changes, poor sleep quality, and anxiety. Children are more vulnerable to the consequences, which include dental arch constriction, snoring, and interrupted sleep cycles.

What Should Clinicians Look For?

If you're seeing patients with persistent throat pain, dry mouth, or vague airway irritation, especially if traditional therapies aren't working, consider the following:

1. Inquire About Breathing Patterns: Do they breathe through their mouths when asleep? Do they experience shortness of breath while wearing a mask?

2. Screen for nasal obstruction: Rule out deviated septum, turbinate hypertrophy, or persistent rhinitis as underlying causes.

3. Evaluate Oral Health: Mouth dryness might raise the risk of tooth decay. Collaboration with dentists can provide a more complete picture.

4. Discuss Posture and Habits: Encourage conscious nose breathing throughout the day, particularly in low-stress environments.

What Can Patients do?

The good news is that airway sensitivity caused by breathing habits may often be reversed, especially if detected early on.

1. Maintain Adequate Hydration: Staying hydrated helps to protect the upper airway's mucosal lining.

2. Practice Nasal Breathing: Gentle exercises, such as alternate nostril breathing or mouth-taping while sleeping (under medical supervision), can help retrain the system.

3. Humidify Indoor Air: Dry conditions might exacerbate airway reactivity.

4. Limit Irritants: Avoid using lozenges, sprays, or scents that may irritate the throat lining.

We frequently conceive of the airway as resilient, and in many respects it is. However, even minor, chronic changes in our breathing patterns might alter the landscape of our upper respiratory health.

As doctors, we should be willing to reconsider what symptoms like prolonged dry mouth, throat clearing, or persistent pain might mean, particularly in the post-mask, post-pandemic situation. Not all cases will necessitate medicine.

Sometimes all that's required is an understanding of how profoundly our environment and behaviours influence how we breathe, and how this, in turn, impacts the very heart of our well-being.