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Heat and water respiratory exchanges: comparison between mouth and nose breathing in humans.

The temperatures (TI, TE) of inspired and expired gas and the mass of expired water (MEH2O) have been measured in four subjects at rest during mouth and nose breathing of dry air at room temperature. TI and TE were measured by copper-constantan thermocouples, MEH2O by freezing and ventilatory parameters by total body plethysmography. During mouth breathing, temperatures are significantly higher (TI = 28.1 degrees C, TE = 31.5 degrees C) and the amount of expired water larger (MEH2O = 27.8 mg dm-3 BTPS) than during nose breathing (TI = 24.8 degrees C; TE = 29.6 degrees C; MEH2O = 26.6 mg dm-3 BTPS). From these experimental data the appropriate computations show clearly that in humans, while either nose or mouth breathing, the expired air is not water saturated; the latent heat exchanges represent the larger part of the respiratory heat exchanges; the counter current expiratory heat recovery is imperfect; in terms of heat and water respiratory exchanges, no large difference exists between the oral and nasal routes. This last point is confirmed by the calculation of a difference less than 10% in the total respiratory heat losses between mouth and nose breathing.

Body Temperature Regulation↗

Defense mechanisms in the mouth and their possible role in the prevention of dental caries: a review.

The mouth harbors organisms in great abundance; yet their variety is limited and it is noteworthy that some species present in the mouth are not found elsewhere. There are many antibacterial substances in the mouth, some of which may contribute to the control of the microbial flora in the mouth. The activity of some is enhanced in the presence of specific antibody, e.g. lactoferrin, although others appear unaffected, e.g. lactoperoxidase. Opinions differ as to whether the level of immunoglobulins in human saliva can be related to caries. Although it has been established in principle that caries can be prevented in animals by means of vaccination, substantial work remains to be done before a vaccine will be available for testing in humans.

Animals↗

Mouth guard for athletes during orthodontic treatment.

Mouth guards have been proven to greatly reduce the number and severity of traumatic dental injuries to participants in contact sports. However, there are some difficult problems in making mouth guards for athletes with orthodontic appliances on their teeth. We developed a method of making mouth guards by using a coating material for such athletes to prevent dental and oral sports injuries and to protect the orthodontic appliances. This mouth guard fits well and does not damage the appliances.

Athletic Injuries↗

A comparison of the rostrocaudal open mouth and rostro 10 degrees ventro-caudodorsal oblique radiographic views for imaging fluid in the feline tympanic bulla.

Fluid within the tympanic bulla is an indication of middle ear disease. Radiography has a relatively low accuracy for the detection of soft tissue opacification in the tympanic bulla, and the most useful radiographic projection, the rostrocaudal open mouth (RCd (open mouth)), is technically difficult to perform in dogs and cats. An alternative projection for the feline tympanic bulla, the rostro 10 degrees ventro-caudodorsal oblique (R10 degrees V-CdDO), was compared to the RCd (open mouth) in 41 feline cadaver heads with the tympanic bullae randomly filled with KY jelly. Computed tomography was used as the gold standard. Each tympanic bulla was recorded as being positive or negative for soft tissue opacification. Although there was no significant difference between the accuracy of the two views, the R10 degrees V-CdDO was subjectively more accurate and easier to perform, and in a live patient may be performed without the need for general anesthesia. The R10 degrees V-CdDO projection is a good alternative to the RCd (open mouth) projection for detecting otitis media in the cat.

Animals↗

Modelling the spread of foot-and-mouth disease in Australia.

Preparedness for an incursion of an exotic animal disease is of key importance to government, industry, producers and the Australian community. An important aspect of Australia's preparedness for a possible incursion of foot-and-mouth disease is investigation into the likely effectiveness and cost-efficiency of eradication strategies when applied to different regional outbreak scenarios. Disease modelling is a tool that can be used to study diseases such as foot-and-mouth disease to better understand potential disease spread and control under different conditions. The Australian Government Department of Agriculture, Fisheries and Forestry has been involved with epidemiologic simulation modelling for more than 10 years, and has developed a sophisticated spatial model for foot-and-mouth disease (AusSpread) that operates within a geographic information system framework. The model accommodates real farm boundary or point-location data, as well as synthesised data based on agricultural census and land use information. The model also allows for interactions between herds or flocks of different animal species and production type, and considers the role that such interactions are likely to play in the epidemiology of a regional outbreak of foot-and-mouth disease. The user can choose mitigations and eradication strategies from those that are currently described in Australia's veterinary emergency plan. The model also allows the user to evaluate the impact of constraints on the availability of resources for mitigations or eradication measures. Outputs include a range of maps and tabulated outbreak statistics describing the geographic extent of the outbreak and its duration, the numbers of affected, slaughtered, and, as relevant, vaccinated herds or flocks, and the cost of control and eradication. Cost-related outputs are based on budgets of the value of stock and the cost of mitigations, each of which can be varied by the user. These outputs are a valuable resource to assist with policy development and disease management.

Animals↗

Fluoride mouth rinsing proficiency of Japanese preschool-aged children.

AIM: To determine whether Japanese preschool-aged children swallow fluoride solution while rinsing and how much fluoride was retained in the mouth after rinsing. METHODS: The subjects were 769 children who participated in a school-based fluoride mouth rinse programme (FMR) using 0.05% sodium fluoride solution daily. The group of younger, mean age of 4 years and 10 months, experienced the FMR for two months, and the group of older children, mean age of 5 years and 4 months, did it for at least 8 months, rinsing for a minute using 7 ml of the solution. The amount of fluoride retained in the mouth was estimated as the amount present in the net rinsing solution prepared minus what returned to the solution expectorated. RESULTS: No child swallowed all the solution. The rate of fluoride retained was 12.0% (mean = 0.19 mg) in the younger group and 10.7% (mean = 0.17 mg) in the older. Only six children retained over 0.5 mg of fluoride. With the extra survey using weekly intervals, the amount retained was below 0.5 mg in all children. CONCLUSION: That Japanese preschoolaged children could perform fluoride mouth rinsing safely and efficiently.

Age Factors↗

Relation between mouth and haematogenous infection in total joint replacements.

OBJECTIVE: To investigate the source of infections associated with orthopaedic prostheses. DESIGN: Analysis of four infections of prosthetic joints with case records; minimum inhibitory and minimum bactericidal concentrations and sodium dodecylsulphate polyacrylamide gel electrophoresis of the cell wall polypeptides of the Streptococcus sanguis isolates from the mouth and infected prostheses; examination of the patients' mouths for periodontal disease and caries. SUBJECTS: Four adults (three men) aged 58-83. RESULTS: For each patient the strain of S sanguis isolated from the mouth was indistinguishable from that isolated from the prosthesis. All patients had severe periodontal disease and caries. CONCLUSIONS: The mouth was probably the source of bacterial infection in the prosthetic joints of these patients; the route of infection was possibly haematogenous. Incipient oral infection should be treated before joint replacement, and oral health should be maintained indefinitely.

Aged↗

Foot-and-mouth disease in British deer: transmission of virus to cattle, sheep and deer.

After exposure for two hours to cattle with foot-and-mouth disease, each of the five species of deer found in the British countryside became infected. Clinical disease was typical and severe in the roe and muntjac deer, with some animals dying, less severe in the sika deer and usually subclinical in the fallow and red deer. Each species transmitted disease to its own species and to cattle and sheep. The amounts of virus present in the blood, and in oesophageal/pharyngeal samples and excreted as an aerosol during the course of the infection in the deer were similar to those recorded for the sheep and cattle in the same experiment. The fallow and sika deer commonly carried virus in the pharynx beyond 28 days after exposure; some red deer also became carriers. In epidemics of foot-and-mouth disease in the UK, it is likely that deer would have such intimate contact with farm animals as occurred in this study. The natural behavior of free-living deer in the UK suggests that, although the five species are susceptible to foot-and-mouth disease, they are unlikely to be an important factor in the maintenance and transmission of the virus during an epidemic of foot-and-mouth disease in domestic livestock.

Air Microbiology↗

Mouth and nose resistance in newborn kittens and puppies.

Newborn mammals, including infants, have difficulties in mouth breathing when the nasal passages are occluded. In this study we examined the possibility that differences in the passive mechanical properties of the upper airways could fully explain this behavior. Steady inspiratory flows through the upper airways in anesthetized supine newborn kittens and puppies resulted in upper airway obstruction, even at flows less than those occurring during resting breathing, suggesting that in the unanesthetized condition muscle tone plays an important role in maintaining upper airway patency. Mouth (Rm) and nose (Rn) resistances have been measured during steady expiratory flows with nostrils closed and mouth passively open or nostrils open and mouth closed. In all the newborns, Rn was substantially smaller than Rm. In contrast, the Rn/Rm in adult dogs is greater than unity. In adult cats Rn/Rm is above or below unity depending upon the flow rate, but the ratio is always larger than in newborn kittens. The difference between newborns and adults is entirely due to the small Rn of the newborn, as Rm is not greater in the newborn than in the adult. We conclude that the obligatory nose breathing behavior of newborns is not fully explained by the passive mechanical properties of the upper airways.

Age Factors↗

Effects of neck flexion and mouth opening on inspiratory flow dynamics in awake humans.

Phrenic nerve stimulation (PNS) can assess airflow dynamics of the upper airway (UA) during wakefulness in man. Using PNS, we aimed to assess the impact of neck flexion and mouth opening in promoting UA unstability. Measurements were made during nasal breathing in seven healthy subjects (ages = 23-39 yr; one woman). Surface diaphragm electromyogram, esophageal pressure referenced to mask pressure, and flow were recorded during diaphragm twitches with neck in neutral position and mouth closed and then with neck flexion and/or mouth opening. Twitches always exhibited a flow-limited pattern. Flow-limiting driving pressure (Pd) and peak Pd were increased by neck flexion (P < 0.01) without significant change in the corresponding flows. UA resistances at these flow values were higher with the neck flexed (P < 0.05). Mouth opening alone did not exert any significant influence. We conclude that the position of the neck has a discernible impact on the flow behavior through the nonphasically active UA faced with a negative Pd.

Abdominal Muscles↗

Effect of elastic loading on mouth occlusion pressure during CO2 rebreathing in man.

In 7 normal subjects, mouth occlusion pressure was evaluated as an index of neural drive to the respiratory muscles during CO2 rebreathing, with and without the addition of 2 degrees of elastic loads. During control and loaded rebreathing, changes in both mouth occlusion pressure and ventilation were linearly related to changes in end-tidal PCO2. With elastic loading, the slope of occlusion pressure versus end-tidal PCO2 response consistently increased from control values in all subjects and was greater with the higher load in 6 of 7 subjects. The ventilatory response to elastic loading was variable and inconsistent owing to the variable increase in frequency of breathing, the tidal volume always being diminished. In normal subjects, both mouth occlusion pressure and ventilation appeared to assess neural drive to the respiratory muscles in response to CO2 rebreathing; with elastic loading, only occlusion pressure continued to reflect neuromuscular output. This increased pressure response could have been mediated by neural reflex and/or intrinsic muscle mechanisms. The data suggest that mouth occlusion pressure may be a useful parameter for evaluating neuromuscular control mechanisms under conditions of increased lung elastance.

Adult↗

Comparison of esophageal, tracheal, and mouth occlusion pressure in patients with chronic obstructive pulmonary disease during acute respiratory failure.

In 14 acutely ill patients with chronic obstructive pulmonary disease who were either intubated or breathed via a tracheostomy, we measured the pressures generated in the esophagus and trachea during the first 0.1 s of spontaneous inspiratory efforts against closed airway (P0.1). No significant difference was found between P0.1 in the trachea and esophagus, where it was measured at 2 balloon levels (distance from balloon tip to nares: 35 and 45 cm). In 4 of the patients we also compared esophageal and mouth occlusion pressures during mouth breathing, the orifice of tracheostomy being temporarily obstructed. Mouth P0.1 in the 4 patients averaged approximately 47% of the esophageal occlusion pressure (4.4 +/- 1.7 versus 8.9 +/- 3.1 cm H2O, respectively). Because in patients with COPD with upper airways bypassed (tracheostomized or intubated) the changes in esophageal and tracheal pressure during occluded respiratory efforts were similar, it is concluded that the difference between esophageal and mouth occlusion pressure is due to the tissue compliance of the oropharynx.

Aged↗

Hypnotically induced auditory hallucinations and the mouth-opening maneuver: a failure to duplicate findings.

OBJECTIVE: The authors sought to replicate the part of a study by Bick and Kinsbourne in which hypnotically induced auditory hallucinations in normal volunteer subjects were abolished by requiring the subjects to open their mouths. METHODS: Sixty-four normal volunteer subjects were hypnotized, and an attempt was made to induce auditory hallucinations. The subjects in whom hallucinations were successfully induced were then asked to perform the mouth-opening maneuver and the control maneuvers of putting their fingers in their ears or squeezing their eyes shut in an effort to end the hallucinations. RESULTS: Sixteen subjects reported having hallucinations. None of them reported that a hallucination was abolished by opening the mouth or closing the eye; four reported ending hallucinations by putting their fingers in their ears. CONCLUSIONS: Opening the mouth does not affect auditory hallucinations induced by hypnosis in normal persons. The most likely reason for the discrepancy between the results of this experiment and those of the Bick and Kinsbourne study is that the design of the latter study was faulty because it permitted demand characteristics to influence the results.

Adult↗

Salivary clearance of sugar and its effects on pH changes by Streptococcus mitior in an artificial mouth.

We recently developed a computer model of oral sugar clearance (Dawes, 1983), and an artificial mouth has now been constructed which will allow variation in the salivary parameters identified in the model and the study of their effects on bacterial acid production. Using a thin layer of S. mitior, strain 572, over a miniature Sb electrode to measure bacterial pH changes during sugar clearance from the "mouth", we found that three consecutive sets of "Stephan curves" could be obtained with the same bacteria during one day. In each of several experimental series, one salivary parameter was varied, while other parameters were held constant. The maximum pH decrease and the surface area of the registered Stephan curve (delta pH.min) were used as measures of acid production. The results indicate that the volume of "saliva" in the mouth before and after swallowing, the unstimulated salivary flow rate, and the buffer capacity had significant influences on the extent of the pH changes. Other factors, such as the maximum flow rate, the delay between start of stimulation and maximum flow, the volume of saliva in the mouth at time zero, and the taste threshold for sugar, were of lesser importance, confirming some predictions from the computer model.

Buffers↗

Surface sensibility of the floor of the mouth and tongue in healthy controls and in radiated patients.

Increased areas of anesthesia in the oral cavity have been shown to significantly impair oral function in normal individuals. In patients who undergo oral cavity reconstruction, loss of sensation plays a major role in producing disturbances in postoperative oral function. Free tissue transfer techniques have permitted the problem of sensory loss to be addressed through the use of sensate cutaneous free flaps, in which microneural anastomoses are performed between a sensory nerve supplying the flap and a recipient nerve in the head and neck. To critically assess the results of such reconstructions, the effect of sensory restoration on oral cavity rehabilitation must be studied. As a first step toward this goal, normal values for sensory discrimination of the floor of mouth and tongue are needed. Previous studies of oral sensation failed to examine the ventral tongue and floor of mouth. The purpose of this study is to determine the surface sensibility of these regions in healthy patients and in patients who received radiation therapy to the oral cavity. Sensation was evaluated using static and moving two-point discrimination in 90 healthy subjects divided equally into three age groups: 20 to 40 years, 41 to 60 years, and 61 to 80 years. In addition, 20 patients who received radiation therapy were studied. The mucosa of the dorsal and ventral aspects of the lateral tongue, tongue tip, and floor of mouth was examined. The tongue tip is the most sensitive area, followed by the dorsal lateral tongue, ventral lateral tongue, and floor of mouth. The effects of age and radiation therapy on sensory discrimination are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Sympathetic mouth movements accompanying fine motor movements in chimpanzees (Pan troglodytes) with implications toward the evolution of language.

Some theories concerning the evolution of language include a gestural stage prior to glottogenesis. These theories propose that connections observed between fine motor movements of the hands and mouth may be responsible for the transfer of human language from one that was primarily gestural to one that is spoken. The fine motor manipulation of objects by five captive chimpanzees was examined to determine whether sympathetic mouth movements accompanied fine and gross motor movements. Sympathetic mouth movements were observed significantly more often during fine motor manipulation for all five participants. A significant increase in the presence of sympathetic mouth movements was observed in behaviors along a continuum of precision of manipulation from precision grip to gross motor manipulation without prehension. The results are discussed in regard to current theories of language evolution and neurological processes.

Animals↗

Use of mouth pressure twitches induced by cervical magnetic stimulation to assess voluntary activation of the diaphragm.

There is a need for a simple method to assess the adequacy of diaphragm activation during voluntary inspiratory efforts in patients with suspected respiratory muscle weakness. We have compared mouth (Pmo,t), oesophageal (Poes,t) and transdiaphragmatic (Pdi,t) twitch pressure elicited by cervical magnetic stimulation (CMS) in five normal men (mean (SD) age 32.2 (1.8) yrs) on two separate study days. Single magnetic stimuli were delivered at functional residual capacity during relaxation and during graded voluntary inspiratory efforts against a closed airway. As voluntary-effort transdiaphragmatic and oesophageal pressure increased, Pdi,t and Poes,t decreased linearly (r range, respectively, 0.82-0.98 and 0.87-0.95). During relaxation, Pmo,t was unreliable due to the poor transmission of intrathoracic pressure, but during inspiratory efforts, the relation between voluntary mouth pressure and Pmo,t was also linear (r range 0.84-0.95). On average, our subjects voluntarily generated 99, 100 and 102% of the maximum transdiaphragmatic, oesophageal and mouth pressures predicted by the respective linear regression equations. Pmo,t was correlated to both Poes,t and Pdi,t during inspiratory efforts, but not during relaxation. These studies confirm that twitch pressures induced by CMS during inspiratory efforts can be assessed at the mouth in normal subjects, providing a simple and non-invasive technique for assessing diaphragm activation during voluntary inspiratory efforts. Potentially, this technique could be made more sensitive and accurate and applied to detect submaximal efforts in patients.

Adult↗

A novel method for predicting disintegration time in the mouth of rapidly disintegrating tablet by compaction analysis using TabAll.

A tableting process analyzer (TabAll) was used to predict disintegration time in the mouth of rapidly disintegrating tablet. Analyzer profiles recorded upper punch displacement and die wall force encountered during tablet processing. Changes in the mixing ratio of spherical sugar granules and microcrystalline cellulose or lactose affected upper punch displacement and die wall force profiles. Analysis of the compaction process revealed a strong association between disintegration time in the mouth and stationary time, relaxation time of upper punch displacement, and relaxation time of die wall force; disintegration time in the mouth decreased as the three parameters increased. Thus, analysis of the compaction process is useful for predicting disintegration time in the mouth of rapidly disintegrating tablet, which can assist the formulation of new rapidly disintegrating tablets.

Compressive Strength↗