ORIGINAL ARTICLE

Electromyographic activity evaluation

and comparison of the orbicularis oris
(lower fascicle) and mentalis muscles
in predominantly nose- or
mouth-breathing subjects
Eliane Hermes Dutra,a Hiroshi Maruo,b and Michelle Santos Vianna-Larac
Curitiba, Brazil

Introduction: The objective of this study was to evaluate and compare the electromyographic (EMG) activity
of the orbicularis oris—lower fascicle (LOO) muscle and the mentalis muscle (MT)—in predominantly
nose-breathing (PNB) and mouth-breathing (PMB) subjects. Methods: Thirty-four subjects, 22 PNB and 12
PMB, with Class II Division 1 malocclusions were evaluated in 2001 (T1) and again in 2004 (T2), 2 years 5
months later. The age ranges of the sample were 11 years to 14 years 11 months at T1, and 13 years 4
months to 16 years 6 months at T2. EMG activity was recorded with bipolar surface electrodes at rest and
during 12 movements; data were processed and normalized by the EMG highest value. The Student t test
and the Mann-Whitney nonparametric test were used to compare the mean values and the variables between
the observation times. Results: Greater EMG activity of the MT was observed in the PMB group at rest and
swallowing at T1 and T2. At T2, increased EMG activity of the LOO at blowing and pronunciation of the
phoneme \b\ was observed as well as a greater increment of EMG activity of this muscle at blowing,
pronunciation of the phoneme \m\, and chewing in the PMB group. In addition, greater EMG activity of the
MT at chewing in the PMB group was observed at T2. Conclusions: These results suggest that mouth
breathing influences EMG activity of the LOO and MT muscles. (Am J Orthod Dentofacial Orthop 2006;129:
722.e1-722.e8)

M
uscle alterations, such as short upper lip,
pouting, hyperactive lower lip, and lack of
lip seal, occur in mouth-breathing sub-
jects.1-3 These morphologic adaptations are associated
with alterations in the electromyographic (EMG) activ-
ity of specific craniofacial muscles.4
Interested in these clinically visible muscle alter-
ations, authors such as Nierberg,5 Möller,6 lsley and
Basmajian,7 Kelman and Gatehouse,8 and Sales and
Vitti9 used electromyography to better understand the
physiology of the perioral musculature (orbicularis oris
and mentalis [MT] muscles).
Opinions about the influence of mouth breathing in
From the Graduate Dentistry Program, Pontifical Catholic University of Paraná,
Curitiba, Brazil.
a
Former master’s program.
b
Titular professor.
c
Assistant professor.
Reprint requests to: Eliane Hermes Dutra, Rua Imuculada Conceição 1155,
CEP 80215-90, Curitiba, PR, Brazil; e-mail, dutra@u.washington.edu.
Submitted, May 2005; revised and accepted, February 2006.
0889-5406/$32.00
Copyright © 2006 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2006.02.027
the EMG activity of the orbicularis oris and MT
muscles are controversial. Pallú et al10 and Tomé and
Marchiori1 reported that mouth breathers have in-
creased EMG activity. However, Vieira11 and Lima,12
studying the lower fascicle of the orbicularis oris
(LOO) and the MT muscles, and the anteroinferior
dental features in mouth- and nose-breathing subjects,
found no difference between such breathing modes.
Although adaptation to mouth breathing might re-
sult in definitive EMG activity changes, a cause-and-
effect relationship has been difficult to establish. Much
controversy stems from differences among authors in
the definition of nasal airway impairment, the complex-
ity of assessing mouth-breathing mode, and confusion
over what mouth breathing really means.13-15 Another
important factor to be considered is the age at which
breathing mode and EMG activity are evaluated. Pre-
vious investigations studied young subjects, with age
before the pubertal period, when mouth breathing could
not yet have resulted in important alterations in the
EMG activity of the muscles evaluated.1,10-12
Considering the controversial aspects of breathing-
722.e1
722.e2 Dutra, Maruo, and Vianna-Lara American Journal of Orthodontics and Dentofacial Orthopedics
June 2006

mode influence in the EMG activity of the LOO and Table I. Mean values with Student t test for independent
MT muscles and the variation of the subject’s ages in samples at T1
the studies cited, this evaluation is essential during the Mean PNB Mean PMB Significance
pubertal period, when the most important physiologic Variable group group t 1-tailed
changes occur. Our aims in this study were to evaluate
and compare the EMG activity of these muscles in a LOO 2 0.7026 0.5349 1.1648 .1264
LOO 6 0.5140 0.5258 ⫺0.0988 .4610
sample of subjects with nose and mouth breathing
during the pubertal period, at 2 times (T1 and T2) P ⱕ.05.
separated by a reasonable interval, to include growth LOO 2, EMG activity of LOO during sucking; LOO 6, EMG activity
of LOO during emission of phoneme \b\.
changes.

MATERIAL AND METHODS Table II.

The study was carried out after the approval of the
Ethics Committee of Research from Pontifical Catholic
University of Paraná. All subjects provided written
informed consent before study participation.
We selected the EMG records of the LOO and MT
muscles obtained in 2001, from 48 Brazilian subjects of
both sexes, from age 11 to 14 years 11 months, with
Class II Division 1 malocclusions16 from the archives
of our postgraduate program. Of these, 14 were not
found, did not accept, or were not authorized to
participate in the second evaluation.
Therefore, the sample comprised 34 subjects, from
age 13 years 4 months to 16 years 6 months, with Class
II Division 1 malocclusions.16 They were divided into
2 groups: 22 predominantly nose-breathing subjects
(PNB group) and 12 predominantly mouth-breathing
subjects (PMB group).
From T1 to T2, the subjects received no treatment
for either their malocclusions or mouth-breathing
mode. Those who underwent treatment during the
evaluation periods were not included in the sample.
The T1 evaluation of breathing mode was made by
multidisciplinary approaches.
1. Visual examination, made by an orthodontist who
verified the presence or absence of lip sealing. The
evaluation was made in a classroom when the
subjects were watching a movie. Three evaluations
were made in a 15-minute period on 3 days.
2. Questionnaire, answered by the parents or guardian,
about each subject’s breathing mode. The question-
naire assessed nocturnal habits such as snoring or
dribbling, allergen recurrent situations, and even-
tual surgery to remove adenoids or tonsils. In
addition to this information, the subjective opinion
of the parents or guardian about the subject’s
breathing mode was considered.
3. Clinical examination by an otolaryngologist, who
evaluated possible upper airway obstruction. The
following structures were examined: palatine ton-
sils, nasal septum, and turbinate and pharyngeal
Mean values with Student t test for indepen-
dent samples at T2
Mean PNB Mean PMB Significance
Variable group group t 1-tailed
LOO 0 0.1118 0.1602 ⫺1.4397 .0798
LOO 1 0.4024 0.7038 ⫺1.9620 .0360
LOO 3 0.5178 0.6712 ⫺1.1139 .1425
P ⱕ.05.
LOO 0, EMG activity of LOO during rest; LOO 1, EMG activity of
LOO during blowing; LOO 3, EMG activity of LOO during recip-
rocal compression of lips.
tonsils, which were evaluated with lateral cephalo-
metric radiography.
4. Clinical examination by a speech and language
therapist, who diagnosed open-mouth posture and
functional aspects of phonation and mastication.
Values from 0 to 10 were assigned for each item
evaluated, according to its importance. All values were
added, and a score was determined for each subject,
indicating whether he or she tended to breathe predom-
inantly through the nose or the mouth. A threshold was
determined by comparison; subjects with scores lower
than the threshold were considered to be predominantly
nose breathers, and those with scores higher than the
threshold were considered to be predominantly mouth
breathers.
The EMG evaluation at T2 followed the same
procedure as T1. An electromyography device of 16
channels was used, with 1000 amplifier gain, 20-Hz
high-pass filter, and 500-Hz low-pass. A 12-bit A/D
converter with data acquisition hardware was also used,
with a 1000-Hz sampling frequency at each channel
(EMG System do Brasil LTDA, São José dos Campos,
SP, Brazil). All recordings were made by the same
operator, who did not know the subjects’ breathing
modes. The calibration in the experiment was from
⫺2500 to ⫹ 2500 ␮V.
Before the placement of the electrodes, each sub-
ject’s skin was cleaned with 96% alcohol to eliminate
oiliness in the area, and facilitate adhesion of the
American Journal of Orthodontics and Dentofacial Orthopedics Dutra, Maruo, and Vianna-Lara 722.e3
Volume 129, Number 6

Table III. Mean values with Mann-Whitney U test for nonparametric data at T1
PNB PMB

Variable Mean rank Sum of ranks Mean rank Sum of ranks Z Significance 1-tailed

LOO 0 17.2273 379 18 216 ⫺0.2162 .4144

MT 0 14.8636 327 22.3333 268 ⫺2.0902 .0183
LOO 1 17.5455 386 17.4167 209 ⫺0.036 .4857
MT 1 18 396 16.5833 199 ⫺0.3964 .3459
MT 2 17.1818 378 18.0833 217 ⫺0.2523 .4004
LOO 3 17.7273 390 17.0833 205 ⫺0.1802 .4285
LOO 4 17.5455 386 17.4167 209 ⫺0.036 .4856
MT 4 16.3636 360 19.5833 235 ⫺0.9009 .1838
MT 5 17.4091 383 17.6667 212 ⫺0.0721 .4712
MT 6 16.3636 360 19.5833 235 ⫺0.9009 .1838
LOO 7 18.1364 399 16.3333 196 ⫺1.5867 .0563
MT 7 16.7273 368 18.9167 227 ⫺0.6126 .2787
LOO 8 16.9091 372 18.5833 223 ⫺0.4685 .3197
MT 8 16.9545 373 18.5 222 ⫺0.4324 .3327
LOO 9 18.5455 408 15.5833 187 ⫺0.8289 .2036
MT 9 16.8182 370 18.75 225 ⫺0.5406 .2944
LOO 10 18.7727 413 15.1667 182 ⫺1.009 .1565
MT 10 17.5455 386 17.4167 209 ⫺0.036 .4856
LOO 11 18.9091 416 14.9167 179 ⫺1.1172 .1325
MT 11 17.3182 381 17.8333 214 ⫺0.1441 .4427
LOO 12 18.1818 400 16.25 195 ⫺0.5406 .2944
MT 12 15.0455 331 22 264 ⫺1.946 .0259

P ⱕ.05.
LOO 0, EMG activity of LOO during rest; MT 0, EMG activity of MT muscle during rest; LOO 1, EMG activity of LOO during blowing; MT 1,
EMG activity of MT muscle during blowing; LOO 2, EMG activity of LOO during sucking; MT 2, EMG activity of MT muscle during sucking;
LOO 3, EMG activity of LOO during reciprocal compression of lips; MT 3, EMG activity of MT muscle during reciprocal compression of lips;
LOO 4, EMG activity of LOO during parting of lip comissures; MT 4, EMG activity of MT muscle during parting of lip comissures; LOO 5, EMG
activity of LOO during pursing of lips; MT 5, EMG activity of MT muscle during pursing of lips; LOO 6, EMG activity of LOO during emission
of phoneme \b\; MT 6, EMG activity of MT muscle during emission of phoneme \b\; LOO 7, EMG activity of LOO during emission of phoneme
\m\; MT 7, EMG activity of MT muscle during emission of phoneme \m\; LOO 8, EMG activity of LOO during emission of phoneme \f\; MT 8,
EMG activity of MT muscle during emission of phoneme \f\; LOO 9, EMG activity of LOO during emission of phoneme \v\; MT 9, EMG activity
of MT muscle during emission of phoneme \v\; LOO 10, EMG activity of LOO during right chewing; MT 10, EMG activity of MT muscle during
right chewing; LOO 11, EMG activity of LOO during left chewing; MT 11, EMG activity of MT muscle during left chewing; LOO 12, EMG
activity of LOO during deglutition of saliva; MT 12, EMG activity of MT muscle during deglutition of saliva.

electrodes and the capture and transmission of the
electrical signals.
Bipolar surface electrodes, 10 mm in diameter,
containing conductor gel were fixed on the skin with
Transpore Plastic Tape (3M Brasil, Sumaré, SP, Bra-
zil). A ground electrode was placed on the left arm to
prevent electrical interference.
The electrodes were placed equidistant to the me-
dian line on the LOO and below the vermilion border of
the lower lip, 15 mm apart. In the same way, electrodes
were placed on the MT, equidistant to the median line
and 15 mm apart.
Before the placement of the electrodes and the start of
EMG recording, explanations about the equipment and
instructions were given to the subjects. All movements
were practiced 5 to 10 times to ensure the position of the
electrodes, the equipment’s function, and the movement’s
execution. After that, the EMG recording started. To
standardize the situations, all movements, including rests,
will be mentioned as movements.
The 13 movements executed during the EMG
recording were (1) rest (LOO 0 and MT 0);
(2) maximum free blowing (LOO 1 and MT 1); (3)
maximum free sucking (LOO 2 and MT 2); (4)
reciprocal compression of the lips (LOO 3 and MT
3); (5) maximum parting of lip commissures (LOO 4
and MT 4); (6) maximum pursing of the lips (LOO 5
and MT 5); (7) emission of the phoneme \b\ (LOO
6 and MT 6); (8) emission of the phoneme \m\ (LOO
7 and MT 7); (9) emission of the phoneme \f\ (LOO 8
and MT 8); (10) emission of the phoneme \v\ (LOO
9 and MT 9); (11) right chewing of orthodontic
elastic—(Morelli, Sorocaba, SP, Brazil) ½ ⫻ 2 mm
(LOO 10 and MT 10); (12) left chewing of orthodon-
tic elastic—Morelli ½ ⫻ 2 mm (LOO 11 and MT 11);
and (13) deglutition of saliva (LOO 12 and MT 12).
722.e4 Dutra, Maruo, and Vianna-Lara American Journal of Orthodontics and Dentofacial Orthopedics
June 2006

Table IV. Mean values with Mann-Whitney U test for nonparametric data at T2
PNB PMB

Variable Mean rank Sum of ranks Mean rank Sum of ranks Z Significance 1-tailed

MT 0 15.3636 338 21.4167 257 ⫺1.6938 .0452

MT 1 16.5 363 19.3333 232 ⫺0.7928 .2139
LOO 2 16.8636 371 18.6667 224 ⫺0.5045 .3069
MT 2 16.3182 359 19.6667 236 ⫺0.937 .1744
LOO 4 15.6818 345 20.8333 250 ⫺1.4415 .0747
MT 4 16.9091 372 18.5833 223 ⫺0.4685 .3197
MT 5 16.9091 372 18.5833 223 ⫺0.4685 .3197
LOO 6 14.4091 317 23.1667 278 ⫺2.4509 .0071
MT 6 16.5909 365 19.1667 230 ⫺0.7207 .2355
LOO 7 15.5 341 21.1667 254 ⫺1.5867 .0563
MT 7 16.4545 362 19.4167 233 ⫺0.8289 .2036
LOO 8 16.0909 354 20.0833 241 ⫺1.1172 .132
MT 8 16,.455 353 20.1667 242 ⫺1.1532 .1244
LOO 9 16.2273 357 19.8333 238 ⫺1.009 .1565
MT 9 15.9545 351 20.3333 244 ⫺1.2253 .1102
LOO 10 16.1818 356 19.9167 239 ⫺1.0451 .148
MT 10 15.5 341 21.1667 254 ⫺1.5856 .0564
LOO 11 16.0455 353 20.1667 242 ⫺1.1532 .1244
MT 11 15.2727 336 21.5833 259 ⫺1.7658 .0387
LOO 12 16.8636 371 18.6667 224 ⫺0.5045 .3069
MT 12 13.7273 302 24.4167 293 ⫺2.9911 .0014

P ⱕ.05.
MT 0, EMG activity of MT muscle during rest; MT 1, EMG activity of MT muscle during blowing; LOO 2, EMG activity of LOO during sucking;
MT 2, EMG activity of MT muscle during sucking; LOO 4, EMG activity of LOO during parting of lip comissures; MT 4, EMG activity of MT
muscle during parting of lip comissures; MT 5, EMG activity of MT muscle during pursing of lips; LOO 6, EMG activity of LOO during emission
of phoneme \b\; MT 6, EMG activity of MT muscle during emission of phoneme \b\; LOO 7, EMG activity of LOO during emission of phoneme
\m\; MT 7, EMG activity of MT muscle during emission of phoneme \m\; LOO 8, EMG activity of LOO during emission of phoneme \f\; MT 8,
EMG activity of MT muscle during emission of phoneme \f\; LOO 9, EMG activity of LOO during emission of phoneme \v\; MT 9, EMG activity
of MT muscle during emission of phoneme \v\; LOO 10, EMG activity of LOO during right chewing; MT 10, EMG activity of MT muscle during
right chewing; LOO 11, EMG activity of LOO during left chewing; MT 11, EMG activity of MT muscle during left chewing; LOO 12, EMG
activity of LOO during deglutition of saliva; MT 12, EMG activity of MT muscle during deglutition of saliva.

The subjects were asked to repeat the movements 3
times in 10 seconds, with a 3.33-second interval be-
tween each movement. During the EMG recordings, the
subjects were positioned with the head oriented accord-
ing to the Frankfort horizontal plane, parallel to the
ground.
All EMG records were analyzed while the movements
were executed. The measurement was repeated in case of
any electrical signal interference, a subject’s inappropriate
movement, or failure in the EMG recording (Fig).
The EMG signals were processed by the software,
which computed the root mean square value from the
second and third EMG activity cycles, each with 1
second of duration. This time period was chosen to
allow the evaluation of short movements, such as the
phonemes.
The mean values obtained in the 2 cycles were
normalized by the peak EMG value of each muscle.
The reference value for the normalization was the
highest root mean square value in most of the
subjects (movement 5, pursing of the lips, for the
LOO, and movement 3, reciprocal compression of
the lips, for the MT).
For the normal frequency distribution evaluation of
the variables, the Kolmogorov-Smirnov test was used.
For comparing the groups’ mean values at T1 and T2,
the Student t test was used for variables with normal
frequency distributions. For variables without normal
frequency distribution, the Mann-Whitney U test for
nonparametric data was used, comparing the mean
values between the PNB and the PMB groups.
RESULTS
The results are shown in Tables I to VI.
In the EMG activity of the LOO at T1 (Tables I and
III), no difference was observed between the 2 groups
(Pⱕ.05). However, at T2 (Tables II and IV), the PMB
group showed greater EMG activity of the LOO at
blowing and at phoneme \b\ than the PNB group (P
ⱕ05). In addition, greater modification rates (Tables V
American Journal of Orthodontics and Dentofacial Orthopedics Dutra, Maruo, and Vianna-Lara 722.e5
Volume 129, Number 6

and VI) of the EMG activity of this muscle at blowing, consider the malocclusion. On the other hand, Marchi-
pronunciation of the phoneme \m\, and chewing were ori and Vitti,31 when comparing subjects with various
observed in the PMB group. malocclusions, observed that, although the groups had
Greater EMG activity of the MT was observed in low activity during rest, those with Class II malocclu-
the PMB group at rest and swallowing at the 2 sions had greater activity of the LOO muscle.
evaluation times (Tables III and IV). In addition, The low EMG activity observed in this study can be
greater EMG activity of the MT at chewing in the PMB attributed to the condition of the muscle in keeping a
group (Table IV) was observed at T2 (P ⱕ.05). partial contraction essential for its posture maintenance,
with only some fibers contracting while the others
DISCUSSION remain relaxed. Tulley30 stated that the muscles that
There might be variations in EMG signals when surround the dental arches are rarely at physiologic rest.
movements of the same subject are compared at differ- On the other hand, Vitti et al32 (evaluating subjects
ent times, or the same movement in different subjects is with normal occlusions), Gustafsson and Ahlgren24
compared. Soderberg and Cook,17 Yang and Winter,18 (studying subjects with competent and incompetent
Mirka,19 Türker,20 De Luca,21 and Soderberg and lips), and Tosello et al33 (who, in addition to classifying
Knutson22 suggested data normalization to make these the subjects according to lip competence, divided them
comparisons possible. This technique reduces the inter- according to Class II Division 1 malocclusion or
vention of variables such as skin impedance, subjects’ clinically normal occlusion) did not observe EMG
sex, position of the electrodes, and individual charac- activity when the lips were relaxed. That is probably
teristics such as quantities of adipose and connective because, when few motor units are recruited, the
tissues. Another issue to be considered is related to the activity is minimal or absent.34
differences in the duration of several movements that When we evaluated EMG activity of the LOO
are intended to be compared. Therefore, we normalized muscle and respiratory mode, we observed no differ-
the data to reduce individual and time variations and to ences at rest between the PMB and PNB groups at both
standardize the duration of the cycle that is being evaluation times (Tables II and III); this was different
evaluated. Studies in which EMG data normalization from the results of Tomé and Marchiori,1 who, when
has been carried out related to the subject of this study studying the same muscle, reported greater activity in
are scarce in the literature; this makes the discussion of the mouth-breathers group. In the same way, Pallú et
the results difficult.
We will devote part of the discussion to the rest
situation, because the total duration of active move- Table V. Modification rates (⌬) between groups with
ments during 24 hours is short when compared with the Student t test for independent samples
period of time that the subjects are in the passive resting
(⌬) Mean (⌬) Mean Significance
state. Variable PNB group PMB group t 1-tailed
In this study, during the evaluation at T1, while
resting, greater EMG activity was observed in the MT LOO 0 (⌬) ⫺0.0178 0.0637 ⫺1.4757 .0749
LOO 2 (⌬) ⫺0.1120 0.1350 ⫺1.2631 .1078
muscle in the PMB group (Table III), and, at T2, the
LOO 3 (⌬) 0.0035 0,2327 ⫺1.3404 0948
difference remained (Table IV). Our results agree with MT 4 (⌬) ⫺0.1489 ⫺0.1821 0.0774 .4694
those of Marx,23 Gustafsson and Ahlgren,24 and To- LOO 6 (⌬) ⫺0.0733 0.1205 ⫺1.2248 .1148
miyama et al25 and show that during rest the PMB LOO 7 (⌬) ⫺0.0521 0.2639 ⫺1.8320 .0381
subjects had greater activity of the MT muscle. In the MT 8 (⌬) 0.1232 0.0935 0.0517 .4795
MT 9 (⌬) ⫺0.1401 0.0753 ⫺1.4199 .3387
literature, authors consider short upper lip, pouting
MT 10 (⌬) ⫺0.0343 0.0787 ⫺0.2642 .3968
lower lip, and lip incompetence characteristics of MT 11 (⌬) ⫺0.0707 ⫺0.0358 ⫺0.0662 .4738
mouth breathers; thus, the MT muscle seems to have a
fundamental role in the lip sealing. 26-28 P ⱕ05.
(⌬), Mean value at T2 minus mean value at T1.
It was observed that, in rest, the LOO muscle had LOO 0, EMG activity of LOO during rest; LOO 2, EMG activity of LOO
low EMG activity in both groups at T1 and T2, when during sucking; LOO 3, EMG activity of LOO during reciprocal
compared with the activity registered during the move- compression of lips; MT 4, EMG activity of MT muscle during parting
ments. These results agree with those of Lowe et al,29 of lip comissures; LOO 6, EMG activity of LOO during emission of
who stated that subjects with Class II Division 1 phoneme \b\; LOO 7, EMG activity of LOO during emission of phoneme
\m\; MT 8, EMG activity of MT muscle during emission of phoneme \f\;
malocclusions had minimal activity of the LOO mus- MT 9, EMG activity of MT muscle during emission of phoneme \v\; MT
cles in rest. That low EMG activity during rest was also 10, EMG activity of MT muscle during right chewing; MT 11, EMG
observed by Tulley30 and Nierberg,5 who did not activity of MT muscle during left chewing.
722.e6 Dutra, Maruo, and Vianna-Lara American Journal of Orthodontics and Dentofacial Orthopedics
June 2006

al10 observed greater EMG activity at rest in predom-
inantly mouth breathers, and Regalo et al,35 evaluating
deaf patients with nose- and mouth-breathing modes,
observed strong EMG activity of the LOO muscles at
rest in mouth breathers, suggesting that these subjects
use greater effort to maintain the labial position.
The similar EMG activity of the LOO muscle,
observed between our PNB and PMB subjects during
rest, suggests that the activity of that muscle is not
influenced by respiratory mode, even in subjects with
difficulty keeping the lips sealed. Our results show that,
in PMB subjects, the MT muscle has a fundamental
role in the elevation of the lower lip for the lip seal,
suggesting that lip incompetence, observed in the PMB
subjects, is associated with greater activity of the MT
muscle and not the LOO.
In the blowing movement, greater activity of the
LOO muscle was noticed in the PMB group at T2
(Table II) than in the PNB group. In the same way,
analyzing the movement of pronouncing the phoneme
\b\, we verified greater activity of the LOO muscle in
the PMB group only at T2 (Table IV). For the analysis
of the difference between the modification rate of each
group, the PMB group had increased LOO muscle
activity for blowing movements and the phoneme \m\
(Tables V and VI). Those data evidence the influence of
mouth breathing in the EMG activity of that muscle,
demanding greater effort for the blowing movement
and pronouncing the phonemes \b\ and \m\, 2 years 5
months after T1. According to Pallú et al10 and Tomé
and Marchiori,1 the lack of muscular balance observed
in mouth-breathing patients makes normal function of
these muscles difficult because the movements are
carried out with compensatory effort. In addition, to
perform these 3 movements (blowing, phonemes \b\
and \m\), some effort of the lips is demanded, which
might be even accentuated by the clinical characteris-
tics of Class II Division 1 malocclusion after 2 years 5
months of growth.
In the chewing movement at T2, the PMB group
had greater EMG activity of the MT muscle during
left-side chewing, and that difference was also verified
during right-side chewing; however, it was not statisti-
cally significant (Table IV). When comparing the dif-
ference between the mean values of the groups at both
times, a greater increase of the activity of the LOO
muscle was noticed in the PMB group (Table VI).
Although the MT muscle does not actively participate
in chewing, it contributes, along with the LOO muscle,
to the mouth-sealing function and prevents the bolus
from leaking during mandible excursions. According to
Tomiyama et al,25 subjects with incompetent lips have
difficulty chewing with the lips in contact. That ex-
plains the greater EMG activity of the MT muscle and
the greater increase in the activity of the LOO muscle
at T2. This means that mouth breathing demands

Table VI. Modification rates (⌬) with Mann-Whitney U test for nonparametric data
PNB PMB

Variable Mean rank Sum of ranks Mean rank Sum of ranks Z Significance 1-tailed

MT 0 (⌬) 17.3182 381 17.8333 214 ⫺0.1441 .4427

LOO 1 (⌬) 15.2273 335 21.6667 260 ⫺1.8019 0358
MT 1 (⌬) 15.6364 344 20.9167 251 ⫺1.4775 0698
MT 2 (⌬) 16.1364 355 20 240 ⫺1.0811 .1398
LOO 4 (⌬) 15.6364 344 20.9167 251 ⫺1.4777 0698
MT 5 (⌬) 17.3636 382 17.75 213 ⫺0.1081 .4574
MT 6 (⌬) 17.3182 381 17.8333 214 ⫺0.1441 4427
MT 7 (⌬) 17.1364 377 18.1667 218 ⫺0.2883 3866
LOO 8 (⌬) 16.8636 371 18.6667 224 ⫺0.5045 3069
LOO 9 (⌬) 15.7727 347 20.6667 248 ⫺1.3694 0854
LOO 10 (⌬) 14.5455 320 22.9167 275 ⫺2.3424 0096
LOO 11 (⌬) 15.6364 344 20.9167 251 ⫺1.4775 0698
LOO 12 (⌬) 16.7727 369 18.8333 226 ⫺0.5766 2821
MT 12 (⌬) 15.7727 347 20.6667 248 ⫺1.3694 .0854

P ⱕ.05.
(⌬), Mean value at T2 minus mean value at T1.
MT 0, EMG activity of MT muscle during rest; LOO 1, EMG activity of LOO during blowing; MT 1, EMG activity of MT muscle during blowing;
MT 2, EMG activity of MT muscle during sucking; LOO 4, EMG activity of LOO during parting of lip comissures; MT 5, EMG activity of MT
muscle during pursing of lips; MT 6, EMG activity of MT muscle during emission of phoneme \b\; MT 7, EMG activity of MT muscle during
emission of phoneme \m\; LOO 8, EMG activity of LOO during emission of phoneme \f\; LOO 9, EMG activity of LOO during emission of
phoneme \v\; LOO 10, EMG activity of LOO during right chewing; LOO 11, EMG activity of LOO during left chewing; LOO 12, EMG activity
of LOO during deglutition of saliva; MT 12, EMG activity of MT muscle during deglutition of saliva.
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 129, Number 6
greater effort for lip sealing and chewing. These results
agree with those of Harradine and Kirschen,36 who
observed greater EMG activity of the orbicularis oris
and MT muscles in subjects with incompetent lips
during chewing.
During the deglutition movement, the subjects in
the PMB group had greater EMG activity of the MT
Fig 1. Subject with electrodes positioned. A, Lateral view; B, frontal view; C, ground electrode.
Dutra, Maruo, and Vianna-Lara 722.e7
muscle at both T1 and T2 (Tables III and IV). Nier-
berg5 established, in an EMG and cephalometric study,
3 deglutition patterns, stating that visceral deglutition, a
variation of the normal pattern, shows considerable
contraction in the MT muscle and little activity of the
masseter muscle and the LOO. Our results show that
the PMB subjects have hyperactivity of the MT muscle
722.e8 Dutra, Maruo, and Vianna-Lara
during deglutition, suggesting a visceral swallow and
agreeing with the results of Gustafsson and Ahlgren24
that verified greater EMG activity of the MT muscle in
subjects with lip incompetence during swallowing.
Pallú et al10 observed, in addition to greater EMG
activity of the MT muscle, greater activity of the LOO
muscle in the mouth-breathing subjects. In a related
study, Vaiman et al37 established normal EMG values
for swallowing water of several muscles, including the
orbicularis oris. Those authors divided their 420 sub-
jects according to age (18-40, 41-65, 66⫹) and verified
a tendency of decreasing EMG activity of the orbicu-
laris oris with age. On the other hand, an increase of the
duration of muscle activity was observed.
Knowledge about muscle physiology and alter-
ations in EMG activity of the perioral muscles of
mouth-breathing patients might indicate the need for a
multidisciplinary treatment, combining otolaryngology
and speech and language therapy with orthodontic
treatment. Thus, in addition to the malocclusion cor-
rection, the patient will be able to reestablish muscular
function, so that the results achieved by orthodontic
treatment are retained.
CONCLUSIONS
From the results of this study, we can conclude the
following.
1. At rest, EMG activity of the MT muscle is greater
in the PMB than in PNB subjects.
2. EMG activity of the LOO is not different between
PNB and PMB subjects in the rest position.
3. In the blowing movement and pronunciation of the
phoneme \b\ at T2, there is greater EMG activity of
the LOO in the PMB subjects.
4. In the PMB subjects at T2, there were greater
increases of EMG activity of the LOO in blowing,
pronunciation of the phoneme \m\, and chewing.
5. At T2, there was greater EMG activity of the MT
muscle for the chewing movement in the PMB
subjects.
6. The MT muscle has greater EMG activity in PMB
subjects during swallowing.
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