Background
Methods
Part 1
Creation of the first questionnaire and oral examination points
Procedures
Analysis
Part 2
Creation of the second questionnaire and oral examination points
Procedures
Analysis of the questionnaire based on clinical evaluation
Analysis of oral examination findings and comparison with HMB scores
Development of a final screening form
Results
Part 1: First questionnaire and oral findings
Group attributes
Analysis of responses by group
Average HMB scores | P-value | Sensitivity (%) | Specificity (%) | ||
---|---|---|---|---|---|
Mouth breathing group | Nose breathing group | ||||
Do you normally breathe through your mouth? | 1.3 | 0.7 | 0.001a | 38.10 | 88.90 |
Are you concerned that you may have bad breath? | 0.9 | 0.5 | 0.028a | 40.40 | 84.90 |
As a baby, were you breast-fed? [negative question] | 0.9 | 0.3 | 0.002a | 44.70 | 83.90 |
Do you think you have an excessive overbite? | 0.6 | 0.3 | 0.001a | 48.60 | 83.90 |
Do you often have nasal congestion? | 0.8 | 0.4 | 0.015a | 37.50 | 81.10 |
Are your front teeth easily discolored? | 0.6 | 0.4 | 0.045a | 38.60 | 80.00 |
Are the gums of your front teeth often red and swollen? | 0.5 | 0.1 | 0.005a | 61.10 | 79.70 |
Is your mouth normally open? | 0.7 | 0.3 | 0.016a | 40.50 | 79.40 |
As a child (until around age 10), did you often have nasal congestion, from rhinitis or allergies? | 0.8 | 0.4 | .009a | 42.90 | 79.40 |
When you swallow, does your tongue protrude between your front teeth? | 0.1 | 0 | .025a | 66.70 | 75.30 |
Does your lower jaw extend beyond your upper jaw? | 0.1 | 0 | .034a | 75.00 | 73.70 |
Are you a fast eater? | 1.1 | 0.9 | 0.34 | 33.30 | 80.50 |
Does your mouth feel sticky when you wake up? | 1.1 | 0.7 | 0.05 | 32.30 | 79.50 |
Do you snore when sleeping? (Or, have you been told that you snore? | 1 | 0.8 | 0.375 | 30.60 | 78.90 |
Is your mouth and/or throat dry and/or sore when you wake up? | 0.7 | 0.4 | 0.053 | 33.30 | 78.20 |
How many times a day do you brush your teeth? | 0.8 | 0.7 | 0.309 | 31.40 | 78.10 |
Does the tip of your tongue normally not touch anywhere in your mouth? | 0.4 | 0.2 | 0.176 | 45.00 | 77.50 |
Do you drink a lot of water during a meal? | 1.1 | 0.8 | 0.17 | 31.70 | 77.50 |
Are you prone to tartar, even though you brush your teeth? | 1 | 0.9 | 0.494 | 28.60 | 76.90 |
Upon waking, do you have phlegm in your throat? | 0.5 | 0.3 | 0.067 | 37.90 | 76.40 |
Can you curl your tongue, as in this photo? | 0.4 | 0.2 | 0.225 | 35.70 | 76.40 |
Are you more comfortable breathing through your mouth? | 0.3 | 0.2 | 0.108 | 42.10 | 76.30 |
Is your lower jaw small? (Or, have you been told that it is?) | 0.4 | 0.2 | 0.066 | 43.50 | 76.30 |
Are you overweight? | 0.3 | 0.2 | 0.201 | 38.10 | 75.90 |
Are you prone to cavities on your front teeth? | 0.3 | 0.2 | 0.168 | 39.10 | 75.60 |
Do you normally chew on only one side of your mouth? | 0.5 | 0.4 | 0.472 | 31.10 | 75.50 |
Do you catch cold easily? | 0.3 | 0.2 | 0.131 | 42.10 | 75.30 |
Is it hard for you to bite off food with your front teeth? | 0.4 | 0.5 | 0.891 | 26.90 | 75.00 |
Do you have poor occlusion, or are your teeth not properly aligned? (Or, have you been told so?) | 0.5 | 0.5 | 0.451 | 31.90 | 75.00 |
Can you wiggle your nose? | 0.2 | 0.2 | 0.929 | 26.30 | 74.70 |
Do you have difficulty breathing (nasal congestion) when you are lying down? | 0.1 | 0 | 0.479 | 40.00 | 74.50% |
Do you often have chapped lips or dry mouth? | 0.8 | 0.7 | 0.285 | 29.30 | 74.40% |
Do the corners of your mouth turn down? | 0.3 | 0.2 | 0.159 | 42.10 | 74.40% |
Do you have a history of smoking? | 0.4 | 0.3 | 0.449 | 33.30 | 74.20% |
Are you able to swallow saliva with your mouth open? | 0.5 | 0.4 | 0.882 | 27.30 | 74.10% |
Do wrinkles appear on your chin when you close your lips? | 0.3 | 0.2 | 0.508 | 33.30 | 74.00% |
Is the tip of your tongue touching your front teeth (or just behind your front teeth) right now? | 0.7 | 0.5 | 0.352 | 32.30 | 73.90 |
Can you whistle? | 0.3 | 0.3 | 0.75 | 29.60 | 73.60 |
Do you make chewing noises when you eat? | 0.2 | 0.2 | 0.606 | 35.30 | 73.50 |
Have you ever had orthodontic treatment? | 0.2 | 0.1 | 0.51 | 35.70 | 72.90 |
Do you exercise to the point of shortness of breath? | 0.7 | 0.6 | 0.623 | 29.30 | 72.70 |
Have you had a tooth or teeth pulled for orthodontic reasons? | 0.1 | 0.1 | 0.7 | 33.30 | 72.10 |
Does food often spill from your mouth? | 0.1 | 0.1 | 0.825 | 25.00 | 71.90 |
Do your gums bleed? | 0.4 | 0.5 | 0.846 | 25.60 | 71.70 |
Is the thickness of your upper and lower lips markedly different? | 0 | 0 | 0.883 | 25.00 | 71.60 |
Do you chew your food well when you eat? | 1.1 | 1 | 0.618 | 28.20 | 71.40 |
Do you grind your teeth in your sleep? (Or, have you been told that you do?) | 0.4 | 0.5 | 0.347 | 25.00 | 70.60 |
Can you chew even hard food well? | 0.1 | 0.2 | 0.314 | 17.60 | 70.20 |
Do you often have sores in your mouth? | 0.5 | 0.7 | 0.198 | 22.90 | 67.90 |
Do you normally sleep on your side, or on your stomach? | 1.1 | 1.3 | 0.226 | 25.00 | 58.80 |
Analysis of medical history and orofacial examination items
Percent applicable (%) | Odds ratio | |||
---|---|---|---|---|
Nose breathing group | Mouth breathing group | |||
Medical history | Asthma (before age 16) | 4.1 | 28.6 | 9.33a |
Asthma (age 16 or older) | 2.7 | 10.7 | 4.26 | |
Allergic rhinitis | 4.1 | 10.7 | 2.80 | |
Atopy (allergies) | 2.7 | 7.1 | 2.73 | |
History of smoking | 28.8 | 35.7 | 1.38 | |
Orofacial development | Open mouth at rest | 1.4 | 21.4 | 19.64a |
Tongue thrust during swallowing | 4.1 | 42.9 | 17.50a | |
Maxillary protrusion | 2.7 | 28.6 | 14.20a | |
Increased chin muscle tonus | 1.4 | 14.3 | 12.00a | |
Mandibular protrusion | 4.1 | 17.9 | 5.07a | |
Crowding | 23.3 | 28.6 | 1.32 | |
Edge-to-edge bite | 6.8 | 3.6 | 0.5 | |
Excessive overbite | 1.4 | 0 | 0 | |
Underbite | 0 | 3.6 | – | |
Open bite | 0 | 7.1 | – |
Part 2: Second questionnaire and oral findings
Group attributes
Analysis of the questionnaire
Sensitivity (%) | Specificity (%) | ||
---|---|---|---|
1. Do you often have nasal congestion? | 73.1 | 69.9 | |
2. Is your mouth normally open? | 80.8 | 78.4 | |
3. Do you normally breathe through your mouth? | 84.0 | 70.7 | |
4. Are the gums of your front teeth often red and swollen? | 42.3 | 80.7 | |
5. Are your front teeth easily discolored? | 65.4 | 63.1 | |
6. Are you concerned that you may have bad breath? | 76.9 | 52.8 | |
7. Do you think you have an excessive overbite? | 42.3 | 76.7 | |
8. When you bite naturally, does your lower jaw extend excessively (mandibular protrusion)? Answer as follows: Yes, if your lower teeth extend beyond upper teeth, as in Fig. a Sometimes, if your upper and lower teeth are aligned, edge to edge, as in Fig. b No, if your upper teeth extend over your lower teeth | 23.1 | 83.8 | |
(A) | (B) | ||
9. When you swallow, does your tongue protrude between your teeth? | 30.8 | 93.1 | |
10. As an infant, were you bottle-fed, breast-fed, or both? Answer as follows:Yes, if bottle-fed onlySometimes, if bothNo, if breast-fed only | 50.0 | 63.6 | |
11. As a child (until around age 10), did you often have nasal congestion, from rhinitis or allergies? | 60.0 | 72.0 | |
12. Before age 16, were you ever diagnosed with bronchial asthma? Answer as follows: Yes, if you had asthma attacks after age 16 Sometimes, if you had asthma before age 16, but not afterwards. No, if you were never diagnosed with asthma. | 17.4 | 92.3 |
Creation of the final questionnaire
Evaluation of the final questionnaire
Analysis of medical history and orofacial examination items
Applicability (%) | Odds ratio | ||
---|---|---|---|
Nose breathing group | Mouth breathing group (includes suspected mouth breathing group) | ||
Discomfort while breathing with the lips closed | 1.1 | 36.4 | 49.71a |
Open mouth at rest | 4.5 | 63.6 | 36.75a |
Increased chin muscle tonus | 3.4 | 19.7 | 6.95a |
Tongue thrust during swallowing | 9.7 | 42.4 | 6.89a |
Maxillary protrusion | 8.0 | 22.7 | 3.40a |
Open bite | 4.5 | 12.1 | 2.90a |
History of asthma | 7.4 | 16.7 | 2.51a |
Mandibular protrusion | 6.8 | 15.2 | 2.44 |
Edge-to-edge bite | 1.7 | 3.0 | 1.80 |
Other malocclusion (crowding, cross bite) | 17.6 | 27.3 | 1.50 |
Excessive overbite | 2.3 | 0 | 0.00 |
Correspondence between HMB scores and 7 key clinical items
Percent applicability (%) | |||
---|---|---|---|
Mouth breathing negative group | Suspected mouth breathing group | Mouth breathing positive group | |
Discomfort while breathing with the lips closed | 2.7 | 12.2 | 29.3 |
Open mouth at rest | 9.9 | 17.8 | 56.1 |
Increased chin muscle tonus | 3.6 | 10.0 | 14.6 |
Tongue thrust during swallowing | 10.8 | 23.3 | 29.3 |
Maxillary protrusion | 8.1 | 10.0 | 26.8 |
Open bite | 3.6 | 8.9 | 9.8 |
History of asthma | 1.8 | 10.0 | 31.7 |