{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:11:48Z","timestamp":1793725908488,"version":"4.6.1"},"reference-count":39,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"General Program of Natural Science Foundation of Guangdong Province","award":["2021A1515011764"],"award-info":[{"award-number":["2021A1515011764"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82000957"],"award-info":[{"award-number":["82000957"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82071079"],"award-info":[{"award-number":["82071079"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ear Nose Throat J"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Mouth breathing (MB) is a pediatric public health concern potentially increasing dental caries risk. We investigated risk factors, relationships between clinical characteristics and medical costs, and their effects on caries severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design:<\/jats:title>\n                    <jats:p>Observation study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Analysis of clinical characteristics, medical costs, and dental caries in MB children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>Eighty-six children with MB secondary to adenoid hypertrophy (AH) and\/or tonsillar hypertrophy, recruited from an ENT department (June-August 2023).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements:<\/jats:title>\n                    <jats:p>MB diagnosis via validated criteria; dental caries assessment; questionnaire on demographics, medical history, body mass index, Paediatric Yorkhill Malnutrition Score, perinatal factors, feeding practices, oral hygiene, parental education, and costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Caries prevalence was 40.7% (35\/86). Caries correlated significantly with longer MB duration (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.013), higher total IgE (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.004), and delayed toothbrushing initiation (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.001). AH severity (assessed by Pharyngeal Airway Space,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.013; choanal obstruction grade,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.006) correlated with caries. Non-caries children showed higher breastfeeding rates (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.026). Multivariate analysis identified formula feeding (odds ratio (OR)\u2009=\u200910.099,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.026), longer disease duration (OR\u2009=\u20091.495,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.035), and delayed oral hygiene initiation (OR\u2009=\u20092.171,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.025) as independent caries predictors. Medical costs positively correlated with maternal education (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.280,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.009), AH grade (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.345,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.001), disease duration (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.383,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001), and prematurity (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.457,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.0001), with maternal education exerting the strongest cost influence. Delayed toothbrushing (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.213) and formula feeding (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.219) positively correlated with higher decayed, missing, filled teeth\/decayed, missing, or filled surfaces (affected surfaces) indices.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>MB-associated caries is highly prevalent and costly. Multiple modifiable risk factors contribute to its occurrence in children.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/01455613251370571","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T05:36:11Z","timestamp":1757396171000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of Mouth Breathing on Dental Caries in Children and Its High Medical Costs"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9046-5351","authenticated-orcid":false,"given":"Huiyi","family":"Deng","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"},{"name":"Department of Allergy, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenyu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Stomatology Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qintai","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"},{"name":"Department of Allergy, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuekun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"},{"name":"Department of Allergy, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/children10081426"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/ipd.12484"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-014-1113-7"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2012.05.007"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2021.04.014"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0022034517738925"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/odi.14516"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.3892\/etm.2020.8611"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2021.12.008"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0125916"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-1684"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191711102"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2023.104628"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1159\/000514502"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2003.07.018"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20991"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-021-01458-7"},{"issue":"1","key":"e_1_3_3_19_2","first-page":"18","article-title":"Mouth breathing: adverse effects on facial growth, health, academics, and behavior","volume":"58","author":"Jefferson Y","year":"2010","unstructured":"Jefferson Y. 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