Investigation on Mouth Breathing Behavior of Adolescents and Analysis of Health Intervention Strategies

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Methods This cross-sectional study employed questionnaire survey method to investigate the mouth breathing behavior of students aged 6 to 10 at Primary School in Shanghai. The questionnaire includes basic information, behavioral habits, health status, cognition and attitudes, as well as intervention needs and preferences. The collected information was summarized after cleaning and statistically analyzing the data. Results The survey showed that about 68% of teenagers have mouth breathing problems, mainly manifested as malocclusion, facial changes, and decreased sleep quality and other health problems. The incidence of mouth breathing caused by harmful habits is higher in boys than girls., while girls have higher awareness of harm and willingness to correct. Although 73.5% of students are willing to accept intervention, 35.9% have lacked knowledge of correction methods, and most of them prefer non-invasive correction methods. Conclusion Mouth breathing has a high incidence in adolescents and significantly affects their health. This study recommends strengthening health education, promoting early screening, optimizing intervention measures, and paying attention to the health needs of vulnerable groups to improve the level of adolescent health management and promote health equity Mouth breathing adolescents health impact intervention strategy questionnaire survey method Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. Background Mouth breathing refers to an abnormal respiratory pattern in which an individual breathes through the mouth instead of the nasal cavity during wakefulness or sleep. It is a common harmful oral habit in clinical practice and is easily overlooked in the early stages[ 1 ]. This phenomenon is particularly prevalent among adolescents, with the incidence of mouth breathing in children as high as 54.81%[ 2 ]. The causes may include obstructive factors, habitual behavior, or functional disorders[ 3 ]. Among them, obstructive mouth breathing is often caused by respiratory system diseases such as tonsillar and adenoid hypertrophy, allergic rhinitis, etc. Children with upper respiratory tract stenosis and obstruction cannot breathe normally through the nose and are forced to breathe through the mouth. They should seek timely medical attention at an otolaryngology department[ 4 ]. Habitual mouth breathing, formed through long-term mouth breathing, can be corrected through health education, lip muscle training, and other methods[ 5 ]. Mouth breathing not only interferes with an individual's daily quality of life, but may also lead to a series of severe health consequences, including abnormal maxillofacial development, dental malocclusion, obstructive sleep apnea-hypopnea syndrome[ 6 ], and even cognitive and metabolic disorders[ 7 ]. Consequently, increasing attention has been paid in pediatric and adolescent health research on the early identification and effective intervention of mouth breathing and its related complications[ 8 ]. Adolescence is a critical period for growth and development, and health issues during this stage directly impact future quality of life and social adaptability[ 9 ]. However, in practical health management, children and adolescents, as vulnerable groups, face higher health risks due to disparities in family economic status, uneven distribution of educational resources, and insufficient health awareness[ 10 ]. For instance, adolescents from low-income families may miss early interventions for mouth breathing due to a lack of medical resources, leading to worsening health conditions. This health inequity urgently requires attention from researchers and policymakers[ 11 ]. This study, based on a survey of mouth breathing among adolescents at Primary School in Shanghai, systematically analyzes the behavioral characteristics, prevalence trends, and potential health impacts of mouth breathing using a questionnaire survey method. The core highlight of this study lies in its special focus on adolescents as a vulnerable group, examining variables such as gender, age, and lifestyle habits to explore the mechanisms and specific impacts of mouth breathing behavior. Additionally, the study systematically reviews feasible options for intervention and treatment strategies for mouth breathing. Ultimately, the study aims to provide robust scientific data to healthcare institutions and policymakers, advocating for increased intervention and management of mouth breathing in adolescents and calling for more societal resources to effectively address this issue. 2. Methods 2.1. Study Subjects The study subjects were students from Primary School in Shanghai, aged 6 to 10 years. The selection of subjects considered a balance of gender, age, and class, covering diverse groups with potential differences in health awareness and behavioral habits, thereby providing varied data sources for studying mouth breathing behavior and its health impacts. Exclusion criteria: Questionnaires with ≥20% missing key data or containing logically inconsistent responses. Consent to participates were obtained from their parents or legal guardians. 2.2. Questionnaire Design This study employed a cluster sampling cross-sectional questionnaire design to systematically explore the prevalence of mouth breathing behavior, its health impacts, and intervention needs among adolescents. The core objective was to uncover behavioral characteristics and potential influencing factors through questionnaire data, providing a scientific basis for intervention strategy development. The questionnaire was designed according to the expanded protocol of orofacial myofunctional evaluation scores proposed by Medeiros et al.[12] The questionnaire was divided into the following modules, comprehensively considering the mouth breathing behavioral status, health impacts, and intervention needs: • Part 1: Basic Information – Including the subjects' gender, ethnicity, and age as basic classification criteria for subsequent differential analysis. • Part 2: Behavior and Habits – Investigated whether subjects were aware of mouth breathing, the existence of mouth breathing habit and other harmful behaviors (e.g., nail-biting, lip-licking), and sleep-related issues. • Part 3: Health Status and Complications – Surveyed common symptoms of mouth breathing (e.g., snoring, dry mouth), facial changes, dental issues (e.g., irregular dentition, protruded upper teeth), tonsillar or adenoidal hypertrophy, and whether related surgeries had been performed. • Part 4: Cognition and Attitudes – Assessed subjects' awareness of the negative impacts of mouth breathing, understanding of its health risks, attempts at correction methods (e.g., lip-closing training, taping), and practice status. • Part 5: Intervention Needs and Preferences – Surveyed subjects' willingness to accept intervention for mouth breathing and preferred intervention methods (e.g., medication, surgery, orthodontic treatment, oral muscle training). 2.3. Statistical Analysis Data analysis was primarily conducted using Excel. Data were first entered and cleaned, with outliers removed. Excel's statistical functions were then used to calculate frequencies and percentages for descriptive statistical analysis. Charts, including bar graphs and pie charts, were created to present the results. 3. Results 3.1. Overview A total of 124 questionnaires were distributed, with 117 collected, yielding a response rate of 94.35%. Among these, 117 were valid, accounting for 100% of the collected responses, while 7 were invalid, representing 5.65% (Table 1 ). Gender distribution showed 48.72% male and 51.28% female respondents (Table 2 ). Age distribution indicated that 8 and 9 years old constituted the majority, at 30.77% and 35.90%, respectively (Table 3 ). Overall, the questionnaire response quality was high, with a reasonable sample distribution, providing a reliable data foundation for subsequent analysis. Table 1 Number of participants in mouth breathing behavior survey of adolescents Counting - the number of questionnaires Frequency Percentage Valid questionnaires 117 94.35% Invalid questionnaires 7 5.65% Total 124 100% Table 2 Gender statistics of mouth breathing behavior survey among adolescents Population counts - gender statistics Frequency Percentage Males 57 48.72% Females 60 51.28% Total 117 100.00% Table 3 Age distribution of participants in the oral respiratory behavior survey Age Frequency Percentage 6 years old 1 0.85% 7 years old 19 16.24% 8 years old 36 30.77% 9 years old 42 35.90% 10 years old 14 11.97% Unknown 5 4.27% Total 117 100.00% 3.2. Current Status of Mouth Breathing Behavior in Adolescents Subsequently, the current study analyzed the frequency of mouth breathing in adolescents and its relationship with lifestyle habits such as sleep quality and harmful habits, as well as behavioral characteristics and potential triggers. Results showed that 11.97% of students frequently engaged in mouth breathing, 56.41% occasionally did so, and only 30.77% reported never having the habit, indicating that approximately 68% of students exhibited mouth breathing behavior (Table 4 ). By gender, boys had a slightly higher prevalence of frequent mouth breathing (35.04%) than girls (33.33%), though the overall difference was minimal (Fig. 1 ). Additionally, 12.82% of students frequently exhibited harmful habits such as nail-biting or lip-licking, while 41.02% occasionally did so, suggesting a potential link between these behaviors and mouth breathing. Boys had a higher prevalence of harmful habits (8.55%) than girls (4.27%) (Fig. 2 ), indicating that boys may be more susceptible to certain harmful behavioral patterns. Regarding sleep, 62.39% of students occasionally felt fatigued or drowsy, while 8.55% frequently did so (Table 5 ), suggesting that mouth breathing may negatively impact sleep quality. Table 4 Proportion of people who are tired or unable to wake up Options Frequency (total) Percentage (total) Gender Frequency Percentage Often 10 8.55% Males 4 40.00% Females 6 60.00% Occasionally 73 62.39% Males 39 53.42% Females 34 46.58% Never 34 29.06% Males 14 41.18% Females 20 58.82% Total 117 100.00% 117 100.00% 3.3. Main Complications of Mouth Breathing Furthermore, this study analyzed the association between mouth breathing and health issues, and assessed its potential impacts on dental health, facial structure, sleep quality, and other health conditions subsequently. The survey revealed that 55.56% of students had irregular dentition, while 17.09% exhibited protruding upper teeth (Table 5 ), indicating that mouth breathing may significantly affect maxillofacial development. Additionally, 28.21% of students reported concerns about facial changes caused by mouth breathing (e.g., elongation of the lower 1/3 of the face, bite issues). Furthermore, 36.75% of students experienced snoring, 28.21% reported dry mouth upon waking, and 39.32% frequently breathed with their mouths open. These findings reflect the adverse effects of mouth breathing on multiple aspects of health. Notably, 13.68% of students were reported to have tonsillar or adenoidal hypertrophy, yet only 1.71% had undergone related surgery (Fig. 3 ), suggesting that some issues were not resolved in a timely manner. Table 5 Whether there is health problems related to mouth breathing Options Frequency (total) Percentage (total) Gender Frequency Percentage Sleep snoring 43 36.75% Males 21 48.84% Females 22 51.16% Dry mouthing upon waking 33 28.21% Males 14 42.42% Females 19 57.58% Frequently open your mouth unconsciously 46 39.32% Males 21 45.65% Females 25 54.35% The upper anterior teeth protrude forward 20 17.09% Males 9 45.00% Females 11 55.00% Crooked teeth 65 55.56% Males 32 49.23% Females 33 50.77% Total 117 100.00% 3.4. Adolescents' Awareness and Practices Regarding Mouth Breathing The current study also assessed the awareness of mouth breathing and corrective practices of adolescents and their parents, and explored the current state of health education and existing challenges. Results showed that only 51.29% of students were aware of the health risks associated with mouth breathing, with some gender differences. Among girls, 28.21% reported understanding the harms of mouth breathing, compared to 23.08% of boys (Fig. 4 ), indicating that girls may be more sensitive to health awareness and knowledge acquisition. The most concerning risks of mouth breathing for students and parents were facial changes (28.21%) and oral diseases (23.93%), followed by sleep quality decline (11.97%) and restricted growth and development (22.22%) (Fig. 5 ). Regarding corrective practices, 35.90% of students had no understanding of correction methods, 7.69% had attempted correction but failed to persist, and only 5.98% consistently practiced correction (Table 6 ). This suggests that, while some parents and students are aware of the risks of mouth breathing, challenges such as difficulty in persistence and insufficient resources hinder effective practice, highlighting the need for enhanced health education and supportive interventions. Moreover, 73.50% of students were willing to accept intervention, while only 19.66% explicitly refused, reflecting a high demand for intervention (Table 7 ). Regarding intervention methods, 41.03% of students preferred orthodontic treatment, 29.91% favored oral muscle training, while medication (14.53%) and surgery (0.85%) had lower acceptance rates (Fig. 6 ), indicating a preference for non-invasive, practical intervention methods. Table 6 Distribution of whether corrective measures were known or tried Options Frequency (total) Percentage (total) Gender Frequency Percentage I don't understand at all 42 35.90% Males 21 50.00% Females 21 50.00% I have learned a little, but I have not practiced it at all 46 39.32% Males 21 45.65% Females 25 54.35% I have practiced, but I can't stick to it 9 7.69% Males 4 44.44% Females 5 55.56% I have been insisting on correction 7 5.98% Males 3 42.86% Females 4 57.14% Unknown 13 11.11% Males 8 61.54% Females 5 38.46% Total 117 100.00% 117 100.00% Table 7 Distribution of willingness to undergo corrective interventions Options Quantity Percentage Gender Quantity Percentage Yes 86 73.50% Males 41 47.67% Females 45 52.33% No 23 19.66% Males 11 47.83% Females 12 52.17% Unknown 8 6.84% Males 5 62.50% Females 3 37.50% Total 117 100.00% 117 100.00% 4. Discussion This study, focusing on adolescents as a vulnerable group, comprehensively analyzed the prevalence of mouth breathing behavior and its health impacts. The results indicate that mouth breathing is highly prevalent among adolescents and adversely affects their health in multiple ways, including abnormal maxillofacial development, dental malocclusion, and poor sleep quality. Given that adolescence is a critical period for growth and development, physical health and future quality of life are easily influenced by external conditions, particularly in cases of insufficient health awareness, limited family economic resources, or uneven educational distribution, making adolescents a high-risk group for health issues. To address this issue, this study proposes strategies such as strengthening health education, promoting early screening, optimizing intervention measures, and addressing students' health needs. These measures aim to enhance adolescents' awareness of mouth breathing issues, facilitate early detection and intervention, and mitigate its long-term health impacts. The study also calls for increased societal attention and resource allocation to adolescent health issues, particularly through collaborative efforts between schools and families, to create an equitable environment for adolescent health development. Future research should further explore specific intervention models and long-term effectiveness evaluations for this vulnerable group, considering factors such as family background and regional characteristics to provide more precise guidance for adolescent health management. It is hoped that this study will offer scientific references for healthcare institutions, educational departments, and policymakers, driving improvements and implementation of adolescent health interventions to better ensure the comprehensive healthy development of this group. According to the results of this study, some strategies and recommendations were given. Health education is the foundation for preventing and intervening in adolescent mouth breathing issues. Schools should incorporate content on mouth breathing into daily health education curricula, using lectures, specialized courses, and health knowledge competitions to help students understand the risks of mouth breathing and its potential impacts, such as facial changes, dental malocclusion, and sleep disorders[ 13 ]. At the family level, parent-teacher meetings, health manuals, and online training should be used to enhance parents' ability to identify early signs of mouth breathing, such as observing whether their children snore or experience dry mouth upon waking. Community health centers and local medical institutions should leverage health promotion days and free clinic activities to provide health education to vulnerable groups, ensuring widespread dissemination of health knowledge across all social strata. For varying degrees of mouth breathing behavior and related complications, diverse correction strategies should be offered. For students with mild issues, non-invasive interventions such as oral muscle training and nasal breathing correction devices are recommended[ 14 ]. These methods are simple, cost-effective, and suitable for promotion in schools and families. For students with tonsillar or adenoidal hypertrophy, otolaryngologists should conduct examinations, with surgical intervention when necessary[ 15 ], followed by postoperative oral function recovery training. Students with dental malocclusion can receive personalized orthodontic treatment at hospitals[ 16 ]. When selecting intervention measures, students' health status and family economic conditions should be considered to ensure that treatment plans are scientifically sound and practical. Early screening is a crucial means of reducing the harms of mouth breathing. Schools should incorporate mouth breathing-related indicators, such as dental alignment, jaw development, and snoring, into annual health check-ups[ 17 ], and flag suspected cases for parental intervention. Medical institutions can establish school-doctor collaboration mechanisms, dispatching professionals to schools for specialized screenings and providing preliminary diagnoses and recommendations for at-risk students[ 18 ]. In regions with weaker primary healthcare infrastructure, telemedicine technology can be utilized to enable real-time health assessments and guidance, improving screening coverage and efficiency[ 19 ]. Effective intervention for adolescent mouth breathing issues requires collaboration among schools, families, society, and medical institutions. Schools should maintain close communication with parents, providing timely feedback on students' correction progress and encouraging parents to assist in behavioral adjustments at home. At the societal level, governments and non-profit organizations should jointly conduct large-scale awareness campaigns, using health lectures, free clinics, and community health workshops to increase public awareness of mouth breathing issues. Medical institutions should provide technical support to schools and communities, regularly dispatching professional teams to participate in screenings and guidance. Additionally, research institutions should be encouraged to conduct epidemiological surveys and intervention effectiveness evaluations on mouth breathing, providing scientific evidence and technical support for optimizing policies and intervention measures, ensuring the long-term sustainability of health management efforts. 5. Conclusion This study comprehensively analyzes the prevalence of mouth breathing behavior and its health impacts, taking adolescents as representatives of vulnerable groups. The results showed that mouth breathing had a high incidence in adolescents and had adverse effects on health in many aspects, including maxillofacial dysplasia, dental deformities, and decreased sleep quality. As adolescents are at a critical stage of growth and development, their physical health and future quality of life are easily affected by external conditions, especially in the case of insufficient health awareness, limited family economic conditions or uneven educational resources, they are more likely to become high-risk groups for health risks. In order to deal with this problem, this study proposes to strengthen health education, promote early screening, optimize interventions, and pay attention to students' health needs. These measures aim to improve adolescents' awareness of oral respiratory problems, promote early detection and early intervention, and reduce their long-term impact on adolescent health. At the same time, the study calls on all sectors of society to pay more attention to adolescent health issues and invest resources, especially with the coordinated support of schools and families, to create a fair environment for the healthy development of adolescents. Future research should further explore the specific intervention models and long-term effect evaluation for adolescents, a special vulnerable group, and provide more accurate guidance for adolescent health management by combining factors such as different family backgrounds and regional characteristics. It is hoped that this study can provide scientific reference for medical institutions, education departments and policy makers, and promote the improvement and implementation of adolescent health interventions, so as to better ensure the comprehensive and healthy growth of this group. Declarations Funding Nursing Discipline Development Fund of Shanghai Ninth Peoples’ Hospital, Grant/Award Number: JYHL2024ZD02-Z2. Author Information Wenting Lu, Xiaowei Wu and Shengdan Yu are contributed equally to this article. Authors and Affiliations Department of Orthodontics, Shanghai Ninth Peoples’ Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China Wenting Lu, Xiaowei Wu, Shengdan Yu & Xiaogang Pan Department of Nursing, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China Lili Hou Authors’ Contributions Lu WT, Wu XW and Yu SD contributed to the investigation, analysis, original draft preparation, and manuscript review and editing. Pan XG and Hou LL contributed to the conceptualization, project administration, validation, and manuscript reviewing and editing. Corresponding Author Correspondence to Xiaogang Pan and Lili Hou. Acknowledgement All authors are grateful to thank the participants who provide kind cooperation in the current study. Ethics Declarations Ethics Approval and Consent to Participate The protocol was approved from the Institutional Research Ethics Committee of Shanghai Ninth Peoples’ Hospital (SH9H-2019-T305-9). Informed consent was obtained from all subjects’ parents or their legal guardians. We ensure that the study was carried out in accordance with the Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. Consent for publication Not applicable (N/A). Clinical Trail Number ： Not applicable (N/A). Availability of data and materials The data used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests None of the Authors have any conflicts of interest. References Lee DW, Kim JG, Yang YM: Influence of mouth breathing on atopic dermatitis risk and oral health in children: A population-based cross-sectional study . Journal of dental sciences 2021, 16 (1):178-185. Leal RB, Gomes MC, Granville-Garcia AF, Goes PS, de Menezes VA: Impact of breathing patterns on the quality of life of 9- to 10-year-old schoolchildren . American journal of rhinology & allergy 2016, 30 (5):147-152. Hitos SF, Arakaki R, Solé D, Weckx LL: Oral breathing and speech disorders in children . Jornal de pediatria 2013, 89 (4):361-365. Lildal TK, Boudewyns A, Kamperis K, Rittig S, Bertelsen JB, Holm J, Barrett TQ, Korsholm J, Abood A, Ovesen T: Outcome of tonsillotomy in children with obstructive sleep-disordered breathing . Sleep medicine 2024, 119 :73-79. Ieto V, Kayamori F, Montes MI, Hirata RP, Gregório MG, Alencar AM, Drager LF, Genta PR, Lorenzi-Filho G: Effects of Oropharyngeal Exercises on Snoring: A Randomized Trial . Chest 2015, 148 (3):683-691. Milkov M, Valcheva Z, Arnautska H, Peev S, Madjova CJSM: Oral breathing in children and its association with obstructive sleep apnea . 2019, 64 :S257. Suzuki M, Tanuma TJSM: Comparison between nasal and oral breathing in patients with obstructive sleep apnea: computational fluid dynamics . 2019, 64 :S368. Ballikaya E, Guciz Dogan B, Onay O, Uzamis Tekcicek M: Oral health status of children with mouth breathing due to adenotonsillar hypertrophy . International journal of pediatric otorhinolaryngology 2018, 113 :11-15. Chen TJ, Dong B, Dong Y, Li J, Ma Y, Liu D, Zhang Y, Xing Y, Zheng Y, Luo X et al : Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents . Lancet (London, England) 2024, 403 (10438):1808-1820. Chen E, Miller GE: Socioeconomic status and health: mediating and moderating factors . Annual review of clinical psychology 2013, 9 :723-749. Braveman P, Gottlieb L: The social determinants of health: it's time to consider the causes of the causes . Public health reports (Washington, DC : 1974) 2014, 129 Suppl 2 (Suppl 2):19-31. Felício CMd, Folha GA, Ferreira CLP, Medeiros APM: Expanded protocol of orofacial myofunctional evaluation with scores: Validity and reliability . International journal of pediatric otorhinolaryngology 2010, 74 (11):1230-1239. Blake H, Dawett B, Leighton P, Rose-Brady L, Deery C: School-Based Educational Intervention to Improve Children's Oral Health-Related Knowledge . Health promotion practice 2015, 16 (4):571-582. Kushida CA, Stevens J, Bennett M, Heit T, Klemp D, Raio D, Cozean J, Cozean C: Multicenter clinical trial for the treatment of obstructive sleep apnea with a non-permanent orthodontic intraoral device in children . European journal of pediatrics 2025, 184 (7):424. Huang H, Zhang L, Zhang Q, Zhong J, Fu L, Mou Y: Comparison of the efficacy of two surgical procedures on adenoidal hypertrophy in children . Archives de pediatrie : organe officiel de la Societe francaise de pediatrie 2020, 27 (2):72-78. Laniado, Orthodontics NJSi: The fragmentation of childrens' oral health: Access to care in pediatric dentistry and orthodontics . 2016:161-166. Inada E, Saitoh I, Kaihara Y, Yamasaki YJPDJ: Factors related to mouth-breathing syndrome and the influence of an incompetent lip seal on facial soft tissue form in children . 2021, 31 (1). Brener ND, Wheeler L, Wolfe LC, Vernon-Smiley M, Caldart-Olson L: Health services: results from the School Health Policies and Programs Study 2006 . The Journal of school health 2007, 77 (8):464-485. Kahn JM: Virtual visits--confronting the challenges of telemedicine . The New England journal of medicine 2015, 372 (18):1684-1685. Additional Declarations No competing interests reported. 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03:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7105349/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7105349/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-026-07853-2","type":"published","date":"2026-02-07T15:58:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88134993,"identity":"905763a0-5fe7-4131-8cdc-71271558f52f","added_by":"auto","created_at":"2025-08-01 21:36:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":105437,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of males and females with the habit of mouth breathing during sleep\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7105349/v1/b223ace23955c2a9ba675599.png"},{"id":88134994,"identity":"950e249b-ec23-4de8-8f8e-c00b3e7c068d","added_by":"auto","created_at":"2025-08-01 21:36:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":121208,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of males and females who have harmful habits in their daily lives\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7105349/v1/6c82a291a0872d8b23d650d7.png"},{"id":88135730,"identity":"c9897b7b-4f16-4a85-8130-ad8d45f9b77a","added_by":"auto","created_at":"2025-08-01 21:44:30","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":52644,"visible":true,"origin":"","legend":"\u003cp\u003ePresence of large tonsils/adenoids and the presence or absence of surgical treatment\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7105349/v1/a245b4a8a5ed5db2ddd16c8c.jpeg"},{"id":88135736,"identity":"d24a7668-7ce4-45b6-9e59-a12968b12b7e","added_by":"auto","created_at":"2025-08-01 21:44:30","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":92840,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of people who know about the health hazards of mouth breathing\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7105349/v1/b04561fab9f7c532d9659fe0.png"},{"id":88135001,"identity":"8ae75b5d-8880-4c46-a600-9497fcc2ec1b","added_by":"auto","created_at":"2025-08-01 21:36:30","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":128753,"visible":true,"origin":"","legend":"\u003cp\u003eConcerns about oral respiratory hazards\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7105349/v1/3155ddfa7d9bd095a67ea076.png"},{"id":88135734,"identity":"cc503f76-368b-45ba-b08c-b0e8a08f8077","added_by":"auto","created_at":"2025-08-01 21:44:30","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":433271,"visible":true,"origin":"","legend":"\u003cp\u003eAcceptance of mouth breathing interventions\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7105349/v1/aa1df361dd6c3a897b318651.png"},{"id":102234326,"identity":"c73e6070-e508-428f-9d9f-fc7e51649cd2","added_by":"auto","created_at":"2026-02-09 16:10:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2448668,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7105349/v1/04dea66a-33f9-4455-a1f4-463c6d36887a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigation on Mouth Breathing Behavior of Adolescents and Analysis of Health Intervention Strategies","fulltext":[{"header":"1. Background","content":"\u003cp\u003eMouth breathing refers to an abnormal respiratory pattern in which an individual breathes through the mouth instead of the nasal cavity during wakefulness or sleep. It is a common harmful oral habit in clinical practice and is easily overlooked in the early stages[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This phenomenon is particularly prevalent among adolescents, with the incidence of mouth breathing in children as high as 54.81%[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The causes may include obstructive factors, habitual behavior, or functional disorders[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Among them, obstructive mouth breathing is often caused by respiratory system diseases such as tonsillar and adenoid hypertrophy, allergic rhinitis, etc. Children with upper respiratory tract stenosis and obstruction cannot breathe normally through the nose and are forced to breathe through the mouth. They should seek timely medical attention at an otolaryngology department[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Habitual mouth breathing, formed through long-term mouth breathing, can be corrected through health education, lip muscle training, and other methods[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMouth breathing not only interferes with an individual's daily quality of life, but may also lead to a series of severe health consequences, including abnormal maxillofacial development, dental malocclusion, obstructive sleep apnea-hypopnea syndrome[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and even cognitive and metabolic disorders[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Consequently, increasing attention has been paid in pediatric and adolescent health research on the early identification and effective intervention of mouth breathing and its related complications[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdolescence is a critical period for growth and development, and health issues during this stage directly impact future quality of life and social adaptability[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, in practical health management, children and adolescents, as vulnerable groups, face higher health risks due to disparities in family economic status, uneven distribution of educational resources, and insufficient health awareness[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. For instance, adolescents from low-income families may miss early interventions for mouth breathing due to a lack of medical resources, leading to worsening health conditions. This health inequity urgently requires attention from researchers and policymakers[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study, based on a survey of mouth breathing among adolescents at Primary School in Shanghai, systematically analyzes the behavioral characteristics, prevalence trends, and potential health impacts of mouth breathing using a questionnaire survey method. The core highlight of this study lies in its special focus on adolescents as a vulnerable group, examining variables such as gender, age, and lifestyle habits to explore the mechanisms and specific impacts of mouth breathing behavior. Additionally, the study systematically reviews feasible options for intervention and treatment strategies for mouth breathing. Ultimately, the study aims to provide robust scientific data to healthcare institutions and policymakers, advocating for increased intervention and management of mouth breathing in adolescents and calling for more societal resources to effectively address this issue.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1. Study Subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study subjects were students from Primary School in Shanghai, aged 6 to 10 years. The selection of subjects considered a balance of gender, age, and class, covering diverse groups with potential differences in health awareness and behavioral habits, thereby providing varied data sources for studying mouth breathing behavior and its health impacts. Exclusion criteria: Questionnaires with \u0026ge;20% missing key data or containing logically inconsistent responses. Consent to participates were obtained from their parents or legal guardians.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Questionnaire Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a cluster sampling cross-sectional questionnaire design to systematically explore the prevalence of mouth breathing behavior, its health impacts, and intervention needs among adolescents. The core objective was to uncover behavioral characteristics and potential influencing factors through questionnaire data, providing a scientific basis for intervention strategy development.\u003c/p\u003e\n\u003cp\u003eThe questionnaire was designed according to the expanded protocol of orofacial myofunctional evaluation scores proposed by Medeiros et al.[12] The questionnaire was divided into the following modules, comprehensively considering the mouth breathing behavioral status, health impacts, and intervention needs:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026bull;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; Part 1: Basic Information\u0026nbsp;\u003c/strong\u003e\u0026ndash;\u0026nbsp;Including the subjects\u0026apos; gender, ethnicity, and age as basic classification criteria for subsequent differential analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePart 2: Behavior and Habits\u0026nbsp;\u003c/strong\u003e\u0026ndash;\u0026nbsp;Investigated whether subjects were aware of mouth breathing, the existence of mouth breathing habit and other harmful behaviors (e.g., nail-biting, lip-licking), and sleep-related issues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePart 3: Health Status and Complications\u003c/strong\u003e \u0026ndash; Surveyed common symptoms of mouth breathing (e.g., snoring, dry mouth), facial changes, dental issues (e.g., irregular dentition, protruded upper teeth), tonsillar or adenoidal hypertrophy, and whether related surgeries had been performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026bull;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp; Part 4: Cognition and Attitudes\u003c/strong\u003e \u0026ndash; Assessed subjects\u0026apos; awareness of the negative impacts of mouth breathing, understanding of its health risks, attempts at correction methods (e.g., lip-closing training, taping), and practice status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026bull;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Part 5: Intervention Needs and Preferences\u0026nbsp;\u003c/strong\u003e\u0026ndash;\u0026nbsp;Surveyed subjects\u0026apos; willingness to accept intervention for mouth breathing and preferred intervention methods (e.g., medication, surgery, orthodontic treatment, oral muscle training).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was primarily conducted using Excel. Data were first entered and cleaned, with outliers removed. Excel\u0026apos;s statistical functions were then used to calculate frequencies and percentages for descriptive statistical analysis. Charts, including bar graphs and pie charts, were created to present the results.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Overview\u003c/h2\u003e\u003cp\u003eA total of 124 questionnaires were distributed, with 117 collected, yielding a response rate of 94.35%. Among these, 117 were valid, accounting for 100% of the collected responses, while 7 were invalid, representing 5.65% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Gender distribution showed 48.72% male and 51.28% female respondents (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Age distribution indicated that 8 and 9 years old constituted the majority, at 30.77% and 35.90%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Overall, the questionnaire response quality was high, with a reasonable sample distribution, providing a reliable data foundation for subsequent analysis.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNumber of participants in mouth breathing behavior survey of adolescents\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCounting - the number of questionnaires\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eValid questionnaires\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.35%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInvalid questionnaires\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.65%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGender statistics of mouth breathing behavior survey among adolescents\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePopulation counts - gender statistics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48.72%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51.28%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAge distribution of participants in the oral respiratory behavior survey\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.85%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.24%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30.77%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.97%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.27%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Current Status of Mouth Breathing Behavior in Adolescents\u003c/h2\u003e\u003cp\u003eSubsequently, the current study analyzed the frequency of mouth breathing in adolescents and its relationship with lifestyle habits such as sleep quality and harmful habits, as well as behavioral characteristics and potential triggers. Results showed that 11.97% of students frequently engaged in mouth breathing, 56.41% occasionally did so, and only 30.77% reported never having the habit, indicating that approximately 68% of students exhibited mouth breathing behavior (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). By gender, boys had a slightly higher prevalence of frequent mouth breathing (35.04%) than girls (33.33%), though the overall difference was minimal (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Additionally, 12.82% of students frequently exhibited harmful habits such as nail-biting or lip-licking, while 41.02% occasionally did so, suggesting a potential link between these behaviors and mouth breathing. Boys had a higher prevalence of harmful habits (8.55%) than girls (4.27%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), indicating that boys may be more susceptible to certain harmful behavioral patterns. Regarding sleep, 62.39% of students occasionally felt fatigued or drowsy, while 8.55% frequently did so (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), suggesting that mouth breathing may negatively impact sleep quality.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eProportion of people who are tired or unable to wake up\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003cp\u003e(total)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003cp\u003e(total)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOften\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e8.55%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e40.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e60.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOccasionally\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e62.39%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e53.42%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e46.58%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e29.06%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e41.18%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e58.82%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100.00%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e100.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Main Complications of Mouth Breathing\u003c/h2\u003e\u003cp\u003eFurthermore, this study analyzed the association between mouth breathing and health issues, and assessed its potential impacts on dental health, facial structure, sleep quality, and other health conditions subsequently. The survey revealed that 55.56% of students had irregular dentition, while 17.09% exhibited protruding upper teeth (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), indicating that mouth breathing may significantly affect maxillofacial development. Additionally, 28.21% of students reported concerns about facial changes caused by mouth breathing (e.g., elongation of the lower 1/3 of the face, bite issues). Furthermore, 36.75% of students experienced snoring, 28.21% reported dry mouth upon waking, and 39.32% frequently breathed with their mouths open. These findings reflect the adverse effects of mouth breathing on multiple aspects of health. Notably, 13.68% of students were reported to have tonsillar or adenoidal hypertrophy, yet only 1.71% had undergone related surgery (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), suggesting that some issues were not resolved in a timely manner.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eWhether there is health problems related to mouth breathing\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003cp\u003e(total)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003cp\u003e(total)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSleep snoring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36.75%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e48.84%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e51.16%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDry mouthing upon waking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.21%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e42.42%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e57.58%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrequently open your mouth unconsciously\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.32%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e45.65%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e54.35%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe upper anterior teeth protrude forward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.09%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e45.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e55.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCrooked teeth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55.56%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e49.23%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e50.77%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100.00%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.4. Adolescents' Awareness and Practices Regarding Mouth Breathing\u003c/h2\u003e\u003cp\u003eThe current study also assessed the awareness of mouth breathing and corrective practices of adolescents and their parents, and explored the current state of health education and existing challenges. Results showed that only 51.29% of students were aware of the health risks associated with mouth breathing, with some gender differences. Among girls, 28.21% reported understanding the harms of mouth breathing, compared to 23.08% of boys (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), indicating that girls may be more sensitive to health awareness and knowledge acquisition. The most concerning risks of mouth breathing for students and parents were facial changes (28.21%) and oral diseases (23.93%), followed by sleep quality decline (11.97%) and restricted growth and development (22.22%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Regarding corrective practices, 35.90% of students had no understanding of correction methods, 7.69% had attempted correction but failed to persist, and only 5.98% consistently practiced correction (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). This suggests that, while some parents and students are aware of the risks of mouth breathing, challenges such as difficulty in persistence and insufficient resources hinder effective practice, highlighting the need for enhanced health education and supportive interventions. Moreover, 73.50% of students were willing to accept intervention, while only 19.66% explicitly refused, reflecting a high demand for intervention (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Regarding intervention methods, 41.03% of students preferred orthodontic treatment, 29.91% favored oral muscle training, while medication (14.53%) and surgery (0.85%) had lower acceptance rates (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e), indicating a preference for non-invasive, practical intervention methods.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of whether corrective measures were known or tried\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003cp\u003e(total)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003cp\u003e(total)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI don't understand at all\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.90%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e50.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e50.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI have learned a little, but I have not practiced it at all\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.32%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e45.65%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e54.35%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI have practiced, but I can't stick to it\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.69%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e44.44%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e55.56%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI have been insisting on correction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.98%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e42.86%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e57.14%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.11%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e61.54%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e38.46%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100.00%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e100.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of willingness to undergo corrective interventions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eQuantity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73.50%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e47.67%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e52.33%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.66%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e47.83%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e52.17%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.84%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e62.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFemales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e37.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e100.00%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e100.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study, focusing on adolescents as a vulnerable group, comprehensively analyzed the prevalence of mouth breathing behavior and its health impacts. The results indicate that mouth breathing is highly prevalent among adolescents and adversely affects their health in multiple ways, including abnormal maxillofacial development, dental malocclusion, and poor sleep quality. Given that adolescence is a critical period for growth and development, physical health and future quality of life are easily influenced by external conditions, particularly in cases of insufficient health awareness, limited family economic resources, or uneven educational distribution, making adolescents a high-risk group for health issues.\u003c/p\u003e\u003cp\u003eTo address this issue, this study proposes strategies such as strengthening health education, promoting early screening, optimizing intervention measures, and addressing students' health needs. These measures aim to enhance adolescents' awareness of mouth breathing issues, facilitate early detection and intervention, and mitigate its long-term health impacts. The study also calls for increased societal attention and resource allocation to adolescent health issues, particularly through collaborative efforts between schools and families, to create an equitable environment for adolescent health development.\u003c/p\u003e\u003cp\u003eFuture research should further explore specific intervention models and long-term effectiveness evaluations for this vulnerable group, considering factors such as family background and regional characteristics to provide more precise guidance for adolescent health management. It is hoped that this study will offer scientific references for healthcare institutions, educational departments, and policymakers, driving improvements and implementation of adolescent health interventions to better ensure the comprehensive healthy development of this group.\u003c/p\u003e\u003cp\u003eAccording to the results of this study, some strategies and recommendations were given.\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHealth education is the foundation for preventing and intervening in adolescent mouth breathing issues. Schools should incorporate content on mouth breathing into daily health education curricula, using lectures, specialized courses, and health knowledge competitions to help students understand the risks of mouth breathing and its potential impacts, such as facial changes, dental malocclusion, and sleep disorders[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. At the family level, parent-teacher meetings, health manuals, and online training should be used to enhance parents' ability to identify early signs of mouth breathing, such as observing whether their children snore or experience dry mouth upon waking. Community health centers and local medical institutions should leverage health promotion days and free clinic activities to provide health education to vulnerable groups, ensuring widespread dissemination of health knowledge across all social strata.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFor varying degrees of mouth breathing behavior and related complications, diverse correction strategies should be offered. For students with mild issues, non-invasive interventions such as oral muscle training and nasal breathing correction devices are recommended[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These methods are simple, cost-effective, and suitable for promotion in schools and families. For students with tonsillar or adenoidal hypertrophy, otolaryngologists should conduct examinations, with surgical intervention when necessary[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], followed by postoperative oral function recovery training. Students with dental malocclusion can receive personalized orthodontic treatment at hospitals[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. When selecting intervention measures, students' health status and family economic conditions should be considered to ensure that treatment plans are scientifically sound and practical.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eEarly screening is a crucial means of reducing the harms of mouth breathing. Schools should incorporate mouth breathing-related indicators, such as dental alignment, jaw development, and snoring, into annual health check-ups[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and flag suspected cases for parental intervention. Medical institutions can establish school-doctor collaboration mechanisms, dispatching professionals to schools for specialized screenings and providing preliminary diagnoses and recommendations for at-risk students[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In regions with weaker primary healthcare infrastructure, telemedicine technology can be utilized to enable real-time health assessments and guidance, improving screening coverage and efficiency[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eEffective intervention for adolescent mouth breathing issues requires collaboration among schools, families, society, and medical institutions. Schools should maintain close communication with parents, providing timely feedback on students' correction progress and encouraging parents to assist in behavioral adjustments at home. At the societal level, governments and non-profit organizations should jointly conduct large-scale awareness campaigns, using health lectures, free clinics, and community health workshops to increase public awareness of mouth breathing issues. Medical institutions should provide technical support to schools and communities, regularly dispatching professional teams to participate in screenings and guidance. Additionally, research institutions should be encouraged to conduct epidemiological surveys and intervention effectiveness evaluations on mouth breathing, providing scientific evidence and technical support for optimizing policies and intervention measures, ensuring the long-term sustainability of health management efforts.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study comprehensively analyzes the prevalence of mouth breathing behavior and its health impacts, taking adolescents as representatives of vulnerable groups. The results showed that mouth breathing had a high incidence in adolescents and had adverse effects on health in many aspects, including maxillofacial dysplasia, dental deformities, and decreased sleep quality. As adolescents are at a critical stage of growth and development, their physical health and future quality of life are easily affected by external conditions, especially in the case of insufficient health awareness, limited family economic conditions or uneven educational resources, they are more likely to become high-risk groups for health risks.\u003c/p\u003e\u003cp\u003eIn order to deal with this problem, this study proposes to strengthen health education, promote early screening, optimize interventions, and pay attention to students' health needs. These measures aim to improve adolescents' awareness of oral respiratory problems, promote early detection and early intervention, and reduce their long-term impact on adolescent health. At the same time, the study calls on all sectors of society to pay more attention to adolescent health issues and invest resources, especially with the coordinated support of schools and families, to create a fair environment for the healthy development of adolescents.\u003c/p\u003e\u003cp\u003eFuture research should further explore the specific intervention models and long-term effect evaluation for adolescents, a special vulnerable group, and provide more accurate guidance for adolescent health management by combining factors such as different family backgrounds and regional characteristics. It is hoped that this study can provide scientific reference for medical institutions, education departments and policy makers, and promote the improvement and implementation of adolescent health interventions, so as to better ensure the comprehensive and healthy growth of this group.\u003c/p\u003e"},{"header":"Declarations","content":"\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eNursing Discipline Development Fund of Shanghai Ninth Peoples\u0026rsquo;\u0026nbsp;Hospital, Grant/Award Number: JYHL2024ZD02-Z2.\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003e\u003cstrong\u003eAuthor Information\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eWenting Lu, Xiaowei Wu and Shengdan Yu are contributed equally to this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Orthodontics, Shanghai Ninth Peoples\u0026rsquo; Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology \u0026amp; Shanghai Research Institute of Stomatology, Shanghai 200011, China\u003c/p\u003e\n\u003cp\u003eWenting Lu, Xiaowei Wu, Shengdan Yu \u0026amp; Xiaogang Pan\u003c/p\u003e\n\u003cp\u003eDepartment of Nursing, Shanghai Ninth People\u0026apos;s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China\u003c/p\u003e\n\u003cp\u003eLili Hou\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLu WT, Wu XW and Yu SD contributed to the investigation, analysis, original draft preparation, and manuscript review and editing. Pan XG and Hou LL contributed to the conceptualization, project administration, validation, and manuscript reviewing and editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding Author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Xiaogang Pan and Lili Hou.\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eAll authors are grateful to thank the participants who provide kind cooperation in the current study.\u0026nbsp;\u003c/p\u003e\n\u003col start=\"4\"\u003e\n \u003cli\u003e\u003cstrong\u003eEthics Declarations\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol was approved from the Institutional Research Ethics Committee of Shanghai Ninth Peoples\u0026rsquo; Hospital (SH9H-2019-T305-9). Informed consent was obtained from all subjects\u0026rsquo; parents or their legal guardians. We ensure that the study was carried out in accordance with the Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable (N/A).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trail Number\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable (N/A).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the Authors have any conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLee DW, Kim JG, Yang YM: \u003cstrong\u003eInfluence of mouth breathing on atopic dermatitis risk and oral health in children: A population-based cross-sectional study\u003c/strong\u003e. \u003cem\u003eJournal of dental sciences \u003c/em\u003e2021, \u003cstrong\u003e16\u003c/strong\u003e(1):178-185.\u003c/li\u003e\n\u003cli\u003eLeal RB, Gomes MC, Granville-Garcia AF, Goes PS, de Menezes VA: \u003cstrong\u003eImpact of breathing patterns on the quality of life of 9- to 10-year-old schoolchildren\u003c/strong\u003e. \u003cem\u003eAmerican journal of rhinology \u0026amp; allergy \u003c/em\u003e2016, \u003cstrong\u003e30\u003c/strong\u003e(5):147-152.\u003c/li\u003e\n\u003cli\u003eHitos SF, Arakaki R, Sol\u0026eacute; D, Weckx LL: \u003cstrong\u003eOral breathing and speech disorders in children\u003c/strong\u003e. \u003cem\u003eJornal de pediatria \u003c/em\u003e2013, \u003cstrong\u003e89\u003c/strong\u003e(4):361-365.\u003c/li\u003e\n\u003cli\u003eLildal TK, Boudewyns A, Kamperis K, Rittig S, Bertelsen JB, Holm J, Barrett TQ, Korsholm J, Abood A, Ovesen T: \u003cstrong\u003eOutcome of tonsillotomy in children with obstructive sleep-disordered breathing\u003c/strong\u003e. \u003cem\u003eSleep medicine \u003c/em\u003e2024, \u003cstrong\u003e119\u003c/strong\u003e:73-79.\u003c/li\u003e\n\u003cli\u003eIeto V, Kayamori F, Montes MI, Hirata RP, Greg\u0026oacute;rio MG, Alencar AM, Drager LF, Genta PR, Lorenzi-Filho G: \u003cstrong\u003eEffects of Oropharyngeal Exercises on Snoring: A Randomized Trial\u003c/strong\u003e. \u003cem\u003eChest \u003c/em\u003e2015, \u003cstrong\u003e148\u003c/strong\u003e(3):683-691.\u003c/li\u003e\n\u003cli\u003eMilkov M, Valcheva Z, Arnautska H, Peev S, Madjova CJSM: \u003cstrong\u003eOral breathing in children and its association with obstructive sleep apnea\u003c/strong\u003e. 2019, \u003cstrong\u003e64\u003c/strong\u003e:S257.\u003c/li\u003e\n\u003cli\u003eSuzuki M, Tanuma TJSM: \u003cstrong\u003eComparison between nasal and oral breathing in patients with obstructive sleep apnea: computational fluid dynamics\u003c/strong\u003e. 2019, \u003cstrong\u003e64\u003c/strong\u003e:S368.\u003c/li\u003e\n\u003cli\u003eBallikaya E, Guciz Dogan B, Onay O, Uzamis Tekcicek M: \u003cstrong\u003eOral health status of children with mouth breathing due to adenotonsillar hypertrophy\u003c/strong\u003e. \u003cem\u003eInternational journal of pediatric otorhinolaryngology \u003c/em\u003e2018, \u003cstrong\u003e113\u003c/strong\u003e:11-15.\u003c/li\u003e\n\u003cli\u003eChen TJ, Dong B, Dong Y, Li J, Ma Y, Liu D, Zhang Y, Xing Y, Zheng Y, Luo X\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eMatching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents\u003c/strong\u003e. \u003cem\u003eLancet (London, England) \u003c/em\u003e2024, \u003cstrong\u003e403\u003c/strong\u003e(10438):1808-1820.\u003c/li\u003e\n\u003cli\u003eChen E, Miller GE: \u003cstrong\u003eSocioeconomic status and health: mediating and moderating factors\u003c/strong\u003e. \u003cem\u003eAnnual review of clinical psychology \u003c/em\u003e2013, \u003cstrong\u003e9\u003c/strong\u003e:723-749.\u003c/li\u003e\n\u003cli\u003eBraveman P, Gottlieb L: \u003cstrong\u003eThe social determinants of health: it\u0026apos;s time to consider the causes of the causes\u003c/strong\u003e. \u003cem\u003ePublic health reports (Washington, DC : 1974) \u003c/em\u003e2014, \u003cstrong\u003e129 Suppl 2\u003c/strong\u003e(Suppl 2):19-31.\u003c/li\u003e\n\u003cli\u003eFel\u0026iacute;cio CMd, Folha GA, Ferreira CLP, Medeiros APM: \u003cstrong\u003eExpanded protocol of orofacial myofunctional evaluation with scores: Validity and reliability\u003c/strong\u003e. \u003cem\u003eInternational journal of pediatric otorhinolaryngology \u003c/em\u003e2010, \u003cstrong\u003e74\u003c/strong\u003e(11):1230-1239.\u003c/li\u003e\n\u003cli\u003eBlake H, Dawett B, Leighton P, Rose-Brady L, Deery C: \u003cstrong\u003eSchool-Based Educational Intervention to Improve Children\u0026apos;s Oral Health-Related Knowledge\u003c/strong\u003e. \u003cem\u003eHealth promotion practice \u003c/em\u003e2015, \u003cstrong\u003e16\u003c/strong\u003e(4):571-582.\u003c/li\u003e\n\u003cli\u003eKushida CA, Stevens J, Bennett M, Heit T, Klemp D, Raio D, Cozean J, Cozean C: \u003cstrong\u003eMulticenter clinical trial for the treatment of obstructive sleep apnea with a non-permanent orthodontic intraoral device in children\u003c/strong\u003e. \u003cem\u003eEuropean journal of pediatrics \u003c/em\u003e2025, \u003cstrong\u003e184\u003c/strong\u003e(7):424.\u003c/li\u003e\n\u003cli\u003eHuang H, Zhang L, Zhang Q, Zhong J, Fu L, Mou Y: \u003cstrong\u003eComparison of the efficacy of two surgical procedures on adenoidal hypertrophy in children\u003c/strong\u003e. \u003cem\u003eArchives de pediatrie : organe officiel de la Societe francaise de pediatrie \u003c/em\u003e2020, \u003cstrong\u003e27\u003c/strong\u003e(2):72-78.\u003c/li\u003e\n\u003cli\u003eLaniado, Orthodontics NJSi: \u003cstrong\u003eThe fragmentation of childrens\u0026apos; oral health: Access to care in pediatric dentistry and orthodontics\u003c/strong\u003e. 2016:161-166.\u003c/li\u003e\n\u003cli\u003eInada E, Saitoh I, Kaihara Y, Yamasaki YJPDJ: \u003cstrong\u003eFactors related to mouth-breathing syndrome and the influence of an incompetent lip seal on facial soft tissue form in children\u003c/strong\u003e. 2021, \u003cstrong\u003e31\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eBrener ND, Wheeler L, Wolfe LC, Vernon-Smiley M, Caldart-Olson L: \u003cstrong\u003eHealth services: results from the School Health Policies and Programs Study 2006\u003c/strong\u003e. \u003cem\u003eThe Journal of school health \u003c/em\u003e2007, \u003cstrong\u003e77\u003c/strong\u003e(8):464-485.\u003c/li\u003e\n\u003cli\u003eKahn JM: \u003cstrong\u003eVirtual visits--confronting the challenges of telemedicine\u003c/strong\u003e. \u003cem\u003eThe New England journal of medicine \u003c/em\u003e2015, \u003cstrong\u003e372\u003c/strong\u003e(18):1684-1685.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mouth breathing, adolescents, health impact, intervention strategy, questionnaire survey method","lastPublishedDoi":"10.21203/rs.3.rs-7105349/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7105349/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThis study focuses on adolescents and aims to investigate the prevalence of mouth breathing, discover its associated health impacts, and explore the intervention needs of mouth breathing, which provide scientific basis for developing effective intervention measures and management strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional study employed questionnaire survey method to investigate the mouth breathing behavior of students aged 6 to 10 at Primary School in Shanghai. The questionnaire includes basic information, behavioral habits, health status, cognition and attitudes, as well as intervention needs and preferences. The collected information was summarized after cleaning and statistically analyzing the data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe survey showed that about 68% of teenagers have mouth breathing problems, mainly manifested as malocclusion, facial changes, and decreased sleep quality and other health problems. The incidence of mouth breathing caused by harmful habits is higher in boys than girls., while girls have higher awareness of harm and willingness to correct. Although 73.5% of students are willing to accept intervention, 35.9% have lacked knowledge of correction methods, and most of them prefer non-invasive correction methods.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eMouth breathing has a high incidence in adolescents and significantly affects their health. This study recommends strengthening health education, promoting early screening, optimizing intervention measures, and paying attention to the health needs of vulnerable groups to improve the level of adolescent health management and promote health equity\u003c/p\u003e","manuscriptTitle":"Investigation on Mouth Breathing Behavior of Adolescents and Analysis of Health Intervention Strategies","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-01 21:36:25","doi":"10.21203/rs.3.rs-7105349/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-18T07:23:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T03:24:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-17T04:42:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-08T22:09:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333970654759727160728922221134778729552","date":"2025-08-06T01:07:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"258791217082286543931442737266861594341","date":"2025-08-04T03:39:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-29T06:00:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214223307528259289033279287893752297807","date":"2025-07-29T05:20:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13344993888072906187726284319401930740","date":"2025-07-29T02:55:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-29T00:09:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-28T23:20:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-28T06:49:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-27T05:48:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-07-27T04:16:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ee902b23-c686-4195-9ea8-502a17e372f1","owner":[],"postedDate":"August 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T16:05:37+00:00","versionOfRecord":{"articleIdentity":"rs-7105349","link":"https://doi.org/10.1186/s12903-026-07853-2","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2026-02-07 15:58:17","publishedOnDateReadable":"February 7th, 2026"},"versionCreatedAt":"2025-08-01 21:36:25","video":"","vorDoi":"10.1186/s12903-026-07853-2","vorDoiUrl":"https://doi.org/10.1186/s12903-026-07853-2","workflowStages":[]},"version":"v1","identity":"rs-7105349","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7105349","identity":"rs-7105349","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}