# Mouth Breathing and Orthodontic Referral in Pediatric Practice: A Cross-Sectional Survey

## TL;DR

This study explores how aware Turkish pediatricians are of mouth breathing's effects on children's facial development and how often they refer patients to orthodontists.

## Contribution

The study identifies factors influencing referral practices, showing that treatment attitudes, not just awareness, affect referrals.

## Key findings

- Most pediatricians are aware of mouth breathing's link to craniofacial issues, but few know specific orthodontic treatments.
- Referral behavior is more strongly tied to treatment attitudes and clinical experience than to awareness alone.

## Abstract

Objectives: Mouth breathing in children may lead to craniofacial anomalies such as maxillary constriction. Pediatricians play a crucial role in recognizing early signs and making timely referrals. This study aimed to evaluate the awareness of pediatricians regarding mouth breathing and its orthodontic implications and to assess the impact of their treatment attitudes and clinical experience on referral practices. Methods: A 20-item online questionnaire was completed by 110 volunteer pediatricians from various regions of Türkiye via professional networks. The survey included items on awareness, treatment attitudes, referral behaviors, and demographics. Composite scores for awareness and orthodontic treatment attitude were calculated and included in the analysis. Data were analyzed using chi-square tests, Spearman correlation, and binary logistic regression. Results: Most pediatricians were aware of the link between mouth breathing and craniofacial issues (awareness rate: 73.6%), yet only 14.5% were familiar with specific orthodontic treatment approaches such as maxillary expansion. Although 70.9% expressed a desire for further training, only 25.5% reported frequently referring patients for orthodontic evaluation. Referral behavior was significantly associated with both clinical experience (p = 0.004) and orthodontic treatment attitude scores (p = 0.004) but not with awareness scores (p = 0.12). Conclusions: Although pediatricians in Türkiye demonstrate relatively high awareness regarding the consequences of mouth breathing, referral practices remain limited. Attitudinal orientation toward orthodontic treatment may play a more influential role in referral behavior than awareness alone.