Abstract
Objectives
Systemic and local problems may lead to the disruption of craniofacial growth and development during growth periods. However, no studies have demonstrated the negative effects of the coronavirus disease 2019 (COVID-19) on the development of oral function in children. In this study, we aimed to investigate whether the COVID-19 pandemic has influenced the development of oral function in children.
Materials and methods
The study participants comprised children who visited public or 58 private dental clinics after the COVID-19 pandemic. The questionnaire comprised 66 items regarding current medical conditions and lifestyle habits that are linked to oral function. The survey was a self-administered questionnaire or a web-based questionnaire using Google Forms.
Results
Compared to our 2014 survey (Nogami et al., 2014), the results of 599 children (282 boys and 317 girls; aged 3–12 years; mean age, 7.8 years, standard deviation, 2.4 years) who were included in the study showed a remarkable increase in their responses for the following questions: “Difficulty maintaining nasal breathing for more than a minute with one’s mouth closed,” “incompetent lip seal,” “round shoulders,” “thick lips,” “dry lips,” “chapped lips,” “morning breath,” “inverted V-shaped upper lip,” “loose lips,” and “frequent dry mouth.”
Conclusion
Systemic and local problems can be categorized into four factors, namely (1) poor sleep habits, (2) commonly observed eating habits, (3) nasal disorders, and (4) general motor functions. Evident from the current study, the COVID-19 pandemic has negatively affected the systemic and oral health of children.
List of abbreviations
COVID-19
Coronavirus disease 2019
ILS
Incompetent lip seal
1
Introduction
The healthy development of oral function in children is important not only for the development of good dental occlusion but also for the healthy growth and development of the whole body. The masticatory ability of children affects their physique and physical functions [ ]. To appropriately diagnose the development of oral function in children, it is necessary to first screen them from various perspectives, including oral findings, general condition, and daily life [ , ].
The coronavirus disease 2019 (COVID-19) pandemic, which has become more severe since 2020, has placed major restrictions on various socioeconomic activities for the protection against coronary disease, forcing many people to lead a different lifestyle [ ]. The environment surrounding children was also severely affected, and many studies have shown that anti -coronavirus measures negatively influence the lifestyle and health of children [ , ]. Several studies have demonstrated increased mental health problems [ ], poor sleep quality [ ], lack of physical activity, and weight gain . In addition, COVID-19 reduced academic achievement among preschool children [ ]. Although the pandemic has been considered to have a negative impact on the development of oral function in children, to our knowledge, no studies have demonstrated the negative effects of the corona countermeasures. This study aimed to test the hypothesis that the development of oral function in children was affected by the COVID-19 pandemic.
2
Methods
2.1
Participants
The study participants were preschool and elementary school students aged 3–12 years who visited public or 58 private dental clinics specializing in pediatric dentistry throughout Japan. All patients were children without serious dental caries, malocclusion, or mandibular dysfunction. The survey was a self-administered questionnaire or a web-based questionnaire using Google Forms and were completed by parents or guardians. The survey period was from October 1, 2023, to January 31, 2024. This study was conducted according to the principles of the Declaration of Helsinki and was approved by the Epidemiological Ethics Committee of Asahi University (No. 35012). Informed consent was obtained from all participants and their parents.
2.2
Questionnaire
We adopted a questionnaire that was similar to our previous national survey conducted in 2014, which was before the COVID-19 pandemic [ ]. The questionnaire consisted of 66 items regarding current medical conditions and lifestyle habits that may be linked to oral function ( Table 1 ). A two-point scale (yes/no) was used for daily health conditions, current medical conditions, and past medical history; a four-point scale (yes, somewhat yes, somewhat no, or no) was used for lifestyle habits. Lifestyle habits were categorized into 11 major categories.
| Category | Item no. | Question items |
|---|---|---|
| Current medical condition and past medical history | Q1 | Asthma |
| Q2 | Allergic rhinitis | |
| Q3 | Adenoid hypertrophy | |
| Q4 | Bronchitis | |
| Q5 | Otitis media | |
| Q6 | Pollinosis | |
| Q7 | Does your child catch a cold more than twice a year? | |
| Q8 | Does your child have a high fever of 39° Celsius or higher more than twice a year? | |
| Q9 | Does your child have swollen tonsils more than twice a year? | |
| Daily habits | Q10 | Does your child get tired easily? |
| Q11 | Is your child a good riser? | |
| Q12 | Is your child good at exercising? | |
| Q13 | Is your child a restless sleeper? | |
| Q14 | Does your child carry a heavy backpack regularly? | |
| Q15 | Does your child have round shoulders? | |
| Q16 | Does your child blink often? | |
| Ear and nose conditions | Q17 | Does your nose become stuffed easily during the day? |
| Q18 | Does your nose become stuffed easily while sleeping? | |
| Q19 | Is your child a habitual snorer? | |
| Q20 | Does your child often have a runny nose? | |
| Q21 | Does your child sneeze often? | |
| Q22 | Does your child often have a nosebleed? | |
| Q23 | Does your child often fail to listen? | |
| Dry mouth | Q24 | Does your child often feel thirsty? |
| Q25 | Is your child’s mouth often dry? | |
| Bad breath | Q26 | Does your child have bad breath in the morning? |
| Q27 | Does your child have bad breath during day? | |
| Speech function | Q28 | Does your child have poor articulation? |
| Q29 | Can your child talk clearly? | |
| Oral function | Q30 | Is your child’s mouth often open during the day? |
| Q31 | Does your child sleep with their mouth open? | |
| Q32 | Can your child breathe through their nose for more than a minute while keeping your mouth closed? | |
| Q33 | Can your child rince their mouth for more than a minute? | |
| Q34 | Can your child gargle? | |
| Q35 | Can your child drink with a straw? | |
| Q36 | Can your child blow out a candle? | |
| Lip condition | Q37 | Are your child’s lips chpped ? |
| Q38 | Are your child’s lips thick? | |
| Q39 | Is your child’supper lip turned upward? | |
| Q40 | Are your child’s lips droopy? | |
| Q41 | Are your child’s lips often cracked? | |
| Q42 | Are your child’s teeth visible between her/his upper and lower lips? | |
| Teeth and gum | Q43 | Are your child’s gums often swollen? |
| Q44 | Does your child have any bloack or gray discoloration on their gums？ | |
| Q45 | Does your child often have canker sores? | |
| Q46 | Are your child’s teeth easily stained? | |
| Q47 | Does your child have tartar build-up? | |
| Dentition and occlusion | Q48 | Does your child have an overbite? |
| Q49 | Does your child have an under bite? | |
| Q50 | Does your child have an anterior open bite? | |
| Eating and drinking habits | Q51 | Is your child’s meal portion small? |
| Q52 | Does your child prefer soft food? | |
| Q53 | Does your child stuff their mouth with food all at once? | |
| Q54 | Does your child swallow their food with the help of a drink? | |
| Q55 | Does your child often drink water or milk during meals? | |
| Q56 | Does your child eat fast? | |
| Q57 | Is your child a picky eater? | |
| Q58 | Does your child tend to swallow without chewing well? | |
| Q59 | Is your child a noisy eater? | |
| Q60 | Does your child keep their mouth closed when they eats? | |
| Q61 | Does your child often choke while eating? | |
| Q62 | Does your child often eat fruits? | |
| Q63 | Does your child consume more than 200 cc of beverages (excluding soups) during meals? | |
| Q64 | Does your child take a long time to finish a meal? | |
| Q65 | Does your child have food left in their mouth for a long time? |
2.3
Statistical analyses
Data were analyzed using descriptive statistics, including frequency and percentages. We analyzed the distribution of responses for the common items between the current survey and the survey conducted before the COVID-19 pandemic. In addition, we defined the question item Q30: “Is your child’s mouth often open during the day?” as the percentage of incompetent lip seal (ILS) in this study. Statistical analyses were performed using the IBM SPSS Statistics for Windows (version 27; SPSS Inc., Tokyo, Japan).
3
Results
Questionnaire responses were obtained from 599 children aged 3–12 years (282 boys and 317 girls; mean age, 7.8 years, standard deviation, 2.4 years; Table 2 ). The frequencies of responses regarding current medical conditions or medical histories are shown in Table 3 . Compared with the results of the surveys conducted before the COVID-19 pandemic, the incidences of otitis media and bronchitis decreased by 21.2% and 14.4%, respectively. The incidences of hay fever and allergic rhinitis showed smaller decreases (4.0% and 3.6%, respectively).
| Age (years) | Number of subjects | |||
|---|---|---|---|---|
| Boys | Girls | Total (%) | ||
| 3 | 14 | 10 | 24 | (4.0) |
| 4 | 26 | 32 | 58 | (9.7) |
| 5 | 29 | 38 | 67 | (11.2) |
| 6 | 53 | 43 | 96 | (16.0) |
| 7 | 34 | 41 | 75 | (12.5) |
| 8 | 34 | 47 | 81 | (13.5) |
| 9 | 31 | 38 | 69 | (11.5) |
| 10 | 23 | 27 | 50 | (8.3) |
| 11 | 23 | 29 | 52 | (8.7) |
| 12 | 15 | 12 | 27 | (4.5) |
| Total (%) | 282 (47.1) | 317 (52.9) | 599 | (100.0) |
| Item no. | Question items | Survey | Responses of the questionnaire | |||||
|---|---|---|---|---|---|---|---|---|
| year | Yes(%) | No(%) | Total(%) | |||||
| Q1 | Asthma | 2023 | 73 | (12.2) | 526 | (87.8) | 599 | (100.0) |
| 2014 | 467 | (13.7) | 2929 | (86.2) | 3399 | (100.0) | ||
| Q2 | Allergic rhinitis | 2023 | 185 | (30.9) | 414 | (69.1) | 599 | (100.0) |
| 2014 | 462 | (27.2) | 2934 | (72.6) | 3399 | (100.0) | ||
| Q3 | Adenoid hypertrophy | 2023 | 13 | (2.2) | 586 | (97.8) | 599 | (100.0) |
| 2014 | 137 | (4.0) | 3261 | (95.9) | 3399 | (100.0) | ||
| Q4 | Bronchitis | 2023 | 58 | (9.7) | 541 | (90.3) | 599 | (100.0) |
| 2014 | 810 | (23.8) | 2582 | (76.0) | 3399 | (100.0) | ||
| Q5 | Otitis media | 2023 | 126 | (21.0) | 473 | (79.0) | 599 | (100.0) |
| 2014 | 1435 | (42.2) | 1956 | (57.5) | 3399 | (100.0) | ||
| Q6 | Pollinosis | 2023 | 146 | (24.4) | 453 | (75.6) | 599 | (100.0) |
| 2014 | 692 | (20.4) | 2705 | (79.6) | 3399 | (100.0) | ||
Table 4 shows the frequency of responses to the questionnaire items included in the pre-COVID-19 survey. The items with the most frequency of “yes” or “somewhat yes” (as following in positive response) was “good at sports” (68.4%), followed by “round shoulders” (60.4%). Among the questions about the ears and nose conditions, “nighttime nasal congestion” was 32.6%, followed by “daytime nasal congestion” (31.2%) and “a runny nose” (29.5%). A total of 24.0% of respondents reported experiencing “dry mouth,” whereas 46.6% reported “morning breath,” and 13.5% reported “whether they could speak clearly.” For oral function, “ILS” was 37.4%, and “breathe during sleep” was 41.4%. For lip condition, the prevalence of dry lips was 47.1%, followed by droopy lips (31.2%) and chapped lips (26.2%). For gum and tooth conditions, “the tendency for tooth staining” was 30.2%, followed by frequent canker sores (23.4%). For eating and drinking habits, the highest item was “keeping their mouth closed during eating” (64.4%), followed by “picky eater” (35.9%) and “prefer soft food” (32.4%).
| Criteria | Item no. | Question items | Survey | Responses of the questionnaire | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| year | Yes(%) | somewhat yes (%) | somewhat no(%) | No(%) | Total(%) | ||||||||
| Daily habits | Q10 | Does your child get tired easily? | 2023 | 12 | (2.0) | 25 | (4.2) | 65 | (10.9) | 492 | (82.1) | 594 | (99.2) |
| 2014 | 727 | (21.4) | 148 | (4.4) | 1272 | (37.4) | 1252 | (36.8) | 3399 | (100.0) | |||
| Q11 | Is your child a bad riser? | 2023 | 22 | (3.7) | 99 | (16.5) | 139 | (23.2) | 338 | (56.4) | 598 | (99.8) | |
| 2014 | 1086 | (32.0) | 1332 | (39.2) | 711 | (20.9) | 270 | (7.9) | 3399 | (100.0) | |||
| Q12 | Is your child good at exercising? | 2023 | 273 | (45.6) | 137 | (22.9) | 128 | (21.4) | 61 | (10.2) | 599 | (100.0) | |
| 2014 | 1377 | (40.5) | 948 | (27.9) | 852 | (25.1) | 222 | (6.5) | 3399 | (100.0) | |||
| Q13 | Is your child a restless sleeper? | 2023 | 63 | (10.5) | 142 | (23.7) | 246 | (41.1) | 148 | (24.7) | 599 | (100.0) | |
| 2014 | 1218 | (35.8) | 1272 | (37.4) | 641 | (18.9) | 268 | (7.9) | 3399 | (100.0) | |||
| Q15 | Does your child have round shoulders? | 2023 | 159 | (26.5) | 203 | (33.9) | 131 | (21.9) | 106 | (17.7) | 599 | (100.0) | |
| 2014 | 625 | (18.4) | 284 | (8.4) | 974 | (28.7) | 1516 | (44.6) | 3399 | (100.0) | |||
| Ear and nose conditions | Q17 | Does your nose become stuffed easily during the day? | 2023 | 67 | (11.2) | 120 | (20.0) | 131 | (21.9) | 277 | (46.2) | 595 | (99.3) |
| 2014 | 626 | (18.4) | 506 | (14.9) | 796 | (23.4) | 1471 | (43.3) | 3399 | (100.0) | |||
| Q18 | Does your nose become stuffed easily while sleeping? | 2023 | 80 | (13.4) | 115 | (19.2) | 93 | (15.5) | 310 | (51.8) | 598 | (99.8) | |
| 2014 | 638 | (18.8) | 319 | (9.4) | 868 | (25.5) | 1574 | (46.3) | 3399 | (100.0) | |||
| Q19 | Is your child a habitual snorer? | 2023 | 55 | (9.2) | 78 | (13.0) | 119 | (19.9) | 344 | (57.4) | 596 | (99.5) | |
| 2014 | 479 | (14.1) | 189 | (5.6) | 791 | (23.3) | 1940 | (57.1) | 3399 | (100.0) | |||
| Q20 | Does your child often have a runny nose? | 2023 | 59 | (9.8) | 118 | (19.7) | 151 | (25.2) | 267 | (44.6) | 595 | (99.3) | |
| 2014 | 697 | (20.5) | 279 | (8.2) | 847 | (24.9) | 1576 | (46.4) | 3399 | (100.0) | |||
| Q21 | Does your child sneeze often? | 2023 | 61 | (10.2) | 99 | (16.5) | 103 | (17.2) | 334 | (55.8) | 597 | (99.7) | |
| 2014 | 582 | (17.1) | 284 | (8.4) | 849 | (25.0) | 1684 | (49.5) | 3399 | (100.0) | |||
| Q22 | Does your child often have a nosebleed? | 2023 | 51 | (8.5) | 112 | (18.7) | 113 | (18.9) | 318 | (53.1) | 594 | (99.2) | |
| 2014 | 475 | (14.0) | 330 | (9.7) | 378 | (11.1) | 2216 | (65.2) | 3399 | (100.0) | |||
| Q23 | Does your child often fail to listen? | 2023 | 26 | (4.3) | 98 | (16.4) | 109 | (18.2) | 364 | (60.8) | 597 | (99.7) | |
| 2014 | 584 | (17.2) | 160 | (4.7) | 755 | (22.2) | 1900 | (55.9) | 3399 | (100.0) | |||
| Dry mouth | Q25 | Is your child’s mouth often dry? | 2023 | 26 | (4.3) | 118 | (19.7) | 148 | (24.7) | 305 | (50.9) | 597 | (99.7) |
| 2014 | 492 | (14.5) | 143 | (4.2) | 960 | (28.2) | 1804 | (53.1) | 3399 | (100.0) | |||
| Bad breath | Q26 | Does your child have bad breath in the morning? | 2023 | 93 | (15.5) | 186 | (31.1) | 128 | (21.4) | 190 | (31.7) | 597 | (99.7) |
| 2014 | 883 | (26.0) | 343 | (10.1) | 810 | (23.8) | 1359 | (40.0) | 3399 | (100.0) | |||
| Q27 | Does your child have bad breath during day? | 2023 | 30 | (5.0) | 82 | (13.7) | 172 | (28.7) | 313 | (52.3) | 597 | (99.7) | |
| 2014 | 387 | (11.4) | 91 | (2.7) | 1004 | (29.5) | 1917 | (56.4) | 3399 | (100.0) | |||
| Speech function | Q29 | Can your child talk clearly? | 2023 | 28 | (4.7) | 53 | (8.8) | 98 | (16.4) | 417 | (69.6) | 596 | (99.5) |
| 2014 | 308 | (9.1) | 97 | (2.9) | 530 | (15.6) | 2464 | (72.5) | 3399 | (100.0) | |||
| Oral function | Q30 | Is your child’s mouth often open during the day? | 2023 | 92 | (15.4) | 132 | (22.0) | 152 | (25.4) | 220 | (36.7) | 596 | (99.5) |
| 2014 | 711 | (20.9) | 332 | (9.8) | 873 | (25.7) | 1483 | (43.6) | 3399 | (100.0) | |||
| Q31 | Does your child sleep with their mouth open? | 2023 | 103 | (17.2) | 145 | (24.2) | 134 | (22.4) | 215 | (35.9) | 597 | (99.7) | |
| 2014 | 1048 | (30.8) | 517 | (15.2) | 888 | (26.1) | 946 | (27.8) | 3399 | (100.0) | |||
| Q32 | Can your child breathe through their nose for more than a minute while keeping your mouth closed? | 2023 | 48 | (8.0) | 63 | (10.5) | 157 | (26.2) | 328 | (54.8) | 596 | (99.5) | |
| 2014 | 867 | (25.5) | 2235 | (65.8) | 240 | (7.1) | 57 | (1.7) | 3399 | (100.0) | |||
| Lip condition | Q37 | Are your child’s lips often chapped? | 2023 | 117 | (19.5) | 165 | (27.5) | 118 | (19.7) | 198 | (33.1) | 598 | (99.8) |
| 2014 | 466 | (13.7) | 127 | (3.7) | 761 | (22.4) | 2045 | (60.2) | 3399 | (100.0) | |||
| Q38 | Are your child’s lips thick? | 2023 | 34 | (5.7) | 84 | (14.0) | 165 | (27.5) | 313 | (52.3) | 596 | (99.5) | |
| 2014 | 383 | (11.3) | 145 | (4.3) | 563 | (16.6) | 2308 | (67.9) | 3399 | (100.0) | |||
| Q39 | Is your child’s upper lip turned upward? | 2023 | 14 | (2.3) | 54 | (9.0) | 107 | (17.9) | 422 | (70.5) | 597 | (99.7) | |
| 2014 | 121 | (3.6) | 32 | (0.9) | 399 | (11.7) | 2847 | (83.8) | 3399 | (100.0) | |||
| Q40 | Are your child’s teeth visible between thier upper and lower lips? | 2023 | 41 | (6.8) | 61 | (10.2) | 104 | (17.4) | 386 | (64.4) | 592 | (98.8) | |
| 2014 | 271 | (8.0) | 143 | (4.2) | 425 | (12.5) | 2560 | (75.3) | 3399 | (100.0) | |||
| Q41 | Are your child’s lips droopy? | 2023 | 77 | (12.9) | 84 | (14.0) | 108 | (18.0) | 327 | (54.6) | 596 | (99.5) | |
| 2014 | 499 | (14.7) | 206 | (6.1) | 460 | (13.5) | 2234 | (65.7) | 3399 | (100.0) | |||
| Q42 | Are your child’s lips often cracked? | 2023 | 62 | (10.4) | 95 | (15.9) | 118 | (19.7) | 323 | (53.9) | 598 | (99.8) | |
| 2014 | 375 | (11.0) | 133 | (3.9) | 482 | (14.2) | 2409 | (70.9) | 3399 | (100.0) | |||
| Teeth and gum | Q43 | Are your child’s gums often swollen? | 2023 | 15 | (2.5) | 31 | (5.2) | 109 | (18.2) | 441 | (73.6) | 596 | (99.5) |
| 2014 | 229 | (6.7) | 70 | (2.1) | 514 | (15.1) | 2586 | (76.1) | 3399 | (100.0) | |||
| Q44 | Does your child have any bloack or gray discoloration on their gums？ | 2023 | 6 | (1.0) | 22 | (3.7) | 55 | (9.2) | 513 | (85.6) | 596 | (99.5) | |
| 2014 | 84 | (2.5) | 22 | (0.6) | 333 | (9.8) | 2960 | (87.1) | 3399 | (100.0) | |||
| Q45 | Are your child’s teeth easily stained? | 2023 | 69 | (11.5) | 112 | (18.7) | 116 | (19.4) | 300 | (50.1) | 597 | (99.7) | |
| 2014 | 805 | (23.7) | 282 | (8.3) | 647 | (19.0) | 1665 | (49.0) | 3399 | (100.0) | |||
| Q46 | Does your child often have canker sores? | 2023 | 21 | (3.5) | 42 | (7.0) | 83 | (13.9) | 450 | (75.1) | 596 | (99.5) | |
| 2014 | 467 | (13.7) | 182 | (5.4) | 613 | (18.0) | 2137 | (62.9) | 3399 | (100.0) | |||
| Q47 | Does your child have tartar build-up? | 2023 | 39 | (6.5) | 101 | (16.9) | 130 | (21.7) | 327 | (54.6) | 597 | (99.7) | |
| 2014 | 973 | (28.6) | 250 | (7.4) | 905 | (26.6) | 1271 | (37.4) | 3399 | (100.0) | |||
| Dentition and occlusion | Q48 | Does your child have an overbite? | 2023 | 38 | (6.3) | 55 | (9.2) | 70 | (11.7) | 431 | (72.0) | 594 | (99.2) |
| 2014 | 364 | (10.7) | 178 | (5.2) | 489 | (14.4) | 2368 | (69.7) | 3399 | (100.0) | |||
| Q49 | Does your child have an under bite? | 2023 | 25 | (4.2) | 20 | (3.3) | 64 | (10.7) | 486 | (81.1) | 595 | (99.3) | |
| 2014 | 171 | (5.0) | 130 | (3.8) | 457 | (13.4) | 2641 | (77.7) | 3399 | (100.0) | |||
| Q50 | Does your child have an anterior open bite? | 2023 | 85 | (14.2) | 78 | (13.0) | 92 | (15.4) | 338 | (56.4) | 593 | (99.0) | |
| 2014 | 567 | (16.7) | 460 | (13.5) | 720 | (21.2) | 1652 | (48.6) | 3399 | (100.0) | |||
| Eating and drinking habits | Q51 | Is your child’s meal portion small? | 2023 | 42 | (7.0) | 106 | (17.7) | 139 | (23.2) | 309 | (51.6) | 596 | (99.5) |
| 2014 | 956 | (28.1) | 349 | (10.3) | 992 | (29.2) | 1102 | (32.4) | 3399 | (100.0) | |||
| Q52 | Does your child prefer soft food? | 2023 | 45 | (7.5) | 149 | (24.9) | 128 | (21.4) | 276 | (46.1) | 598 | (99.8) | |
| 2014 | 1127 | (33.2) | 336 | (9.9) | 939 | (27.6) | 997 | (29.3) | 3399 | (100.0) | |||
| Q56 | Does your child eat fast? | 2023 | 54 | (9.0) | 77 | (12.9) | 163 | (27.2) | 302 | (50.4) | 596 | (99.5) | |
| 2014 | 976 | (28.7) | 699 | (20.6) | 959 | (28.2) | 765 | (22.5) | 3399 | (100.0) | |||
| Q57 | Is your child a picky eater? | 2023 | 97 | (16.2) | 118 | (19.7) | 141 | (23.5) | 242 | (40.4) | 598 | (99.8) | |
| 2014 | 945 | (27.8) | 631 | (18.6) | 868 | (25.5) | 955 | (28.1) | 3399 | (100.0) | |||
| Q58 | Does your child tend to swallow without chewing well? | 2023 | 34 | (5.7) | 98 | (16.4) | 179 | (29.9) | 286 | (47.7) | 597 | (99.7) | |
| 2014 | 906 | (26.7) | 1302 | (38.3) | 210 | (6.2) | 981 | (28.9) | 3399 | (100.0) | |||
| Q59 | Is your child a noisy eater? | 2023 | 42 | (7.0) | 73 | (12.2) | 143 | (23.9) | 338 | (56.4) | 596 | (99.5) | |
| 2014 | 500 | (14.7) | 172 | (5.1) | 1005 | (29.6) | 1722 | (50.7) | 3399 | (100.0) | |||
| Q60 | Does your child keep their mouth closed when they eats? | 2023 | 222 | (37.1) | 164 | (27.4) | 117 | (19.5) | 93 | (15.5) | 596 | (99.5) | |
| 2014 | 1118 | (32.9) | 1293 | (38.0) | 781 | (23.0) | 207 | (6.1) | 3399 | (100.0) | |||
| Q65 | Does your child have food left in your mouth for a long time? | 2023 | 6 | (1.0) | 16 | (2.7) | 68 | (11.4) | 506 | (84.5) | 596 | (99.5) | |
| 2014 | 412 | (12.1) | 170 | (5.0) | 924 | (27.2) | 1893 | (55.7) | 3399 | (100.0) | |||
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