Evidence map›Paper›PMID 42286593›Full record

ArticleBMC oral health2026

The association of malocclusion severity and uncertainty stress with mouth-breathing behavior in adults: a cross-sectional study.

Yanqi Li, Chenxu Ling, Jiahao Chen, Ruyu Sun, Huan Zhou, Xuepeng Chen, Weifang Zhang

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Article in BMC oral health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

7 authors.

Yanqi LiChildren's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children And Adolescents' Health And Diseases, Hangzhou, Zhejiang, China.
Chenxu LingChildren's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children And Adolescents' Health And Diseases, Hangzhou, Zhejiang, China.
Jiahao ChenStomatology Hospital, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China.
Ruyu SunStomatology Hospital, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China.
Huan ZhouStomatology Hospital, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China.
Xuepeng ChenStomatology Hospital, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China. cxp1979@zju.edu.cn.
Weifang ZhangChildren's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children And Adolescents' Health And Diseases, Hangzhou, Zhejiang, China. chzwf@zju.edu.cn.

Funding

Key Research and Development Program of Zhejiang Province 2023C03072
6 · The paper itself

Abstract

backgroundThis study aims to examine the associations between malocclusion severity, uncertainty stress, and mouth-breathing behavior in adults. In order to clarify how psychological stress may influence oral functional patterns and provide new insights for orthodontic assessment and intervention.

methodsA total of 894 adult patients diagnosed with malocclusion from the Department of Orthodontics, Hospital of Stomatology, Zhejiang University School of Medicine, participated in this cross-sectional study. Malocclusion severity was evaluated through clinical assessment based on the index of orthodontic treatment need (IOTN), including both the Dental Health Component (DHC) and the Aesthetic Component (AC). Uncertainty stress was assessed via standardized questionnaire. Mouth-breathing behavior was identified using a structured self-report screening survey, with validity examined against clinical electronic medical records from orthodontic examinations conducted within one month of questionnaire administration. Multiple logistic regression models and structural equation modeling were used to explore the relationships between malocclusion severity, uncertainty stress, and mouth-breathing behavior.

resultsAfter controlling for confounding factors, uncertainty stress remained significantly associated with mouth-breathing behavior (OR = 1.263, 95% CI: 1.069 to 1.492, p < 0.01), as did the IOTN-AC scoring (OR = 1.087, 95% CI: 1.006 to 1.174, p < 0.05), whereas the IOTN-DHC scoring showed no significant association (p > 0.05). Structural equation modeling showed that uncertainty stress correlated with mouth-breathing behavior (β = 0.19, 95% CI: 0.14 to 0.24, p < 0.001). IOTN-AC had a significant direct effect on mouth-breathing behavior (β = 0.13, 95% CI: 0.08 to 0.18, p < 0.001), as well as a significant indirect effect via uncertainty stress (β = 0.05, 95% CI: 0.02 to 0.08, p < 0.001).

conclusionsUncertainty stress and mouth-breathing behavior are closely associated among adults. When both IOTN-DHC and IOTN-AC were considered, only IOTN-AC remained significant, suggesting that aesthetic severity may be an associated factor influencing mouth-breathing behavior in adults. These findings highlight the importance of integrating psychological stress evaluation into routine orthodontic care, with the aim of improving both functional outcomes and quality of life in adult patients.

trial registrationNot applicable.

Indexed as

MalocclusionMouth BreathingStress, PsychologicalAdultCross-Sectional StudiesFemaleHumansMaleSeverity of Illness IndexSurveys and QuestionnairesUncertaintyYoung Adultmalocclusionmouth-breathingOrthodontic treatmentuncertainty stress

Identifiers

PMID42286593
PMCPMC13483124

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.