1. Does your child usually breathe through mouth? | Yes | No |
2. Is your child’s mouth normally kept open at times of sleep or periods of inactivity? | Yes | No |
3. Does your child struggle to breathe during sleep | Yes | No |
4. Does your child experience dry mouth while waking up | Yes | No |
5. Does your child have frequent incidences nasal congestion? | Yes | No |
6. Does your child experience sore throat frequently? | Yes | No |
7. Does your child have bad breath? | Yes | No |
8. Are the gums of your child’s front teeth often red and swollen? | Yes | No |
9. Is your child’s front teeth easily discolored? | Yes | No |
10. Does your child have an excessive overbite? | Yes | No |