Sleep Assessment

Question 1 of 21

1 of 21

Mouth breathing - Day

Sleep Assessment
Questionnaire

Please answer the following questions about your child's symptoms. This assessment helps identify potential Sleep-Related Breathing Disorders (SRBD) and underdeveloped airway.

Progress0 of 21

Mouth breathing - Day

Mouth breathing - Night

Speech issues

Snoring / noisy breathing

Hyperactivity / poor focus

Picky eating / poor chewing

Restless sleep / night terrors

Crooked or crowded teeth

Frequent cavities

High arched / narrow palate

Ear infections / blocked ears

Large tonsils / adenoids

Teeth grinding / clenching

Dry mouth / bad breath

Daytime sleepiness / fatigue

Bedwetting

Dark circles under eyes

Difficulty transitioning to solid food

Double row of teeth in lower front region

Difficulty with attention in school/work

Drool on pillow while sleeping

This questionnaire is for informational purposes only and is not a substitute for professional medical advice. Please consult with our dental specialists at Bunny Teeth Advanced Dentistry for a proper evaluation.

Bunny Teeth Advanced Dentistry • 5 Rajachar Street, T. Nagar, Chennai – 600017 • +91 94442 31819

Sleep Assessment

Mouth breathing - Day

Sleep Assessment Questionnaire

Sleep Assessment
Questionnaire