Parental knowledge, attitudes, and perceptions regarding myofunctional appliances in Coastal Karnataka, India: a cross-sectional study

Background: The study aimed to evaluate the parentral knowledge, attitudes, and perceptions (KAP) regarding the need for and effectiveness of myofunctional appliances in managing skeletal discrepancies among growing children. Methods: A cross-sectional descriptive survey was conducted among parents of children aged 7–13 years using a structured online questionnaire. A web-based questionnaire was developed using Google Forms, and 126 parents completed the survey. The calculated sample size was 126 participants. A structured 10-item questionnaire was developed to assess parental knowledge, awareness, attitudes, and perceptions regarding functional orthopedic appliance therapy in children. Results: Most parents demonstrated a positive attitude toward myofunctional appliance therapy. Approximately 90.5% of parents were aware of jaw and dental malalignment issues, 81% were willing to allow their child to undergo appliance therapy, and 83.3% believed that treatment timing impacts outcomes. Conclusions: The study revealed considerable parental awareness and favourable attitudes toward myofunctional appliances. Enhanced parental education and awareness initiatives are recommended to bridge the gap between awareness and theutilization of orthodontic services.

Myofunctional therapy; Orthodontic appliances, parental awareness; Health knowledge, attitudes

[1] Klontz HA. Facial balance and harmony: an attainable objective for the patient with a high mandibular plane angle. American Journal of Orthodontics and Dentofacial Orthopedics. 1998; 114: 176–188.

[2] Cox NH, van der Linden FP. Facial harmony. American Journal of Orthodontics. 1971; 60: 175–183.

[3] Paduano S, Rongo R, Bucci R, Carvelli G, Cioffi I. Impact of functional orthodontic treatment on facial attractiveness of children with class II division 1 malocclusion. European Journal of Orthodontics. 2020; 42: 144–150.

[4] Wishney M, Darendeliler MA, Dalci O. Myofunctional therapy and prefabricated functional appliances: an overview of the history and evidence. Australian Dental Journal. 2019; 64: 135–144.

[5] McNamara JA Jr. Components of class II malocclusion in children 8–10 years of age. The Angle Orthodontist. 1981; 51: 177–202.

[6] Marsico E, Gatto E, Burrascano M, Matarese G, Cordasco G. Effectiveness of orthodontic treatment with functional appliances on mandibular growth in the short term. American Journal of Orthodontics and Dentofacial Orthopedics. 2011; 139: 24–36.

[7] Baccetti T, Franchi L, Toth LR, McNamara JA Jr. Treatment timing for twin-block therapy. American Journal of Orthodontics and Dentofacial Orthopedics. 2000; 118: 159–170.

[8] Mani B, Shaga IB, Ayyapillai A, Gangadharan G, Mathew J, Somasundaram R. Knowledge, attitude, and perception regarding myofunctional appliance: a cross-sectional survey of parents’ view. International Journal of Preventive and Clinical Dental Research. 2021; 8: 1–3.

[9] Uzunçıbuk H, Gökulu G, Marrapodi MM, Di Blasio M, Cicciù M, Minervini G. Investigation of parents’ awareness of early orthodontic evaluation and treatment in paediatric patients: a cross-sectional study. European Journal of Paediatric Dentistry. 2025; 26: 24–31.

[10] Madiraju GS. Exploring parental perceptions and barriers to early orthodontic treatment in children: a mixed-methods study. Healthcare. 2026; 14: 180.

[11] Alfuriji S, Alofi A, Albalawi M, Alnaqa G, Alrufayyiq K, Alharbi M, et al. Parents’ awareness towards preventive and interceptive orthodontic treatment. BMC Research Notes. 2025; 18: 41.

[12] Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA Jr. Mandibular changes produced by functional appliances in class II malocclusion: a systematic review. American Journal of Orthodontics and Dentofacial Orthopedics. 2006; 129: 599.e1–599.e12.

[13] Pachori Y, Navlani M, Gaur T, Bhatnagar S. Treatment of skeletal class II division 1 malocclusion with mandibular deficiency using myofunctional appliances in growing individuals. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2012; 30: 56–65.

[14] D’Antò V, Bucci R, Franchi L, Rongo R, Michelotti A, Martina R. Class II functional orthopaedic treatment: a systematic review of systematic reviews. Journal of Oral Rehabilitation. 2015; 42: 624–642.

[15] Bidjan D, Sallmann R, Eliades T, Papageorgiou SN. Orthopedic treatment for class II malocclusion with functional appliances and its effect on upper airways: a systematic review with meta-analysis. Journal of Clinical Medicine. 2020; 9: 3806.

[16] Pacha MM, Fleming PS, Johal A. A comparison of the efficacy of fixed versus removable functional appliances in children with class II malocclusion: a systematic review. European Journal of Orthodontics. 2016; 38: 621–630.

[17] Al-Jewair TS. Meta-analysis on the mandibular dimensions effects of the MARA appliance in patients with class II malocclusions. The Angle Orthodontist. 2015; 85: 706–714.

[18] Papageorgiou SN, Koletsi D, Eliades T. What evidence exists for myofunctional therapy with prefabricated appliances? A systematic review with meta-analyses of randomised trials. Journal of Orthodontics. 2019; 46: 297–310.

[19] Mohammed H, Čirgić E, Rizk MZ, Vandevska-Radunovic V. Effectiveness of prefabricated myofunctional appliances in the treatment of class II division 1 malocclusion: a systematic review. European Journal of Orthodontics. 2020; 42: 125–134.

[20] Balian A, Salerno C, Manti A, Lanteri V, Cirio S, Cagetti MG. Effectiveness of prefabricated myofunctional appliances on vertical dimension in children: a systematic review and meta-analysis. European Journal of Paediatric Dentistry. 2025; 26: 286–297.

[21] García E, Santos L, Borrell C, Aura JI, Marqués L. Parental perceptions of early interceptive orthodontic intervention in children and adolescents: a cross-sectional study. European Journal of Paediatric Dentistry. 2025; 26: 218–223.

[22] Di Spirito F, Cannatà D, Schettino V, Galdi M, Bucci R, Martina S. Perceived orthodontic needs and attitudes towards early evaluation and interventions: a survey-based study among parents of Italian school-aged children. Clinics and Practice. 2024; 14: 1159–1170.

[23] Verulkar AA, Kamble RH, Srivastav S, Potode N. Evaluation of awareness of functional jaw orthopedics appliances in population: a systematic review. Journal of Contemporary Orthodontics. 2021; 5: 7–12.

[24] Granja GL, Lima LCM, Leal TR, Bernardino VMM, Neves ÉTB, Paiva SM, et al. Impact of parental oral health literacy on orthodontic treatment need in schoolchildren. Dental Press Journal of Orthodontics. 2025; 30: e2524238.

[25] Al-Mashhadani S, Nasser M, Alsalami A, Burns L, Paisi M. Barriers and facilitators to dental care services utilization among children with disabilities: a systematic review and thematic synthesis. Health Expectations. 2024; 27: e70049.

[26] Valliappan S, Megalaa N, Annamalai I, Vidhya G, Subbiah GK, Ranjith K, et al. Knowledge, attitude and perception regarding myofunctional appliance among children—prospective study of parents’ view. Journal of Pharmacy and Bioallied Sciences. 2024; 16: S1465–S1467.