COM Patient Assessment & Evaluation 2 — Questions and Answers
Question 1: During clinical observation of lip posture, which finding is considered the primary indicator of habitual mouth breathing?
- Slight parting of lips at rest with no visible tongue (Correct answer)
- Lips sealed at rest with nasal airflow
- Upper lip hypotonia with lower lip tucked behind upper incisors
- Symmetric lip closure during swallowing only
Correct answer: Slight parting of lips at rest with no visible tongue
Habitual mouth breathing is primarily indicated by habitual lip parting at rest, often accompanied by reduced lip tone.
Question 2: When assessing tongue resting posture, the clinician notes the tongue tip contacts the lower incisors. This is most consistent with:
- Normal tongue posture
- Anterior tongue thrust (Correct answer)
- Tongue tied (ankyloglossia)
- Posterior tongue placement
Correct answer: Anterior tongue thrust
Anterior tongue thrust is characterized by the tongue tip resting against or between the lower (or upper) incisors rather than at the palatal spot.
Question 3: Which assessment tool is most commonly used in orofacial myology to quantify lip seal strength?
- Tongue pressure measurement device
- Iowa Oral Performance Instrument (IOPI)
- Button-pull test with calibrated gauge (Correct answer)
- Visual analog scale
Correct answer: Button-pull test with calibrated gauge
The button-pull test using a calibrated force gauge provides an objective measure of orbicularis oris (lip seal) strength.
Question 4: A COM assessment reveals that a 9-year-old patient has an open bite. Which additional assessment is most critical before beginning orofacial myofunctional therapy?
- Audiological screening
- Dental occlusion classification by an orthodontist (Correct answer)
- Dietary recall for sugar intake
- Fine motor skill evaluation
Correct answer: Dental occlusion classification by an orthodontist
Skeletal or dental contributions to the open bite must be evaluated by an orthodontist before myofunctional therapy begins to determine appropriate case management.
Question 5: During nasal airflow assessment, the clinician holds a mirror under the patient's nose during quiet breathing. What does fogging on both sides of the mirror indicate?
- Nasal obstruction bilaterally
- Patent nasal airway bilaterally (Correct answer)
- Unilateral nasal obstruction
- Mixed nasal and oral breathing
Correct answer: Patent nasal airway bilaterally
Bilateral fogging on the mirror indicates airflow is exiting both nares, confirming a patent nasal airway.
Question 6: When documenting frenum evaluation findings, which term describes a lingual frenum that restricts tongue elevation to the palate but allows protrusion past the lower incisors?
- Class I ankyloglossia
- Class II ankyloglossia (Correct answer)
- Class III ankyloglossia
- Class IV ankyloglossia
Correct answer: Class II ankyloglossia
Class II ankyloglossia allows some protrusion but restricts vertical tongue elevation; Kotlow's classification differentiates tethered tissue severity.
Question 7: A COM evaluates a patient's swallowing pattern and observes mentalis muscle contraction. This finding most likely indicates:
- Normal mature swallow pattern
- Anterior tongue thrust swallow (Correct answer)
- Lateral tongue thrust swallow
- Posterior nasal drip compensation
Correct answer: Anterior tongue thrust swallow
Mentalis (chin) muscle contraction during swallowing is a compensatory behavior associated with anterior tongue thrust as the patient strains to achieve lip seal.
COM Patient Assessment & Evaluation 2
During clinical observation of lip posture, which finding is considered the primary indicator of habitual mouth breathing?