Does your child sleep well at night?
Does your child have difficulty breathing through their nose?
How often does your child’s Pediatrician or Pediatric Dentist ask you these questions about your child’s sleep habits? If you your answer is “never” or” not often enough” then you are not alone. Pediatricians and Pediatric Dentists are the first responders to airway problems in children. Because parent’s aren’t asked questions about their child’s sleep habits, airway problems often go undiagnosed and children continue to suffer in silence.
Since a Pediatric dentist sees a child more often than any other health care provider they are in the best position to recognize airway problems. Sleep related breathing disorders (SRBD), is a silent health crisis, impacting 50-70 million Americans. It is not exclusive to the adult population. Because it’s not as easily recognized in children, it is often left undiagnosed. Obstructive Sleep Apnea(OSA) is the most common SRBD in both children and adults.
The signs and symptoms of SRBD are many but if a child has any of the following symptoms, it may indicate an airway problem and warrant immediate attention by an Airway focused Pediatric Dentist:
– Snoring at night
– Clenching/Grinding their teeth
– Open mouth breathing
– Sleeping with their mouth open
– Bed wetting
– Excessive day time sleepiness or hyperactivity.
– Diagnosis of ADHD/ADD
– Crowded teeth
When children are exposed to allergens and other environmental stressors their nasal passages, tonsils and adenoids get inflamed. This makes it difficult for them to breathe through their nose hence children resort to open mouth breathing postures. Breathing unfiltered air through the mouth causes micro trauma to the adenoids and tonsils which worsens the problem. Open mouth breathing posture also leads to an imbalance between the forces exerted by the oral musculature ( the tongue, the cheek and the lips) thereby making the upper jaw narrow. The direction of the growth of the mandible is also alerted from the downward and forward direction to downward and backward direction. This leads a retro gnathic or a setback mandible which also narrows the airway passage. Because the upper and lower jaws are narrow, teeth come in crooked. We now know that the etiology of malocclusion is open mouth breathing posture.
It is important to treat SBRD/OSA in children because timely recognition and management can not only improve the quality of a child’s life but also give the child a chance to grow into healthy adults by ensuring normal growth and development.
So, what is the role of an Airway centric/aware Pediatric dentist and orthodontist in addressing these issues?
Dentists and dental specialists are the experts of the oral cavity. They are in the best position to evaluate, diagnose and treat airway related issues. They can address soft tissue dysfunctions that are compromising the airway volume and can also alter the growth patterns of the cranio-facial respiratory complex. They not only refer patients to the airway aware medical colleagues but also work with them in managing patients with OSA and SRBD.
How are sleep related breathing disorders treated by dentists?
This is accomplished by the use appliances like the Myobrace system, Healthy start( to name a few) which work on the concept of teaching children how to breathe through their nose. These appliances are worn at night and children learn to achieve effective lip seals and to rest the tongue at the right position on the palate thereby encouraging nasal breathing. Myofunctional therapy is an integral part of the appliance therapy. Specific oral exercises are performed by children for a few minutes everyday to achieve a balance in the forces exerted by the oral musculature. Since appliance selection is a key factor in the success of the therapy it is essential to seek a dentist/dental specialist who has a through knowledgeable about these appliances and their utility in improving the symptoms of SRBD. Light wire expanders, like the ALF, BWS are often used in conjunction with the myobrace system. They aid in expanding the maxilla in all and the mandible in all three dimensions of space thereby providing enough room for teeth to come in the mouth. This can eliminate the need for braces in the future in addition to helping children lead healthier lives.
To put things in perspective, Airway aware/focused dentists are health coaches for children. By providing them guidance with nutrition, by teaching them good posture and breathing habits they can help them lead a healthy life and help children achieve their highest potential.