Why is a dentist asking you that question? There are several reasons a dentist could be the first one to notice if your child has an airway problem. Despite the distinct separation between medicine and dentistry with things like education and insurance, they are intertwined. The mouth is an important part of your body. Problems in the mouth affect the entire body, and systemic health problems affect the mouth.
There is a particularly noteworthy correlation between the mouth (teeth and jaws) and the airway. Many people are aware of the connection between sleep apnea and the mouth; most are not aware that this connection is true for both adults and children.
What is Pediatric Sleep Apnea?
Pediatric sleep apnea is a condition in which a child stops breathing for any length of time during sleep. As with adults, it can be accompanied by snoring, gasping, and choking sounds. It can also be silent.
Children who stop breathing at night do not get quality sleep, which is essential for growth and development. Sleep is also integral in the healing process, so children with sleep apnea tend to be ill more often than other children.
In addition to sleep apnea, children can also suffer from other types of sleep-disordered breathing, in which breathing does not stop but is restricted enough to reduce oxygen levels and quality of sleep.
How Can a Dentist Tell If My Child has an Airway Problem?
There are certain signs of pediatric sleep-disordered breathing that appear in the mouth. During your child’s dental evaluation or professional teeth cleaning, one of our hygienists may note some of these signs and ask you more about your child’s sleep patterns.
The following list includes things we, as dentists, look for as red flags for airway problems.
- Teeth grinding – It is not normal for children to grind their teeth. If they do, you should suspect a breathing problem. In children, teeth grinding is a protective reflex that is the body’s attempt to open the airway and get more oxygen to the brain.
- Narrow jaw structure – The shape of the jaws is an important factor in the size of the airway. A narrow upper and/or lower jaw often indicates a narrow or constricted airway.
- Large overbite – In children whose lower jaws are much smaller than the upper jaws, large overbites develop. In addition to the size of the jaws, the relationship of the upper and lower jaws to each other influences the airway significantly. A large overbite often indicates that the lower jaw is putting pressure on the airway, causing restricted breathing.
- Mouth breathing – Children who consistently breathe through their mouths, especially at night, have a higher risk for plaque buildup, gingivitis, and cavities. High levels of plaque buildup in certain areas of the mouth are distinctive of mouth breathing.
- Mouth breathing – Children who consistently breathe through their mouths, especially at night, have a higher risk for plaque buildup, gingivitis, and cavities. High levels of plaque buildup in certain areas of the mouth are distinctive of mouth breathing. Realize hygienists these signs as evidence of mouth breathing and will ask questions about your child’s sleep habits to find out if the mouth breathing is a result of an airway problem.
- these signs as evidence of mouth breathing and will ask questions about your child’s sleep habits to find out if the mouth breathing is a result of an airway problem.
- Tongue position – How the tongue is situated affects the position of the teeth, which ultimately impacts the development of the upper jaw. When the tongue does not rest up against the roof of the mouth, the upper jaw can develop into a narrow, high arch. As we discussed above, a narrow jaw predisposes a child to a constricted airway and sleep-disordered breathing.
- Acid erosion of teeth – Many patients with sleep apnea also suffer from acid reflux. This is because the attempt to breathe when the airway is blocked creates a negative pressure in the chest cavity, pulling stomach acid up into the esophagus and mouth. This acid erodes tooth enamel, leaving a very distinctive appearance.
How Is a Pediatric Airway Problem Diagnosed?
You, as the parent, are an important part of the diagnosis process. Detailed information about your child’s sleep habits and patterns are integral in diagnosing an airway problem. Simply sharing your observations about how your child sleeps can provide us with vital pieces of the airway puzzle.
Often a sleep test is required to determine the severity of a sleep-disordered breathing problem. This test gives precise details about oxygenation levels, sleep stages, and disturbances in sleep.
Another tool we have at Designer Smiles for evaluating the airway is our three-dimensional imaging system, the Prexion CBCT scanner. With a 3D image, we can measure the volume of the child’s airway, the size of the upper and lower jaws, and the size of soft tissue structures like tonsils and adenoids. This 3D imaging is a valuable tool in assessing anyone’s risk for airway problems.
Surgical removal of the adenoids and tonsils is the most common treatment for pediatric OSA. In uncomplicated cases, the operation results in the complete elimination of OSA symptoms in 70 to 90 percent of the time. Although generally an outpatient procedure, some children with chronic medical conditions like obesity or severe OSA or complications of OSA should be carefully monitored overnight following the surgery. because breathing abnormalities may not appear until REM sleep begins several hours in the next extended sleep cycle after the operation. Owing to post-operative swelling, full resolution of the OSA symptoms may not occur for six to eight weeks.
If adenotonsillectomy is not indicated or if the surgery does not fully resolve the symptoms, positive airway pressure therapy like that commonly prescribed for adults probably will be helpful.. (PAP therapy may also be prescribed before surgery in severe pediatric OSA cases.) PAP should be regarded as palliative rather than curative, however. Optimal pressure settings (sufficient to reduce or eliminate obstructive events without increasing arousals or central apneas) should be determined in an overnight sleep study, and efficacy studies and re-titrations should be regularly conducted: generally yearly or when there are significant weight changes in older children and adolescents.
As in adults, compliance with PAP therapy is a key factor in determining success. Adolescents pose a particular challenge. For many children, however, the dramatic improvement in the way they feel after PAP therapy is begun becomes an important motivating factor.
Other Treatment Steps
Oral appliances for the treatment of pediatric OSA are helpful in some cases, especially in adolescents whose facial bone growth is largely complete. One device that rapidly expands the transversal diameter of the hard palate over a six-month to one-year period has been used successfully in children as young as 6.
Weight management, including nutritional, exercise, and behavioral elements, should be strongly encouraged for all children with OSA who are overweight or obese. An adequate nightly duration of sleep is an important component of weight management.
Other treatments are directed towards additional risk factors in individual cases; i.e., allergy medications for children with seasonal/environmental allergies, asthma medications/inhalers, and treatment for gastroesophageal reflux.
We love our patients and love to help them form healthy dental life that will last them a lifetime. For more information call us today to answer all of your questions so get appointment.