Sleep Disordered Breathing And Role Of A Dentist In Children

I am at TUFTS, Doing Pediatric dental sleep medicine. Isn’t a dentist’s job to drill and fill teeth? So What lead me here

In the last decade, I chose the path of prevention. My journey began with search to prevent crooked teeth and need for teeth removal and braces (clip). Through the process I learned crooked teeth which appeared to be a esthetic concern had deeper health effects. 

Children with narrow upper jaw ( high arched palate) have predisposed risk to develop SDB ( sleep disordered breathing) . SDB has the following symptoms 

Increased day time sleepiness  Morning headaches  Lack of concentration  Fatigue  Waking up tired  Attention deficits  Irritability  Poor performance in school  Increase in blood pressure 

Night time symptoms

Age inappropriate bed wetting  Frequent awakening (to empty bladder too) 
Snoring  Mouth breathing   Bruxism ( night time teeth grinding) 
Restless sleep  Abnormal position while sleeping  Frequent change in position  Recent onset parasomnia ( sleep tremors, nightmares, confused arousals, sleep walking)

The above increases the risk to develop obstructive sleep apnea in children. The condition in which the breathing stops during sleep. Having a wider forward growing face helps in prevention risk of SDB and OSA. 

How to identify and prevent early? 
It can be identified and prevented as soon as the child is born.

1. Ensuring the child is exclusively and extended breastfed atleast till
   2 years of age
2. The upper and lower jaws should be aligned straight. Lower jaws receding behind than upper isn’t healthy. 
3. Gaps or spacing in milk teeth ( physiological space) is a good indicator that the jaws are growing wider and forward. Though it’s very rare to find its ideal. ( pic attached) Milk teeth that look well aligned without gaps are a warning sign of improper jaw growth.
4. Non restricted mouth. Restrictions like tongue ties have a huge influence on narrow jaws. The tongue needs to be in its resting position on the palate this helps the jaw grow wider ( restrictions however prevents the entire tongue go up ). Restrictions also create soft tissue dysfunctions leading to downward and backward growth of jaws (chin retrusion)
5. Mouth is to eat nose is to breath. Open mouth posture is a big alarm. 
6. Night grinding isn’t normal . Many of my patients with severe sleep apnea diagnosed , walked in with bruxism as symptom.

When risk identified early the disease can be prevented with simple lifestyle changes.
Speak to your airway focused preventive Pediatric dentist today to ensure a healthy future to your child 
Below is pic of a child with receding jaw corrected non invasive with orofacial myofunctional therapy ( a 4 year follow up)