Pediatric Sleep-Related Breathing Disorder

What's the history?

Based on a wide variety of credible, peer-reviewed research, we understand that the root cause of many chronic inflammatory symptoms is associated with a compromised airway, which can cause disturbances to breathing both during the day and at night while a patient is sleeping. While the presentation of these symptoms may be different in adults vs. children, our philosophical basis of therapy is similar in that we employ minimally invasive medical & dental devices, myofunctional exercises, and lifestyle changes to address the root cause. By treating this root cause, we can eliminate the need for pharmaceutical intervention (ie. prescription medications) that is limited in benefit to masking symptoms of this inflammation without ever "healing" the true etiology. 

In a 2016 study of over 500 pediatric subjects published in the Journal of the American Orthodontic Society, researchers used this same therapeutic modality and demonstrated almost complete resolution (>90%) of symptoms including morning headaches, snoring, labored breathing. Additional symptoms that demonstrated improvement by 74-90% included teeth grinding, night sweats, daytime sleepiness and irritability, restless sleep, bedwetting, and throat infections. 

What is sleep-disordered breathing? What is its relation to a compromise in airway health?

 

Sleep-disordered breathing is an umbrella term for several chronic conditions in which partial or complete cessation of breathing occurs many times throughout the night, resulting in daytime sleepiness or fatigue that interferes with a person's ability to function and reduces quality of life. SDB causes systemic inflammation and can manifest itself in a variety of symptoms that can be easily overlooked, misdiagnosed, and most unfortunately, left untreated.

Awareness related to sleep-disordered breathing in both adults and children has increased drastically over the past two decades. Traditionally seen in the field of sleep medicine, most patients diagnosed with "sleep issues" fit the stereotype of an older person, oftentimes overweight, who snores loudly. However, in more recent years, physicians, dentists, and research scientists have tested and proven that sleep and airway disturbances occur much more commonly, and the presentation of associated symptoms looks very different based on the patient type.

 

For example in a child, audible breathing at nighttime is indicative of an airway issue that would disturb sleep; if a child is actually snoring, then he or she has a further progression of the disorder, or is presenting with more severe symptoms. Additionally, "young fit females" has become a classification for high risk patients who's symptoms are not only different to identify from what is typically associated with this disorder, but oftentimes these patients get misdiagnosed or their symptoms are "excused away" based on lifestyle or other factors (more on this later)

Common Symptoms Associated with Pediatric Sleep-Disordered Breathing:

Poor Nighttime habits

  • Mouth breathing

  • Snoring

  • Sleep walking/ talking

  • Teeth grinding

  • Wakes up at night, restless sleep

  • Night sweats

  • Bedwetting

  • Nightmares

behavioral issues

  • Difficulty listening, interrupting often

  • Fidgets with hands

  • ADHD, hyperactivity, attention deficit

  • Difficulty in school (specifically math, science, spelling)

myofunstional, anatomical

  • Speech problems

  • Tongue thrust, dysfunctional swallow

  • Crowded teeth 

  • Delayed or stunted growth

immunological, hormonal

  • Frequent throat infections

  • More frequent upper respiratory infections

  • Allergies, asthma

  • Skin conditions, eczema

  • Morning headaches

  • Increased risk of type 2 diabetes, obesity

What is the root cause of this disorder? 

Research from the past 20 years has linked these outward signs and symptoms to the following root causes:

  • Mouth breathing instead of nasal breathing

  • A narrow palette

  • Improper tongue placement and/or dysfunctional tongue movement patterns

  • Improper jaw relationships &/or a deficient mandible

Said another way, if the child has any of these conditions, then the mandible (or "lower jaw") will drift down and back towards the spinal cord, thus restricting the airway that sits posteriorly. 

Effects of Mouth Breathing

Pictured here are 2 different types of scans to show the effects of mouth breathing on the airway. Opening the mouth 1/2 inch causes the oropharynx (or the upper part of the airway) to be reduced by 6mm

As a frame of reference, the average 7 year old child should have an airway that is approximately 7mm anteroposteriorly. So when a child of that age is breathing through his or her mouth, it's comparable to having their airway reduced to the size of a coffee straw. 

For adults, a healthy airway can be measured within a range of 11-15mm. 

For more information, we recommend viewing the following video: "How improper breathing leads to TMJ  Disorder and Crowded Teeth"

How is this related to the patients' condition who have other chronic conditions or congenital anomalies? 

For children who present with other comorbidities (ie. those who experience seizures associated with a hypoxic birth, those with special needs, those who are on the autism spectrum, etc.), improved health can still be accomplished via improved neurological functioning (cognition and mood), improved immunity and endocrine balance, and decreased inflammation. 

To expedite these optimized clinical outcomes, our team uses a series of intra-oral appliances to accomplish the following:

  • Establish nasal breathing

  • Reinforce proper tongue placement and function

  • Advance the mandible downward and forward, thus opening up the airway 

  • Expanding the dental arches and promoting optimal growth and development and dental eruption in children, or more ideal arch relationships in adults

Additionally, we have ongoing collaborative relationships with leading experts in speech pathology, occupational therapy, ENT physicians and pediatricians, dietitians, integrative medicine doctors, and chiropractors to help educate you on any additional issues your child may be facing that we can resolve.​

How do I know this will work for my child? 

In a study of 220 children over the course of 5.5 months presenting with vary levels of symptom severity, the following results were found as related to resolution of these symptoms via early interventional, oral appliance therapy.  

As an example on how to interpret the chart below, of those children who presented with the symptom "headaches", 98% of all of those children who were experiencing chronic headaches had improvement, with average improvement of headaches being 94% better, and 85% of the children experience COMPLETE resolution of their headaches all together. 

For more information, or to schedule a complimentary evaluation for your child, please contact our office at info@centraldentist.com or call us at 214-368-0900