The Role of Dentistry in Pediatric Sleep DisordersWritten by Heather Siler
Sleep-Related Breathing Disorders (SRBD’s) is characterized by recurrent episodes of interrupted breathing during sleep. Sleep apnea is the most common disorder in children and adults and occurs when the airway becomes blocked by various soft tissues (tonsils or tongue) near the back of the throat. The result of this blockage is that the windpipe gets partially closed off and the tissues vibrate as air passes producing snoring. Sleeping on the back makes it worse because the lower jaw can slip back causing the tongue to block the airway as well.
SRBD’s present problems for the child, dental and otherwise. Reporting of SRBD’s in children is low when compared to adults. Some parents aren’t even aware that their child is having problems with their airway. The dental team is often the ones who identify SRBD’s and make the necessary referrals to help relieve the problems and issues associated with its presence. Following are some of the causes and symptoms associated with SRBD’s:
- High and narrow palate- if the child presents with a high and narrow palate, the chances are greater that they will have an SRBD. Referral to an Orthodontist is necessary to evaluate for a palatal expander to widen the palate to prevent SRBD’s.
- Short Lingual Frenum- a short lingual frenum can permit SRBD’s because it allows for the tongue to partially block the airway when the jaw repositions during sleep. Referral to a periodontist or an oral surgeon to surgically clip the frenum may be in order.
- Obesity- if the child is obese, fatty tissue deposits in the soft palate decrease the size of the airway promoting SRBD’s. Losing weight can help.
- ADHD- the incidence of ADHD has steadily increased over the decades. If a child is dealing with sleep issues, a misdiagnosis of ADHD can occur. Adults with sleep disorders tend to be sluggish and drowsy. Whereas, children with the same disorders are hyperactive, uncooperative, and unable to focus. Sleep disorder management often reverses this diagnosis.
- Unable to sleep peacefully & Night Terrors- Due to the interruption of sleep, the child is more likely to wake up repeatedly during the night and suffer night terrors when they actually do sleep. Diagnosing and ending sleep apnea ensures a well-rested
- Recurrent episodes of stopping breathing- With blockage of the windpipe, the airway closes off waking the child by gasping for air. Breathing interruptions cease with SRBD therapy.
- Snoring- the vibration of enlarged tonsils or the position of the tongue blocking the airway promotes snoring. Removal of the tonsils and/or adenoids or a frenectomy usually terminates snoring.
- Mouth breathing- most children and adults dealing with SRBD’s are mouth breathers. This, in turn, causes decay and xerostomia. Mouth breathing changes the ph of the saliva making it more acidic hence causing decay. Breathing through the mouth also causes the mouth to be dry and constant wetting and drying of the oral tissue. Furthermore, chronic mouth breathing is a precursor to dental and skeletal malocclusion. Counteracting these maladies includes products to offset xerostomia, concentrated fluoride treatments at home, and referral to the appropriate specialist to eliminate the causes and symptoms of SRBD’s.
- Bruxism- Teeth grinding is thought to be done by the sufferer of SRBD’s because they are constantly fighting to open their airway in order to Halting SRBD’s should rectify bruxism. Other options may also include a mouth guard to be worn while sleeping. The guard is used to reposition the jaw to keep the airway open and protect the teeth from the grinding.
The key to diagnosing and treating SRBD’s is to observe and question both parent and child if you suspect this is the case. Keep in mind that a lot of the symptoms and remedies overlap and referral to the appropriate specialist is important.