Orthodontists are not just about fixing crooked/crowded/spaced teeth to create a beautiful smile. We can also be part of the health care team working to improve a patients sleep quality. Sleep disordered breathing (SDB) covers a range of sleep disturbances arising from upper airway resistance and manifesting as heavy breathing, mouth breathing, snoring, and/or sleep apnea. Children with SDB can exhibit behavioral symptoms such as bedwetting, changes in mood, ADHD, and poor school performance. They can also be found to sleep in “awkward” positions in their bed. Early diagnosis and treatment will go a long way to improving overall health and well-being for the child. The functional airway evaluation screening tool identifies 6 red flags for Pediatric Sleep Disordered Breathing. These 6 red flags are commonly assessed during an initial Orthodontic evaluation.
The first flag is nasal breathing versus mouth breathing. Nasal breathing is important to properly filter the air entering our body, humidify the air and boost oxygen uptake for the body. The next flag is the presence of mentalis strain on lip closure. The mentalis muscle is located at the tip of the chin and is the primary muscle of the lower lip. Mentalis strain shows as a dimpling of the chin on lip closure and can indicate a growth pattern being affected by mouth breathing instead of nasal breathing. Next is enlarged tonsils referred to as tonsil hypertrophy. Enlarged tonsils can be seen just past the uvula if they are enlarged. The pediatrician and/or dentist can check for this at routine health screenings. The fourth flag is ankyloglossia, better known as tongue tie. This is when a muscle at the floor of the mouth attaches to the tongue in a way that limits mobility. This is often identified at birth, but there are different degrees of tongue tie that often go undiagnosed. The next is excessive dental wear, most likely from tooth grinding, also known as bruxism. This will present as worn down or chipped teeth. The sixth and final flag is a narrow palate which is the roof of the mouth. Since the roof of the mouth is also the floor of the nose, a narrow palate can increase nasal airway resistance. A yes to two of the above flags can indicate a mildly increased risk for SDB, four yes’s is a moderate risk, with all six indicating a severe risk. A chart with pictures demonstrating the 6 red flags can be found on our website at www.orthodontists.com under the treatment tab for snoring/sleep apnea. Also available is the Pediatric Sleep Questionnaire for further assessing risk for SDB.
While the diagnosis of sleep disordered breathing is made by a sleep physician, the orthodontist can play a big role in the detection of risk factors for SDB. Early examination can identify for all 6 red flags including enlarged adenoid tissue on one of the diagnostic records taken for Orthodontic evaluation. Removal of enlarged tonsils and/or adenoids is often the first line of treatment for children identified with SDB. The Orthodontist can also treat a narrow palate using arch expansion devices, which have been shown in studies to be helpful, not just for tooth alignment, but for improved airway. If you feel that your child is suffering from sleep disordered breathing, please have them assessed by a trained healthcare professional.