Last month I wrote about what sleep apnea is and the symptoms that occur from it. The most common type of sleep apnea is obstructive sleep apnea (OSA) where there is a physical blockage to a person’s airway, causing them to not get the proper amount of oxygen into their bodies that can result in several symptoms. In children, the symptoms can include poor performance in school, waking up with headaches, grinding their teeth, ADHD and poor behavior. Treating OSA frequently requires multiple specialists and this article will focus on how dentistry can help.
An orthodontist can be helpful in identifying the physical characteristics that can block the patient’s airway causing obstructive sleep apnea. These characteristics include a patient with a lower jaw that is set back, and upper jaw that is set back, a narrow upper jaw, a tongue thrust habit, difficulty keeping lips together and a long lower facial height. Often, these physical abnormalities are the cause of the sleep apnea and treating them can eliminate the need for a CPAP. The CPAP is the gold standard when it comes to treating obstructive sleep apnea, however compliance can be an issue.
So how can my orthodontist help my child sleep better? An orthodontist can orthopedically change the physical anatomy that is causing the patient’s airway to be obstructed. A common presentation in patients with OSA is a narrow palate, frequently seen children who are mouthbreathers. The narrow palate can be widened with an expander. As the upper jaw is widened, the nasal cavity gets wider as well, allowing the patient to breathe better and take in more oxygen.
Another common presentation is a a lower jaw that is small and set back. When you are lying down in bed at night and have a small jaw, the jaw drops back and the tongue moves back with it. The tongue then obstructs the airway. If your child has a small jaw, helping it grow forward can be a good option.
Sometimes the amount of advancement needed of the jaws is beyond what orthodontics can do. An oral surgeon can surgically advance the upper and lower jaw. Other times a dentist or dental specialist can advance the lower jaw with oral appliance therapy (OAT). An OAT is an appliance that a patient wears while they are sleeping to hold the lower jaw forward and hence bringing the tongue forward and keeping it from blocking the patient’s airway.
Advancing or widening the jaws, whether orthopedically or surgically, opens the patient’s airway and in return helps the patient breath better and sleep better to improve the quality of life.