True North Orthodontics: An Airway Aware Practice

22 Apr 2019 blog

By the numbers

Perhaps you have heard of obstructive sleep apnea (OSA) or have a family member or friend who has had a sleep study to test for this disease. If you are one of these people you are not alone as the most recent statistic shows that 10% of the population (or about 400,000 Albertans) has been diagnosed with a sleep disorder. Those with sleep disorders may experience decreased oxygen delivery to the brain causing the person to either disrupt their sleep in an attempt to breathe or to never achieve the deep sleep cycles that are needed for restful sleep. In many cases, this disease goes undiagnosed but more and more adults are becoming aware of this issue.

Children may also suffer from sleep disorders with the most common causes being enlarged tonsils and adenoids (lymph tissue in the upper airway) and obesity (1). Recognizing this disorder can be difficult as children may not appear tired but rather show signs of mouth breathing, hyperactivity, irritability, poor athletic performance, bed wetting, or the inability to focus at school. At my most recent trip to Western University of Health Sciences to instruct dental students on orthodontic diagnosis, some of the most common questions asked by dentists and students related to sleep apnea and orthodontics – clearly many people are concerned about this issue!

What can be done to detect sleep disorders in children?

As an orthodontic specialty practice, we have a large number of children that my team and I see and observe everyday. This places us in a unique position to screen for the signs and symptoms of many diseases including sleep disorders and make an appropriate referral to diagnose the issue.
In order to determine if a referral to a specialist should be made, patients with a suspected airway issue are examined intraorally. Some of the intraoral signs of possible airway issues might include a high shaped palate, narrow dental arches, the presence of a dental crossbite, and certain jaw growth patterns (1). In these instances early or two-phase orthodontic treatment with dental expansion has been documented to decrease nasal airway resistance as well as treat some jaw growth patterns but this may or may not be the cause of an individual’s sleep disorder (2)(3). Early orthodontic treatment is not intended as a catch-all for treating sleep disorders, however many of our young patients experience benefits that improve their sleep and breathing patterns. Our practice is also able to take imaging in our consultation of the upper airway recommended by Calgary Children’s Hospital to screen for enlarged adenoids (lymph tissue at the back of the upper airway). This further empowers us to make an informed referral to the appropriate medical professional and also initial orthodontic treatment in a timely manner if indicated.

Contact us at True North Orthodontics in Calgary to have your child assessed with an airway focused approach to orthodontic treatment. We believe in treating the ‘entire picture’ of health through orthodontic treatment.

References:

1) Neelapu, B. C., Kharbanda, O. P., Sardana, H. K., Balachandran, R., Sardana, V., Kapoor, P., … & Vasamsetti, S. (2017). Craniofacial and upper airway morphology in adult obstructive sleep apnea patients: A systematic review and meta-analysis of cephalometric studies. Sleep medicine reviews, 31, 79-90.

2) Pirelli, P., Saponara, M., & Guilleminault, C. (2004). Rapid maxillary expansion in children with obstructive sleep apnea syndrome. Sleep, 27(4), 761-766.

3) De Felippe, N. L. O., Da Silveira, A. C., Viana, G., Kusnoto, B., Smith, B., & Evans, C. A. (2008). Relationship between rapid maxillary expansion and nasal cavity size and airway resistance: short-and long-term effects. American Journal of Orthodontics and Dentofacial Orthopedics, 134(3), 370-382.

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