“Why is my orthodontist asking about my child’s sleeping or behavior? Don’t they just straighten teeth?”
Not at all. We are realizing that orthodontic care can make a big difference in overall health. OSA (Obstructive Sleep Apnea) and SDB (Sleep Disordered Breathing) have largely gone unrecognized in children but can have serious implications.
They can contribute to growth problems, failure to thrive, asthma Type 2 Diabetes, ADD, ADHD, autism, hypertension, stroke and even cardiovascular disease.
Have you ever wondered if your child suffers from Obstructive Sleep Apnea (OSA) or Sleep Disordered Breathing (SDB)?
Daytime Symptoms suggested of OSA/SDB:
- Mouth breathing
- Excessive daytime sleepiness
- Inattention, behavioral problems
- Hypo-nasal speech (“good mording” instead of “good morning”)
- School problems
- ADHD-like behaviors
Night/Sleep Symptoms Suggestive of OSA/SDB:
- Snoring-Any type of snoring is a warning sign
- Pauses in breathing
- Restless sleep
- Night-time sweating
- Night terrors or sleep walking
- Sleeping in unusual positions (head extended)
- Enuresis (bed wetting)
Causes: The most common and significant are:
- Obstructive tissues (enlarged tonsils, adenoids, turbinate bones in the nose, deviated septum)
- Lack of room for the tongue (narrow jaws, recessive upper or lower jaws, tongue-tied)
What happens physiologically:
With improper breathing, blood oxygen decreases and carbon dioxide increases. This triggers release of cortisol (the “fight or flight” or “survival” stress hormone) that increases heart rate and activates muscles to force breathing. Although the person doesn’t actually wake up, they are driven from deep restorative sleep to “catch their breath”. Once they begin to relax to the deeper levels of sleep, it happens all over again.
This is hard on the body – like running a race all night long. You wake up exhausted and unrested, but more importantly, prolonged levels of increased cortisol negatively affects the immune system, normal hormone production, insulin function, gastric acid production, and learning and memory retrieval, and a host of other organs and body functions.
What are the implications of decreased O2 in a growing and developing brain of a child?
We now know that any airway resistance is not healthy and is harmful to the developing brain. It makes it difficult or impossible to store the information they learned today into long-term memory.
- Sleep Questionnaire (provided below)
- Clinical Examination
- 3D imaging
- Home sleep testing
- Overnight Sleep Test
- Growth-oriented Orthodontics (jaw expansion, advancement of upper and/or lower jaws to create room for the tongue and open the airway) rather than pulling teeth or using headgear (which can actually decrease the airway)
- Reduction of obstructive tissues (Remove Tonsils/Adenoids, allergy correction or naturopathic)
- Research has shown that the best results occur when both are done!
When to assess and treat?
As soon as you are aware of the problem! Although 7-8 years of age is typically the best time for a child’s first orthodontic check-up, there are occasional situations where the issues are severe and require earlier attention. If you’re unsure or worried as a parent, Dr. Bronsen Schliep understands your concern, as he’s been there himself as a father of two young children. Please don’t hesitate to email him at email@example.com with any questions. He’s happy to help!
Pediatric Sleep Questionnaire (PSQ)
An effective screening tool for children suspected of experiencing sleep-disordered breathing is the Pediatric Sleep Questionnaire. If your child scores 8 or more, Dr. Bronsen suggests that the parents start paying close attention to their child’s sleep habits for additional signs or symptoms. If your child scores 12 or more, it would be wise to bring your child into Nebraska Orthodontics for a complete evaluation and clinical examination. Please feel free to score your child and email Dr. Bronsen Schliep at firstname.lastname@example.org, if you have any questions or concerns.
Dr. Bronsen would like you to complete this form as accurately and honestly as possible. In our practice, we are very interested in our patients’ overall health. Orthodontic treatment can be an important part of managing the health problems caused by sleep and breathing disorders.
Pediatric Sleep Questionnaire:
____ While Sleeping, does your child snore more than half the time?
____ While Sleeping, does your child always snore?
____ While Sleeping, does your child snore loudly?
____ While Sleeping, does your child have “heavy” or loud breathing?
____ While Sleeping, does your child have trouble breathing, or struggle to breath?
____ Have you ever seen your child stop breathing during the night?
____ Does your child occasionally wet the bed, sleepwalk, or have night terrors (circle any)?
____ Does your child tend to breathe through the mouth during the day?
____ Does your child have a dry mouth on waking up in the morning?
____ Does your child wake up unrefreshed in the morning?
____ Does your child wake up with headaches in the morning?
____ Is it hard to wake your child up in the morning?
____ Does your child have a problem with sleepiness during the day?
____ Has a teacher or supervisor commented -your child appears sleepy during the day?
____ Did your child stop growing at a normal rate at any time since birth?
____ Is your child overweight?
____ This child often does not seem to listen when spoken to directly
____ This child often has difficulty organizing task and activities
____ This child often is easily distracted by extraneous stimuli
____ This child often fidgets with hands or feet or squirms in seat
____ This child often is ‘on the go’ or often acts as if ‘driven by a motor’
____ This child often interrupts or intrudes on others (butts into conversations or games)
Total Score = _________
Ronald D. Chervin, et al Arch Otolaryngol Head Neck Surg. 2007;133(3):216-222
For our adult population, there are many assessments available for sleep-disordered breathing and obstructive sleep apnea. The following “Adult Sleep Questionnaire” is a good starting point as a screening tool and a guide as to whether it may be beneficial to schedule a clinical exam to take an x-ray, along with gathering a complete medical history. Please feel free to score yourself (with the assistance of a bed partner, preferably) and email Dr. Bronsen Schliep at email@example.com, if you have any questions or concerns.
Adult Sleep Questionnaire:
- Do you snore loudly (louder than talking or loud enough to be heard through closed doors)? Yes / No
- Has anyone observed you stop breathing during your sleep?
- In the morning, do you wake up feeling unrefreshed or have a headache?
- During the daytime, do you often feel tired, fatigued, or sleepy?
- Is it difficult to close your lips and breathe comfortably through your nose?
- Do you frequently awaken with:
- Dry Mouth
- Nasal Congestion
- Chest Pain
- Excessive sweating
- Choking & Gasping
- Feeling groggy & unrefreshed
At Nebraska Orthodontics, our practice is much more than simply straight teeth!