Airway Health & Sleep Disordered Breathing

Breathe Well, Sleep Well and Smile Brochure

Airway Health and Sleep Disordered Breathing (SDB) in children is a much more critical and common problem than what has previously been thought. SDB can manifest itself in a variety of symptoms that can be easily overlooked, misdiagnosed, and most unfortunately often left untreated. The symptoms associated with SDB can include mouth breathing, loud snoring and fatigue can point to serious underlying health issues and the need for treatment. 20 years of research has identified an association between Sleep Disordered Breathing and crowded or crooked teeth or other dental concerns. SDB can have a lasting impact on your child’s growth and development and even create behavior challenges similar to ADD/ADHD or bedwetting.

Sleep Disordered Breathing

Sleep Disordered Breathing in children is a much more critical and common problem than what has previously been thought. SDB can manifest itself in a variety of symptoms that can be easily overlooked, misdiagnosed, and most unfortunately often left untreated. The symptoms associated with SDB can include mouth breathing, loud snoring and fatigue can point to serious underlying health issues and the need for treatment. 20 years of research has identified an association between Sleep Disordered Breathing and crowded or crooked teeth or other dental concerns. SDB can have a lasting impact on your child’s growth and development and even create behavior challenges similar to ADD/ADHD or bedwetting.

The central issue for many children suffering from the effects of Sleep Disordered Breathing (SDB) or Obstructive Sleep Apnea (OSA) is a compromised airway. When a child’s airway is narrow, underdeveloped or obstructed in any way, the child will struggle to receive enough oxygen during the night, wake-up or change position to breathe, causing fragmented and interrupted sleep. This cycle leads to mouth breathing and an open mouth posture during the day, compounding the issue and makes things worse.

Daytime issues like an open mouth posture and mouth breathing and structures like narrow palates and retrognathic jaw position cause further issues at night while sleeping. Snoring and apnea decrease oxygen supply to the body and brain, interrupt sleep and prevent the child from obtaining the vitally important stages of deep and REM sleep. Sleep Disordered Breathing, that can range from Snoring to Obstructive Sleep Apnea, is a vicious cycle and leads to symptoms such as:

  • Swollen tonsils and adenoids
  • Frequent ear and upper respiratory infections
  • Bed wetting
  • More severe allergies, asthma
  • Digestive issues
  • Disrupted sleep patterns
  • Delayed growth
  • Depression
  • Headaches
  • ADD/ADHD like behavior
  • Cognitive and learning issues
  • Poor memory and ability to focus
  • Aggression and socialization issues

Airway focused orthodontic treatment not only results in beautiful smiles, but offers a CURE for children suffering from SDB or OSA or PREVENTS it in children who might be at risk. Proper orthodontic treatment can open up and develop the airway of a growing child by expanding the upper palate, bringing the upper and lower jaws forward and allowing the airway to widen.

It is vital to not only address the underlying causes of both SDB and dental malocclusion but to also ensure that the causative issues do not reoccur. By incorporating the MYOBRACE SYSTEM and the MYOFUNCTIONAL TRAINING ACTIVITIES into our orthodontic care, we can help your child eliminate damaging habits like mouth breathing, improper swallowing and tongue thrusting and offer a true CURE.

By evaluating and screening your child for LIP-TIES OR TONGUE-TIES (tight maxillary and lingual frenum attachments) and offering procedures when appropriate, we can treat the anatomical barriers to good airway growth and health

Proper oxygenation through correct breathing, a healthy airway and a full night’s sleep in turn lead to an improved immune and hormonal system, better school and sports performance and an overall healthier and happier child. BEAUTIFUL STRAIGHT TEETH ARE THE ICING ON THE CAKE.

Teeth & Airway Health

The position of the teeth, even as early as 2 years old, can indicate insufficient jaw size, poor airway development and be a symptom of poor myofunctional habits that can lead to Sleep Disordered Breathingand Obstructive Sleep Apnea. The earlier the signs are recognized and treated, the healthier your child will be.

No Spacing or Crowding Between Baby Teeth
A normal and healthy bite with all the primary teeth present will appear to have SPACES between all the baby teeth. This is a good indication that the tongue is correctly placed on the roof of the mouth and is acting like a “scaffold” for proper tooth position and palate size development. Permanent teeth that come in after the baby teeth fall out are much bigger and wider than the baby teeth they replace and need the extra room spacing provides. No spaces between your child’s baby teeth usually indicate not only that the adult teeth are going to be crowed or even “crowed out completely”, but also indicate that the dental arches are too narrow and can lead to poor facial growth and unhealthy airway development. Early intervention and treatment can not only prevent the need for braces which will likely be inevitable, but can also prevent poor airway development that can lead to poor heath and sleep.

Tooth Wear and Chipping
When the teeth look “flattened, ” worn-down, short or chipped, it can indicate tooth grinding or bruxism and point to a potential airway problem. If a child is having a hard time getting enough oxygen while sleeping, the body will unconsciously respond to try and make breathing easier. One way the body accomplishes this is by moving the lower jaw forward (like the “jaw thrust” in CPR) to automatically open the airway. With repeated movement of the lower jaw coming forward, not only will you hear “tooth grinding” sounds, you will see damage to the teeth. Hearing or seeing evidence of tooth grinding means that your child is likely struggling to get enough oxygen while sleeping and treatment should begin as early as possible to cure this serious problem.

Over-Closed or “Deep” Bite
When a child bites down and the lower incisors are hardly visible, this means there is an over closed or “deep bite” bite and a vertical discrepancy, which has serious future consequences for airway size and growth and development if not treated early.

An “Open” Bite
Front top and bottom teeth that do not overlap at all when the back teeth are touching and have a large gap or space between them (for example you could stick the tongue “through” the gap) are usually the result of a habit such pacifier or thumb sucking. Often it appears that the canine teeth are “longer”, when in fact the upper front 4 teeth are actually pushed “up” higher than the rest of the teeth. Unfortunately, this “open bite” leads to poor myofunctional issues like an open mouth posture and low tongue position, a tongue thrust, mouth breathing and further constriction of the palate leading to poor jaw growth and airway development compromise. Even though sucking and soothing habits are “normal” for babies and infants, the sooner they are addressed and stopped, the better. Early corrective and conservative treatment should be the goal in order to put the growth pattern of the face, jaws and teeth back on track and the correct any poor myofunctional habits that often coexist.

Front Crossbite
A cross-bite involving the front teeth: if the lower teeth are biting in front of the upper teeth, it is a situation that demands immediate intervention. The condition will prevent the upper jaw from growing forward and as the teeth grow longer with time, it will be harder to reverse the cross-bite.

Side Crossbite
A cross-bite involving the side primary molars means that the top jaw is smaller than it should be and is an indication of a constricted palate which is a risk factor for poor airway development and should receive immediate intervention.

Around age 8, as the baby upper lateral incisors are shed, if the palate is constricted, there will be very little space or no for the permanent laterals to erupt. These teeth need at least 7 mm of room to come into the mouth properly. Unless the palate is expanded and room is made, the loss of space will not be regained. In addition to severe tooth crowding, a constricted palate is a sign of unhealthy air way development and improper jaw growth. Early treatment around age 7 or 8 is vital.

Extreme “Overjet” and “Overbite”
Although the top teeth may look like they are way too forward and should be “pulled back”, its actually the opposite. The top teeth may look “buck”, but they are actually positioned in the maxillary arch correctly and the trouble lays with the underdevelopment of the lower jaw. This lower jaw “protrusion” is also known as a “retrognathic mandible.”

This type of “bite” and jaw position puts a child at extremely high risk for developing a constricted airway and Obstructive Sleep Apnea. Treatment to help guide the lower jaw forward should begin as young as possible knowing that the jaw basically stops growing around the time all the permanent teeth come in, usually around age 12. The earlier treatment for this condition begins, the more conservative and effective it can be. Waiting too long can result in unfavorable treatment options, including jaw surgery and if not addressed at all, will likely lead to OSA and poor health.

Flared Lateral Incisors
If lateral incisors are fully erupted around age 9, and they look like they are flared sideways, this is a warning that there is impending crowding. Due to a lack of space, the underlying canines are pushing against the roots of these laterals and shifting their position. This can be detected with early screening and good imaging, preventing potential damage to the permanent lateral tooth roots as well as creating room for the permanent canines to erupt in a more normal path.

Displaced Canines
Around age 11, the upper canines will appear. Among all the permanent teeth, these travel the longest path before they emerge. They start their journey from the space right next to the nose, almost under the eye, and travel down over many years. If there is insufficient space due to a constricted palate, they will emerge “ectopically,” or sideways, or they will be impacted within the palate. Complications and lengthy treatment time can be avoided with early treatment.

Frenums – “Tongue and Lip Ties”
If the tongue is RESTRICTED and UNABLE to touch and rest on the upper palate, a simple Frenectomy procedure may be necessary to improve your child’s health and dental issues. We are proud to be members of the Academy of Laser Dentistry and to use the State-of-the-art Lightscalpel© CO2 laser.

The Nose is for Breathing, the Mouth is for Eating

  • Normal and healthy breathing is done through the nose, NOT the mouth. Each nostril functions independently and synergistically to filter, warm, moisturize, dehumidify and smell the air. Only by the act of breathing through your nose is the air being properly prepared to enter the lungs.
  • Babies are born obligatory nose breathers, but somewhere along the way nose breathing can change to mouth breathing, with dire consequences. Harmful effects of mouth breathing include drying out oral and pharyngeal tissues and not filtering the air entering our bodies from bacteria and irritants. This often leads to inflamed tonsils and adenoids, more frequent upper respiratory infections, dry cough, gingivitis and caries.
  • Additionally, mouth breathing causes the jaws to grow incorrectly, the tongue to hang lower in the mouth, the upper palate to constrict and narrow, in turn causing a restricted nasal cavity space, as well as crooked teeth. This is an example of “form following function” – poor bone structure and muscle formation will occur from poor breathing function (mouth breathing.)
  • Normal respiration follows a gentle wave pattern with 10 to 12 breaths per minute and is driven by the diaphragm. Mouth breathers take too many breaths, with rates from 12 to 20 breaths per minute or more and incorrectly use their chest muscles to breathe.
  • Breathing delivers oxygen to the cells of the body and removes excess carbon dioxide. Carbon dioxide is produced as a byproduct of exercise and digestion of food. But, carbon dioxide is not just a “waste product:” having the right amount of carbon dioxide in your body is critical to health.
  • Carbon dioxide plays a significant role in the release of oxygen from hemoglobin and how much oxygen your organs receive. It also triggers breathing, maintains blood pH and prevents smooth muscle spasms. All of these functions are reduced or impaired in mouth breathers.
  • Surprisingly, oxygen is absorbed on the exhale, not on the inhale. The back pressure created in the lungs with the slower exhale of nose breathing allows more time for the lungs to transfer oxygen to the blood. This exchange requires carbon dioxide. Exhaling through the mouth allows too much carbon dioxide to leaver the body, resulting in less oxygen being absorbed in the body.
  • An enzyme called nitric oxide is released in the nasal cavity ONLY WHEN NASAL BREATHING. Nitric Oxide is a vasodilator. It dilates blood vessels carrying oxygen increasing the efficiency of oxygen exchange in the body by 18 percent.
  • There is no Nitric Oxide inhaled with mouth breathing, therefore less oxygen is absorbed.
  • The reduced oxygen absorption leads to a cascade of poor sleep, poor stamina, low energy level and in kids can lead to ADHD symptoms. Children diagnosed with ADHD may in fact be mouth breathers who are simply sleep deprived.
  • With proper nasal breathing, the tongue rests against the palate without touching the teeth and the lips are closed.
  • In this position, the tongue provides passive pressure on that roof of the mouth that stimulates stem cells located in the palatal suture and within the periodontal ligaments around all the teeth, to direct normal palatal growth. The teeth erupt around the tongue which acts like a scaffold, producing a healthy arch form and straight teeth.
  • The lateral pressures from the tongue also counter inward forces from the buccinator (cheek) muscles which can “collapse” the arch and constrict the palate.
  • The low carbon dioxide levels associated with mouth breathing lead to over- breathing or hyperventilation (breathing too much, too deep and too fast) because the body is trying to keep the proper amount of carbon dioxide in the body for proper oxygen exchange and blood pH.
  • With less oxygen being delivered to the brain, muscles and all the cells of the body, the body functions less than optimally.
  • Sleep is often disturbed and of poor quality, leaving the mouth breather with fatigue, focus, behavior and cogitative issues during the day.
  • As the mouth dries out, the pH of saliva drops, leading to increased caries.
  • The lack of air filtration and humidification a result mouth breathing, irritates the tonsils and adenoids causing them to become inflamed and enlarged and increases the risk of upper respiratory tract infections.
  • Lower levels of carbon dioxide cause smooth muscle spasms associated with gastric reflux, asthma and bed wetting.
  • Smooth muscle is found throughout the body – in the respiratory system, digestive system and circulatory system, therefore mouth breathing can cause body-wide symptoms and problems.
  • When properly breathing through the nose, the lips are closed and the tongue is correctly positioned, “resting” on the top palate behind, but not touching, the front upper teeth. You can usually find correct position of the tongue or “the spot” by saying the word “banana” or pronouncing the letter “N.”
  • With mouth breathing, the tongue hangs in a down and low position, resting either in between the top and bottom teeth or behind the bottom teeth.
  • When the tongue is in the proper position and resting on “the spot,” it acts as a scaffold or support for the shape and form of the upper palate and the teeth.
  • When the tongue does not rest on “the spot,” the buccinator (cheek) muscles and orbicularis oris (lip muscles) are allowed to push “inward” unopposed, causing the upper arch to collapse.
  • Children who mouth breathe have an underdeveloped, narrow maxilla with a high vaulted palate. They develop a retrognathic (pushed back) mandible and generally have a long face. This is known as “long face syndrome.”
  • Some think the long face syndrome is actually dictated by genetics, rather than mouth breathing. Much anthropologic research has proven this false.
  • Modern man is not genetically programed to grow this way, it’s our lifestyle, diet and unhealthy habits, like mouth breathing, that is causing these skeletal changes to occur in “modern man.”
  • A study to demonstrate how mouth breathing alone could change jaw development and occlusion was conducted on monkeys by Dr. Egil Harvold and his team in the 1940’s.
  • In the study, Dr. Harvold artificially switched the naturally nose-breathing monkeys to mouth breathing by surgically blocking their noses with silicone plugs.
  • The monkeys were uncomfortable with the new mouth breathing, but eventually adapted to their new pattern of mouth breathing.
  • However, where they originally had normal jaw shapes and normal teeth, after being forced to breathe through their mouths, they all developed changes to their jaws and developed malocclusions (crooked teeth).
  • Breathing through the mouth creates changes in development of both the maxilla and mandible,  and causes the airway to become constricted, predisposing the child sleep problems that result in poor health, growth and cognitive development and set children up for obstructive sleep apnea later in life.
  • It may seem logical that mouth breathing occurs because the nose is congested, but that is not always the case.
  • The brain of a mouth breather thinks TOO MUCH carbon dioxide is being lost too quickly from the body and makes adjustments in the body to stop the escape.
  • One way the brain directs the body to try and “stop” the release of too much carbon dioxide is to stimulate the goblet cells in the nose to produce mucous to slow the breathing.
  • This creates a vicious circle of mouth breathing, triggering mucous formation causing nasal passages to constrict and become blocked, leading to more mouth breathing. In fact, mouth breathing can cause nasal congestion leading to more mouth breathing.
  • Determining if someone is a mouth breather is not always easy. Some people admit they always breathe through their mouth. Others believe they are nose breathers, but if you watch them, their mouth is open most of the time.
  • Some may have their mouth while sitting still, but if they get up and walk across the room, their mouth is open.
  • Kids often have a “cute” or “angelic” look with their lips parted making their lips look “full” and plump.
  • You can usually observe or see the tongue resting behind the bottom teeth.
  • Often kids who mouth breathe chew with their mouth open allowing them to breathe while they eat. They often tend to eat very fast or messily.
  • An open mouth posture caused by chronic mouth breathing, leads to the lips becoming “weak” and unable to remained closed easily. This leads to drooling, both awake and asleep and can cause a rash around the mouth.
  • Chapped lips are also common because mouth-breathers tend to lick their lips frequently. Nasal breathing allows for proper mouth lip seal is efficient at keeping saliva in and air out.
  • Mouth breathing at night dries the tissues so the mouth, teeth, tissues and the throat are dry upon waking
  • This further inflames the tonsils or adenoids.
  • Always needing a glass or bottle of water at hand is a sign of mouth breathing
  • If someone wakes with a dry mouth or in a puddle of “drool,” they are likely a mouth breather at night, which means they are also likely mouth breathing during the day.

Aides for Better Breathing

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