Don't Ignore The Snore (Especially In Children!)
Dentists like myself value proper breathing as a requisite for a healthy life. We have many tools in our kits to evaluate patients who may be at higher risk. The following pictures will give you a general idea of some of the warning signs we look for in our adult and child patients.
These are just a few things we look for. The relationship between the jaw, lips, tongue, soft palate and larynx is defined as the orofacial complex. The parts must fit together to breathe, swallow, and speak properly. The orofacial complex is aptly named; it is very complex and challenging to understand in its entirety. I do not suggest trying to diagnose any problems yourself. You need to seek professional care if you suspect you or your child may have breathing issues.
On the other hand, snoring is easy to diagnose at home without professional help. Snoring, mouth breathing and sleep apnea are collectively associated with Sleep Disordered Breathing, or SDB. SDB causes poor oxygenation in the body and the brain dysfunctions as a result. Children are uniquely susceptible to oxygen deprivation because their brains are still developing. Low oxygen and lack of adequate sleep for children's brains often leads to poor concentration, attention problems, hyperactivity, aggression, impulsivity, somatic complaints, and social withdrawal. The issues could be life-long and irreversible if not addressed early.
A study published in 2012 by Bonuck and Freeman examined the effects of snoring, apnea, and mouth-breathing patterns on behavior, from infancy through 7 years in more than 11 000 children. By 4 years, children in the symptomatic clusters were around 20% to 60% more likely to exhibit behavioral difficulties consistent with a clinical diagnosis. By 7 years, they were about 40% to 100% more likely. The worst symptoms were associated with the worst behavioral outcomes. Since the authors' findings were published, childhood snoring particularly and SDB generally have gotten massive attention. The consensus is that it should be diagnosed and treated as early as one year of age. (5)
Identifying snoring in your child does not mean that there is a problem. But since behavioral problems are associated with it, parents should suspect it if their child is:
Sleepy during the day
Irritable
Tired and rambunctious at the same time
Wetting the bed
Struggling in school
You can listen to your child while they sleep, and video monitors are a big help. Even if you don't hear anything, you should consult your child's pediatrician if they demonstrate the behaviors listed above. They can identify specific issues like allergies and enlarged tonsils that could be the cause. Sleeping with an open mouth is just as bad as snoring, therefore observation is as important as listening.
Identifying problems with the orofacial complex should be done by dentists with the knowledge base to do so. The initial evaluation should include identifying problems with tooth crowding, tongue position, the airway's size (pharynx), the ability to breathe through the nose, and more. We can get an exact idea of the relationship of all these things by taking a three-dimensional image. A nice feature of most scanning software is seeing the airway's exact dimensions and how it relates to the complex. Sophisticated algorithms in the software allow for multiple different views for a complete analysis. One of the views is called a lateral cephalometric analysis. This tool is critical when expansion appliances and orthodontic movement are indicated.
Critical to the success of the treatment is identifying underlying causes of orofacial complex problems. The causes can be wide-ranging and include things like thumb-sucking, allergies, and nutritional issues. For this reason, multi-specialty approaches are critical. My partners and I have recently rolled out Connecticut Sleep Centers to help our adult and children patients sleep well and be well. Remember, early diagnosis and interventions are critical. It is more effective, cheaper, and less complicated. My sleep center website offers a quick self-assessment to help you determine if there is any concern. Feel free to take advantage of it if you have any problems. The following video contains a brief introduction to some of the services offered.
