I have been fortunate to have been able to spend a lot of time at Lake Powell, one of the most impressive and beautiful places I have seen, and I could tell stories about these trips for hours. One trip I remember in particular involved several families and over 20 people camping in tents and boats. I stayed up late with a bit of insomnia one night and was amused to find myself surrounded by a cacophony of snoring sounds; a huge variety of tones and cadence, from men and women and even children. A moonlight sonata of pathologic sleep and nearly half of my fellow explorers were affected.
One voice in particular I was able to identify and found more alarming than others; that of an eleven year old boy; one whom I had been treating in my general dental practice since early childhood. I knew him to be a heavy grinder beginning at an early age and he had had extensive orthodontics to correct a crossbite. He had a few dental needs from time to time and I treated him symptomatically, bonding the deciduous (baby) teeth as he wore through them, a filling here, sealants there. I didn’t know he snored because I never asked. I’m a dentist.
It has only been in recent years that I have become aware of breathing disorders, their complexity, their medical significance and the dental manifestations. In retrospect, this young man exhibited many of the cardinal warning signs of airway obstruction in children that are actually easy to spot and obvious once you know what to look for. Excessive tooth grinding or bruxism, overly large tonsils, heavy snoring, crossbite of the molar teeth and crowding of the front teeth, and marginal performance in school are all now recognized as being heavily associated with pediatric sleep breathing disorder or partial airway obstruction. Sleep apnea is not just a syndrome which affects only middle-aged, overweight men.
Dr. David Gozal is an internationally recognized authority on pediatric sleep disorders. He states that habitual snoring affects 7-13% of children and that 2-3% of children ages 2-8 actually suffer from obstructive sleep apnea (OSA). The risk of OSA is increased with asthma, allergic rhinitis, passive smoking exposure, premature birth and is especially prevalent in African American populations.
His research has proven associations between snoring and OSA in children and hyperactivity disorders, aggressive behavior and learning problems. His studies showed that first grade students whose school performance was poor, suffered from sleep apnea at 6-9 times higher rate than other students. He has been able to demonstrate improved school performance and even increased IQ in young people whose sleep breathing disorders were corrected, usually with tonsillectomy and/or adenoidectomy, especially if performed before the age of seven. Some of his research is focused on developing techniques to screen for sleep apnea in children using urine tests.
Some adverse cardiovascular effects associated with apnea in adults can be seen very early on in young children who may exhibit increased systemic diastolic hypertension and decreased endothelial function secondary to OSA. There is speculation that these children may then be predisposed to premature cardiovascular disease as adults.
Potential warning signs of an obstructed airway include forward head posture, obvious mouth breathing, dark circles under the eyes, daytime fatigue in overweight children or hyperactivity and attention deficit problems in smaller children, failure to thrive and snoring. Young children with severely crowded front teeth and narrow upper arch form in the back teeth will frequently be suffering from the inability to breath properly through the nose.
Interestingly, relying on parental report of witnessed snoring has proven to be an inaccurate screening tool, as many breathing disorders increase in severity in the early morning hours. As a result, many parents may never see or hear the problem.
My young friend is grown now and moved away. He was a very good baseball player and became a polite and productive young man. I don’t know if he still snores or grinds his teeth and I don’t know if he has or will develop sleep apnea. I wish I had known more about sleep breathing issues earlier in my career and maybe could have given him more relief at a young age if I had recognized the signs. I also need to screen his father who was playing the base notes at the lakeside symphony that night.
Bottom line; recognize that heavy snoring is not just a source of entertainment, especially in a child.
JC Goodwin, DMD, DACSDD, is a general dentist practicing in Arizona since 1987. He uses dental lasers, both surgical and non-surgical, in his office as well as same day crown technology and DNA testing. He started the Sleep Effect Center for Apnea Management in 2009 and holds a Diplomate credential in Dental Sleep Medicine. He is a member of the ADA, the Academy of Clinical Sleep Disorders Disciplines, the American Academy of Dental Sleep Medicine, the World Congress of Minimally Invasive Dentistry and is affiliated with the Centers for Dental Medicine.