Do any of these symptoms sound familiar: Snoring, suddenly waking up due to gasping or choking, daytime sleepiness? What about teeth grinding? These are all clinical manifestations of obstructive sleep apnea. If you or your child exhibits any of these symptoms, you may want to talk to your dentist about it.

OSA is a condition in which breathing is interrupted and you actually stop breathing for a moment. The National Sleep Foundation estimates about 18 million Americans suffer from the condition. OSA risk factors include: obesity, neck circumference, family history and smoking. However, there are also some anatomical risk factors, such as small upper and lower jaws and tongue ties.

What if we could help prevent children from developing OSA by reducing their risk factors?

As an orthodontist, I have a unique opportunity to help guide growth of the mouth and jaw, and there is research to suggest that early orthodontic therapy as part of a multidisciplinary approach can help reduce the risk of developing OSA.

Most people think an orthodontist’s role is just making someone’s teeth look good. But one of the important things I do is assess someone’s facial structure and their proportions. If growth is not occurring in a favorable way, then my role is to help redirect growth. In adults, we plan for how we are going to compensate for how their facial bones grew. It is important to note that there are orthodontic treatment plans that have the potential of increasing OSA risk factors or making symptoms worse over the long-run. That is why at my office we are very cognizant of our patients’ sleep and breathing habits and incorporate them into their overall treatment plan.

At our office, part of our initial consultation is to go through a sleep questionnaire to understand the patient’s sleep habits and quality. We then move on to a clinical and radiological exam to see the shape, size and location of the jaw bones as well as the development of the teeth. We are trying to screen for potential risk factors that we know increase one’s chance of OSA.

Children that present with crossbites (bottom teeth on the outside of upper) are about three times more likely to develop sleep apnea. We also know that children with small lower jaws (big overbites) are 2.5 times more likely to develop sleep apnea. Radiographically we are looking at the shape and size of the airway to determine if there are any obvious obstructions, such as the adenoids. We make the proper referrals to other specialists as needed.

Sleep is an integral part of a child’s overall development and health, and so it is critical we address these problems as soon as symptoms arise. Moreover, it is important to note that there are many orthodontic options for a growing child that are not available once growth has been completed. Therefore seeking orthodontic treatment early, even as early as age 4 or 5, can be helpful. The sooner we can change the trajectory and eliminate risk factors the better.

OSA is multifactorial, and that is why it is best treated by a team approach. My team consists of dentists, pediatricians, sleep physicians and ENTs. In short, it is best to be honest with your dental provider and tell them if you or your child exhibits any of the symptoms or risk factors discussed.


Dr. Shira Z. Tor is a partner at Weiss and Tor Orthodontics in Beachwood.

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