Dentaltown February 2018 - 88

Fig. 3b

Fig. 4a

Fig. 4b

This treatment protocol has helped me
identify underlying root causes that can
contribute to sleep and breathing issues.
The Healthy Start habit corrector (Fig. 2,
p. 86) is designed with active myofunctional
therapy built into every appliance. It provides
repetitive correction of swallowing, tongue
placement and nasal breathing, and promotes
arch expansion. The prongs behind the lower
part on the lingual aspect prevent tongue
thrusting, the side panels keep the tongue
in the proper space, and the ramp lets the
tongue be placed in a more upward position.
A child swallows one time a minute during
sleep. By wearing the habit corrector while
sleeping, the myofunctional therapy will be
repeated more than 500 times per night.

A collaborative effort

Conclusion

Case study
A 6-year-old patient presented with a
history of snoring on a regular basis, wetting
the bed, waking up at night, grinding teeth
and talking in her sleep. She was under the
care of a speech therapist for 3½ years and
diagnosed with apraxia. Her medical doctor
suspected sleep apnea, but the patient had not
been tested. She had academic difficulties and
her parents were thinking about switching
schools. The patient's mother brought her in
for treatment because of the misalignment
of her jaws, the dark circles under her eyes
and a tongue-tie.

Observation
When I greeted Desi as she walked down
the hallway, I noticed her gait was off and
she appeared weak on the right side. Desi
seldom spoke and had trouble sitting still
for the exam. Clinically she was a pseudo
Class III, with a bilateral crossbite and venous

88

FEBRUARY 2018 // dentaltown.com

requires doctors to
diagnose sleep apnea
and dental professionals
to treat their patients
accordingly. This protocol
sets a precedent on a
growing area in dentistry
and will only improve
the quality of care in
our profession.
pooling underneath the eyes (Figs. 3a, p. 87,
and 3b, this page). Her tongue position was
low, and I observed a tongue thrust when
she answered questions about school and
her favorite color. Desi was predominantly
a mouth breather.

Treatment
The Healthy Start treatment was
implemented. A combination of functional
appliances (pseudo Class III, habit corrector
and Occlus-O guide IG/G) addressed the
habits, orthodontic conditions and pseudo
Class III condition (Figs. 4a and 4b). A
lingual frenectomy with a diode laser was
done in conjunction with treatment from a
chiropractor who worked with Desi before
and after the laser procedure to improve
range of movement and strengthening her
musculature.

Dentistry is no longer just about teeth
but is about the overall health of our patients.
There are many Desis out there, and these
children are struggling to breathe and sleep.
It is imperative for the dental community
to provide airway treatment and to promote
proper growth and development. Education
for the dental provider is vital. As dentists,
we look for education that provides the
necessary knowledge and helps us gain the
advantages of a hands-on experience that
is critical for easier implementation in our
practices. It should become our priority to
look beyond the teeth and to identify health
issues that affect our younger patients. In
turn, we can recommend comprehensive
treatment that provides a healthier lifetime
of beautiful smiles.
It's 2018 and dentistry is still evolving. As
members of the dental community, we need
to understand that airway is a significant part
of a child's growth and development. Poor
habits contribute to these sleep issues, and
dentists can provide a form of treatment that
can address the root causes to ensure that all
children have the chance to sleep soundly,
breathe well and become healthier versions
of themselves. ■
References
1. ADA Proposed Policy Statement on the Role of Dentistry in
Treatment of Sleep-related Breathing Disorders ADA Meeting
Oct 2017
2. Stevens B, Bergersen EO. The Incidence of Sleep Disordered
Breathing Symptoms in Children form 2-19 years of age. J Am
Ortho Soc 2016; 24-28.
3. Sahin U, Ozturk O, Ozturk M, Songur N, Bircan A, Akkaya
A. Habitual snoring in primary school children: Prevalence and
association with sleep related disorders and school performance.
Med Princ Pract 2009; 18:458-465.
4. Urschitz, MS, Eitners S, Guenther A, et al. Habitual Snoring,
Intermittent Hypoxia, and Impaired Behavior in Primary
School Children. Am J Resp Crit Med 2003; 168:464-468.
5. Reiter, J., Rosen, D. Diagnosis of Common Sleep Disorders in
Adolescents. Current Opinion in Pediatrics Journal 2014 26
(4):407-412
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