The Orthodontic Connection in Prevention of Obstructive Sleep Apnea and Sleep Disordered Breathing

"Why is my orthodontist asking about my sleeping behavior and my child's sleeping behavior? Don't they just straighten teeth?"

The orthodontic profession is realizing that orthodontic care can make a big difference in overall health. OSA (Obstructive Sleep Apnea) and SDB (Sleep Disordered Breathing) have largely gone unrecognized in children but can have serious implications, contributing to growth problems, failure to thrive, asthma, Type 2 diabetes, ADD, ADHD, autism, hypertension, stroke - even cardiovascular disease.

Causes

The most common and significant causes of sleep apnea and sleep disorder are:

• Obstructive tissues (enlarged tonsils, adnoids, turbinate tissues (in the nose), deviated septum)
• Lack of room for the tongue (narrow jaws, recessive upper or lower jaws, tongue-tied)

What happens physiologically?

With improper breathing, blood oxygen decreases and carbon dioxide increases. This triggers release of cortisol (the "fight or flight" or "survival" stress hormone) that increases heart rate and activates muscles to force breathing. Although the person doesn't actually wake, they are driven from deep restorative sleep to "catch their breath". Once they begin to relax to the deeper levels of sleep, it happens all over again. This is hard on the body - like running a race all night long. You wake up exhausted and unrested, but more importantly, prolonged levels of increased cortisol negatively affects the immune system, normal hormone production, insulin function, gastric acid production, and learning and memory retrieval, and a host of other organs and body functions.

What are the implications of decreased oxygen in a growing and developing brain of a child?

We now know that any airway resistance is not healthy and is harmful to the developing brain - it makes it difficult or impossible to store the information they learned today into long-term memory.

Treatment

• Growth-oriented Orthodontics (jaw expansion, advancement of upper and/or lower jaws to create room for the tongue and open the airway) rather than pulling teeth or using headgear (which can actually decrease the airway)
• Reduction of obstructive tissues (Remove Tonsils/Adenoids, and reduce turbinate tissue).
• Allergies should be controlled by an allergist or by a naturopathic practitioner.
• In adults, the gold standard of treatment is CPAP (continuous positive air pressure).
• The alternative to CPAP in adults is a special dental sleep appliance.

When to assess and treat?

As soon as you are aware of the problem! Dr. Mireles works closely with San Antonio physicians, allergists, ENT doctors, sleep medicine specialists and pediatric sleep specialists.
 
Our goal is to treat our San Antonio patients in a manner that will minimize or prevent these disorders at an early age. The quality of life for most of these patients has improved tremendously. The improvements obtained for some of these patients have literally made the difference between life and death.