If you’re like me, while in the car, you listen to the radio. The stations I listen to promote retainers to wear at night to stop snoring. I guess that shows the demographics of the stations I listen to (I never thought I’d be as old as my parents).
Why is snoring such a big deal now? We’ve all spent vacations with our grandparents, and grandpa always snored. Grandma sometimes did too. Well, in medicine they have discovered this actually isn’t a normal part of getting old, but a sign of what’s called sleep apnea.
Sleep apnea has become the “buzz phrase” lately in medicine. It’s very obvious in adults, particularly in males. They typically appear to stop snoring for 5-20 seconds, then take a big snort or snore and start breathing again.
We used to think this was just snoring loudly or strongly. We now know they actually stop breathing and their oxygen levels drop. This is quite common in adults, particularly men, but did you know that it is quite prevalent in children, too?
We shouldn’t hear kids breathing as they sleep. Most kids with airway issues don’t snore as we would typically describe it. It’s usually more like a loud breathing.
Spectacular Smiles, Superior Customer Service: Today’s Orthodontics
Bill M. Dischinger, DMD
Key Takeaways
- Snoring and loud breathing in children are often unrecognized signs of sleep apnea, which is frequently misdiagnosed as ADHD.
- Enlarged tonsils, adenoids, and narrow palates can cause airway obstructions that drastically disrupt sleep and overall behavior.
- Modern orthodontists use advanced 3D imaging (CBCT) to evaluate airway volume and jaw positioning as part of their routine diagnosis.
- Treatments like light-force braces, specialized palatal expanders, and lower jaw advancement appliances can significantly improve pediatric airway issues.
The Misdiagnosis of ADHD and Airway Issues
Studies state that 10% of children are described as having sleep apnea. This is the actual diagnosed level by pediatricians. I can tell you this is vastly underestimated though.
How many of you have had your pediatrician ask you if Johnny or Suzi snore? Probably few of you at best. Pediatricians unfortunately just don’t have the time to discuss every single issue that could be going on. They have to look for the “bad” stuff.
But did you know that over 25% of kids that are diagnosed with ADHD actually don’t have it? They just don’t get proper sleep due to airway issues. These can then manifest themselves in ways such as ADHD (or just daytime fidgetiness), morning and evening tiredness and over activeness.
So many of our little boys have this issue, but have been “labeled” in school as boys that can’t pay attention. It happens in girls as well, but many of the girls are able to overcome the ADHD behavior better than boys and not receive this label.
Causes of Airway Blockages
So what causes these airway issues and how do we change it? Airway issues could be caused by one or many things at once. The one we all probably know about is enlarged tonsils.
In the 60’s – 80’s, taking out tonsils was quite common. Remember Peter Brady on the Brady Bunch? Then there was a huge swing the other way where it was hardly ever done.
Now we are starting to swing a little back up as airway issues are being more recognized. In most cases, the adenoids are also a problem when the tonsils become enlarged. Adenoids are located farther back and up the throat than tonsils and can only be seen through imaging techniques (techniques we have in our office).
If one or both of these are enlarged, the airway is greatly compromised and should be removed. My youngest son had this procedure done and his airway improved significantly.
Nasal obstructions can occur as well. Yes, sometimes when someone has that deviated septum repaired, they actually are telling the truth and didn’t have a nose job. The turbinates’ in the nasal cavity sometimes need to be reshaped as well.
Why Your Orthodontist Looks at Your Airway
That’s all great, but why am I talking about airway in a book that’s supposed to be about orthodontics?
Well, it is very easy for orthodontists that own a certain type of x-ray machine to evaluate the airway (yes, we own one of these). There is a new x-ray machine called CBCT. Stands for Cone Beam Computed Tomography.
Basically, it takes a 3 dimensional x-ray with Cat-Scan capability to see the soft tissue. It can give the exact measurement of a person’s airway volume. The machine takes about 8 seconds to take a scan with a dosage of 17 micro sieverts.
The American Radiology Board recommends we keep our radiation exposure below 1,000 micro sieverts per year. Pretty amazing machine, huh? We take one of these scans on all our patients, and airway evaluation is part of the diagnosis.
Many patients with airway issues will have a poor position of their tongue. Our tongue is supposed to rest in the roof of our mouth and when we swallow, it should slightly touch the back of our front teeth up near the gumline. Yes, I can see you swallowing and thinking about it right now.
A lot of people have a narrow palate, and the tongue is unable to do this. It sits low and farther back, the last contributor in causing a blockage of the airway.
Remember discussing jaws that are positioned too far back? The lower jaw is the most common and biggest contributor, but sometimes the upper jaw can be at fault, too. So, your orthodontist should be looking at this as part of their routine evaluations.
Orthodontic Solutions for Airway Problems
What can we do though? Many things! First, if tonsils or adenoids are issues, I will refer you to an ENT to have them evaluated and possibly removed.
If the palate is narrow, we can widen and enlarge it to its proper dimension. As discussed earlier, we can do this with our light force braces. There are some situations though, that I would use a palatal expander.
Wait, you thought I said I don’t use palatal expanders? Well, this is one time I would. Sometimes. Okay, now you’re really confused. Let me explain.
Sometimes I will have a child come in that has an airway issue, and it has affected their ability to behave properly or even not wet the bed. If I use my light force braces, I will change this, but it will take 6-8 months to see a change in these side effects. If we use a palatal expander, we’ll see results in 2-4 weeks.
We attach the expander onto the baby teeth, not the permanent molars, so we won’t see any long term problems with these teeth. When the palate is widened to its proper size, the airway will increase significantly, and most times to its proper volume. For these kids that have an airway issue that affects their success in school, they just can’t wait for me to take 6-8 months to help them.
They need help now. These are the kids I will use an expander on. In addition, most kids that have this narrow palate, also have a deviated septum according to new research that has been done.
By using the palatal expander, we can actually change the shape and size of the floor of the nasal cavity as well, typically getting rid of that deviated septum. I typically like to use the palatal expanders for kids age 4-10 so that I can attach it only to baby teeth. There are exceptions to this, and we would discuss those on an individual basis.
If the mandible (lower jaw) is too far back, we use our AdvanSync appliance I already discussed in chapter 2 to correct it. This change will greatly increase the airway volume as well.
The last issue is the upper jaw being too far back. This is something that will result in an Underbite (the lower front teeth biting forward of the upper front teeth). This would be the other time I use a palatal expander because research has shown that the use of an expander aids in the forward movement of the upper jaw when used with an appliance that helps it come forward.
Signs of Airway Issues in Children
Let’s review what signs to look for in your children if you suspect an airway issue. Snoring or loud breathing while sleeping (or even while awake for that matter). And for heaven’s sake, if they are actually stopping breathing, take them straight to an orthodontist that can take a CBCT scan or to an ENT today!
Open mouth breathing typically is a sign of some sort of airway constriction, whether in the nasal passages or somewhere in the throat area. If you can actually see their tonsils when they open, they are enlarged. They will be these big red balls that puff out towards the middle of the throat when they open wide.
You can actually see them move towards the middle as they say “Ah”. ADHD behavior can be due to airway issues, and is suspected to be the true culprit in 25% of children with an ADHD diagnosis. Bed wetting past the age this should normally stop can be a sign as well.
Lastly, one we haven’t talked about. If your child grinds their teeth at night, they typically have an airway issue. This is the brain trying to move the jaw around in an attempt to open up that airway.
The tongue can be a big culprit in all of this. Our tongue should rest in the roof of our mouth. For some people this is not possible due to the tongue being ‘tied’ or ‘tethered’ too low.
This makes the tongue sit back too far and can block the airway. It also contributes to the palate forming narrow.
Many of these kids had trouble breast feeding. I never thought I’d be asking about breast feeding in my orthodontic office, but in these kids that I suspect airway issues, it is part of our discussion as it can be one of the early signs.
Pediatric airway issues are a huge epidemic in our society that, unfortunately, are being overlooked by the medical world. In orthodontics, particularly in an office that understands airway issues, this can and must change!
Frequently Asked Questions
Q: What are the common signs that my child might have an airway issue?
A: Look out for snoring, loud breathing, or open-mouth breathing while sleeping. Other hidden signs include bed wetting past a normal age, grinding teeth at night, and behavioral issues that mimic ADHD, which are often caused by poor sleep quality.
Q: How can an orthodontist help diagnose sleep apnea or airway problems?
A: Orthodontists equipped with a CBCT (Cone Beam Computed Tomography) machine can take advanced 3D x-rays to accurately measure a patient’s airway volume. This technology helps evaluate the soft tissue, nasal cavity, and jaw positioning to identify the root cause of the blockage.
Q: Why might an orthodontist use a palatal expander instead of braces for an airway issue?
A: While light-force braces can gradually widen a palate over 6-8 months, a palatal expander can deliver rapid results in just 2-4 weeks. For children struggling with severe behavioral or developmental side effects from restricted airways, this fast expansion opens the airway quickly and can even help correct a deviated septum.