Developing an index for the orthodontic treatment need in paediatric patients with obstructive sleep apnoea: a protocol for a novel communication tool between physicians and orthodontists

Abstract

IntroductionSleep disordered breathing in the paediatric population can manifest as an array of different systemic symptoms; among them is a distinct malocclusion and craniofacial phenotype. Emerging research suggests that the treatment of this malocclusion and/or craniofacial phenotype through orthodontic intervention may help with the symptoms of these patients. Selecting the patients who would benefit from orthodontic treatment can be a difficult task for the physician with minimal dental training. Therefore the aim of this study is to develop a simple index to be used by medical professionals to identify those paediatric patients with orthodontic treatment needs who may benefit their obstructive sleep apnoea (OSA) symptoms.Methods and analysisThe methodology in this project has been devised through the WHO's recommendations on developing an index, with modifications based on the specific needs of this study. Based on the available literature, a draft index will be produced and subjected to multiple iterative revisions based on the feedback from: the Index Development Group, a group of multidisciplinary and internationally acclaimed experts in the field; the External Review Group, a group of potential end users and interested parties and the Steering Committee. Once the index has been formalised, it will be subjected to a pair of reliability tests using physicians and orthodontists scored 2 weeks apart. Subsequently, the index will be validated using dichotomous responses from orthodontists on whether they would treat a patient for OSA symptoms, and comparing the responses to the score of the index on the same patient.Ethics and disseminationThe index will be translated into French and will be presented in orthodontic and medical conferences, workshops, seminars, round table discussions, and free copies for download will be made available on the website of the University of Alberta Interdisciplinary Airway Research Clinic (iarc.ualberta.ca). Furthermore, the index will be published in a peer-reviewed medical journal to further increase the exposure of the index.

The Role of Orthodontics in Diagnosis and Treatment Planning of Pediatric Obstructive Sleep Apnea Syndrome: Case Report

“…Ancak araştır-macılar, OUAS'a neden olabilecek maloklüzyon ve kraniyofasiyal anomalilerin ortodontik tedavisinin semptomların azalmasına yardımcı olabileceğini ve bu anomalilerin olumsuz etkileri ortadan kaldırıl-madığı müddetçe tonsillektominin tek başına fayda etmeyeceğini vurgulamaktadır. 15,30 Son yıllarda mandibulanın fonksiyonel apareyler ile daha önde konumlandırılması ile OUAS tedavisiyle ilgili ça-lışmalar gündeme gelmektedir. [31][32][33][34][35] Mandibulanın anteroposterior yöndeki konumunun iyileştirilme-sinin hem kraniyofasiyal morfolojiyi iyileştireceği hem de OUAS semptomlarını azaltacağı bildirilmiştir.…”

Pediatric Obstructive Sleep Apnea Syndrome: Emerging Evidence and Treatment Approach

“… Mouth breathing patients are characterized by a hyperdivergent facial pattern, postrotation of the lower jaw plane, and upper airway space reduction. Furthermore, unilateral or bilateral crossbite is often found [ 3 , 18 ]. Nonmouth breathing children exhibit II skeletal class with low mandibular growth, retracted tongue position, and deep bite [ 1 , 3 ].…”

“…Mouth breathing patients are characterized by a hyperdivergent facial pattern, postrotation of the lower jaw plane, and upper airway space reduction. Furthermore, unilateral or bilateral crossbite is often found [ 3 , 18 ].…”

“…Mouth breathing patients are characterized by a hyperdivergent facial pattern, postrotation of the lower jaw plane, and upper airway space reduction. Furthermore, unilateral or bilateral crossbite is often found[3,18]. (b) Nonmouth breathing children exhibit II skeletal class with low mandibular growth, retracted tongue position, and deep bite[1,3].By the clinical evaluation, a major classification between two OSAS phenotypes emerges:(i) Classic OSAS phenotype (presence of adenotonsillar hypertrophy in children, with or without malocclusion) (ii) Congenital OSAS phenotype (craniofacial anomalies associated with a genetic disease, i.e., Pierre Robin sequence).…”

Prevalence of Malocclusion in Students in a Subpopulation of Mato Grosso, Brazil

“…3 The association between malocclusions and changes in the speech articulation and swallowing functions has received greater emphasis, especially in the association with mouth breathing, due to the severity of the associated alterations, such as obstructive sleep apnea and postural changes. 4 It is considered the third oral problem in the oral diseases priority scale, after dental caries and periodontal disease, according to the World Health Organization. 5 In Brazil, the National Oral Health Survey conducted in 2010 6 found the presence of at least one dental malocclusion condition in 66.7% of the 5-year-old children, 38.9% of the 12-year-olds, and 34.9% in the age group of 15 to 19 years.…”