Pediatric obstructive sleep apnea—Dental professionals can play a crucial role

Abstract

The significant contribution of dental professionals to the management of selected adult obstructive sleep apnea (OSA) cases is understood. Among children, it has also been suggested that dental professionals may also help screen and manage this morbidity in selected cases. It has also been noted that our understanding of pediatric OSA lags significantly behind adult OSA. During the screening process for potential pediatric OSA cases, dental professionals may be quite helpful as specific craniofacial abnormalities have been previously associated with pediatric OSA, including Class II malocclusion, vertical facial growth and maxillary transversal deficiency. As dental professionals assess children more frequently than physicians, they can help screen sleep‐disordered breathing signs and symptoms using validated questionnaires. In more advanced cases, orthodontists may be leading contributors to the management of selected cases where a craniofacial involvement is suspected. Rapid maxillary expansion and mandibular or maxillary anterior repositioning devices have been proposed as managing alternatives. So far, there is no substantial evidence if these approaches can be adopted to treat OSA fully or if the reported OSA signs and symptoms improvements observed in a selected group of patients are stable long‐term. Nevertheless, dentists and orthodontists' integration into a transdisciplinary team should be encouraged to play a significant role. This review discusses dentists or orthodontists' potential contribution to screen and manage selective pediatric OSA patients as part of a transdisciplinary team.

Sleep‐disordered breathing and malocclusion in children and adolescents—a systematic review

“…[50][51][52][53] Some studies have found a positive association between SDB symptoms and mandibular retrognathia, steep mandibular plane, and convex facial profile. 26,50,53,60 Previous studies have found that upper airway dimensions are smaller in children with large skeletal overjet and mandibular retrognathia, which might predispose to SDB. [37][38][39]62 The association between mandibular retrognathia and SDB is in agreement with the included study by Ikävalko et al 2018 but not with Ikävalko et al 2012.…”

“…65 It has previously been found that the craniofacial morphology is associated with the dimensions of the upper airway due to an extended head posture including morphological deviations of the upper spine and low tongue position. 26,[66][67][68] These factors and certain craniofacial morphological deviations like mandibular retrognathia are factors related to SDB. 26,36,66,67 Horizontal maxillary overjet is not always seen in children with mandibular retrognathia due to the dentoalveolar mechanism, 65 which indicates that the underlying craniofacial morphology is important in the discussion regarding association between malocclusion and SDB.…”

“…16,18,24,25 SDB in children may be correlated with anatomical characteristics of the craniofacial morphology and dental occlusion. 7,9,18,26 Previous studies have shown that patients with OSA often have extended head posture, which may influence the development of the craniofacial skeleton and dental occlusion. In addition, low tongue position has been found to be associated with OSA, and the low tongue position has an impact on the development of the dimension of the palate and maxillary dental arch.…”

Automated Adenoid Hypertrophy Assessment with Lateral Cephalometry in Children Based on Artificial Intelligence

“…As cephalometry is routinely performed in orthodontic practice, orthodontists are strongly recommended to screen their patients for sleep breathing disorders and AH in clinical practice [35]. Children with suspected AH based on lateral cephalograms could be referred by orthodontists to the ENT department for diagnosis and treatment [9].…”

“…Children with AH usually present in orthodontics department with malocclusion, thus the routine screening of AH in dental practice is helpful for preventing relevant craniofacial and systemic consequences [9]. Nasal endoscopy stands as the current gold standard of diagnosing AH [10].…”