Early Treatment, Airway & Expanders

Boy Sleeping.

The number of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) has been steadily increasing over the past decade. Yet according to a recent study, many children diagnosed with this condition don't really have it; their behavioral problems are actually related to sleep-related breathing disorders (SRBD), such as sleep apnea.

The 2012 study, published in the journal Pediatrics, followed more than 11,000 children for six years, starting when they were 6 months old. The children who had SRBD were 40 percent to 100 percent more likely than kids without breathing issues to develop behavioral problems resembling ADHD by the age of 7. So if your child is exhibiting ADHD-like symptoms — or has even been diagnosed with ADHD — it's worth considering whether interrupted sleep might be an issue.

It makes perfect sense when you think about it: A well-rested individual, young or old, can function a lot better on a good night's sleep. Yet a lack of sleep affects adults and children differently. While sleepy adults tend to act sluggish and drowsy, sleep-deprived kids are more likely to become hyperactive, uncooperative and unable to focus — just like kids with ADHD.

What Exactly Is Sleep Apnea?

The condition is characterized by recurrent episodes of interrupted breathing during sleep. The child's airway becomes blocked by soft tissues near the back of the throat — tonsils or the tongue, for example — that partially close off the windpipe. These tissues can vibrate as air passes by, causing snoring. It's often worse while sleeping on one's back because this encourages the lower jaw to slip back, which in turn pushes the tongue in front of the airway.

Overweight children have a higher incidence of sleep apnea due to fatty tissue deposits in the soft palate, which decrease the size of the child's airway.

Does your child have a sleep-related breathing disorder? You can gather clues to report to your health professional by observing your child sleeping. Look for the following signs:

  • Snoring
  • Pauses in breathing
  • Chronic mouth breathing
  • Constant tossing and turning
  • Night panics
  • Bed-wetting

How Is It Treated in Children?

There are various treatments that can be very effective, depending on the cause. Enlarged tonsils and adenoids can be surgically removed. A therapy known as Continuous Positive Airway Pressure (CPAP) involves the use of a machine that delivers mild air pressure through a mask worn during sleep to keep the airway open.

How palatal expanders work.

Dentistry also can also play a role in treatment. For younger children who are still growing, the use of an orthodontic appliance called a palatal expander has proven helpful in some cases. A palatal expander gently widens the roof of the mouth (palate) over time by separating bones that don't permanently fuse together until puberty. It's most often used to create more room for crowded teeth, but the expansion can also increase airflow.

Older children who have stopped growing can sometimes benefit from Oral Appliance Therapy (OAT). This involves wearing a custom-made oral appliance designed to reposition the jaw during sleep so that the tongue is held away from the back of the throat, reducing the potential for obstruction.

The first step is to figure out what's keeping your child from getting the restful sleep that's so crucial to good health and well-being. So if you have any questions about sleep apnea, please contact our office or schedule an appointment for a consultation. We can start the process that will determine the best treatment for your child.

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Narrow palate.A major benefit of receiving orthodontic treatment in childhood is that it's possible to take full advantage of a youngster's own natural growth process to treat or even prevent malocclusions (“bad bites”). A palatal expander is a device designed to help us do that.

Palatal expanders create more space in a child's mouth by gradually widening the upper jaw. Although this may sound scary, it's really quite easy — both to do and to tolerate. That's because the upper jaw (maxilla) actually develops as two separate halves that don't completely fuse together until sometime after puberty. Before that happens, the two bones can gently be separated and stabilized over a period of several months.

The three situations that most commonly call for maxillary expansion are:

Crossbite — When a child's upper jaw is too narrow to fit correctly with the lower jaw, the back top teeth will bite inside of the lower teeth instead of outside. This can be corrected by expanding the upper jaw.

Crowding — Even before all of a child's permanent (adult) teeth come in, we can tell when there will not be enough room to accommodate them. Widening the upper jaw can create the necessary space without the need for tooth extractions.

Impacted Teeth — When a tooth that hasn't come in (erupted) yet because it is blocked by other teeth, widening the upper jaw can allow it to erupt into proper position on its own. This most often happens with canine or eye teeth — the pointier ones located directly under the eyes.

Expanding the upper jaw has other benefits: It can broaden the smile in an aesthetically pleasing way, it can limit the number of teeth that need to be removed to create space and can also improve breathing. And it can shorten overall orthodontic treatment time (the amount of time your child will need to wear braces).

How Expanders Work

How palatal expanders work.

An expander is custom-made for each individual and fits over several top teeth in the back of the mouth. The appliance has two halves that are connected in the middle with a screw. To activate the device, you simply turn the screw a very small amount each day with a special key. This induces tension at the junction of the two palatal bones, causing them to gradually move apart. Once the desired expansion is achieved, we will leave the appliance in for a few more months to allow new bone to form in the gap and stabilize the expansion. Generally, expanders are worn for 3-6 months altogether.

What to Expect

There can be some soreness or a feeling of pressure for a few minutes after the key is turned, but activating an expander actually causes less discomfort than having braces tightened. Your child may find that speaking and eating feels different at first as the tongue adjusts to the presence of the appliance. It is also completely normal to see a gap develop between the front teeth. This shows that the expander is having the desired effect. When all is said and done, your child's permanent teeth will be beautifully aligned with neither too much nor too little space between them.

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