Clinical symptoms of untreated sleep disordered breathing (SBD) may include, excessive daytime sleepiness, bed-wetting, behavioral problems, failure to grow and in some cases heart complications.  If left untreated, these heart issues can become even more problematic in adulthood.

The dental signs of SBD are extreme wear of the teeth (due to grinding), cheek biting, narrow arches with severely crowded teeth or teeth in cross bite.  (A cross bite can be noticed when the child bites down and his or her jaw shifts to one side when closing or chewing.) Another common sign of SBD is abnormal tongue swallowing and positioning.  Often these patients breathe chronically through their mouth and position their tongue in a forward position to allow for mouth breathing to occur.

There are an increasing number of children with behavioral problems that are diagnosed as Attention Deficit Hyperactivity Disorder ( ADHD).  Many studies have shown that a large number of these children diagnosed with ADHD were later shown to have a sleep disorder that caused them to exhibit behavior problems during the day, due to lack of adequate sleep at night.

What should you as a parent do?

See your pediatrician and tell them about your concerns.  They will most likely evaluate the tonsils and adenoids and make a recommendation if they feel it is necessary, to have an evaluation by an ENT (Ear, Nose and Throat) Specialist.

Your family dentist is also a good source for referral to an Orthodontic specialist who can help your child increase their nasal breathing, correct the severe crowding and narrow jaws and eliminate the cross bites through the use of maxillary (upper jaw) palatal expansion.

An an Orthodontist , in practice for over 25 years, we have seen thousands of patients, some as young as 6 years of age,  who had expansion appliances placed in both upper and lower jaws, and all snoring and teeth grinding disappeared along with  cross bites and severe crowding.

Furthermore, numerous studies done mostly by the medical community have shown time and time again, the health benefits of maxillary palatal expansion. Some studies have also shown that problems such as bed wetting, excessive daytime sleepiness and even behavioral problems all are resolved with a change in the jaw size, shape and function and a substantial increase in nasal breathing through palatal expansion.

In summary, if your child has any of the following symptoms, they may be a candidate for tonsil and adenoid removal, as well as an evaluation by an Orthodontic specialist for maxillary palatal expansion.

• Continuous load snoring
• Chronic mouth breathing
• Excessive daytime sleepiness
• Frequent headaches
• Grinding and excess wear of the teeth (especially the baby teeth)
• Behavior problems such as not paying attention, aggressiveness and hyperactivity
• Enlarged tonsils and adenoids
• Problems sleeping, bed wetting and sleep walking

If you have concerns that your child may have SDB, a call to your pediatrician is the next step.  We also offer a free consultation to have your child evaluated to determine if their persistent snoring, teeth grinding or daytime sleepiness, could be due to narrow jaws, severe crowding, a cross bite or mouth breathing.   You can call Margaret at 916-435-8000 (Rocklin) or 530-432-3483 (Penn Valley) to schedule a complimentary evaluation.

Here are some more startling facts:

Approximately 40% of patients over the age of 40 snore, and half of them snore EVERY night

Among those that snore on a regular basis, OSA is prevalent in 17% of men and 15% of women

An estimated 18 million Americans have OSA and another 16 million remained undiagnosed

Why Should You Care?
If you, a spouse or loved one snores on a regular basis they may have obstructive sleep apnea (OSA).  While snoring may seem just a nuisance to anyone in bed with or nearby the snoring individual, it is truly a silent killer for many Americans.
Obstructive Sleep Apnea (OSA) is associated with higher risk of high blood pressure, coronary heart disease, stroke, congestive heart failure, irregular heart beat, impotence, behavior and cognitive problems and the big one….death.
Furthermore, OSA leads to excessive daytime sleepiness.  This can cause injuries at work, poor job performance and possible job loss.

It is also estimated that people with OSA are 10 TIMES more likely to die in a car accident than someone without OSA.

Okay, I Snore, How Do I Know I Have Obstructive Sleep Apnea?

You will first need to have a sleep study done by a Physician who specializes in Sleep Medicine.  You can get a referral to a sleep center from your family medical doctor or a dentist.

Once a sleep study is performed, you will get a diagnosis regarding the severity of you OSA.  In the case of mild to moderate OSA, you will often get a referral back to your dentist or dental specialist who have expertise in oral appliances and dental sleep medicine.

With mild to moderate OSA, an oral appliance worn at bedtime is very effective at eliminating the snoring and thus the sleep apnea.  Patients who have these oral appliances will immediately notice the benefits.

These benefits include feeling rested for the first time in a long time, not having daytime sleepiness (no more 3 pm trips to Starbucks), clearer thoughts (brain not in a “fog”) and more energy than they have had in a long time.
Of course a follow sleep study will be needed to confirm the success of the oral appliance and make sure it is adjusted for maximum effectiveness.

If after your initial sleep study, it is determined that you have severe OSA, there will be several different treatments recommended by your sleep medicine specialist.
A CPAP (continuous positive airway pressure) device is usually recommended and fitted for your use at bedtime.   In very extreme cases, surgery is recommended.
Drs. Cater and Galante can assist you in finding the Best Sleep Center and Sleep Medicine Specialist to help you or a loved one with this truly deadly disease.  We offer a free exam and consultation to determine if you may have OSA.
Call today to set up your complimentary exam, 916-435-8000.

In recent years, this area of Medicine has grown due to the expanding population of people over 40 years of age.  It is well documented that over 90 million people in the United States snore.  Of this 90 million somewhere around 32 million have Obstructive Sleep Apnea.

Basically, OSA( Obstructive Sleep Apnea)  is a disease that results from the narrowing of your airway.  As we age and/or gain weight, the ability of the tongue-base musculature to expand the upper airway during normal respiration often declines.

This causes you to basically stop breathing while sleeping. This is what is known as an apneic episode.  The apneic episode causes you to briefly awake long enough to gasp a few breaths of air and then resume your sleep and snoring.

Over the past 15 years, oral appliances have developed into a viable and scientifically sound method for eliminating upper airway obstruction in a larger percentage of patients.

The American Academy of Sleep Medicine has recently published a report that lends substantial importance and credibility to the use of oral appliances in the treatment of OSA.

Overall, those patients with mild to moderate OSA have a 52% chance of controlling their OSA with an oral appliance. Severe OSA patients, however, are best treated with CPAP (Continuous Positive Airway Pressure)  devices or surgery.

The Different Types of Oral Appliances

The best success has come from appliances known as MRAs.  MRA stands for mandibular (lower jaw) repositioning appliance.

There are non-custom (off the shelf, or boil and bite) appliances and custom-made (adjustable) appliances.  Currently, the custom-made, adjustable MRA have been proven to work the best.

It is best to always seek a dentist who has experience with these type of appliances.

How The Oral Appliances Can Help:

Basically, these oral appliances work to expand the airway and improve breathing while sleeping.  Young, thinner patients with lower body mass have some of the best response rates to these types of appliances.

Patients with or with out TMJ dysfunction may or may not be a contraindication to the use of oral appliances.

It has been shown that women are overall more successfully treated with oral appliances than men.

Are There Any Side Effects of Wearing These Appliances?

Fortunately, the side effects are minor compared to the side effects of OSA.  There may be some limited tooth pain, dry mouth, and overall facial muscle soreness.  Again it is important to receive care from a dentist or dental specialist who has expertise in the area of Dental Sleep Medicine and Obstructive Sleep Apnea.

There is one specific appliance that has been used for decades and is well documented in the medical literature to improve airway, decrease sinus and allergy problems and improve sleep.  This appliance is called a Rapid Palatal Expander and is commonly used by Orthodontists for expansion purposes in young children.

Since dental sleep medicine and obstructive sleep apnea,  are not included in the curriculum of most dental schools and post-graduate residencies, additional training is required before initiating treatment.

The American Academy of Dental Sleep Medicine (www.aadsm.org) is a good resource for locating physicians , dentists and other dental specialists who have expertise in these types of appliances.

If you think you might have sleep apnea and have questions, please call our office at 916-435-8000