A recent publication (August 12, 2013) reviewed the use of a common children’s orthodontic procedure, Rapid Maxillary Expansion, to treat childhood Obstructive Sleep Apnea. Dr. Zheng Xu, from the University of Texas Health Science Center, did a review of current literature and studies.
Rapid Maxillary Expansion was first described in the 1890s and is a relatively simple non-removable orthodontic appliance worn by young children and adjusted by their parents. The device widens the upper arch, teeth and bones, creating space to allow teeth to erupt and allow the tongue to have more room. As a positive side effect, since the roof of the mouth is also the floor of the nose, the nasal passages are widened, reducing the resistance and allowing more air to pass.
Childhood Sleep Apnea is usually described as a restriction of air movement and volume while a child is breathing. From the article: Obstructive sleep apnea syndrome (OSAS) is a common condition in children and can result in serious neurocognitive, cardiovascular and metabolic complications if left undetected and untreated. According to a report by the American Academy of Pediatrics, depending on the population studied, the prevalence of OSAS is in the range of 1 to 5 percent. The sequelae of OSAS include excessive daytime sleepiness, poor school performance, learning disability, attention deficit, hyperactivity, behavior problems, cardiovascular abnormalities and metabolic disorders.
In recent years, the medical profession has reviewed and recognized the use of orthodontic treatments as potentially of benefit in the treatment of sleep-based breathing disorders. Dr. Christian Guilleminault, the well–regarded head of Stanford University’s Sleep Medicine Department, has published a series of articles relating sleep disturbances to cranial-facial growth disturbances, most of which dentists refer to as malocclusions, or bad bites. Multiple studies have shown the efficacy of orthodontic procedures to help alleviate the symptoms and, in conjunction with medical procedures such as the removal of tonsils and swollen adenoid tissue, to totally alleviate the symptoms of obstructive sleep apnea in children.
The study does state that treatment may involve several modalities in order to achieve desired results.
I am personally aware of two medical-center-based studies which are examining these concepts and may be enthusiastically endorsing this approach in the near future. The orthodontic appliances used are expanded versions of the Rapid Maxillary Expander. One head of pediatrics of a university-based medical center, at a recent conference, presented the significant cost benefit of this approach compared to a medical-based only approach. He further showed the long-term medical cost differences between treated and untreated children, which can run 400 percent more in untreated children.
What I find most interesting is that there were a lot of articles published in the 1980s about the relationship of airway problems and developing malocclusions (bad bites), but they, for the most part, were not given broad notice. It has taken decades for this research and their authors to come again to the forefront of current medical thinking. Hopefully, this time it will become a universal and accepted part of medical/dental thinking and practice.
The study may be read in its entirety at: http://www.jscimedcentral.com/Dentistry/Articles/dentistry-1-1010.pdf. This article is also available online at: http://bradleedentalcare.com/zebra-magazine-sept2013.html.
Daniel F. Babiec, DMD, MAGD, FICOI is a partner at Bradlee Dental Care, 3690 King Street, Suite KL in the Bradlee Shopping Center in Alexandria. If you have questions, please contact our office at 703/820-0809 or visit us on the web at www.BradleeDentalCare.com.