Sleep Medicine for Ortho-Pedo Residents


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Lack of good quality sleep in childhood is known to coincide with impaired neurological development and associated behavioral issues like ADD/ADHD. As many physical and behavioral risk indicators of poor sleep hygiene can be readily detected by dental professionals who treat children, it becomes imperative for dental/dental hygiene schools and post-graduate dental residency training programs, to incorporate didactic and clinical Sleep Medicine content into their curriculums. This slide presentation demonstrates evidence to support the hypothesis that, with early identification of at-risk children, health problems associated with Sleep Disordered Breathing in childhood, can be either prevented, reversed and/or better managed, with appropriately timed and targeted orthodontic, orthopedic and/or orthotropic treatment modalities.

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  • Sleep Medicine for Ortho-Pedo Residents

    1. 1. Optimum Development of the Teeth, Jaws and Face: Yet Another Reason to Breastfeed Kevin Boyd, M.Sc. (Nutrition), D.D.S. Hypothesis: Ancestral (Paleo) regimens of Infant and Early Childhood Feeding (IECF) were/are protective against skeletal malocclusion pre-Industrial/Westernized cultures
    2. 2. The Problem:SDB/OSA/Neuro-cognative Impairment: - compromised naso-respiratory function -unhealthy sleep architecture (PSG) The Solution:Early Identification and Collaboration: -Sleep Medicine -Evolutionary Medicine -Evolutionary Dentistry
    3. 3. Take Away Points:1. Sleep is not a luxury, sleep is as necessary to survival and well-being as food and water2. There is a bi-directional association(e.g., perio/T2DM)between certain craniofacial phenotypes(high-vaulted palate, posterior crossbite, retrognathia, hyper-divergent growth) and clustering with other known risk factorsfor SDB/OSA (snoring, ATH, bedwetting, night terrors, restless legs/active sleep, etc.)3. preventive strategies include OMT, infant feeding/diet counseling; Tx alternatives to CPAP/surgery include RME, BB-O4. collaborativeopportunities(responsibility?) exist for orthodontists, pediatric dentists, GP’sand RDH’s to identify/screen at-risk kids for SDB/OSA….refer (ENT’s, OMT’s, Sleep specialists)and Tx p.r.n.e.g., The AAPMD
    4. 4. In conclusion:-abnormal craniofacial morphology, but not excess body fat, was associated with SDB in children6–8 years of age.-patients with dental malocclusions, deviant craniofacial features and tonsillar enlargement shouldalways be examined as regards to their sleeping habits, snoring and pauses in breathing duringsleep.-children with tonsillar hypertrophy, cross bite and convex facial profile could be candidates forearly intervention and orthodontic treatment to prevent the progression of SDB in coming years.
    5. 5. Childhood Sleep Disorder Breathing:A Dental Perspective
    6. 6. Obtuse naso-labial angle associated with most bi-maxillary retrognathic (modern) skulls Hyoid bone inferior position (to MP) associated with most bi-maxillary retrognathic (modern) skullsNarrowed posterior pharyngeal spaceassociated with most bi-maxillaryretrognathic (modern) skulls
    7. 7. Lateral cephalographs of 3 children with chronic mouth breathing: images show different grades of airwayobstruction relative to adenoid size. A, Grade 1 in a girl 12 years 3 months old. B, Grade 2 in a boy 4 years 4months old. C, Grade 3 in a boy 4 years 9 months old who also exhibits the typical morphologic and dentalcharacteristics of long face syndrome.
    8. 8. Am J Orthod Dentofacial Orthop. 1997 May;111(5):502-9.-In the deciduous dentition, a distinctive occlusal and skeletal pattern of Class IImaloccluson exists. In addition to concomitant diagnostic dental relationships in thesagittal plane (distal step, Class II deciduous canine relationship, excessive overjet),transverse interarch discrepancy due to a narrower maxillary arch is a constantfeature of early Class II malocclusion. Skeletal findings in children with Class IImalocclusion typically include significant mandibular retrusion and shorter totalmandibular length.-the clinical signs of Class II malocclusion are evident in thedeciduous dentition and persist into the mixed dentition.
    9. 9. 3. preventive strategies include OMT, infant feeding/diet counseling; Tx alternatives to CPAP/surgery include RME, BB-O
    10. 10. Hypothesis:Ancestral (Paleo) regimens of Infant andEarly Childhood Feeding (IECF) were/areprotective against skeletal malocclusionpre-Industrial/Westernized cultures
    11. 11. “ …(malocclusion) is a relatively new phenomenon in the human population and we do notfind it in skeletons until after the seventeenth century. ” -Peter Gluckman “… jaw anomalies (malocclusions wherein the teeth cannot fit properly in the jaw) arerelatively new to European populations. Well-preserved skeletons from the 15th and16th centuries show almost no malocclusion in the population….”
    12. 12. “….there is much circumstantial evidence that jaws and faces do notgrow to the same size that they used to precisely because of our softer,more processed diets.” Daniel E. Lieberman
    13. 13. Abingdon Cemetery
    14. 14. Is the basis for McNamara’s “Ideal” anthropologically informed?
    15. 15. The Angle Orthodontist: 54 (1): 5-17 1984 Angle Orthod. 54(1): 5-17 1984
    16. 16. Pierre-Robin pt. –retrusivemandible…retrusivemaxilla!
    17. 17. ILLINOIS SLEEP SOCIETY CONFERENCE 2012 Advancing Mandibles and Maxillas with Biobloc- Orthotropics: A Non-Surgical Approach to Increasing Posterior Pharyngeal Airway Space in Pediatric OSA Patients Kevin Boyd, DDS Kevin L. Boyd, M Sc, DDSCourtesy of Brian Hockel, DDS
    18. 18. 2/15/2010 BIOBLOC STAGE-1 Tx 2/21/2012 BIOBLOC STAGE- 3 Tx Example: Assign an arbitrary control value for airway radius of 1.0. A 50% reduction in airway radius would mean that the new airway radius would be 0.5. Now, according to Poiseuille, that gives us...R = 1/(0.5)4
R = 1/0.0625 = 16
Therefore, resistance to airflow is increased 16-fold with a decrease in airway diameter (and radius) of 50%.
    19. 19. Correlating PSG data with Biobloc TX response Stephen Sheldon, MD CMH
    20. 20. Original Article Changes of pharyngeal airway size and hyoid boneposition following orthodontic treatment of Class I bimaxillaryprotrusionQingzhu Wanga; Peizeng Jiab; Nina K. Andersonc; LinWangd; Jiuxiang LineABSTRACT
    21. 21. Another possible explanation for our findings is that oral cavity features such as highpalates, narrow dental arches, and retruded chin all are additional risk factors for SDB inchildren3838. Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructivesleep apnea syndrome. Ann Intern Med. 1997;127:581–587Although dentists and orthodontia recognize the importance of evaluating and treatingOSA, they have yet to realize howwell-positioned they are for the prevention of sleep-disordered breathing (SDB).