March 12, 2019
by Barry Raphael, DMD; Steve Carstensen, DDS; Mark Cruz, DDS; Jerald Simmons, MD; Jill Ombrello, DDS; Glennine Varga
When the American Dental Association ratified its “Policy on the Role of Dentists in the Treatment of Sleep-related Breathing Disorders” in 2017, the intention was to clarify the boundaries between medicine and dentistry to make sure dentists didn’t overreach into the diagnosing of apnea. The policy statement, recognizing the many comorbidities that also occur in children as a result of poor breathing and sleep, had a provision for the treatment of children as follows:
“In children, screening through history and clinical exam may identify signs and symptoms of deficient growth and development or other risk factors that may lead to airway issues. If risk for SRBD is determined, intervention through medical/dental referral or evidence-based treatment may be appropriate to help treat the SRBD and/or develop an optimal physiologic airway and breathing pattern.”
The theory and practice of helping children develop “an optimal physiologic airway and breathing pattern” are stimulating many conversations in the dental, pediatric and orthodontic communities, both officially and on blogs across the web. The American Association of Orthodontists will be issuing a “consensus and guidance” statement when their board ratifies its own version, but if their recent symposium, which drew over 1,000 members anxious for their guidance, is any indication, they will, at best, take a measured stance to whether orthodontics can even influence the growth and development of a child’s airway, their declared expertise in “dentofacial orthopedics” notwithstanding. An English orthodontic blog, which is the web’s version of right-wing talk radio, take an even more aggressive hands-off approach.
Others, like many of the contributors to this journal, have been far more proactive in searching for ways to help children grow and develop more optimally, including addressing the anatomy of the airway, the resilience of the airway to collapse and the behaviors adopted as compensations for breathing difficulties, such as mouth breathing and aberrant swallowing patterns.
Whatever side of the issue you may take, I will argue that the issue of whether this treatment or that treatment can make the airway better or worse is beside the point. The truth if the matter is that many more children are now suffering from fragmented sleep and other sleep disorders, leaving them with daytime comorbidities like attention deficit and neurocognitive damage as well as physical deformities of the jaws and teeth. The question we should be asking is not, “what doesn’t work?”, but “what can we do to help children sleep and breathe better, have better quality of life outcomes and protect themselves from the ravages of poor sleep when they get older?”
To that end, the ADA is holding their second conference on “Children’s Airway Health” at the ADA headquarters on March 3rd to 4th, 2019. The purpose of these sold out conferences is to determine what can and must be done to help children achieve an optimal airway and breathing pattern.
They have also created a special task force whose duty will be to suggest for the dental profession appropriate methods of screening, assessment, and diagnosis of SRBD’s (with medical collaboration) and to provide means for dissemination of this information to the profession. We, on this task force, appreciate what you, here at the Oral Health Dental Journal, have done to illuminate this issue for the North American professions. I will have more good news for you later this year, I am sure. The ADA Conference can be seen via live-stream from anywhere – go to ADA.org/CELive for details. Keep up the good work! OH
About the Author
Dr. Barry Raphael is in the private practice at the Raphael Center for Integrative Orthodontics in Clifton, New Jersey. His focus is on dealing with the underlying environmental causes of malocclusion and using early treatment modalities to address both form and function. He teaches these principles at the Mount Sinai School of Medicine in New York City and at the Raphael Center for Integrative Education. He is currently the president of the New Jersey Association of Orthodontists, component of the AAO (no implication of endorsement assumed).
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