Life-changing diagnostics

What a journey you are about to embark on with each page turn of the fall issue of this magazine! I was fortunate enough to be asked to write the intro letter to what has proven to be a leading source of information in pediatric dentistry. Where else are you finding up-to-date research on pediatric sleep-related breathing disorders (SRBDs), myofunctional therapy, and restorative techniques? We are long overdue to have OSA/SRBDs at the forefront of our conversations in pediatric dentistry.

Recognizing the signs

I am constantly verbalizing the need for dentists to recognize the signs of adult and pediatric SRBDs. I feel it’s fairly well known now that snoring, tooth grinding, tongue ties, and mouth breathing should equate to more questions from providers regarding a child’s sleep. However, behavioral disorders are not translating well as being a symptom of sleep apnea for dentists to consider, one of which I want to discuss today: Oppositional Defiant Disorder (ODD). While dentists are not the parents’ first-line consult for ADHD/ODD conversations, we should be, because what you will find in this population of patients is underdeveloped jaws, large overjets, mouth breathing, and extremely sad children.

“While dentists are not the parents’ first-line consult for ADHD/ODD conversations, we should be, because what you will find in this population of patients is underdeveloped jaws, large overjets, mouth breathing, and extremely sad children.”

I have treated numerous children with ODD over my career, and they nearly all present the same — they will not make eye contact with me, they will not talk to me, and they have not only fear, but intense frustration for life. The parents are completely distraught and end up in my office after exhausting years of medical treatments, unsuccessfully. To give an example, a recent patient presented at 6 years old, struggling intensely with ODD and bedwetting. This small child was being treated with Desmopressin for bedwetting, which the parents had recently discontinued on their own because of its lack of efficacy. The only reason the mother sought my opinion was because she happened to see a reel on Instagram discussing myofunctional therapy and bedwetting! She was absolutely shocked to know there could be a correlation between those two topics, which led her to seek a consult with a myofunctional therapist, who then referred her to me. Imagine her heartbreak at the number of medical visits, psychology appointments, money spent, and dead ends reached, only for a social media algorithm to be how she found this information. Her child had maxillary and mandibular hypoplasia, a 7 mm overjet, and a tongue tie; the sleep study revealed an AHI of 4 with hypoxemia and numerous wakes. If we are medicating our children, there should not be a stone unturned to ensure we have the right diagnosis! In cases of ODD, a sleep study should be prescribed to rule out obstructive sleep apnea.

As a result of reading this message, I hope you will learn more about attention and behavior disorders, so you can educate your patients and offer the most important appointment they will have: a dental airway exam. As dentists, we need to do our part to decrease the burden of pediatric behavior disorders by recommending sleep studies and airway exams to rule out OSA/SRBDs, which will be a life changing diagnostic test for these patients.

Respectfully,
Kalli Hale, DDS, MPH, D.ABDSM, D.ABSB