Sleep-disordered Breathing & Airway Problems In Children

Sleep-disordered breathing appears to be a significant problem for a proportion of children.

I see a lot of children whose parents ask questions about improving the breathing or airways of their children, often having already been informed such treatment is necessary and important by another dental professional. I would therefore like to briefly outline the scientific evidence currently available related to treatment of airway problems in children.

The first line of treatment is commonly the removal of enlarged adenoids and tonsils. This is well supported in the scientific literature and needs to be performed with the appropriate guidance from ENT specialist doctors

I would like to have something positive to say about the role of facial growth and orthodontics and treating childhood breathing problems. After all this is a problem and we would like to be able to help. However there is often a desire to “do something” without regard to the cost-benefit analysis – ie are we actually making a positive difference with our treatment for our patients?

Unfortunately there is no or minimal research evidence that supports the use of orthodontic treatment as part of the treatment of sleep disordered breathing in children. Some dental professionals promote “airway friendly orthodontics” but there is no reputable scientific support for many/most of the claims made for such treatment. It may give the appearance of “doing something” but appears to fail in any cost-benefit analysis in the majority of cases

There is very weak evidence that mode of breathing influences facial growth and skeletal pattern.

There is very weak evidence that orthodontic treatment has a role in treating sleep disordered breathing.

However, this is a growth area in orthodontics, with active promotion of orthodontic treatment in treating sleep disordered breathing.

So what do I believe, based on the best scientific evidence available?

My treatment will be directed at correcting problems of crowding and bite (occlusion) and if we get an improvement in breathing this will be a bonus. I certainly will not be informing my patients that I am carrying out treatment to improve their breathing. I can still sleep at night.

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