Fairfield County Edition

Dentistry for a Good Night’s Sleep

Sleep Breathing Disorders Begin with Jaw Alignment

You need your sleep! Not getting proper sleep impairs your immune system, is implicated in your being more sensitive to pain and is often an underlying cause of depression.

What are some of the things that may prevent you or your child from getting a proper night’s sleep? Activating your brain before bedtime by working on your computer or smartphone can delay the onset of sleep. Sleeping in a room not dark or quiet enough is another problem. 

One of the hugely overlooked causes of improper sleep is a sleep breathing disorder (SBD). This is a situation where you are not getting enough oxygen, which causes conscious or unconscious arousals from sleep that disrupt your natural sleep cycles. SBD affects both children and adults and numerous studies link SBD to ADD/ADHD, chronic fatigue, bedwetting, aggression, depression, restless sleep and more.

How do you know if you suffer from a sleep breathing disorder?

In addition to the above symptoms, a few vital signs are: waking up not feeling refreshed; breathing too loudly while sleeping; grinding or clenching your teeth; or waking up with a headache.

Most often, the biggest contributor to SBD is the tongue being too far back in the throat, thereby narrowing the air passage. One of the possible treatments is to use a sleep appliance that pulls the tongue forward. The usual reason that the tongue is back in the throat is that the mouth is too small for the tongue. This restriction of space is due to jaws that are underdeveloped and thus too small both in width and in a front to back direction. Also, the bite is usually over-closed (the chin is too close to the nose). The abnormal jaw relationship often causes temporomandibular joint dysfunction (TMD). In fact, the association between TMD and SBD is found to be extremely common.

The lack of proper jaw development starts as a child, often due to extended bottle feeding, pacifier use and poor nutrition. Some other factors are heredity, finger sucking and tongue tie. Tongue tie refers to the band of tissue that tethers the tongue to the floor of the mouth. When the band is so tight that you cannot touch the roof of your mouth with your tongue when your mouth is wide open, you are tongue-tied. The tongue is a unique orthodontic instrument and helps develop the roof of your mouth and the width of your jaws. When you are tongue-tied, proper jaw development doesn’t occur, and the problems start.

What to look for in your child

Anything that indicates a lack of space for the tongue is a warning sign that there may be a problem, especially if the symptoms listed above are present. Other important warning signs include: bedwetting, chronic allergies, difficulty in school, nightmares, mouth breathing, daytime drowsiness, snoring, aggression, restless sleep, grinding teeth, talking in sleep, sleep walking, frequent headaches, speech problems and excessive sweating while asleep.

Parents should look for: crowding of the baby or permanent teeth; the lower jaw is too far back compared to the upper jaw; and when closed the upper front teeth cover all or most of the lower front teeth. Breathing while sleeping should be very quiet; if it isn’t, this may indicate a problem. Grinding of the teeth in a child will almost always be due to worms or to an SBD problem. If your child has enlarged tonsils, it impinges on the airway and also retards midfacial development. Dry lips due to chronic mouth breathing are another warning sign.

Nine out of 10 children exhibit one or more of the above symptoms. If there is a problem, depending on the severity, various treatments are available. However, ultimately the underlying lack of jaw space will need to be addressed by expanding the jaws to allow the tongue to come forward out of the airway. With this goal in mind, the right dentist will offer orthopedic/orthodontic treatment to correct the problem. It is best to begin treatment as early as possible.

Warning signs in adults

If the abnormal jaw development remains uncorrected in childhood, problems will persist and may even become worse as an adult. The SBD may become critical enough that diseases associated with sleep apnea may manifest. These include hypertension, diabetes, Alzheimer’s disease, heart disease and acid reflux. In the mouth, look for gum recession, abfraction (ditching of the tooth at the gum line), tongue tie, teeth fracturing and tooth imprints on the sides of the tongue.

When you close your mouth, do your upper front teeth close over your bottom front teeth so that you cannot see all or most of your lower front teeth? Are your teeth crowded? Do you grind or clench your teeth? Do you notice popping, clicking or noises in the jaw joint in front of your ears? All of these are potential signs of trouble.

If it seems that there is an SBD problem, you may be able to do a Home Sleep Test, and a medical sleep specialist will evaluate the data. Depending on the findings, there are different options, including referral to a medical sleep specialist for a C-PAP machine, fabricating a sleep appliance or correcting the problem orthopedically/orthodontically. Of course, as a preventative measure, the best time to start treatment is during childhood to allow for proper development of the jaws and adequate room for the tongue.

Mark A. Breiner, DDS, FAGD, FIAOMT is a pioneer and recognized authority in the field of biological and holistic dentistry. He is the author of Whole-Body Dentistry: A Complete Guide to Understanding the Impact of Dentistry on Total Health. Breiner practices dentistry in Fairfield. Connect at 203-371-0300 x1 or
WholeBodyDentistry.com. See ad, page 2.

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