Connecting Heads

Sleep Disorder Problems

November 12, 2014 at 4:15 pm Leave a comment

The airway, it seems, has now become a buzz word in dentistry. Sleep disorders are increasingly being treated by dentists. Guy’s and St. Thomas’ have a NHS patient information sheet for patients suffering from snoring and obstructive sleep apnoea. It advises patients to have a Mandibular Repositioning Appliance fitted by a dentist.
Professor Mark Woolford, Associate Dean at King’s Dental Institute, fits these appliances in his clinic at Guy’s and tells me that the number of patients presenting for this treatment is escalating.

This begs the question as to why these patients need this appliance. Well, the answer is simple, they have a retrognathic mandible which restricts their pharyngeal airway. To counter this they adopt a forward head posture  which, in turn, impacts on the back muscles. Furthermore a retrognathic mandible is usually associated with a narrow palate which also means a smaller nasal airway.

So the cause is obvious but what can we do to improve the situation? This is where Dentofacial Orthopaedics comes in to play. Almost all children exhibiting a malocclusion will have an under developed upper jaw and a retrognathic lower jaw. In fact the majority of Class II malocclusions are retrognathic in the maxilla as well as the mandible. Most malocclusions have an underlying orthopaedic cause.

Appliances which develop the maxilla will also improve the nasal airway. In young patients the lower jaw will often track forwards spontaneously after upper arch development. Functional appliances used in the growing child will reposition the mandible and improve head posture.

In the past snoring has been regarded as a social inconvenience but obstructive sleep apnoea (OSA) is now recognised as a life threatening condition. ADHD has also been linked with low oxygenation and bruxism, an early sign of a reduced airway.

To date the dental profession has had little, if any, dialogue with ENT practitioners and yet, as guardians of the airway, it can only be a matter of time before dentists and their medical colleagues realise the important role of Dentofacial Orthopaedics in the growing child.

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