Pediatric Sleep Disordered Breathing


Does Your Child Snore? 

Many parents think it’s cute but it is actually dangerous.

Children are not just small adults.  They are growing, developing people who will suffer the long term consequences of their bodies and brains not receiving the oxygen that they need for proper growth and development.

The threshold for sleep disordered breathing (SDB) in children is much lower than adults. Episodes during sleep where breathing stops or is reduced for 10 or more seconds is considered an apnea or hypopnea. These events are most accurately measured during overnight sleep studies but are easily recognized by educated and concerned parents.  Most pediatric sleep centers view apneas or hypopneas that occur more than once per hour as abnormal.

No child should ever snore. Some parents wrongly believe that if their child snores that means that they are sleeping well. The lack of education on pediatric sleep disordered breathing is an important issue for our society and healthcare system to address.

Below are other diagnostic factors that should be considered.

Does your child have to have apnea to have his growth and development affected?

SDB is believed to have been a relative factor in changes in the production of growth hormone and is also associated with impaired physical growth development. Current research suggests that snoring, even without measurable apneas, is associated with cognitive, behavioral, and psychosocial problems. 

Children who snore have been shown to have lower scores on learning and memory tests including some types of intelligence quotient (IQ) tests. It is also another factor in issues with childhood obesity and facial development. Studies show that both children and adults with more attractive faces are considered to be more intelligent and successful than those with unattractive smiles and facial development issues related to sleep disordered breathing.

What sleep signs and symptoms should I look for?

There are many indications that your child may be affected by SDB. You should consider having your child evaluated for a sleep related issue if he or she:

  • snores or gasp while sleeping
  • breathes through their mouth
  • has nasal obstruction
  • enlarged tonsils or adenoid
  • bed wets
  • exhibits hyperactivity
  • experiences daytime sleepiness

What growth and development signs should I watch for?

A sleep evaluation should be considered if there are any signs of:

  • growth and development problems
  • hyperactivity
  • attention deficit
  • tendency toward obesity

It is important to know that there is a critical period in brain development that determines how a child will perform in school. SDB problems can start at birth and awareness, diagnosis and treatment as early as possible are essential.

From a dental perspective, it’s important to evaluate the pediatric patient for potential SDB problems by screening for: 

  • high palatal vaults
  • crowded teeth
  • dental crossbites or severe overbites
  • speech disorders (especially lisping)
  • children who grind their teeth  

From a facial development perspective, important signs that a child might be struggling to move air through their upper airway include:

  • development of childhood obesity
  • forward head posture
  • long faces
  • allergic shiners (bags under eyes) 
  • mouth breathing  

What should I do if I suspect a problem?

Share your concerns with your pediatrician, ENT or a den

Snore No More


What is the Snore No More Program?

Our dedication to treating our patients with sleep related breathing disorders has allowed us to develop a program and systems that support our patients through the process of education, diagnosis and treatment of a condition that is commonly misunderstood and often under diagnosed.

Snore No More allows our patients to use a custom oral appliance that is less expensive, easy to wear and often just as effective as the more expensive dental sleep appliances that are often covered by medical insurance. 

Program Benefits

Through this program we are able to help our patients that are not diagnosed with sleep apnea and have fewer risk factors associated with this condition as a treatment for those with primary snoring issues. Treatment of the patient with mild snoring is often critical in preventing the progression of the condition of snoring into a more serious diagnosis of obstructive sleep apnea. 

Our screening process attempts to sort out the snorers from those with obstructive sleep apnea (OSA) through 3D imaging, biometric measurements and subjective assessments.

Many patients will avoid diagnosis of their sleep related breathing disorders because they do not want to go to an overnight sleep lab and deal with the hassle of the paperwork and insurance. Our goal is to help those patient gain the education, assistance and diagnosis that best serves them and their overall health by providing them with a low risk, inexpensive but thorough assessment by a board certified dentist to determine the severity of their condition without a huge commitment.

The Snore No More assessment includes:

  • 3D volumetric airway assessment through the use of ultra-low dose imaging
  • Dental evaluation to determine if you are a candidate for oral appliance therapy
  • Calculation of Body Mass Index
  • Evaluation of other relevant medical conditions linked to obstructive sleep apnea
  • Careful evaluation of patient surveys to determine additional risk factors that can develop due to lack of treatment
  • Neck circumference assessment as a risk factor for obstructive sleep apnea
  • Appropriate recommendations for additional testing and treatment

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Dental Sleep Appliances


What is a Dental Sleep Appliance?

Oral appliance therapy is an effective treatment option for snoring and obstructive sleep apnea (OSA). A custom-fit oral sleep appliance can improve your sleep, restore your alertness and revitalize your health. Worn only during sleep, an oral appliance fits like a sports mouth guard or an orthodontic retainer. It supports the jaw in a forward position to help maintain an open upper airway.

Oral appliance therapy is an effective, non-invasive treatment that fits easily into your lifestyle. Patients like oral appliance therapy because it is comfortable, easy to wear, quiet, portable, convenient for travel and easy to care for.

Oral appliance therapy can be covered by many medical insurance plans and our clinic is in network with Medicare, Blue Cross Blue Shield and United Health Care. To obtain medical insurance reimbursement for your appliance, you'll need a sleep study and based on those results your physician will need to write a prescription for the appliance. After a careful evaluation, Dr. Tenholder will recommend the oral appliance that is best for you.

If I'm Eligible, What's Next?

At your first visit, we will conduct a complete clinical evaluation. This will include an examination of your teeth, jaw, tongue and airway, and possibly a new three dimensional x-ray of your mouth to determine the location of your airflow restriction. After we determine if you are a candidate for oral appliance therapy, we will talk with you about the benefits of treatment, the potential side effects and the cost of therapy.

Oral appliances are customized using impressions of your teeth. These impressions are sent to a dental lab where the appliance is made. Once the appliance is fabricated you will return to our office for your fitting. It will be adjusted for comfort and tested for its effectiveness.

What to Expect After Your First Visit

Follow up visits will be arranged to ensure maximum benefit and minimize any potential complications. You may be advised to return to your physician for a follow up sleep study at that time to ensure that you are able to fully benefit from this therapy.

It is necessary that you return to our office with your appliance for regular checkups for your dental health as well as to ensure the long-term treatment success of your therapy with your dental sleep appliance

What is Sleep Apnea?


What is Sleep Apnea and How do I Know if I Have it?

Obstructive sleep apnea is a very common, often undiagnosed and serious sleep disorder that causes you to stop breathing during sleep. The airway repeatedly becomes blocked by your tongue and relaxed upper airway muscles, limiting the amount of air that reaches your lungs. When this happens, you may clench your teeth to move your tongue out of your throat, snore loudly or making choking noises as you try to force air out of your lungs and breathe. Your brain and body become oxygen deprived, you become acidic due to high levels of carbon dioxide and you may wake up. This may happen a few times a night, or in more severe cases, several hundred times a night.

As you fall asleep, the muscles of the upper airway relax. The narrowed airway causes snoring by making the tissue in back of the throat vibrate as you breathe, especially when you sleep on your back.

Do You Always Wake Up Tired?

People with sleep apnea often wake up in the morning feeling tired or unrefreshed even though they have had a full night of sleep. Daytime fatigue and lack of ability to concentrate often result in automobile accidents and impaired ability to perform tasks at work or school.

Even though there may not be an awareness of the awakening, the cumulative effects can be debilitating.

The lack of oxygen your body receives, the pressure on your internal organs and the damage to your hard and soft tissues of your mouth and throat can have negative long-term consequences for your health. This includes:

  • High blood pressure
  • Heart disease
  • Stroke
  • Pre-diabetes and diabetes
  • Depression
  • Heartburn & Gastric reflux disease (GERD)
  • A worsening of your condition from snoring to sleep apnea if left untreated
  • Increase in decay and tooth fracture
  • Increased incidence of periodontal disease

Do You Want to Snore No More?

Obstructive sleep apnea in adults is considered a sleep-related breathing disorder. Causes and symptoms differ for obstructive sleep apnea in children and central sleep apnea. (" target="_blank">"/> See Pediatric Airway)

If the obstruction of the airway is in the nose instead of the mouth, dental sleep appliance therapy is often ineffective. This is why careful diagnosis and treatment planning is essential for the optimal treatment of the patient. Three dimensional imaging known as cone beam computed tomography (CBCT) is invaluable in visualizing airway restrictions and recommending appropriate treatment for the patient with sleep related breathing disorders and is available at our clinic at Synergy Dental Solutions.

How Can I Tell if I Have Sleep Apnea or if I am Just Snoring?

Only a sleep medicine physician can diagnose obstructive sleep apnea using an in-lab sleep study or a home sleep apnea test, but a trained dental team is often a the front line opportunity for screening and education based on their access to visualize the mouth and tongue. Many signs of sleep apnea are visible by observing the condition of the teeth and the relationship of the tongue to the soft palate.

Severe sleep apnea is best managed using continuous positive airway pressure (CPAP) therapy. Dental devices, or oral appliance therapy, are considered the front-line treatment for mild and moderate obstructive sleep apnea.

Surgical options are sometimes necessary for the treatment of some patients with more severe airway restrictions. Weight management is also considered as a primary treatment for obstructive sleep apnea and is often much easier once your body receives support of your airway during sleep as the levels of your stress hormone cortisol are reduced. This happens as a result of your body not feeling “stressed out” during your sleep as a result of you struggling for air.That is a question that only a sleep medicine physician can answer through sophisticated testing and data analysis.

However, our Snore No More assessment is fairly accurate at determining those who are at risk for having obstructive sleep apnea as compared to those who are primary snorers. If you'd like to take a test, please complete the " target="_blank">"/> Watermark Medical ARES Questionnaire and bring it to our office for your appointment.

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For more information on sleep related issues, visit " target="_blank">"/> Sleep Education.