289435372 © Chernetskaya | Dreamstime.com
Monitor and treat airway issues in children

Is it an airway disorder? 5 things to stop ignoring during pediatric dental exams

Feb. 20, 2024
Parents often don't recognize the signs of airway dysfunction in their children, which is a serious problem. Dental hygienists can help educate them and provide guidance.

During the last several hundred years, industrialized countries have seen a drastic change in how people’s faces, mouths, and airways develop. Many diets have become soft and processed and require little chewing, mothers often breastfeed for shorter durations than mothers used to, parents allow their children to use pacifiers and sippy cups for prolonged periods, and mouth breathing and sleep issues can be overlooked.

All this has led many people to experience underdeveloped craniofacial structures. When this happens, their airway and breathing efficiency is drastically affected. Our society has many drugs, machines, and “band aids” to cover people’s symptoms. We need to look for the root causes of many of our society’s health issues. Who better to start with than children? There should be much more early intervention so that children may not be as affected physically, mentally, and emotionally as the last few generations.

If you’ve worked in dentistry any length of time, you’ve heard the verbiage dental professionals use to explain or justify the how and why of a particular sign or symptom. This can be sensitive during discussions with parents and caregivers of young patients. “Some kids just do that.” “It’s very common.” “They’ll grow out of it.” “It isn’t a problem unless it’s affecting speech or eating.” These are just some of the phrases we use. It’s how we’re taught, and what’s been modeled to us by some of our peers and superiors. But now we know better, so we must do better.

You might also be interested in

How orofacial myofunctional therapy fits with dental hygiene

The myofunctional therapy lens

With the ability to look at patients through a myofunctional therapy lens now, I’m not just looking at their teeth and tissues, but at the whole person. I’m aware of the warning signs that were slipping through the cracks. Even with so much research and science emerging, some providers are not keeping up with the basics of overall health and well-being of the people they treat.

Every single patient, regardless of age, should be screened for airway issues. The airway impacts the ability to get good restorative sleep, and good sleep impacts every aspect of mental, emotional, and physical well-being. There’s a shift in the world of dentistry, and as dental hygienists we play a key role in facilitating this shift.

Here are five aspects of a pediatric evaluation in dentistry that are either commonly ignored or described as “normal” or “common.” These need to be taken seriously to prevent ongoing and potentially lifelong problems.

1. Signs of bruxism and wear on primary teeth

Some parents tell you they can hear their child grinding their teeth during sleep while other parents are unaware of the issue. Wear is an early sign of an airway problem and should never be ignored. This is the brain telling the jaw to move around in an effort to open the airway during sleep to get more oxygen. These children may also have enlarged tonsils.

2. Lack of primary tooth spacing

All primary teeth should have nice sized spaces between them. If they’re starting to push together or already have, craniofacial development has fallen behind. You should refer to an airway savvy dentist or orthodontist for early intervention, or a myofunctional therapist who can guide parents toward the correct providers. This can be done as early as three years old.

3. Open-mouth breathing, snoring, and loud breathing

No amount of snoring is normal for any person, and it’s a red flag that indicates a restricted airway and lack of oxygen to the brain. Open mouth breathing is also considered sleep disordered breathing and should be taken seriously. Many parents don’t know their child suffers from sleep disordered breathing because they sleep in separate rooms, so encourage them to check in on their kids periodically after they’re asleep. If snoring or mouth breathing is observed, they should seek guidance from a myofunctional therapist or airway provider.

4. Tongue-tie

This one can be tricky and difficult to screen for without training and knowledge. A myofunctional therapist can screen and then guide a family through this process. But if a tongue-tie has been diagnosed, it should not be ignored. The effect a tongue-tie goes far beyond breastfeeding and speech and can have a cascade effect on an individual throughout their life.

Tongue-tie release/frenectomies should be performed only by providers who have advanced training and a significant amount of experience doing these procedures. A good rule of thumb is that if a provider does not recommend myofunctional therapy before and after a frenectomy, they likely have not had advanced training. More research should be done to find the right person. Also note that a good frenectomy provider may not be available in your area, so travel may be necessary.

5. Enlarged tonsils 

This is often a sign of mouth breathing but can also be caused by food, household, or environmental allergens. Tonsils are graded 1-4, and grades 3 and 4 put patients at high risk for airway obstruction. These children are often loud breathers, snorers, or have already developed sleep apnea. If you notice enlarged tonsils, encourage parents or caregivers to ask the child’s doctor about an ENT referral. If the doctor does not think there’s a problem, a second opinion is a good idea. An airway provider or myofunctional therapist can help guide families toward ENT providers who are airway-focused.

Quality sleep is an essential aspect of health. If children are not sleeping well, their brains and overall development are compromised. All dental offices should screen for airway and sleep issues with a questionnaire, or at the very least should ask parents how their kids are sleeping.

Other questions you might ask are “Do they have nightmares or sleepwalk?” “Are there any issues with bedwetting?” (This can be sensitive, so never ask in front of the child.) “Are they a restless sleeper?” “Are they difficult to wake in the morning?” “Do they get up to use the bathroom at night?” “Do they show signs of behavior issues such as ADHD/ADD?” These are all signs of poor sleep and airway issues, which again, be referred to an airway provider or myofunctional therapist.

The effects of poor sleep quality are a multi-billion-dollar industry, and dentistry holds a considerable amount of responsibility in helping to turn around the sleep crisis. With our commitment to something as simple as screening young patients and intervening early, we can change the trajectory of the health and well-being of future generations for the better! 

After years in dental hygiene, Kelsey Fenner, BSDH, RDH, became interested in a “whole human” approach to treating patients and developed a passion for addressing orofacial dysfunction and imbalance. She is inspired by the transformative power of OMT and the impact this noninvasive and natural therapy can have on overall health, well-being, and quality of life. She owns Flow Myofunctional Therapy, a fully virtual OMT practice serving ages 4+. She calls Colorado home with her husband and two sons.