Tell me a little bit about your background.
I went to dental school, and after dental school I had a choice whether to specialize in one field, so I chose orthodontics. I went to Northwestern University for my orthodontic residency. I was an artist growing up, went to college to become a medical illustrator, and changed my path. So, I thought that orthodontics and creating beautiful smiles was more of the artistic part of dentistry.
How soon would you recommend a child has an orthodontic checkup?
Kids should have an evaluation, around seven years old, to look at how their jaws are growing and how teeth are coming into the mouth to make sure that there is room for teeth and rule out the need for early treatment or intervention to modify jaw growth.
What are the symptoms of sleep apnea in children and what should a parent do if they observe these symptoms?
The symptoms of sleep apnea in children include hyperactivity, kids that are tired during the day or have restless sleep, mouth breathing during the day or at night, allergies, crowded teeth, narrow jaws, bed wetting, dark shadows under the eyes. Many of these are signs of poor sleep.
If you start having the conversation [about these symptoms] having to do with ADHD, I, as a parent, would explore this option of: ‘is this really caused by poor sleep?’
Why is it that obstructive sleep apnea causes hyperactivity?
There is a direct correlation between a child’s airway and the quality of their sleep. About ten percent of children in the population have obstructive sleep apnea (OSA). If you have an obstructed airway that doesn’t allow for good airflow, your brain doesn’t get enough oxygen, so your brain tells you to wake up. This can happen multiple times per hour. Because you are not getting a good quality of sleep individuals will have all sorts of symptoms. In adults it’s diabetes, heart issues, or acid reflux. But in kids, it’s totally different.
So, this often gets misdiagnosed?
Well, there’s no blood test for ADHD. So, kids will get categorized by their teachers, their coaches, their pediatricians. If a child is hyperactive or has trouble focusing, he or she can get categorized as having ADHD, and if the cause is poor sleep, then correct the sleep and you correct the ADHD.
What happens with kids, if they’re constantly having their sleep interrupted is they are not getting the quality of deep sleep that is required. During deep sleep, there are many things that happen to rejuvenate children. It’s when short-term memory gets converted to long-term memory. Kids with sleep apnea will also often have bad grades because that short-term memory isn’t getting converted. There are kids that wet their bed at an older age. That usually is caused by sleep apnea. During deep sleep your body produces certain hormones. One of those hormones suppresses the creation of urine so that you can sleep through the night without having to get up to go to the bathroom. If you’re sleep is constantly being interrupted, your body creates more urine, and kids will wet the bed.
Deep sleep is when growth hormone is produced at the highest level, so if you’re constantly being interrupted, your growth spurts are shorter and not as big. So, some kids will not develop at the same rate if they have sleep apnea. If you correct their apnea, many kids will get an immediate growth spurt.
What causes this airway obstruction?
Sometimes it’s tonsils and adenoids, so I will sometimes refer patients to an ears, nose, and throat (ENT) specialist to have their tonsils and adenoids removed, if that’s the cause.
Is this always surgical?
No, that’s just one example, if it happened to be their tonsils and adenoids. Very often it’s just narrow jaws. It is very common for me to see kids that come in with crowded teeth. Well, the reason they have crowded teeth is because they have narrow jaws, so we expand the jaws to make room for the all of the teeth. As we expand the jaws, and sometimes move the front teeth more forward, it makes more room for the tongue. If the tongue has more room, it also comes forward and opens the patient’s airways. Very often, correction of a patient’s airway is by modifying the jaw growth by expansion or forward movement of the jaws and front teeth.
Do you see this very often in children?
Yes, I do. About twenty percent of children that we see at an early age could benefit from early treatment. I see kids with signs of apnea hundreds of times per year. At our office we’ve treated thousands of kids that have airway obstructions or airway constrictions. When you see crowded teeth or narrow jaws, most often, it is affecting their airways. Teeth that are pushed in towards the tongue will always push the tongue in towards the throat. When that happens, it constricts the airway. When we look at it in 3D, we can visually see the constriction and we can measure it. We look at those measurements to determine if the patient potentially has mild, moderate, or severe apnea.
Would you say that one treatment stands out at the most common treatment?
The most common thing we do with kids at an early age is expansion of the jaws to uncrowd the teeth. Expansion and forward movement of the teeth and jaws creates space for teeth and creates room for the tongue and the airways. We can expand with high tech braces or expanders, so this is not a surgery, it is very conservative orthodontic expansion.
Do you frequently get patients that are referred by pediatricians?
I do. Because people know about what we do now, I get patients referred by pediatricians, by ENT specialists, by dentists, speech pathologists and speech therapists.
How does this develop over time? Are there instances where it will correct itself?
It typically does not self-correct. When you see jaws developing a certain way, they tend to continue to develop the same direction, or get worse. There is jaw development that occurs naturally, but it doesn’t just spontaneously expand and catch up on its own.
How has your practice changed over time?
When I first got out of school it was all about straight teeth and getting the bite to fit really well. Then we got into facial aesthetics: what we do, and how we affect the smile and the overall face. Now the overall focus of our practice at Get It Straight is airways and how we affect the patient’s overall health. When we’re done treating a child, I want them to be the healthiest individual that they can be. We have a huge effect on children’s development. We don’t just focus on how they’re going to look when they’re a teenager. We think about how they’re going to look as a twenty, thirty, or forty-year-old.
For more information visit www.get-it-straight.com.
