8 Essentials All Dental Team Members Should Know

Pediatric airway is a fairly new topic being discussed in our profession. As dental sleep medicine becomes a more common topic in dental offices, so should awareness of sleep breathing in children.
Here are 8 essentials dental team members can use to initiate helping children with obstructed sleep breathing inside and outside the practice:
1) Educate yourself. Find out if your dentist offers any early intervention therapies to support the airway such as palatal expansion, functional orthodontics, myo-functional therapy or lingual frenectomy procedures. Research continuing education courses that offer topics regarding airway. The American Academy of Physiological Medicine & Dentistry (AAPMD) and courses like Orthotropics Mini-Residency by Dr. Bill Hang, Early Orthodontics by Dr. Brock Rondeau and Airway Centric courses by Dr. Howard Hindin and Dr. Michael Gelb. Dr. Barry Raphael, who writes for this magazine, offers “Airway Ortho Lecture Series.” There are many others – you get the idea that it’s about helping the kids out early in life.
2) Identify. Dental team members are exceptional at connecting with patients and can spend the most time with them. The obstacle is introducing the topic. Valerie Deegan recently spoke on behalf of the Foundation for Airway Health, sharing the story of her son Connor. His behavior was at times irritable, inattentive, hyperactive, impulsive, aggressive, and withdrawn. Signs included lips apart with mouth closed, dark circles under his eyes, forward head posture, mouth open, recessed jaw and long face. She also described him as a noisy eater, snoring, gasping during the day and night, and troubled with asthma. She described his sleep as restless; he would fall asleep very fast, fighting to stay awake yet hard to wake in the morning and embarrassed by nighttime enuresis. After a diagnosis of airway restriction and treatment, she says she suddenly had a new son. Be ready to cry, and check out Valerie’s video on YouTube: https://www.youtube.com/watch?v=Sk5qsmRyVcE “Finding Connor Deegan”. Sharing stories like this could be a great way to introduce the topic.
3) Educate others. This topic is the single most important step. Find ways to educate parents, teachers, family, friends, patients and the community. Sleep airway education to the general public is woefully inadequate. The dental profession has the drive to change that and it should start with you!
4) Communicate. Amy Morgan of Pride Institute offers a compelling article (p. 46, following) regarding communication with parents for children with sleep related breathing disorders. It is imperative that these conversations occur. A short conversation can have a LIFE-CHANGING impact on a growing child (and the family!).
5) Have a game plan. If your office does not offer any early intervention to positively impact a child’s airway, talk with your dentist and find out to whom you can make a referral. Research your community for an orthodontist or dentist promoting airway growth or check out airway practitioner networks such as the AAPMD (www.aapmd.org.) If referring is not an option, consider a talk with your dentist about investing in continuing education to learn procedures that support the airway.
6) Understand the cost of waiting. Consider a child born tongue-tied and unable to position the tongue on the roof of the mouth during swallow. The palate develops vertically rather than laterally and impacts the floor of the nose making it difficult to breathe. Since form follows function the teeth become crowded and the tongue seems too big for mouth possibly developing a full collapse of the airway during sleep. The health care cost for a child unable to breathe could be astronomical. A simple lingual frenectomy and functional exercises could impact the growth and development of a child immensely. Investing in breathing early may prevent major cost later.
7) Insurance. Well, this is always a hot topic. Pediatric procedures involving the airway are typically reserved for Ear, Nose and Throat doctors with procedures like adenoidectomies and tonsillectomies. Dentists are able to provide frenectomy, functional orthodontics and some oral devices. Will the insurance cover it? That depends. Oral devices for OSA are considered medically necessary with medical insurance, but none are FDA-cleared for growing children. If a procedure is being performed as a medical necessity it could be billed to medical insurance. Always check the patient’s dental insurance policy as well; some appliances to promote growth are covered by orthodontic benefits.
8) Document your cases. Whether you are treating adults or children, having the proper documentation is critical. Develop a series of records to track your patient’s successes such as subjective questionnaires and photos. Images make the biggest impact when educating, and videos can be used on websites and other practice social media. Talk to your patients and parents of patients about sharing treatment success with a release form. Most all of us are emotionally driven and the ability to share success stories is a great way to spread the word about the silent airway issues impacting our children’s growth and development. Use these Essentials to become a credible resource for your immediate circle of family, friends, community and patients!

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