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Q. My son was recently having an orthodontic exam when his orthodontist said he might be suffering from sleep apnea. My son has always snored in his sleep, but I just thought it was due to sensitive sinuses. Should I take our orthodontist’s diagnosis seriously?

A. Snoring is a condition that can sometimes be detected during a dental exam, although parents who are seriously concerned about this possibility should consult a board certified pediatric ear, nose and throat specialist for further diagnosis.

However, I have seen many cases of children with compromised airways, which is not the same as a true airway obstruction that you may see in Obstructive Sleep Apnea (OSA). OSA is much more common in adults and should be treated by a sleep specialist. Snoring in children is often easily resolved if diagnosed properly and at an early age.

If your child is snoring then you should not overlook it as a sinus issue or possible adenoid or post nasal problem that will resolve itself over time. Unfortunately, this type of airway obstruction can lead to considerable craniofacial asymmetries and imbalances that can be more difficult to correct as the child grows older.

Common causes of palatal constriction are thumb and finger sucking, pacifier usage beyond what would be considered a normal age, and abnormal swallowing or tongue positioning habits. Again, all of these are very treatable with minimal or no discomfort to the child.

One of the ways an orthodontist can detect a snoring problem is the growth and development of the mid-face region. An open airway means that air passes through the nasal cavity at a normal rate and helps stimulate the growth of the upper jaw and mid-face. A compromised airway means that air can not pass through the nasal cavity at a normal rate and gets blocked or obstructed usually from a constricted palate. It is important to remember that the bone that forms the roof of the mouth is also the same bone that forms the floor of the nasal cavity.

If a child has a constricted upper palate, then they are going to have a compromised nasal passage. If diagnosed at an early age, the child may undergo a non-invasive treatment that involves expanding the palate and ultimately opening up the nasal airway.

Expansion of the palate can be done with removable retainers with an expansion screw built into them or with a glued in appliance that is activated anywhere from once a day to once a week. Typically, the removable appliances are less invasive, resulting in more comfort for the child. Orthopedic corrections and changes are much easier to accomplish in a younger child and produce a much more stable result.

Conversations between the orthodontist and the parents will often determine which type of appliance is to be used. Factors to consider include: age of the child, severity of the problem, oral hygiene, compliance and cooperation. All of these elements are taken into consideration and the orthodontist will make a decision as to which treatment option would be best for the child before making a recommendation. Usually children should be screened by the age of 6.

Of course there can be other contributing factors to snoring that can be addressed by your pediatrician. These can include but are not limited to enlarged adenoids or tonsils, chronic sinus problems and the possible side effects of some medications.

A team approach between your orthodontist, pediatrician, ear, nose and throat specialist, and even an allergist, will usually be able to solve the problem in a fairly short period.

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