The tonsils and adenoids were removed. (BREATHE). Several days of popsicles for breakfast, lunch and dinner ensued. It was rrrrrrough (more for my wife and myself), but Grace did it. As far as I was concerned the hard part was over.  Afterall, now that the hard part was done, finding someone to treat her should be a slam dunk!

Famous last words. 

As with most professions, there are many different schools of thought when it comes to treatment. For a very long time, orthodontics performed in the United States was focused on ensuring straight teeth and correcting specific occlusion in relation to the opposing arch. It was an art of form and function. If teeth needed to be extracted to accomplish fit, then so be it.

When a child develops crooked or misaligned teeth, it’s easy to assume that the reason is genetic or spontaneous (that’s just how the teeth grew). In fact, the culprit is often the tongue!

You know how a couch cushion can warp over time to fit the body that sits in it the most often? Teeth are the same way. The tongue – one of the strongest muscles in the body -- exerts constant pressure on the teeth. This pressure serves to gradually shape the teeth over time. If the pressure or posture of the tongue is abnormal, children can develop an overbite, open bites, big spaces between teeth, and even crossbites.

In a mouth with all teeth in their proper place, the front teeth should slightly overlap the bottom teeth when the jaw is closed. If you notice a big gap between your child’s front teeth and lower teeth, then your child likely has what is known as an “open bite tendency.”

Open bite tendency may be the result of natural development. It could also be the result of adult teeth growing in and pushing the baby teeth forward – a condition remedied when all baby teeth are gone and adult teeth have room to maneuver into place.

Can you imagine choking over 100 times a night while you sleep? If you have obstructive sleep apnea (OSA), this may actually be your reality! According to the American Academy of Sleep Medicine, up to 25 million adults in the United States suffer from OSA, and that number may actually be low, since many people don’t even know they have the condition.

In this condition, a person’s airway becomes obstructed while they sleep. This obstructed airway causes the person to stop breathing or to breathe shallowly for anywhere from a few seconds to a few minutes at a time! The result is that the person never enjoys deep, healthy REM sleep.

If you suffer from tooth pain, jaw pain, headaches, neck pain, or any combination thereof, there could be a number of things causing your trouble. For instance, if your teeth are misaligned, they could be putting pressure on your jaw bone and muscles, which could cause your headaches and neck pain.

One surprising source of pain is something called “occlusal interference” – in other words, your teeth are getting in each other’s way.  

So show of hands...Who wants to send their 3 ½ - year old daughter to a hospital...to sleep in a strange bed with their head wrapped up like an Egyptian mummy and wired to a multitude of blinking sensors?

Here again, it is my most fervent hope that with this series, healthcare professionals like ENT’s and dentists can work together in educating and instructing parents as to the warning signs of airway blockage/dysfunction.

The day of the sleep study, my wife chose to accompany Grace to the hospital, so I stayed home with Georgia. As recounted for me later, Grace did pretty well for the first part of the test.  However, she quickly became agitated when all the wires and the head bandages were revealed 

As mentioned in my previous entry, we needed to get Grace’s tonsils and adenoids out before we could begin to develop her upper and lower arch.  But there was one other item on the to-do list that had be addressed even before we could proceed with the surgery..

Upon arrival in Pennsylvania, we requested an ENT referral from our pediatrician.  Four weeks later we were seen by an ENT at Children’s Hospital of Philadelphia.  Grace and I walked into the appointment and were asked all the usual questions by the nurse practitioner.  When asked why we were there I replied “To have Grace’s tonsils and adenoids removed” -- at which point we were (as one might expect) subjected to another round of questions regarding her history of sore throats, ear aches, etc.which she really didn’t suffer from at the time.

Nocturnal teeth grinding is an extremely common habit. Many of those who gnash their teeth at night wake up with severe jaw pain, sore facial muscles -- even headaches and neck pain. However, not everyone who grinds is even aware of the problem. Not every grinder experiences pain as a result of this destructive habit,  but ignoring nocturnal grinding -- or “bruxism” as it’s known in the medical community – is not the answer.

Long-term bruxism also wears down your teeth, destroying the protective enamel of your molars and even making your teeth more susceptible to cracking.  

Finally. THE DAY YOUR BRACES COME OFF. Home free!

Not so fast. It takes time for your teeth and the underlying bone and tissue to stabilize in their new position. For the next few months your teeth may be at a high risk of relapse. That’s why your orthodontist will fit you with a custom-manufactured retainer and tell you to wear it throughout the day for say…three to six months.

Even after this initial period, you’re not quite out of the woods. Your orthodontist will probably advise you to wear your retainer each night.

TONSILS AND ADENOIDS REDUX: SAVING GRACE

Thank you, readers! Since beginning this series, we have received several response emails suggesting treatment plans for Grace -- all of them interesting and enlightening. Here’s hoping you’re sharing and discussing these entries with colleagues, patients and friends. It’s so important to observe our kids with a discerning eye while they sleep...and listen to what their breathing tells us.

NEXT TOPIC: Grace and her tonsils and adenoids.  As you can see from these initial photos, Grace had a very small/narrow upper and lower arch.