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.

You absolutely know that you need to stop biting your lips. You hate how your lips constantly have sores on them, which are painful and make you self-conscious. (Not to mention that open wounds on your lips and your regular morning cup of hot coffee just don’t mix.) How can you finally kick this annoying lip biting habit?

Your dentist may have a solution. He or she can actually fit you with a special oral appliance that makes it impossible for you to bit your lip. One such appliance is call the Lip Biting Inhibitor. It attaches a plastic guard over the front of your upper or lower teeth, which makes it impossible for you to pull your lip back between your teeth and start chewing.

There’s nothing like a good night’s sleep to help you feel energized, rested, and mentally alert for the challenges of a new day. Unfortunately, if you suffer from sleep apnea or suspect that you do, a good night’s sleep may seem like an impossible dream.

What to do…and what causes sleep apnea?

There are different types of sleep apnea, but the most common form is obstructive sleep apnea. This occurs when the muscles in the back of your throat relax during sleep, causing your airway to narrow or close altogether. If your partner has told you that you snore loudly, you are very likely struggling to breathe all night long. If you can’t get enough air, airway failure may cause you to awaken sporadically throughout the night. It happens so fast that you don’t even remember it. Some sleep study tests have shown that people with sleep apnea wake up over 100 times a night.

Many things have changed over the past 10,000 plus years . . . and thank you in advance for recognizing the understatement of the year. 

We have survived and thrived on this planet, despite the many natural and man-made factors that challenge not only our quality of life but our very existence as well. To narrow it down just a bit, we know that airborne evils, e.g.  pollen, pollution, dust (to name a few) can and do affect our breathing both as adults and as children.

However, if we agree that our kids are growing and developing both physically and mentally from birth until puberty, then we need to agree that, whenever possible, their exposure to those environmental factors should be limited, if not prevented entirely.

I don’t know about you, but I can’t go anywhere these days without an adult relative or friend telling me how they feel about snoring, Sleep Apnea and/or CPAP.

Grace and my Dad or the Dude as my girls call him, both faces of Sleep Apnea.

Maybe I run in odd circles, but as I sit here writing this, I have had 3 different conversations about something to do with sleep apnea in the past 3 days -- one with my father who has to go back in for a sleep study; one with our good friend Rachel who discussed how her ex-boyfriend’s CPAP completely changed his life for the better; and one with my wife’s step dad who needs to be on CPAP, but confessed he despised the thing and gave up on it after a week. 

Whew!

If you are new to sleep apnea or just want more information here is a very good basic overview of Sleep Disordered Breathing from the AAPMD

I started with SML (Space Maintainers Laboratories) in 1996. I was there full time until 2006, when I partnered with an Orthodontist friend to start an ortho product company called SPEE Corp. After a few years we parted ways.

As an infant, Grace was always a challenge to get to fall to sleep.  You couldn’t swaddle her tight enough… and we tried everything to soothe her.  We experimented with all the different swaddling blankets and wraps -- “baby straight jackets” as I used to refer to them. They would help after she was asleep, but none seemed to ease her into a restful slumber.  

As she got older, she would fight even harder, forgetting something down stairs, or wanting one more hug or saying her sister was keeping her up, when all the while her sister had long since gone to sleep.  

Dentists, you know that a patient’s upper arch develops more quickly than their lower arch. This can make things difficult if you want to expand both arches at the same rate. A patient would much prefer to complete the upper arch and lower arch expansion process together, especially if you plan on recommending braces afterwards.

One option is to use two different arch expanding devices to help the lower arch keep pace with the upper arch. The lower Jackson appliance is known for the rapid results it can create. If you want to try and keep your patient’s lower and upper palate expansion in sync, consider using an upper Schwarz paired with a lower Jackson appliance.  

From the time I attended my first Dental Continuing Education course, which was with the late Dr. John Witzig, I can remember a common theme among a large percentage of the “Before” photos: mouth breathing.  Having majored in Sports Medicine in college, I knew that, by design, we are all meant to breathe through our noses -- especially when sleeping.  It’s the body’s way of filtering and moistening the oxygen we require. 

Yet so often sitting in the back of the room watching photo after photo of kids being treated, whether it was Witzig, Rondeau, Spahl, Pfitzinger, Veis, Gelb, Mew, Hang, Song (just to name a few... and believe me that is only a few), I would see that same look:  long narrow faces, circles under youthful eyes, nose turned up, mouth open. 

As parents we have so much to do -- and while our kids sleep, we find ourselves rushing to do them. Straightening the house, prepping meals, paying bills. Not to mention connecting with the outside world via phone or pc for a few precious minutes..or catching up on favorite programs at night before exhaustion claims you and you fall into sleep.

Thing is, many of the signs of pediatric airway dysfunction are revealed while we sleep, and it would behoove us as our children’s healthcare champion to spend some time observing...watching...and listening as they dream. 

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