THE TRUTH ABOUT SOME COMMON DENTAL MYTHS

The profession of dentistry has experienced an amazing evolution over its lifetime. References to tooth decay can be found in various ancient texts. At one time, a local barber would provide haircuts and pull troublesome teeth in the same shop. Dentistry evolved from these humble beginnings to what we know today: a structured medical discipline where patients benefit from evidenced-based care. Oddly enough, though, several oral health myths and misconceptions have failed to fade away....

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SIMPLE STEPS TO MAINTAIN YOUR ORAL HEALTH

On the list of common reasons people avoid the dentist, cost is usually near the top. It is a fact — some dental treatments are expensive. However, you have some control in working to avoid pricey dental procedures. Two of the best ways to avoid needing expensive dental treatments are to visit a dentist regularly for an exam and cleaning and following proper dental hygiene advice every day.

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COMMON SLEEP DISORDER WREAKS HAVOC ON THE BODY

The National Sleep Foundation estimates over 18 million adults in the United States, or about one in every 15 people, suffer from sleep apnea. Obstructive sleep apnea is a sleep disorder that interrupts breathing, resulting in disruptive sleep. Individuals suffering from obstructive sleep apnea will experience a repetitive (partial or complete) airway collapse throughout their sleep, which prevents air from reaching the lungs.

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CHILDREN AS WELL AS ADULTS CAN DEVELOP SLEEP APNEA

regulation of growth hormone, allowing the cells of this developing organism to multiply and repair. In the cognitive area, it is during sleep that a child consolidates all that was learned during the day. It is also during sleep when emotions are regulated and stored.


Because sleep is important for children, the consequences of chronic OSA can be paramount. It can affect the central nervous, cardiovascular and metabolic systems. This can influence a child’s ability to concentrate in school and cause poor academic performance, behavioral and cardiovascular problems and poor growth and development. Many children diagnosed with attention deficiency and hyperactivity disorder (ADHD) or behavioral disorders at school have been found to have OSA. Poor sleep quality and lack of adequate blood oxygenation were the primary causes of the original diagnosis.


Apnea in children can be produced by the difference between the amount of air a child needs to enter their lungs and the amount of space in their airway that allows air to enter. The amount of airway space can decrease when a child is sleeping because the muscles that line the airway relax or because of the

presence of enlarged tonsils and adenoids, fatty deposits lining the airway and/ or an anatomically small airway. Although most airways decrease due to lower muscle tone during sleep, in some children the space left can be critically small, allowing almost no air into the lungs.


A pediatric dentist can be a good screener for this type of sleeping disorder because their area of expertise is neighboring the airway. During a dental visit, tonsil size should be evaluated, and large tonsils should be followed up by a thorough examination and history taking to rule out OSA. Pediatric dentists will ask about snoring because this is an important factor to consider: 50 percent of frequent snorers have OSA. Another important factor to consider is elevated body mass index (BMI), a measure of body fat based on height and weight. Recent studies have determined the prevalence of OSA due to a high BMI is increasing rapidly. To objectively rule out OSA, an overnight sleep study may be performed; this will accurately determine if OSA is present and if treatment should follow.


Managing OSA depends on the severity of the condition. It usually begins with surgery to remove the tonsils and adenoids. Other treatment options are weight loss for children with a high BMI, use of a continuous positive airway pressure (CPAP) device and/or anti-inflammatory medications. Dental practitioners can also play an important role in the treatment and management of OSA by providing additional options such as the creation of mandibular advancement devices, rapid maxillary expansion and functional appliance therapy.


OSA is a troublesome condition that can affect a significant part of our child population. A complete history and examination at the dentist’s office can help screen those children who are at risk. An overnight sleep study can objectively diagnose OSA. Once diagnosed, many options are available to manage this condition. With early diagnosis and treatment, health and behavioral consequences produced by OSA can be reverted.

DR. LINA SHARAB

Dr. Cristina Perez is an assistant professor at the University of Kentucky College of Dentistry and the Director of the Pediatric Residency Program. As a pediatric dentist with additional expertise in orofacial pain, her clinical interests include temporomandibular disorders and obstructive sleep apnea. More information about UK Dentistry is available at  www.ukhealthcare.uky.edu/dentistry.

more articles by dr Christina Perez

Many people may be aware of adults who suffer from obstructive sleep apnea (OSA), a disorder of breathing during sleep, but few realize children can also suffer from this condition.


During an apnea event, a child may only be able to take a small amount of air – or none at all – into his or her lungs. A child with OSA can breathe normally during some portions of the night, but during an obstructive episode, the ribcage moves, trying to fill the lungs with air, but the airway is obstructed in such a way this is not mechanically possible.


Imagine how hard it is to hold your breath under water even for a couple of seconds. Children with OSA are involuntarily holding their breath for 10 seconds at a time, more than 10 times per hour all night long. Once a child’s brain is aware air is needed, the child wakes up and can breathe normally until the obstructions sets in again. This disturbance can cause very poor sleep quality. Furthermore, these lapses in air intake can cause the level of oxygen in the blood to be so low the child can suffer important consequences to their general health.


Sleep is a fundamental process in a child because it helps the physical recovery of the muscles, ligaments and bones children use and overuse all day. In a growing child, sleep is important for the secretion and