ADA Guidelines for Children’s Airway Health
Posted on 09/03/2018
ADA Guidelines for Children’s Airway Health
I had the pleasure of being invited to participate as a key opinion leader along with twenty-nine other clinicians and scientists in a roundtable conference at ADA (American Dental Association) headquarters in Chicago for setting up the guidelines regarding the subject of “Children’s Airway Health”. The other participants included; Christian Guillminault, David Gozal, Stephen Sheldon, Steve Carstensen, Jeff Rouse, Kevin Boyd, Ron Mitchel, Valerie Crabtree, Mark Cruz, Kritie Gatto, Pat McBride, Jill Ombrello, Barry Raphael. The presidents and trustees of ADA and American Association of Orthodontics were also key participants in this ground-breaking historical meeting planned by Drs. Steve Carstensen and Barry Raphael.
A big feature of the Conference on Children’s Airway Health was having all the speakers and other leaders in children’s airway together in the ADA Trustee’s Boardroom for a pre-conference Roundtable discussion about the deeper meanings of the ADA Policy statement on the Role of Dentist in the Treatment of SRDB (sleep related disordered breathing) and to begin to form an agreement about defining identification and treatment of airway related problems in children.
According to input from participants the preliminary set of guidelines included:
- Use tools to identify children at risk for airway compromise.
- Discuss diagnosis protocols with families.
- Apply appropriate diagnostic methods to support medical decision-making.
- Present various treatment options.
- Immediately treat children falling within their scope of expertise and scope of practice.
- Follow these children during the growth years to assess airway health when indicated.
The following two-day conference at ADA Headquarters was a first-of-its-kind dental symposium open to all that was focused on compromised airway health in pediatric patients — and the role dentists can play in risk assessment, referral for diagnosis and treatment.
The most appreciated case by the audience presented at this symposium was our patient treated by Teledontic Protocol with “astonishing results”, said by Dr. Barry Raphael.
An 8-year-old boy referred for evaluation and treatment of possible OSA. The family described significant nocturnal grinding with occasional snoring. The recent academic performance of the patient was significantly declined due to excessive day time sleepiness and ADD like symptoms.
The patient had class two facial skeletal relationship, class II malocclusion and constricted jaws. Considering his other symptoms and familial history (dad and ten-year-old brother were diagnosed with OSA), he was referred for in lab sleep study. He was diagnosed with moderate obstructive sleep apnea, AHI of 5.8 overall and 7.7 in REM sleep, nadir 95% and severe sleep bruxism.
The treatment proceeded with phase one of Teledontic Treatment Protocol including expansion of the Pharyngorofacial system followed by the restoration of malocclusion by use of GAC In-Ovation R brackets with total time of 14 months. The Teledontic protocol was followed by bed time use of pharyngorofacial stabilizing orthotic (PSO) and periodic evaluation every four to six months.
The second stage of treatment started at age 14 including six months of pharyngorofacial expansion followed by full braces for proper correction of occlusion. This stage of treatment was completed in 20 months.
The second sleep test after completion of his treatment showed complete relief of the OSA with an AHI of 0 and nadir of 94%. His snoring and daytime sleepiness along with his academic performance improved significantly and now attending his education at Washington State University.
When these symptoms are not addressed at an early age, the children tend to grow up to become adults with severe sleep apnea. We need to tackle this early. We know that children who don't sleep well have serious consequences.
Dentists are often on the front lines with these medical disorders, so the best approach is to include a dentist equipped with this advanced knowledge and technology for treatment of pediatric OSA among the medical professionals on the team.
We're saving children, one child at a time, to let them become the best versions of themselves. The ultimate goal is to make children's lives better.