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Pediatric Sleep Disordered Breathing/Obstructive Sleep Apnea

Pediatric Sleep Disordered Breathing/Obstructive Sleep Apnea

Sleep-disordered breathing (SDB) is a general term for breathing difficulties occurring during sleep. SDB can range from frequent loud snoring to Obstructive Sleep Apnea (OSA) a condition involving repeated episodes of partial or complete blockage of the airway during sleep. When a child’s breathing is disrupted during sleep, the body perceives this as a choking phenomenon. The heart rate slows, blood pressure rises, the brain is aroused, and sleep is disrupted. Oxygen levels in the blood can also drop.

Approximately 10 percent of children snore regularly and about 2-4 % of the pediatric population has OSA.   Recent studies indicate that mild SDB or snoring may cause many of the same problems as OSA in children.


The most obvious symptom of sleep disordered breathing is loud snoring that is present on most nights. The snoring can be interrupted by complete blockage of breathing with gasping and snorting noises and associated with awakenings from sleep. Due to a lack of good quality sleep, a child with sleep disordered breathing may be irritable, sleepy during the day, or have difficulty concentrating in school. Busy or hyperactive behavior may also be observed. Bed-wetting is also frequently seen in children with sleep apnea.

A common physical cause of airway narrowing contributing to SDB is enlarged tonsils and adenoids.  Overweight children are at increased risk for SDB because fat deposits around the neck and throat can also narrow the airway. Children with abnormalities involving the lower jaw or tongue or neuromuscular deficits such or cerebral palsy have a higher risk of developing sleep disordered breathing.

Potential consequences of untreated pediatric sleep disordered breathing

  • •Social: Loud snoring can become a significant social problem if a child shares a room with siblings or at sleepovers and summer camp.
  • •Behavior and learning:  Children with SDB may become moody, inattentive, and disruptive both at home and at school.   Sleep disordered breathing can also be a contributing factor to attention deficit disorders in some children.
  • •Enuresis: SDB can cause increased nighttime urine production, which may lead to bedwetting.
  • •Growth:  Children with SDB may not produce enough growth hormone, resulting in abnormally slow growth and development.
  • •Obesity: SBD may cause the body to have increased resistance to insulin or daytime fatigue with decreases in physical activity.  These factors can contribute to obesity.
  • •Cardiovascular:   OSA can be associated with an increased risk of high blood pressure or other heart and lung problems.

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Dental Phobia-Treatment and Coping Methods

Communicating With Your Dentist

Talking with your dentist is the key to beating dental distress. Modern dentistry can be almost painless. Therefore, it’s worth taking the time to discuss your fears — and the potential treatment options — with your dentist.

You can feel more in control if you take part in decisions about your treatment. And that can help you to feel less anxious. Your dentist should discuss with you all the procedures you may need. You may be able to have several procedures done at one time or have a series of shorter appointments. Ask your dentist to describe the types of pain control available. Then decide which you feel will work best for you.

During the appointment, ask your dentist to explain what’s happening at every stage of the procedure. This may help to lower your anxiety. When you know what the dentist is about to do next, you can prepare yourself. You won’t be taken by surprise.

On the other hand, some people may feel less anxious if they don’t know what’s happening. If this is true for you, explain this to your dentist. He or she should be willing to adapt to your wishes whenever possible.

Another helpful technique is to agree on a hand signal you can use if you want everything to stop right away. This will give you a sense of control. It can help to lessen your anxiety. You don’t have to wait until you’re having pain to give the signal. You may ask the dentist to stop because you’d like to rinse your mouth or simply catch your breath, or just take a break for a few seconds.

You may feel embarrassed to discuss your fears. Remember that you are not alone. Fears are not uncommon. Once your dentist knows what the issues are, he or she will be better able to find workable solutions.

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Drowsy Driving ~ Raising awareness among health care communities and the public about the costs and dangers of obstructive sleep apnea when left untreated

Drowsy driving can be as dangerous as drunk driving. Drivers are 15 times more likely to be involved in a deadly motor vehicle accident when they have excessive daytime sleepiness, a common symptom of sleep apnea. Motor vehicle accidents due to drowsy driving account for $48 billion in medical costs each year. Current legislation recommends that commercial drivers get screened and treated for sleep apnea. However, many drivers do not know that they have sleep apnea. The American Academy of Sleep Medicine estimates that 18 million Americans have sleep apnea. 80 to 90 percent of cases remain undiagnosed and untreated. The Institute of Medicine reports 50 to 70 million Americans suffer from chronic sleep disorders, including sleep apnea. Help protect yourself, your loved ones and your fellow travelers.

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Imagine what it would be like if you suddenly lost one or two of your front teeth. Smiling, talking, eating—everything would suddenly be affected.

Mouthguards, also called mouth protectors, help cushion a blow to the face, minimizing the risk of broken teeth and injuries to your lips, tongue, face or jaw. They typically cover the upper teeth and are a great way to protect the soft tissues of your tongue, lips and cheek lining. Knowing how to prevent injuries like these is especially important if you participate in organized sports or other recreational activities.

When it comes to protecting your mouth, a mouthguard is an essential piece of athletic gear that should be part of your standard equipment from an early age. In fact, studies show that athletes are 60 times more likely to suffer harm to the teeth if they’re not wearing a mouthguard. While collision and contact sports, such as boxing, are higher-risk sports for the mouth, you can experience a dental injury in non-contact activities too, such as gymnastics and skating.


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Mouth care during chemotherapy

Some people having chemotherapy treatment find that their mouth gets very sore. This information gives some ideas about how you can look after your mouth before and during your chemotherapy treatment.

Chemotherapy drugs interfere with the way that cells of the body divide and reproduce. Both healthy cells and cancer cells are affected by chemotherapy drugs. Healthy cells can generally repair the damage caused by the chemotherapy, but cancer cells can’t and so they eventually die. When the healthy cells in the lining of the mouth are affected, this can lead to a number of side effects.

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Sleep Treatment Options For Those Who Can’t Tolerate CPAP


An acrylic oral devise can effectively treat obstructive sleep apnea without the discomfort or claustrophobic effects of the CPAP machine.

An estimated 18 million Americans suffer from obstructive sleep apnea (OSA), with many of those cases undiagnosed. OSA can come with serious side effects and consequences including fatigue, obesity, and an increased risk of heart attack, stroke and diabetes.

Continuous positive airway pressure, or CPAP, has been clinically proven to help. With CPAP, OSA sufferers wear a mask that delivers continuous air that keeps a patient’s throat muscles and air passages from collapsing, thus preventing the snoring and pauses in breathing associated with apnea. CPAP is one of the most effective sleep treatment options available. There’s just one problem however—some people can’t stand it.

One study estimates 30-50 percent of CPAP users don’t like the treatment; another survey discovered that about half of patients stop using the device within 1-3 weeks of it being prescribed. However, discomfort shouldn’t be a reason an OSA suffer doesn’t get help for his or her condition—the consequences are just too great. Other sleep treatment options are available for patients who dislike CPAP and should be explored.


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Tooth Decay in Baby teeth

America’s Pediatric Dentists Bite Into Problem of Rampant Tooth Decay In Little Teeth and Encourage Parents to Join the Monster-Free Mouths Movement

Approximately 60 Percent of Kids Have Tooth Decay By Age 5; New Report Shows Significant Gaps In Knowledge About Children’s Oral Health

CHICAGO, January 28, 2014 / PRNewswire / — The American Academy of Pediatric Dentistry’s (AAPD) first-ever “State of Little Teeth Report” underscores the significant threat that tooth decay has to the health, welfare and future of children in the U.S. And while studies show that delaying the first dental exam until the age of 2 or 3 can have an adverse impact on a child’s oral health, the “State of Little Teeth Report” reveals that 40 percent of parents and caregivers surveyed wait to take their child to the dentist until after age 2. To address this nation-wide threat to children’s health, the AAPD is launching the Monster-Free Mouths Movement, an educational campaign to arm parents and caregivers with important tools and information to help fight tooth decay, also known as the Mouth Monsters.
According to the Centers for Disease Control and Prevention, tooth decay is the number one chronic infectious disease among children in the U.S., posing an immediate and long-term threat to the teeth of young children and to their overall health and development.

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Sleep Apnea and the Obese Patient


Sleep Apnea and the Obese Patient
by Randal S. Baker, MD, FACS

Loud snoring is a common sign of a breathing problem that can lead to other issues. According to the American Academy of Sleep Medicine, approximately 10 to 30 percent of adults snore. Loud snoring, however, is a sign of a serious disorder and affects about five in every 100 people.

When a person snores, it is because the breathing passages in the back of the throat are narrowed and not fully open, thus restricting the amount of air taken in while sleeping. It is like trying to breathe through a wet, sloppy noodle. When the body cannot get enough air, it signals the brain to breathe harder and force the air in (that terrible snoring sound), or if it cannot get any air in (and you stop breathing); it wakes the body up in order to correct the problem.

This can happen hundreds of times a night, and the cumulative effect can lead to chronic sleepiness, trouble concentrating and even depression. The body’s repeated lack of restorative sleep over an extended period can also lead to more serious problems as well, including high blood pressure, heart attack and stroke.

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Digital Radiography: An Improvement?

Despite the many advantages of digital radiography, many practitioners in North America still have not made the switch from conventional, film-based radiography. From our observations and discussions with thousands of dentists, the reasons for not transitioning to digital radiography include high cost, no other forms of digital in the office (ie, computers in the operatories, practice management software, etc), unwillingness to endure the hassle of conversion and staff training, and for some, the complete disbelief that digital radiography is an improvement over conventional forms. Many of the objections are valid; however, the overall benefits of digital radiography far surpass the limitations.
This article includes a discussion of the advantages and limitations of digital radiography, the diagnostic quality of digital radiography versus conventional film-based, the various types of digital radiography available based on image size, the types of digital radiography best suited for specific clinical indications, and anticipated future advances in digital radiography.

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Treating completely blocked canines and full step Class II malocclusion

Dr. Todd Bovenizer presents a full step Class II malocclusion with blocked-out canines utilizing light open coil springs and elastics with the Damon™ System’s Damon™ Q brackets

Evaluation and treatment of Class II malocclusion can present a challenge to the practitioner. One must consider the facial ramifications, as well as skeletal and dental characteristics. This particular case presented with severe crowding that further complicated the diagnosis and treatment planning. This case exemplifies a challenge in multiple planes of space, A-P, transverse, and vertical.

The following case will illustrate how I implemented the combination of variable torques of Damon™ Q, with NiTi coil spring, and early elastic therapy to avoid extraction of maxillary premolars. The ending result was a well-developed transverse arch with ideal incisal inclination.

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Doctors Explore Connection Between Sleep Apnea and Heart Failure

-Tyrone Conner’s heart was in such bad shape that he could barely walk up a flight of steps.

“I felt like I was 80 years old,” said Conner, 50, of Norristown.

He also suffered from sleep apnea, snoring heavily and gasping for breath every night.

What he did not initially realize was that the two problems were linked.

Conner’s physicians, at Thomas Jefferson University Hospital, made the connection, but many do not. Sleep apnea afflicts as many as 60 percent of patients with heart failure — the term for a weakened heart muscle that cannot keep up with the body’s demands. Yet only 2 percent of them nationwide are treated for the nocturnal breathing problem, said Sunil Sharma, associate director of the Jefferson Sleep Disorders Center.

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Kodak Cosmetic Imaging Software

The Kodak Cosmetic Imaging Software enables us to take digital photographs of the patient’s mouth and simulate his or her smile with different cosmetic restorations, such as bleachings, bondings, diastema closures, veneers, and porcelain crowns. Being able to visualize the recommended treatment makes the case more exciting and gives the patient a better idea of what the end results will be.

Logicon Caries Detector Software

This software is a technological tool available to dentists to help detect cavities between teeth, called interproximal cavities. The software compares a digital X-Ray of the patient’s teeth with a database of known problems. It then highlights any areas of concern, indicating the depth of the cavity. This alerts the dentist to check the area more closely for further evaluation. Results are then permanently saved digitally in the patients chart. Early detection of cavities leads to less invasive procedures, reducing the need for more involved treatment in the future.

Intra-Oral Camera

It lets you see what we see! To help provide you with the best dental care, we utilize the intra-oral camera. The camera is a small, pen-shaped wand used to show problems such as deteriorating fillings, fractured teeth, bleeding gums, soft tissue injuries, or any other dental abnormalities. The camera is painless and does not emit any radiation. Seeing these images helps the patient understand any recommended treatment. When finished, these images are digitally stored in the patient’s chart for permanent record.

Clinical Computers

Our practice has technologically advanced considerably. We have integrated clinical computers in each operatory. Having these computers aids us in treating patients because the records are now digitally recorded.

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