Puberty causes a growth spurt that can lead to a recurrence of sleep disordered breathing, even after pediatric treatments have been completed.
Pediatric Sleep Disordered Breathing
Sleep disordered breathing includes snoring, sleep apnea, and limited air flow through the night. Primary snoring without a loss of oxygen is not considered a significant problem by the medical community. However, snoring occurs when the mouth is open, and open mouth posture contributes to other problems.
Mouth breathing can result in dry mouth, which can both increase the risk of cavities as well as swelling of the tonsillar tissues. Mouth breathing can also alter the course of growth of the face and jaw.
Pediatric Airway Treatments
Some treatments appropriate for children in the pediatric years include tonsillectomy and/or adenoidectomy, and phase one orthodontics such as maxillary expansion. Initially following completion and healing from these therapies, children will often have an easier time managing nasal breathing, closed mouth posture, and a reduction of sleep disordered breathing. However, the rapid growth that kids have during puberty can upset the balance previously established between the bite, the nose, the neck, and the airway.
As dentists, we often suggest orthodontic expansion (making enough room in the mouth for the tongue and the teeth) while a child is in the pre-puberty phase. This is because the upper jaw (maxilla) is believed to reach its maximum growth by age 10 or 11, while the lower jaw takes a mid-puberty growth spurt. We time the use of functional growth treatments (like ALF or palatal expanders) using both a child’s chronological age and dental eruption stage.
Role of the Tongue
While the structural development certainly sets the stage for improved oral function and sleep, the evidence suggests ongoing muscle training of the tongue is crucial for the child not to revert to sleep disordered breathing. In our practice, we utilize ALF appliances to support nasal breathing and an elevated tongue position within the mouth. We also refer out for physical therapy and myofunctional therapy when additional support is needed to return the child to a functioning closed mouth position.
The proper position of the tongue is sometimes simply gained by being attracted to the wire loops on the ALF. Many of our patients tell us that even when they take out their ALFs, they (surprisingly to them!) find their tongues are now naturally resting on the roof of the mouth as it should. In some cases, the ALF can assist in positioning the tongue, but if the patient has general low tone or poor overall posture, a referral to a physical therapist or myofunctional therapist may also be necessary.
Physical therapy can help a patient retain proper tongue positioning after treatment. One way is by teaching the patient how to manage neck posture (since the base of the tongue is attached deeply to the neck). Myofunctional therapy helps by teaching specific tongue activities designed to strengthen the tongue itself along with the swallowing mechanism.
Want to know more about sleep disordered breathing following onset of puberty? Read the research by Guilleminault et al to learn more
https://www.ncbi.nlm.nih.gov/pubmed/23522724
To read a great review article by Chang about sleep disordered breathing in children in general,
https://www.ncbi.nlm.nih.gov/pubmed/19527603
An excellent resource for parents learning about the relationship of mouth breathing and facial development,
http://caugheydds.com/always-breathe-correctly/
For more information about sleep disordered breathing in adults,
http://caugheydds.com/snoring-sleep-apnea-appliance/