This past week marked two firsts for me. It was ever invited to lecture at a hospital and the first time I was invited to speak by a physician. How did this happen?
I was sitting at a table with a couple of physicians, talking about kids and the pediatric sleep and airway literature. While I was citing one study after another, it was clear that the physicians had never heard of them. My rudimentary knowledge of the pediatric sleep disordered breathing literature was light years beyond what the physicians knew, so the pediatrician at the table asked if I would come speak at a pediatric grand rounds. I happily accepted, but I want you to remember that they didn’t even understand the relationship between nocturnal enuresis (nighttime bed-wetting) and sleep disordered breathing!!! (Note: I am not even referring to the solutions, simply the fact that the two were related, which has been demonstrated in the literature many times and is accepted as a fact.)
I invited my ENT to join me on the podium and while we were putting the lecture together, we went through hundreds of papers and one thought went through my mind: Orthodontists MUST take on the role of gatekeepers in pediatric sleep disordered breathing (SDB). It became crystal clear in my mind. Gone were the loud voice of the naysayers who feel that the orthodontist shouldn’t be involved or that our role is based on “hocus pocus” or sleight of hand.
Want to know what IS unreasonable, though? Kids who are 9 or 10 being told that their nighttime bed-wedding was due to their dyslexia and that they should “wait until they’re 12 and if it’s not gone, come back for another evaluation”. This REALLY did happen in my practice last week. Or how about the family that came to me last week with two kids showing minimal signs of any sleep issues whose GP was tiring to sell them plastics mouthpieces to “solve” their problem for $10,000? I told them there were no symptoms and no anatomic issues, so why was someone trying to a fix a problem that didn’t exist? (In adults, SDB is a much bigger issue related to lack of symptoms and medical problems, but not so much in the pediatric population.)
People, this is real and it’s happening every day, and worse, the GP community is getting more and more saturated with the idea that selling mouthpieces is a great way to make more money and solve sleep problems. While the former is true, there isn’t one peer reviewed study to support the latter.
There are some loud voices out there in orthodontics claiming that this is an MD problem and that all kids with symptoms should be sent to MDs for evaluation, but I’m here to tell you that most MDs (and I’ve spoken with dozens on the subject) have ZERO idea bout the literature on the subject. Yes, ZERO!!! Don’t kid yourself if you think hat a child with large adenoids and tonsils who exhibits several apparent signs of sleep disordered breathing is going to get help at an MDs office. What will likely happen is that they end up at a GP’s office who aggressively markets their plastic mouthpiece as a long term solution and who doesn’t even know the literature but has paid a franchise fee to the company who makes the mouthpiece.
WE are experts in craniofacial anatomy, NOT the MDs. WE are the ones who see 60-100 kids per day (BTW-the scientific literature supports that up to 4% of all kids show actual sleep apnea. Think about that for a moment related to how many kids we see every week) and do a full 3D craniofacial evaluation at the NP appointment (note that my ENT diagnosis using MY CBCT because getting a flexible scope up the nose of a 5 year old isn’t something he’d rather do if avoidable).
Every week I get messages from parents begging for help because the medical community has no idea what to do with these kids. Read this one I just got last night.
"Hi Glenn. I know you have touched on the topic several times but my daughter turns 9 in March and still wets the bed. Just wondering if you can point me in the right direction. Not sure exactly what’s relevant but she is a deep sleeper, sleep walks (rare),snores lightly, predominantly a mouth breather. Has a hump on her neck. She is starting to get embarrassed by it and doesn’t want to stay over any of her friends or family for fear of wetting the bed. We try and limit her drinking and wake her up to take her to the toilet before we go to bed. Any help would be much appreciated.”
These messages are heartbreaking and worse, the medical community doesn’t generally know what to do with these kids. They need help and at a time when GPs are doing more and more ortho, and at-home aligner companies are trying to scavenge ortho patients, we can help our specialty stand out, take our place at the table as the experts in craniofacial development and yes, help our practices and specialty stand out.
It is the opinion of many orthodontists and many in the medical community that the 2019 AAO midwinter conference on SDB made a few erroneous conclusions. Many MDs believe that WE need to be the ones helping act as primary gatekeepers because the medical community is overwhelmed and simply doesn’t have the time to diagnose these kids. And the idea that we should send kids for a full sleep study is also eschewed by many in the medical community who support the belief that anatomy is the primary cause of pediatric sleep apnea and SDB and that one must first deal with the anatomic issues.
I am not advocating that we diagnose or treat these kids alone. I have always said that we must build our team of SDB experts including an ENT, pediatrician, pediatric dentist, myofunctional therapist, GP and OMFS. But you MUST educate yourself on the subject. YOU must do a deep dive on the literature to separate fact from fiction. YOU Must do a thorough check and history on every child who walks through your door.
Don’t know where to get started? Don’t worry, because I’ve got your back. I invited Dr. Rebecca Bockow, dual trained Perio/Ortho and expert on pediatric SDB to give a scientifically based online course for Orthopreneurs University. Click HERE to learn more. Best of all, when you register for the course, you can access the recording for up to 30 days!!!
Let’s help these kids and take our place as part of the interdisciplinary SDB team and prevent these kids and families from being ignored or worse, being subjected to quackery that costs them more than the cost of a full orthodontic case.