Airway Sleep Dentistry in the Pediatric Population

Do you just want to screen patients? We need more people screening patients, right? If you just want to screen, that's amazing. Please do so. And then find a trusted provider who you can refer to. After that, if you're gung-ho and you really want to treat, through those same programs, they definitely have courses to help you treat patients. And then it's just, then it's sort of your philosophy. How do you want to treat them? Welcome to the Phil Klein Dental Podcast. An often overlooked aspect of treating the pediatric population is airway obstruction, sleep apnea, and other sleep disorders in young children. Your role in assessing and intervening early can help prevent a wide range of dental and systemic health issues linked to poor sleep quality. This also presents an opportunity for your practice to grow. Expanding into sleep dentistry can bring a new level of fulfillment to your career and positively impact your patients' lives. Our guest today is Dr. Jacqueline Patterson, a general dentist and orofacial myofunctional therapist with over 15 years of experience. She believes that early assessment of airway obstruction and intervention with devices and other means in children can non-invasively improve both their dental and overall health. with benefits that will last a lifetime. Our guests will be joining us in a second, but first... With countless dental composites on the market today, choosing the right one can be overwhelming, yet a few products rise above the rest, and Voco composites lead the way. For over a decade, Grandioso's tooth-like physical properties have remained unmatched by any other restorative material. With its stunning aesthetics, exceptional durability, and superior handling, Grandioso stands out as the clear choice for all of your composite needs. And if you're looking to simplify posterior restorations with a single-shade solution, Check out AdmiraFusion Extra. This omni-chromatic nano-hybrid covers all 16 Vita Classical shades with a single shade. It achieves this without compromising strength, handling, or radio opacity, providing fast, strong, and aesthetic posterior fillings. Join thousands of dentists who trust VOCO for proven performance, superior aesthetics, and lasting results. Explore VOCO's full range of composite materials and request a sample. Dr. Patterson, thanks for joining us. Thank you for having me, Phil. We're happy to have you back. And if you didn't listen to Dr. Patterson's other podcast, you can catch it on Spotify or Apple Podcasts. Just look up the Phil Klein Dental Podcast Show and do a search for Patterson and you'll see Dr. Patterson's content on airway and sleep dentistry, which is some really, really good stuff and nuances about. her journey through education and private practice, where she really developed a niche with sleep disorders. So today, to start this podcast, let me ask you this. How can you tell if your pediatric patients have airway issues? So there's a lot of different ways to identify airway issues in pediatric patients. There's, you know, looking at the physical and looking at behavioral as well. When you're looking at Any physical aspects, you want to see if they're mouth breathing at all. That's sort of a telltale sign you want. I look at the posture, forward head posture, typically that they are in that posture to keep their airway open and they're kind of getting used to that posture. Another sign is, you know, these kids who have Venus pulling underneath their eyes. I mean, I'm not sure. if they have a nine to five job or what, but you know, they really shouldn't be looking like they never get any sleep. So that's a sign as well. What's the posture look like? What is exactly the posture? I always think of that Napoleon dynamite character where head is forward, mouth is open, kind of like a slack look, jaws kind of down. That's what I look forward to. Kids with major airway issues are not usually, upright with lips closed. So when I actually get them in the chair, I'll look at, you know, occlusion, occlusion, occlusion. When they're in primary dentition, there should be spacing. There should be primate spacing. They shouldn't have this, this Hollywood smile when they have no adult teeth because they're already starting out at a deficit. So I'll look at spacing. I'll look at crowding. I look at open bite, deep bite, cross bite. Class three, underbite. So all of those malocclusions are typically telling me that there's some underdevelopment of the jaw. I'll look at different habits like tongue thrusting, pacifier use, thumb sucking, those different things, because the thumb and the pacifier are taking the place of where the tongue should be. So I already know if they have another object in their mouth, their tongue is not where it's supposed to be. It's going to be low and back and not up and forward. So those are some things I look for physically in a child. And then we do questionnaires. So we have mom and dad report back about sleep. You know, are they noisy sleepers? You know, heavy breathing, snoring, mouth open, tossing and turning. that sort of thing, are they bedwetters and they're, you know, over the age of five and they're still wetting the bed significantly, that's also a sign of sleep disordered breathing in kids. And behavior-wise, we have signs and symptoms as well. You know, on the one aspect, are they always tired and unfocused? But then are they hyperactive? Because that can also show, like, your body is... telling you to go, go, go. This is not the time to sleep. And then in children, that presents itself as hyperactivity a lot of times. So there's different things that I look at. I mean, you'll have a kid in your chair who can't sit still, who's all over the place. And the mom or dad has no idea why. And then you start talking about sleep. And they're like, well, you know what? They do wake up often or, you know, they do wet the bed. So it's just having these conversations with the parents to get more information if you suspect anything. And with your education on sleep disorder, breathing disorders in these patients, you can pretty much spot a high risk patient, right? Even if a young kid is overweight in the category of obese or seriously obese, that's something right away that will tell you that patient has higher risk. It's just the facts. And then once you see that, you go further down the road. So when do you make the... decision to intervene and tell the parents, listen, your kid's a great kid, but without good sleep, he or she is a disadvantage in school and all these other things will happen down the road systemically besides the deleterious effects of dental breakdown based on gum disease and tooth decay by being a mouth breather. Right. So when do you say, okay, it's time to intervene? What are you actually going to do in general for some of these cases as a dentist? So, I mean, I have the conversation right away. As soon as I see them for their exam, I have a conversation about what I'm seeing, why I think it's important. And I also come from a place as a parent who has three kids who have all been through some type of airway intervention. So I try to... relate in that respect. Like, no, I had kids who wet the bed late. You know, I had kids who were hyperactive during the day or just tossing and turning all night. night. Or, I mean, my daughter who is class three skeletal, but I knew to intervene early so that she wouldn't have any further airway issues or wouldn't need surgery down the road. So I relate these stories to the parents. I always want sleep and airway to be sort of... on its own. So if they come for a periodic exam or a new patient exam, I'll always touch upon it. But I will say, you know, today we're going to look at the teeth. And I will talk about how, you know, sleep and airway relate back to what I'm seeing in the mouth. But then I always say, you know, I want to have a separate conversation with you because I think this is really serious matter. So I'm going to reappoint you back just for the sleep consultation and we'll look at different treatment modalities that I use. Like I really spend the time. on it because I want to impart on them that this isn't just a quick part of their exam. I want to impart that it's a very serious thing. So that's the way that I do it. So when they come back for that second appointment, usually the parents are pretty cooperative with your suggestion? Right. Because if they're coming back, their interest is at least peaked, right? They're like, okay, well, she was serious. She's gone through, you know. Sleep issues with her own kids. She's been doing this for a while. You know, let's hear her out. So then that's when I always have samples of the types of interventions that I would maybe use on their child. So different expanders. growth appliances, trainer appliances, I'll show them. I let the kids touch them. I kind of get everybody involved. And then if I suspect, especially through their questionnaire, more severity, there are FDA approved home sleep tests for kids. So I'll have the kids take a sleep test and have more information, you know, for the patients through that. So that's sort of my next step is either a sleep test or getting them right into a trainer appliance. And I talk a lot, especially with children and their parents about myofunctional therapy, about these habits because they're actively growing. And I tell parents, look, you're lucky that we identified this so early because we can piggyback on their natural growth. We'll be getting right back to our guest in a second. 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They're already forming habits. Let's get them to form the proper habits. So I try to get them energized. You know, like this is the best time to start. This is great. And then some parents get sort of down on themselves. Oh, they're already nine years old. And I didn't realize they had a tongue tie until now. And, you know, I'm like, look, there are adults walking around in their 60s, 70s who have had horrible sleep. or issues their whole lives, and they would have hoped that their parents would have seen this or their providers would have seen this when they were nine. So it's a lot of encouragement for the parents themselves because they have to be on board because the kids are not going to typically just do this on their own. We need the support of the parents. And how much do you work with orthodontists when it comes to appliances on these kinds of cases? Because if you're going to start an appliance which... most likely will really help that patient with airway issues, that patient may also need orthodontic treatment. So how do you work with the orthodontist when you want to move forward with an appliance? So because I'm definitely an airway-centric dentist and I work with orthodontists who are sort of on my same wavelength in terms of expansive orthodontics, early treatment of children. I mean, I would love them to be seen. at least by the age of seven. And some orthodontists, you know, won't really do any treatment until they're 12. And we're missing out on so much growth potential if we're waiting that long. So I seek out orthodontists who will start early. And I have orthodontists who refer to me who will not start ortho until they have a myofunctional therapy assessment because they're tongue thrusting, because their habits are going to slow down the ortho treatments. So, so I have some pretty good docs that I work with, but I also do a lot of appliance work myself. So if it's not most of these kids, I can do expansion on myself and I do upper and lower expansion. You just get more retention that way. And some orthodontists and other providers will only do upper expansion, expansion. So, you know, so it's, it's sort of, You go with what you're comfortable with, what your treatment goals are, and then you find a like-minded provider. And again, to our audience, we're talking about pediatric population right now, but we will be doing another podcast with Dr. Patterson covering everything, all patients of all ages, because a lot of patients in their 60s and older are highly susceptible to sleep. breathing disorders, right? Just because they've gained weight and constriction of the throat and a lot of issues. There's just a whole lot of aging issues that could affect breathing properly while you're sleeping. But let's get back to the pediatric population. So intervention, early detection, I mean, that is the name of the game in almost every field of medicine, including dentistry, because dentistry is a field of medicine. Cancer detection, we know the results of that by getting it early. So let's talk about what would happen if airway issues aren't addressed early on. So there wasn't somebody as smart and well-versed as Dr. Patterson in that office. And the patient came in and a dentist is just doing his or her thing, you know, looking for cavities and doing the same old treatment that he or she has done for. his or her entire career and this goes untreated not discussed and the patient's probably let's say the patient's seven years old and they have a lot of these things going on that you would typically pick up and address this this dentist is not doing that what happens when that patient's 12 or 14 what are we looking at down the road so if they're Most of these pediatric patients are mouth breathers. So if they are continuing to mouth breathe and no one addressed it, then you have a higher caries rate. You have a higher, more susceptible to periodontal disease. So we're starting them on that road to lots of restorations, lots of bone loss. We're not addressing their growth, their poor jaw growth. So we're not. They're not going to be to their potential on how wide or how far forward their jaws could grow if we got to them a little earlier. The head and neck pain. A lot of my older patients who have had these issues since they were younger have head and neck pain. There's teenagers, head and neck pain. Their posture is a certain way. They're waking up clenching and grinding and their jaws hurt. Then they'll develop, you know, TMJ issues. Gosh, there's so many. There's focus and behavior issues. So they're not getting enough sleep, and they're 5, 6, 7, and it kind of goes undetected. And, oh, little Johnny, just maybe he's hyperactive, has ADHD. You know, maybe there's some meds involved. You know, maybe. But maybe their grades suffer. Maybe their friendships suffer. Maybe their confidence suffers. Crooked teeth. Maybe if we don't get to them by the age of 12. And we didn't start expansion early. And in my functional therapy, they're very, very crowded. And the dentist that they present to, you know, doesn't do expansion on kids over a certain age. Then we're talking about extractions to straighten the teeth. And then, you know, which basically we're making a smaller space smaller by extracting. permanent teeth. So which leads to more problems, you know, more headaches, more, you know, there's no space for the tongue, more likely to be apneatic when they're older. So, I mean, there's, that's just the tip of the iceberg. Then you get into cardiovascular issues, neurological issues, as you age, more chronic issues, because we didn't address something when they were seven. So that's also what I like to impart to the patient's parents. is, you know, we could stop them from having X, Y, and Z. And so often the parents are like, oh, that's what I have. That's that look that I, you know, I have crowding. Is that what happened to me? So it's very educational for everybody because if they can see it in themselves and they have any way to stop it from happening in their kids, a lot of parents will do what they have to do, what they can do to. make sure that their kids aren't suffering from these disorders. basically did not learn any of this in dental school, to get to the level where they can at least assess the patient, be pretty confident that the patient has sleep disorders, and then they can proceed in the best path from there, which means collaborating with the parents, with the medical community, to make sure this child has the opportunity to get some corrective measures to avoid all the sequelae that you just described. What does it take for a dentist to get to that level? And I assume continued education is a big part of this. So, you know, learn from my mistakes. I kind of just stumbled upon it and what have you. But there are a lot of companies that treat airway and sleep in kids that have introductory courses for dentists. You don't have to necessarily want to treat it, but they will educate you on the why. So there's companies like Myofunctional Research Company that does Myobrace. There's Healthy Start. There's Vivos. There's Foundation for Airway Health. I'm sure I'm missing a few, but a lot of them have introductory courses because they know that the doctors have to start somewhere. They can't just jump into treatment. And so I would encourage those doctors out there and hygienists, any provider out there, to seek out those companies that I mentioned just to... Get some education on it. And then through that, there's always going to be providers available within those programs that you can reach out to. If you reach out to the company, they can, you know, you can say, hey, I need more information on this. Who can I reach out to? And they'll typically reach out to one of their providers to give you a call or drop you an email or something like that. So that can get the conversation started. That can get things going for you. And then from there, you can decide, you know. Do you just want to screen patients? Which is, we need more people screening patients, right? If you just want to screen, that's amazing. Please do so. And then find a trusted provider who you can refer to. But yeah, at least at the very least, you know, if you're listening to this, now you know a little bit more. And when you know better, you should do better. And now, you know, try to look into how can I make sure that I'm helping. this population get to better health so that's that's a way to do it after that if you're gung-ho and you really want to treat through those same programs they definitely have courses to help you treat patients and then it's just then it's sort of your philosophy how do you want to treat them there's a lot of different ways so um and i'm not saying one way one way is better than the other yeah but it right this whole area of sleep dentistry has transformed your career hasn't it? And on a personal level, just from the standpoint of passion and not doing the same thing, you obviously weren't completely satisfied with being a general dentist. And you went into this almost by accident. And it's just, you know, lit you on fire as far as passion. It has because it was really important to me. I mean, I have passions outside of dentistry, but it was really important to me to find something within it. Because, you know, I spent a lot of time. On my degree, I love being a dentist. I do love what I do, but I just needed something else. And, you know, everyone's like, oh, just place more implants. And, you know, I'm like, that just doesn't do it for me. And so when I stumbled upon this type of dentistry, because it is a type of dentistry where we can help people and we can be involved with different avenues and pathways. reaching out to their physicians, reaching out to ENTs, other myofunctional therapists. I mean, it's just, it's a, it's a whole community. So I love the community aspect of it. I love feeling that I'm, I'm helping the whole body, the whole patient a little bit more. I mean, dentistry, it's a part of the body, oral cavity is a part of the body, but I feel like I get to do a little bit more when I'm treating airway. So yeah, I. It's transformed how I see my patients, how I interact with my patients, how I interact with other providers, because I'm always going to talk to them about this. Oh, do you know about this or that? And then I speak more. I put on Lunch and Learns. I do more consulting. Because I want to spread the word, I've gotten more opportunities to spread the word. Yeah, it's certainly expanded your horizons in the profession. And it's just a fantastic thing to... To go beyond what you're typically destined to do as a dentist, which is, wow, I see decay, let's fix this. And that's so important. I'm not in any way disparaging. That's the bread and butter of what dentistry is. And we need dentists to do that. We can't have everybody doing sleep dentistry. But sleep dentistry certainly has moved forward in a much faster pace. than it has like 10 years ago, 15 years ago. It was getting, you know, some dental practices were looking into it, but it's picking up some steam. It's a great way to deal with it. differentiate your practice too from the other dentists on the block. And it's a practice builder, right? I mean, parents are going to go tell other of their friends. Dr. Patterson identified something that was very, very important and serious in my son. And if you have any questions about this, Dr. Patterson's the one to ask. And then you end up getting their family and their friend's family. I'm sure you found that happen as well. Oh, yeah. Oh, yeah. And then I've been fortunate to be able to treat people. you know, abroad too, because especially with myofunctional therapy, you can do a lot of it virtually. And so I, you know, had patients and I had a patient in Korea who had family in Las Vegas and then would like came to Vegas to visit. And then I did their phrenectomy when they're here, you know, so it gives you some opportunities. And then I do work with a company called Toothpillow, sort of a lot of the people who work with Toothpillow worked at Vivos. And I love the idea of Tupilo because it's a virtual way to reach this population. A lot of patients, if their dentists don't know anything about this, but the parents are educated and are just trying to find a provider and there's no one in their area. This sort of virtual platform of Toothpillow helps them find a provider in their state because it's, you know, so I'm the Toothpillow provider for all of Nevada, but I have patients who are eight hours away from me who don't have anybody who they can see about their concerns for airway health and their kids. And so the platform's great because I diagnose, I see the patients, but it provides me with a lot of support staff. on the back end that, you know, there's an app and there's, you know, it's, it's, it's cool how the kids get, get the engagement. They'll send the kids their, their functional appliances. And if they need expansion, then they come to see me in person, but it's, it lessens how many times they actually have to travel to see me, things like that. So there are there. So anyway, and I'm not beholden to any one group or any one company, any way that we can get. the word out and get more kids involved and and so we won't have all of these issues with the adults right like let's start when they're younger yeah absolutely well said amen to that uh hats off to you again for the great service you're providing our profession and uh you're inspiring Dr. Patterson and i hope our listeners uh open up their minds to airway sleep dentistry because there's a whole lot that they could do to help the pediatric population as they grow older and also older patients that are suffering with sleep issues that literally lead to public health issues like what I mentioned earlier. Have a great evening. Thank you so much, Dr. Patterson. Thank you. Thank you.