Lack of good quality sleep in childhood is known to coincide with impaired neurological development and associated behavioral issues like ADD/ADHD. As many physical and behavioral risk indicators of poor sleep hygiene can be readily detected by dental professionals who treat children, it becomes imperative for dental/dental hygiene schools and post-graduate dental residency training programs, to incorporate didactic and clinical Sleep Medicine content into their curriculums. This slide presentation demonstrates evidence to support the hypothesis that, with early identification of at-risk children, health problems associated with Sleep Disordered Breathing in childhood, can be either prevented, reversed and/or better managed, with appropriately timed and targeted orthodontic, orthopedic and/or orthotropic treatment modalities.

2. Optimum Development of the Teeth, Jaws and Face:
Yet Another Reason to Breastfeed
Kevin Boyd, M.Sc. (Nutrition), D.D.S.
Hypothesis:
Ancestral (Paleo) regimens of Infant and
Early Childhood Feeding (IECF) were/are
protective against skeletal malocclusion
pre-Industrial/Westernized cultures

4. The Problem:
SDB/OSA/Neuro-cognative Impairment:
- compromised naso-respiratory function
-unhealthy sleep architecture (PSG)
The Solution:
Early Identification and Collaboration:
-Sleep Medicine
-Evolutionary Medicine
-Evolutionary Dentistry

6. Take Away Points:
1. Sleep is not a luxury, sleep is as necessary to survival and well-being as food and water
2. There is a bi-directional association(e.g., perio/T2DM)between certain craniofacial
phenotypes(high-vaulted palate, posterior crossbite, retrognathia, hyper-divergent
growth) and clustering with other known risk factorsfor SDB/OSA (snoring, ATH,
bedwetting, night terrors, restless legs/active sleep, etc.)
3. preventive strategies include OMT, infant feeding/diet counseling; Tx alternatives to
CPAP/surgery include RME, BB-O
4. collaborativeopportunities(responsibility?) exist for orthodontists, pediatric dentists, GP’s
and RDH’s to identify/screen at-risk kids for SDB/OSA….refer (ENT’s, OMT’s, Sleep specialists)
and Tx p.r.n.
e.g., The AAPMD

7. In conclusion:
-abnormal craniofacial morphology, but not excess body fat, was associated with SDB in children
6–8 years of age.
-patients with dental malocclusions, deviant craniofacial features and tonsillar enlargement should
always be examined as regards to their sleeping habits, snoring and pauses in breathing during
sleep.
-children with tonsillar hypertrophy, cross bite and convex facial profile could be candidates for
early intervention and orthodontic treatment to prevent the progression of SDB in coming years.

10. Childhood Sleep Disorder Breathing:
A Dental Perspective

11. Obtuse naso-labial angle associated with
most bi-maxillary retrognathic (modern)
skulls
Hyoid bone inferior position (to MP)
associated with most bi-maxillary
retrognathic (modern) skulls
Narrowed posterior pharyngeal space
associated with most bi-maxillary
retrognathic (modern) skulls

14. Lateral cephalographs of 3 children with chronic mouth breathing: images show different grades of airway
obstruction relative to adenoid size. A, Grade 1 in a girl 12 years 3 months old. B, Grade 2 in a boy 4 years 4
months old. C, Grade 3 in a boy 4 years 9 months old who also exhibits the typical morphologic and dental
characteristics of long face syndrome.

15. Am J Orthod Dentofacial Orthop. 1997
May;111(5):502-9.
-In the deciduous dentition, a distinctive occlusal and skeletal pattern of Class II
maloccluson exists. In addition to concomitant diagnostic dental relationships in the
sagittal plane (distal step, Class II deciduous canine relationship, excessive overjet),
transverse interarch discrepancy due to a narrower maxillary arch is a constant
feature of early Class II malocclusion. Skeletal findings in children with Class II
malocclusion typically include significant mandibular retrusion and shorter total
mandibular length.
-the clinical signs of Class II malocclusion are evident in the
deciduous dentition and persist into the mixed dentition.

19. 3. preventive strategies include OMT, infant feeding/diet counseling; Tx alternatives to
CPAP/surgery include RME, BB-O

20. Hypothesis:
Ancestral (Paleo) regimens of Infant and
Early Childhood Feeding (IECF) were/are
protective against skeletal malocclusion
pre-Industrial/Westernized cultures

21. “ …(malocclusion) is a relatively new phenomenon in the human population and we do not
find it in skeletons until after the seventeenth century. ” -Peter Gluckman
“… jaw anomalies (malocclusions wherein the teeth cannot fit properly in the jaw) are
relatively new to European populations. Well-preserved skeletons from the 15th and
16th centuries show almost no malocclusion in the population….”

22. “….there is much circumstantial evidence that jaws and faces do not
grow to the same size that they used to precisely because of our softer,
more processed diets.” Daniel E. Lieberman

24. Abingdon Cemetery

35. Is the basis for McNamara’s “Ideal” anthropologically informed?

36. The Angle Orthodontist: 54 (1): 5-17 1984
Angle Orthod. 54(1): 5-17 1984

38. Pierre-Robin pt. –
retrusive
mandible…retrusive
maxilla!

39. ILLINOIS SLEEP SOCIETY CONFERENCE 2012
Advancing Mandibles and Maxillas with Biobloc-
Orthotropics: A Non-Surgical Approach to
Increasing Posterior Pharyngeal Airway Space
in Pediatric OSA Patients
Kevin Boyd, DDS
Kevin L. Boyd, M Sc, DDS
Courtesy of Brian Hockel, DDS

40. 2/15/2010 BIOBLOC STAGE-1 Tx 2/21/2012 BIOBLOC STAGE- 3 Tx
Example: Assign an arbitrary control value for
airway radius of 1.0. A 50% reduction in airway
radius would mean that the new airway radius
would be 0.5. Now, according to Poiseuille, that
gives us...R = 1/(0.5)4 R = 1/0.0625 = 16 Therefore,
resistance to airflow is increased 16-fold with a
decrease in airway diameter (and radius) of 50%.

41. Correlating PSG data with Biobloc TX response Stephen Sheldon, MD CMH

42. Original Article Changes of pharyngeal airway size and hyoid bone
position following orthodontic treatment of Class I bimaxillary
protrusionQingzhu Wanga; Peizeng Jiab; Nina K. Andersonc; Lin
Wangd; Jiuxiang LineABSTRACT

48. Another possible explanation for our findings is that oral cavity features such as high
palates, narrow dental arches, and retruded chin all are additional risk factors for SDB in
children38
38. Kushida CA, Efron B, Guilleminault C. A predictive morphometric model for the obstructive
sleep apnea syndrome. Ann Intern Med. 1997;127:581–587
Although dentists and orthodontia recognize the importance of evaluating and treating
OSA, they have yet to realize howwell-positioned they are for the prevention of sleep-
disordered breathing (SDB).