Missing teeth and pediatric obstructive sleep apnea
Missing teeth in early childhood can result in abnormal facial morphology with narrow upper airway. The potential association between dental agenesis or early dental extractions and the presence of obstructive sleep apnea (OSA) was investigated.
We reviewed clinical data, results of polysomnographic sleep studies, and orthodontic imaging studies of children with dental agenesis (n = 32) or early extraction of permanent teeth (n = 11) seen during the past 5 years and compared their findings to those of age-, gender-, and body mass index-matched children with normal teeth development but tonsilloadenoid (T&A) hypertrophy and symptoms of OSA (n = 64).
The 31 children with dental agenesis and 11 children with early dental extractions had at least 2 permanent teeth missing. All children with missing teeth (n = 43) had clinical complaints and signs evoking OSA. There was a significant difference in mean apnea-hypopnea indices (AHI) in the three dental agenesis, dental extraction, and T&A studied groups (p < 0.001), with mean abnormal AHI lowest in the pediatric dental agenesis group. In the children with missing teeth (n = 43), aging was associated with the presence of a higher AHI (R2 = 0.71, p < 0.0001).
Alveolar bone growth is dependent on the presence of the teeth that it supports. The dental agenesis in the studied children was not part of a syndrome and was an isolated finding. Our children with permanent teeth missing due to congenital agenesis or permanent teeth extraction had a smaller oral cavity, known to predispose to the collapse of the upper airway during sleep, and presented with OSA recognized at a later age. Due to the low-grade initial symptomatology, sleep-disordered breathing may be left untreated for a prolonged period with progressive worsening of symptoms over time.
KeywordsObstructive sleep apnea Upper airway collapsibility Alveolo-dental growth Dental agenesis Oral-facial development
- 3.Aknin JJ (2007) La croissance cranio-faciale, Aknin JJ (ed). Paris SID Publ 159-178Google Scholar
- 9.Enlow DH (1990) Facial growth, Third edn. Saunders, PhiladelphiaGoogle Scholar
- 12.Aknin JJ. (ed.) (2007) La croissance cranio-faciale Paris SID publ 1–254Google Scholar
- 15.Lisson JA, Scholtes S (2005) Investigation of craniofacial morphology in patients with hypo and oligodontia. J Orofac Orthop 66:1197–1207Google Scholar
- 20.Andersen E, Skovgaard LT, Poulsen S, Kjaer. (2004) The role of jaw innervation on the dental pattern in the mandible. Orthod. Craniofac. Res. 7:211–215.Google Scholar
- 25.Marchesan IQ (2004) Lingual frenulum: classification and speech interference. Int J Orofacial Myology 30:31–38Google Scholar
- 26.Chauvois A, Fournier M, Girardin F. (1991) Reeducation des fonctions dans la therapeutique orthodontiques. Paris: S.I.D.1–190Google Scholar
- 27.Huang YS, Quo S, Berkowski JA, Guilleminault C. (2015) Short lingual frenulum and obstructive sleep apnea in children. Int J Pediatr Res 1:1–4.Google Scholar
- 28.Iber C, Ancoli-Israel S, Chesson AL, Jr., Quan SF. for the American Academy of Sleep Medicine. (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 1st ed. Westchester: American Academy of Sleep Medicine.Google Scholar
- 30.Palombini LO, Tufik S, Rapoport DM, et al. (2013) Inspiratory flow limitation in a normal population of adults in Sao Paulo, Brazil. Sleep 13(36):1663–1668Google Scholar
- 32.Lee SY, Guilleminault C, Chiu HY, Sullivan SS (2015) Mouth breathing, nasal “dis-use”, and pediatric sleep-disordered-breathing. Sleep Breath(in press)Google Scholar