Physical Assessment in Pediatric Sleep Hygiene and Airway Health

  • Kevin L. Boyd


In addition to plaque-mediated dental diseases of childhood, mainly early childhood caries (ECC) and gingivitis, recent evidence suggests that pediatric malocclusion is additionally being recognized as a serious public health dilemma per its frequent comorbid association with sleep and breathing disturbances. Specifically, retrognathic, narrow, excessively vertical, and deficient sagittal skeletal phenotypes in children are often associated with increased risk susceptibility for impaired nasal breathing (Juliano and Ligia, J Clin Sleep Med 5:554, 2009; Kawashima, et al., Ear Nose Throat J 79:499, 2000; Seerone, et al., Angle Orthod 87:138, 2017).


  1. 1.
    Juliano M, Ligia ML. Polysomnographic findings are associated with cephalometric measurements in mouth-breathing children. J Clin Sleep Med. 2009;5(6):554.CrossRefGoogle Scholar
  2. 2.
    Kawashima S, et al. Cephalometric comparisons of craniofacial and upper airway structures in young children with obstructive sleep apnea syndrome. Ear Nose Throat J. 2000;79(7):499.CrossRefGoogle Scholar
  3. 3.
    Seerone A, et al. Risk factors for small pharyngeal airway dimensions in preorthodontic children: a three-dimensional study. Angle Orthod. 2017;87(1):138.CrossRefGoogle Scholar
  4. 4.
    Chervin RD, et al. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000;1:21–32.CrossRefGoogle Scholar
  5. 5.
    Corruccini RS. An epidemiologic transition in dental occlusion in world populations. Am J Orthod. 1984;86:419–26.CrossRefGoogle Scholar
  6. 6.
    Gilbert SF. Ecological developmental biology: developmental biology meets the real world. Dev Biol. 2001;233:1–12.CrossRefGoogle Scholar
  7. 7.
    Boyd KL. (R)evolutionary health care, guest editorial. Infant Child Adolesc Nutr. 2012;4(6):32–3.CrossRefGoogle Scholar
  8. 8.
    Casko JS, Shepherd WB. Dental and skeletal variation within the range of normal. Angle Orthod. 1984;54:5–17.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Gibbons A. An evolutionary theory of dentistry. Science. 2012;336(6084):973–5.CrossRefGoogle Scholar
  10. 10.
    Angle EH. Classification of malocclusion. Dental Cosmos. 1899;41(3):248–64.Google Scholar
  11. 11.
    Steiner CC. Cephalometrics for you and me. Am J Orthod. 1953;39:729–55.CrossRefGoogle Scholar
  12. 12.
    Andrews LA. The six keys to normal occlusion. Am J Orthod. 1972;62(3):296–309.CrossRefGoogle Scholar
  13. 13.
    Boyd KL, Sheldon SH. Sleep disorder breathing: a dental perspective. In: Principles and practice of pediatric sleep medicine. 2nd ed. Amsterdam: Elsevier Inc; 2012. p. 275–80.Google Scholar
  14. 14.
    Commission on Dental Accreditation. Accreditation standards for advanced specialty education programs in orthodontics and dentofacial orthopedics. Accessed 20 Feb 2017, from
  15. 15.
    Pilla Via M, et al. Diagnosis of pediatric obstructive sleep apnea syndrome in settings with limited resources. JAMA Otolaryngol Head Neck Surg. 2015;141(11):990–6.CrossRefGoogle Scholar
  16. 16.
    Personal communication with this author.Google Scholar
  17. 17.
    Singleton LG. The human side of orthodontia. Angle Orthod. 1934;4(4):305–11.Google Scholar
  18. 18.
    Keane H. Pleasure and discipline in the uses of Ritalin. Int J Drug Policy. 2007;19:401–9.CrossRefGoogle Scholar
  19. 19.
    American Association of Orthodontists. Your child’s first orthodontic checkup. AAO promotional brochure. Accessed 20 Feb 2017, from
  20. 20.
    Baccetti T, et al. Early dentofacial features of Class II malocclusion: a longitudinal study from the deciduous through the mixed dentition. Am J Orthod. 1997;111(5):502–9.CrossRefGoogle Scholar
  21. 21.
    Rubin RM. The orthodontist’s responsibility in preventing facial deformity. In: McNamara J, editor. Naso-respiratory function and craniofacial growth, Craniofacial growth series, vol. 9. Ann Arbor, MI, Center for Human Growth and Development; 1979.Google Scholar
  22. 22.
    Whiting GF. Mouth-breathing and its Attendant Evils. Dental Cosmos. 1883;25(6):295–306.Google Scholar
  23. 23.
    Pullen HA. Mouth-breathing. Dental Cosmos. 1906;48(10):998–1014.Google Scholar
  24. 24.
    Haskin WH. The relief of nasal obstruction by orthodontia-A plea for early recognition and correction of faulty maxillary development. Laryngoscope. 1912;22(11):1237–60.CrossRefGoogle Scholar
  25. 25.
    Bogue EA. Enlargement of the nasal sinuses in young children by orthodontia. J Am Med Assoc. 1909;53(6):441–4.CrossRefGoogle Scholar
  26. 26.
    Cohen SA. Malocclusion and its far reaching effects. J Am Med Assoc. 1922;79(23):1895–7.CrossRefGoogle Scholar
  27. 27.
    Bogue EA. The position of the deciduous teeth, an important diagnostic symptom. Int J Orthodon Oral Surg. 1921;7(5):237–50.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kevin L. Boyd
    • 1
    • 2
  1. 1.Lurie Children’s HospitalChicagoUSA
  2. 2.Private practice, Dentistry for ChildrenChicagoUSA

Personalised recommendations