Nothing is sweeter than a sleeping child. Sometimes, however, that little angel’s snores become the stuff of nightmares, indicating a serious yet treatable condition.
Dr. Marianna Evans, a board-certified periodontist and orthodontist at Infinity Dental Specialists’ Main Line Health Center in Newtown Square, says many children today have upper-airway problems that can result in insufficient oxygen levels, thereby leading to developmental and behavioral problems. These problems include sleep apnea, capable of creating health risks in both children and adults; ADHD and daytime sleepiness that result in poor school performance; underdeveloped jaws with crowded teeth that cause a need for braces, and ultimately make patients more susceptible to periodontal disease and tooth loss later in life.
An estimated 10 percent of all kids snore, according to the National Sleep Foundation, but the reasons can vary. Snoring is caused by a blockage in the airflow through a child’s nose and throat that creates audible vibrations. Occasional snoring can be blamed on a stuffy nose from sickness or seasonal allergies, but blockage that regularly produces snores could be the result of several things.
Enlarged adenoids and tonsils are the most common cause of snoring in children. On the other hand, skeletal problems such as small upper or lower jaws not only present with crowded teeth but are other potential causes of snoring and ones that—until recently—have gone largely untreated in young children.
With a dual degree in orthodontics and periodontics from the University of Pennsylvania, Dr. Evans has expanded her scope of treatment to include management of periodontal problems in adults utilizing the latest advances in gum and bone regeneration and tooth replacement with dental implants and more importantly addressing skeletal and tooth eruption problems in children with orthopedic and orthodontic appliances.
“Many periodontal problems such as gum recession and, in some situations, even tooth loss commonly found in adults can be prevented with some types of orthodontic treatment in young age,” says Dr. Evans. This preventive early treatment was not available in the past, which is why so many adult patients with history of orthodontic treatment and regular dental care are presenting today not only with shifting teeth but also with severe periodontal complications.
It is difficult to believe but a lot of dental problems are related to recurrent ear/nose/throat infections that are very common in growing children. Dr. Evans explains: “Teeth, jaws and airway structures are not only in close proximity to each other but are developing and growing simultaneously, and any disturbances in one of them will affect others.”
Children usually develop recurrent and chronic upper-airway infections such as asthma, otitis media, allergic rhinitis and sore-throat problems before the age of 5, which is also before the permanent teeth are starting to erupt. Most of these problems present with congestion and transition from normal nasal to mouth breathing. Scientific evidence today shows that chronic airway problems and mouth breathing in children impair growth of the facial soft tissues, upper and lower jaws and teeth.
Once these skeletal and dental complications take place, a vicious cycle develops with their structural impingement on airway function and predisposition to dramatic medical condition such as sleep apnea during childhood or later in life. These patients often present to Dr. Evans’ practice with underdeveloped upper and lower jaws, cross-bites, crowded teeth with fragile gums and insufficient bony support. “That is why when left untreated these patients develop severe periodontal complications and require complex tooth replacement with implants later in life,” says Dr. Evans.
“Our focus today is on preventive care,” she says. “We can redirect the child’s growth or work with ENT specialists to improve the child’s airway.” She says snoring is one of the first signs of potential airway obstruction. If the child does not appear ill and their pediatrician cannot diagnose a potential cause for the snoring, it could be due to a skeletal problem that needs to be evaluated by an orthodontist. “Frequent snoring is not normal in a child. They should be evaluated by an ENT, have a sleep study done and see an orthodontist who can identify and correct jaw problems.”
Dr. Evans’ practice uses 3-D imaging technology to evaluate the patient’s skeletal, dental and upper airway structures and determine the problem’s source. These show details that a traditional radiograph does not. If there is a soft tissue cause, Dr. Evans will refer patients to an ENT with whom she can coordinate treatment. If, however, it is a skeletal issue involving the jaw, palate or mandible, she can offer treatment options.
“The American Association of Orthodontists recommends the first visit to the orthodontist before the age of 7,” says Dr. Evans. “Bones and soft tissue are moldable things at this age. Things that are immobile in adulthood are treatable in children.” It is critical to identify and address jaw problems before eruption of the permanent teeth. Today orthodontists utilize appliances such as expanders to grow jaws, not only to create room for a full set of permanent teeth but also to improve breathing. Dr. Evans has a number of patients in her practice who were able to avoid surgeries to remove tonsils and adenoids with expansion therapy and reduced asthma medications.
Early orthopedic/orthodontic treatment can offer aesthetic benefits as well. It can improve conditions such as a recessed jaw, under bite, buck teeth, short face and narrow smile, all of which develop as a result of growth problems. “Our idea of beauty comes from having the proportions which signify good health,” explains Dr. Evans.
Dr. Evans’ message to parents is to start early. “There are limitations with age,” she says. “We can correct a child’s health by expanding the bone and airway, but the effect is dramatic while the bones are growing vs. not growing.”
With the latest advances in diagnosis and treatment, Dr. Evans is definitely bridging specialties beyond orthodontics and ENT to provide patients with the comprehensive care they deserve.
“Orthodontics today is not about braces; we set up the foundation to keep teeth for life,” she says. “The future is in prevention.”
About Dr. Evans
Dr. Marianna Evans is a board-certified dual specialist in orthodontics and periodontics. Her multidisciplinary training allows her to manage complex orthodontic and periodontal cases, and focus on early prevention of dental problems using the latest advances in orthodontics and periodontics.
Dr. Evans divides her time between private practice, teaching at the University of Pennsylvania Department of Orthodontics and clinical research. She and her team are focused on individualized patient care and working together to deliver the highest standard of care.
Feel free to e-mail questions to firstname.lastname@example.org or schedule a complimentary consultation by calling 484-420-4643.
Main Line Health Center
Newtown Square, PA 19073
Photography by Jody Robinson