The role of pediatric dentist in the comprehensive

management of obstructive sleep apnea (OSA)

Second-year residents in Pediatric Dentistry : Sofía Cuadrado y
Antonella Sánchez
Teacher: Dra Liliana Otero
 TABLE OF CONTENTS
01 02 03

INTRODUCTION THE ASSESSMENT OF TREATMENT AND

PEDIATRIC OSA RISK DENTAL
FACTORS IN A DENTAL MANAGMENT
OFFICE

04 05 06
COMPLICATIONS POLICY STATEMENT Conclusion
(AAPD)
 01
OBSTRUCTIVE
SLEEP APNEA
 02
THE ASSESSMENT
OF PEDIATRIC OSA
RISK FACTORS IN
DENTAL OFFICE
WHO IS AT RISK?

Nocturnal polysomnography (nPSG)

CLINICAL ASSESMENT

QUESTIONNAIRES
Bony and soft
craniofacial features Pediatric sleep
questionnaire (PSQ)/
STOPBANG, Berlin,etc
General features

Craniofacial imaging exams

• Moin Anwer, Hafiz M et al. “The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea.” The Saudi dental journal vol.
33,7 (2021): 424-433. doi:10.1016/j.sdentj.2021.02.001
WHO IS AT RISK?
CLINICAL ASSESMENT Adenotonsillar Lower facial Narrow
hypertrophy height maxilla

Bony and soft

craniofacial features inferiorly Reduced
Labial positioned upper pharynx
incompetency hyoid bone dimensions
General features

Craniofacial imaging exams

• Moin Anwer, Hafiz M et al. “The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea.” The Saudi dental journal vol.
33,7 (2021): 424-433. doi:10.1016/j.sdentj.2021.02.001
WHO IS AT RISK?
MEDICAL HISTORY EVALUATION

Syndromes:
craniosynostotic
Cerebral palsy,
síndromes,
myotonic dystrophies,
achondroplasia, Pierre
other myopathies
Robin sequence, cleft
lip and palate
Cardiovascular and
respiratory diseases
History of
(Exposure to
adenotonsillectomy
environmental tobacco
surgeries
smoke also has been
associated with OSA)

• Moin Anwer, Hafiz M et al. “The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea.” The Saudi dental journal vol.
33,7 (2021): 424-433. doi:10.1016/j.sdentj.2021.02.001
 03
TREATMENT AND
DENTAL MANAGMENT
PEDIATRIC OSA MANAGEMENT IN A DENTAL OFFICE
Pediatric dentist may play a role in managing pediatric OSA as part of an interdisciplinary team

Rapid maxillary • Some of these possible management options

have been suggested as an alternative to
expansion (RME adenotonsillectomy (A&T), the first line of
treatment in pediatric OSA.

• These alternatives should also be

considered in cases with residual OSA after
Mandibular A&T

advancement devices
(MADs)

• Moin Anwer, Hafiz M et al. “The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea.” The Saudi dental journal vol.
33,7 (2021): 424-433. doi:10.1016/j.sdentj.2021.02.001
 04
Complications of
untreated OSA
 Heart diseases
Endocrinopathies

Learning problems
Behavioral problems

Perioperative and postoperative

breathing complications
(sedation, general anesthesia, and surgical
procedures)

• Moin Anwer, Hafiz M et al. “The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea.” The Saudi dental journal vol.
33,7 (2021): 424-433. doi:10.1016/j.sdentj.2021.02.001
 05

Policy statement
Recognizing that there may be consequences of untreated OSA,
the AAPD encourages health care professionals to:

Screen patients for sleep-related breathing disorders such

as OSA and primary snoring

Assess the tonsillar pillar area for hypertrophy

Assess tongue positioning as it may contribute to

obstruction.

Recognize obesity may contribute to OSA

Recognize craniofacial anomalies may be associated with

OSA

• Moin Anwer, Hafiz M et al. “The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea.” The Saudi dental journal vol.
33,7 (2021): 424-433. doi:10.1016/j.sdentj.2021.02.001
Recognizing that there may be consequences of untreated OSA,
the AAPD encourages health care professionals to:

Refer to an appropriate medical provider

(e.g., otolaryngologist, sleep medicine
physician, pulmonologist) for diagnosis and
treatment of any patient suspected of having
OSA.

Consider nonsurgical intraoral appliances

only after a complete orthodontic/craniofacial
assessment of the patient’s growth and
development as part of a multidisciplinary
approach.

• Moin Anwer, Hafiz M et al. “The role of the dentist in the diagnosis and management of pediatric obstructive sleep apnea.” The Saudi dental journal vol.
33,7 (2021): 424-433. doi:10.1016/j.sdentj.2021.02.001
 06

CONCLUSIONS
REFERENCES
• Fagundes, Nathalia Carolina Fernandes, and Carlos
Flores-Mir. “Pediatric obstructive sleep apnea-Dental
professionals can play a crucial role.” Pediatric
pulmonology vol. 57,8 (2022): 1860-1868.
doi:10.1002/ppul.25291

• Moin Anwer, Hafiz M et al. “The role of the dentist in the

diagnosis and management of pediatric obstructive sleep
apnea.” The Saudi dental journal vol. 33,7 (2021): 424-
433. doi:10.1016/j.sdentj.2021.02.001
FOUR MAIN TYPES OF TREATMENTS

Medical treatment Behavioral therapy

This involves the use of medications, Behavioral therapies involve various
surgery, radiation therapy, chemotherapy or techniques that are used to treat mental
other medical procedures to treat a particular health conditions, such as depression, anxiety
illness and addiction

Alternative therapies Lifestyle changes

Alternative therapies include a range of Lifestyle changes involve making
treatments that are not considered part of modifications to an individual's diet, exercise
conventional medical practice habits or behaviors
RISK FACTORS

Age Genetics Lifestyle

Many diseases occur more Some diseases have a Certain behaviors can
frequently in certain age hereditary component and can increase the risk of
brackets be passed down through developing
families certain illnesses

Environment Medical history Gender

Exposure to certain A personal or family history Some illnesses are more
substances in the environment of certain illnesses can common in one gender than
can increase the risk of increase the risk of the other
developing diseases developing related conditions
DISEASE PREVALENCE
0-5% of the population in
these regions are affected by
the disease

6-14% of the population in

these regions are affected by
the disease

15-30% of the population in

these regions are affected by
the disease

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
SYMPTOMS AND DIAGNOSIS

Most common symptoms

Use this slide to display the most
common symptoms of the disease
being discussed. Include a graph with a
clear title and labels for each axis. You
can also explain how the disease is
diagnosed, including the types of tests
or procedures used, to help your
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identified and treated

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RISK FACTORS AND COMPLICATIONS
Risk factors Description Prevalence Contributing factors Complications Severity

Insomnia are more Changes in sleep Chronic insomnia and

Age over 50 80% of cases High
prevalent with age patterns waking up frequently

Women are more risk of

Pregnancy and Impaired memory and
Gender experience it due to 30% of cases Moderate
menopause concentration issues
hormones

Irregular sleep schedule, Damage in some cognitive

Lifestyle 40% of cases Stress, bad habits High
lack of physical activity functions

Substance Substances like caffeine Recreational drugs can Heart disease, stroke, kidney
10% of cases Moderate
abuse or drugs disrupt sleep patterns damage, blindness
DISEASE HISTORY

Discovery of the disease Early research First treatment Milestone discoveries

Breakthrough treatment Epidemic outbreak Current research Future directions

DIAGNOSIS AND TREATMENT FLOWCHART
Patient symptoms
List the symptoms that the
patient is experiencing:
A. Write the symptoms of the
patient
B. Write the symptoms of the
patient
C. Write the symptoms of the
patient
Start
Diagnostic test Diagnosis confirmed Prescribe treatment
List the diagnostic tests that This step represents the List the recommended
were performed: confirmation or ruling out of a treatment options
A. Write the diagnostic test specific disease diagnosis based A. Write the
performed on the results of the treatment options
B. Write the diagnostic test diagnostic tests B. Write the
performed treatment options
C. Write the diagnostic test C. Write the
performed treatment options
End
REAL LIFE
IMPACT
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DISEASE MANAGEMENT
Number of cases of the disease over
Region Number of cases Percentage of cases
time
● Describe the trend of the disease cases over North 1,000 20%
time
South 2,500 50%
● Provide key insights or observations about
the graph East 1,200 24%
● Explain any significant changes or patterns in
the graph
● List the regions or areas that are relevant for the disease
● Enter the number of cases for each region, area or
country
● Describe any notable variations or trends among the
regions
● Provide additional details or observations about the
table

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DISEASE OVERVIEW AND CONCLUSIONS
Information Key findings
Poor sleep habits, medical ● Summarize the most important or relevant aspects
Causes
conditions, substance use of the disease
● Use bullet points to present the key findings in a
Anxiety, stress, fatigue, impaired clear and organized manner
Symptoms
concentration

Physical examinations, sleep diary,

Diagnosis
medical history Conclusions
Sleep hygiene, medications,
Treatment In this section, summarize the key findings
relaxation techniques 1 from the disease study

Sleep schedule, creating relaxing

Prevention Provide an overview of the implications for
bedtime routine
2 the current diagnosis and treatment plan
THANKS
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