Effects of oral care in Down syndrome children with obstructive sleep apnea.

Down syndrome (DS) children with sleep apnea often present with oral breathing associated with nasal obstruction. This causes the oral cavity and pharynx to become dry. We describe the treatment of three DS children with sleep apnea who were treated using products for oral dryness. Snoring disappeared after treatment in two of the children and apnea disappeared in all three. The symptoms of a reddened oral mucosa and coated tongue disappeared in all three DS children. Saliva pH testing demonstrated that the pH value increased in all of the children after treatment. These results indicate that oral care can improve the oral hygiene status of DS children, and that proper oral care can help prevent oral mucosal dryness and thereby reduce sleep apnea symptoms.

Surgical treatment for sleep apnea: changes in craniofacial and pharyngeal airway morphology in a child with achondroplasia.

Here, we report the case of a male child with achondroplasia who was diagnosed with obstructive sleep apnea and underwent adenoidectomy and tonsillectomy. By analyzing lateral cephalograms, we evaluated the craniofacial and pharyngeal airway morphology immediately before surgery (age, 5 years 6 months) and 1 year 2 months after surgery (age, 6 years 8 months). Adenoidectomy and tonsillectomy dilated the pharynx and improved the craniofacial and pharyngeal morphologies, apparently thus improving the sleep apnea.

Traumatic injury to permanent tooth resulting in complete root resorption: a case report.

When a tooth is avulsed and replanted following traumatic dental injury, complications such as replacement and inflammatory resorption may occur. Ultimately, resorption may result in loss of the tooth. This case report describes a traumatic injury to a permanent tooth resulting in complete root resorption within a short period, which required surgery. In the present case, improper treatment measures such as dry condition of the avulsed tooth before replantation and extra-oral retrograde root canal filling may have led to rapid complete root resorption. Even if it is impossible to avoid resorption completely, the overall knowledge of both dentists and patients regarding traumatic dental injuries should be improved to delay the progress of resorption.

Effects of functional orthodontic appliances in the correction of a primary anterior crossbite--changes in craniofacial morphology and tongue position.

Chin caps have been used for the correction of primary anterior crossbites, but previous studies of the treatment effects have highlighted problems such as pressure on the temporomandibular joint (TMJ). Therefore, to reduce pressure on the TMJ, a functional orthodontic appliance, the Yanagisawa Class III (YC3) shield was developed to improve the overjet in the primary dentition. The aim of this study was to determine the treatment effects of the YC3 in correcting a primary anterior crossbite compared with a chin cap. The pre- and post-treatment lateral cephalograms of 10 patients (5 male, 5 females) and 10 treated with a YC3 (5 males, 5 females) were compared in relation to craniofacial morphology and tongue position [the YC3 was used from 51 months of age +/- 7 months to 74 months of age +/- 12 months (i.e. for 23 +/- 9 months) and the chin cap from 53 months of age +/- 2 months to 75 months of age +/- 1 month (i.e. for 22 +/- 5 months)]. A Mann-Whitney U-test was used to determine any statistical differences. The YC3 group showed significantly higher values for gonial angle and U1 to SN (P < 0.05), and significantly lower values for interincisal and tongue position (P < 0.05), compared with the chin cap group. The results indicate that the use of the YC3 not only improves overjet, but also changes the tongue position. The findings also suggest that the YC3 results in functional effects on the skeletal system during the mid-growth period.

Sleep disordered breathing in children with achondroplasia. Part 2. Relationship with craniofacial and airway morphology.

We evaluated the craniofacial and airway morphology in children with achondroplasia complicated by snoring and apnea during sleep (AP group) in comparison with children with snoring and apnea during sleep without chromosomal aberrations (adenoid group) and healthy children without sleep disordered breathing or malalignment (healthy group). Lateral cephalograms in 10 children each (four males and six females) in the three groups were analyzed. When the AP and healthy groups were compared, the AP group showed significantly lower values for facial depth, nasal floor length, point A, point pog, and saddle angle (p<0.01) and significantly higher values for mandibular plane angle and gonial angle (p<0.01) regarding craniofacial morphology and significantly lower values for D-AD1, D-AD2, and upper pharynx (p<0.01) regarding airway morphology. When the AP and adenoid groups were compared, the AP group showed significantly lower values for facial depth, nasal floor length, point A, point pog, and saddle angle (p<0.01) and significantly higher values for mandibular plane angle and gonial angle (p<0.01) regarding craniofacial morphology and significantly lower values for D-AD1, D-AD2, and upper pharynx (p<0.05) regarding airway morphology. Thus, the craniofacial/airway morphology in the AP group was characterized by upper airway stenosis, a retruded position of the chin, and an increased mandibular plane angle due to partial early ossification of cranial bones, and an increased lower facial height due to an increased mandibular angle, which may tend to induce sleep snoring and apnea.

Survey of the present status of sleep-disordered breathing in children with achondroplasia Part I. A questionnaire survey.

An achondroplasia is known to be the inherited disease causing a growth impairment of limb bones. Recently, as a symptom of achondroplasia, a sleep-disordered breathing has been reported. Considering the scientific evidence that the sleep-disordered breathing in children such as that due to tonsillar hypertrophy inhibits somatotropin secretion and causes growth retardation, sleep-disordered breathing in children with achondroplasia may aggravate growth/developmental retardation in addition to the bone growth impairment. However, the present status of the development of sleep-disordered breathing in children with achondroplasia has been unknown. Therefore, in order to clarify the present status of sleep-disordered breathing in children with achondroplasia (AP group), we carried out a questionnaire survey of the breathing state during sleep, growth/development history and the oral state at preschool age and school age in the AP group, and compared the results with previously reported data in healthy children (control group). 1. Among the questionnaire items, the incidences of snoring, apnea, mouth breathing, anterior cross bite, and open bite at preschool age were significantly higher in the AP group than in the control group (P < 0.01) At school age, the AP group showed significantly higher incidences of mouth breathing and cross/open bite (P < 0.01) and snoring and apnea (P < 0.05) than the control group. 2. Height and weight at birth and at the ages of 1.5 and 3 years, excluding birth weight, were significantly lower in the AP group than in the control group (P < 0.01). 3. The chronological age at the initiation of eruption of the deciduous or permanent teeth did not significantly differ between the two groups. Thus, the AP group showed higher incidences of sleep-disordered breathing and malocclusion than the control group, and development of sleep-disordered breathing at preschool age.

The relationship between tongue-base position and craniofacial morphology in preschool children.

The association between tongue-base position and craniofacial morphology was investigated in 35 preschool children (17 girls and 18 boys), 3 to 6 years of age, by the lateral cephalometric radiographs. There was no statistical difference in the measurements of those between girls and boys. Posterior facial height, nasal floor length, mandibular corpus length and tongue-base position were positively correlated with age, and tongue-base position was correlated with maxillary position, vertical mandibular rotation and the nasopharyngeal airway space. The results of this study showed that tongue-base position influenced maxillo-mandibular growth even in young preschool children.