I just read through the 2024-2025 American Academy of Pediatric Dentistry's 2024-2025 recommendations, and I was incredibly pleased with many of the things I saw!

Policy on Obstructive Sleep Apnea (OSA)

“The AAPD recognizes that obstructive sleep apnea occurs in the pediatric populations. Undiagnosed or untreated OSA is associated with cardiovascular complications, impaired growth (including failure to thrive), learning problems, and behavioral problems. In order to reduce such complications, AAPD encourages healthcare professionals to routinely screen their patients for increased risk for OSA and to facilitates medical referral when indicated. 

“Arousals related to obstructive events cause sleep fragmentation which is believed to be responsible for excessive daytime sleepiness in older children or adolescents and hyperactivity, behavioral problems, and impaired academic performance in younger children. For this reason, children with untreated OSA may be inappropriately diagnosed as having ADHD. 

Recommended OSA screening questions:

• Does your child snore loudly when sleeping?

• Does your child have trouble breathing while sleeping?

• Does your child stop breathing during sleep?

• Does your child occasionally wet the bed at night?

• Is your child hard to wake in the morning?

• Does your child complain of headaches in the morning?

• Does your child tend to breathe through his/her mouth? 

• Have you or the teacher commented your child appears sleepy during the day?

• Does your child fall asleep quickly? 

  
  

https://www.aapd.org/research/oral-health-policies--recommendations/obstructive-sleep-apnea/

Management of the Developing Dentition and Occlusion in Pediatric Dentistry 

“The best practices asserts that the management of developing dentition and occlusion is an essential part of comprehensive oral health care and that early diagnosis and treatment of abnormalities can aid patients in achieving the goal of stable, functional, and esthetic occlusion.”

“Oral habits may apply negative forces to the teeth. The relationship between oral habits and unfavorable dental and facial development is associational rather than cause and effect. Habits of sufficient frequency, duration, and intensity may be associated with denton-alveolar or skeletal deformations such as increased overate, reduced overbite, open bite, posterior cross bite, or increased facial height. The duration of force is more important than magnitude. The resting pressure from the lips, cheeks, and tongue has the greatest impact on tooth position as these forces are maintained most of the time. Oral habits include, but are not limited to:

• nonnutritive sucking (ie pacifiers, thumbs, etc)

• bruxism

• tongue thrust swallow

• abnormal tongue position

• self-injurious/self-mutilating behavior

• obstructive sleep apnea 

“Research on the relationship between malocclusion and mouth breathing suggests that impaired nasal respiration may contribute to the development of increased facial height, anterior open bite, increased overate, and narrow palate.”

“OSA may be associated with narrow maxilla, cross bite, low tongue positions, vertical growth, increased over jet, and open bite.”

Physical findings may include:

• growth abnormalities

• signs of nasal obstruction

• adenoidal facies

• enlarged tonsils

• hypo nasal voice quality

• possible retrognathia

• micrognathia

• macroglossia

• hypoplasia of the mid face

Treatment Considerations: 

• Patient/parent counseling

• Behavior modification techniques

• Myofunctional therapy

• Appliance therapy (extra oral and intramural)

• Expansion 

• Referral to other providers (including, but not limited to):

  • Orthodontist

  • Psychologist 

  • Myofunctional therapists

  • Otolaryngologists 

https://www.aapd.org/research/oral-health-policies--recommendations/management-of-the-developing-dentition-and-occlusion-in-pediatric-dentistry/