Sleep Apnea & Behavior Problems in Children

Your child won't keep his or her first teeth forever, but that doesn't mean those tiny pearly whites don't need conscientious care. Maintaining your child's dental health now will provide health benefits well into adulthood, as primary (baby) teeth serve some extremely important functions.

Kids developing jaws and teeth.

For one thing, primary teeth serve as guides for the eruption of permanent (adult) teeth, holding the space into which these new teeth will erupt. The crowns (tops) of the permanent teeth actually push against the roots of the baby teeth, causing them to resorb, or melt away. In this way, the adult teeth can take their proper place.

What's more, your child's primary teeth will be there for most of childhood, helping your child to bite, chew and speak. For the first six or so years, he or she will be relying on primary teeth exclusively to perform these important functions. Until around age 12, your child will have a mix of primary and permanent teeth. You will want to make sure those teeth stay healthy and are lost naturally — when it's time.

Your Child's First Teeth

Kids mouth anatomy.

Your child's 20 baby teeth will begin to appear usually between six and nine months, though in some cases it may start as early as three months or as late as twelve months. The two lower front teeth tend to erupt first, followed by the two upper ones, these teeth are called the central incisors. Then the neighboring teeth called lateral incisors will erupt too. The first molars come in next, followed by the canines (eyeteeth). And finally, the last teeth to erupt are the two-year molars. Sometimes your baby can experience teething discomfort during this process. If so, there are courses of action to help make your child more comfortable.

Your infant's gums should be gently wiped after each feeding with a water-soaked gauze pad or damp washcloth. As soon as the first tooth erupts, establish a daily brushing routine with a small, soft-bristled toothbrush and no more than a thin smear of fluoridated toothpaste. Your child may need your help with this important task until about the age of 6.

Your Child's First Dental Appointment

Age one dental visit

The American Academy of Pediatric Dentistry recommends that your child see a dentist by his/her first birthday, or as early as the first tooth erupts. Though this may sound early, learning proper pediatric oral hygiene techniques, checking for cavities, and watching for developmental problems is extremely important.

There are a number of forms of tooth decay that can affect babies and small children. Early Childhood Caries (tooth decay) can develop rapidly, progressing from the hard, outer enamel layer of a tooth into the softer, inner dentin in six months or less.

Most of all, it's important for your child to have a positive experience at the dental office as he/she will be a regular visitor for years to come.

Pediatric Dental Treatments

There are a variety of dental treatments offered to prevent tooth decay in children, or to save or repair teeth when necessary. They include:

Topical Fluoride — Fluoride incorporates into the enamel of teeth, making it harder and more resistant to decay. Although there is a small amount of fluoride in toothpastes and in some drinking water supplies, a higher concentration can be applied professionally to your child's teeth for maximum protection.

Dental Sealants — A plastic coating can be applied at the dental office to prevent cavities by sealing the little grooves on the chewing surfaces of back teeth known as “pits and fissures.” These little crevices become the perfect environments for decay-causing bacteria. Immature tooth enamel is more permeable and therefore less resistant to tooth decay. Dental sealants are easy to apply and provide years of protection (Watch Dental Sealant Video).

Root Canal Treatment — Perhaps you have had a root canal treatment yourself, to save an injured or severely decayed tooth. Well, sometimes children need root canals, too. In children these are called pulpotomies or pulpectomies. As mentioned above, baby teeth are important guides to the permanent teeth that are already forming beneath your child's gums. Therefore, saving them from premature loss can help prevent a malocclusion (“mal” – bad; “occlusion” – bite) that requires orthodontic treatment.

Bonding — Chips and minor fractures to front teeth — common childhood occurrences — can be repaired with tooth-colored bonding materials. These lifelike resins made of plastic and glass can be used on baby teeth as well as permanent teeth and last until the youngster has completed facial growth (Watch Bonding Video).

Orthodontic Concerns

Orthodontic Problems.

By around age 7, most malocclusions have become evident. Interceptive orthodontic treatment around this time can help direct proper tooth positioning and/or jaw growth, eliminating or simplifying the need for later treatment. There are many orthodontic problems that can be detected early and are examples of why a trained professional should evaluate your child during his/her growth and development.

Sports & Your Child's Teeth

If your child is active in sports, a custom-made mouthguard is a highly recommended safeguard. According to the American Dental Association, an athlete is 60 times more likely to suffer dental harm when not wearing one of these protective devices. A custom mouthguard is made specifically for your child using a model of his or her teeth. This will offer greater protection than an off-the-shelf model. It's an investment that pays off highly in the form of reduced pain, suffering — and dental expenses down the road!

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Boy Sleeping.

The number of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) has been steadily increasing over the past decade. Yet according to a recent study, many children diagnosed with this condition don't really have it; their behavioral problems are actually related to sleep-related breathing disorders (SRBD), such as sleep apnea.

The 2012 study, published in the journal Pediatrics, followed more than 11,000 children for six years, starting when they were 6 months old. The children who had SRBD were 40 percent to 100 percent more likely than kids without breathing issues to develop behavioral problems resembling ADHD by the age of 7. So if your child is exhibiting ADHD-like symptoms — or has even been diagnosed with ADHD — it's worth considering whether interrupted sleep might be an issue.

It makes perfect sense when you think about it: A well-rested individual, young or old, can function a lot better on a good night's sleep. Yet a lack of sleep affects adults and children differently. While sleepy adults tend to act sluggish and drowsy, sleep-deprived kids are more likely to become hyperactive, uncooperative and unable to focus — just like kids with ADHD.

So what exactly is SRBD?

The condition is characterized by recurrent episodes of interrupted breathing during sleep. The child's airway becomes blocked by soft tissues near the back of the throat — tonsils or the tongue, for example — that partially close off the windpipe. These tissues can vibrate as air passes by, causing snoring. It's often worse while sleeping on one's back because this encourages the lower jaw to slip back, which in turn pushes the tongue in front of the airway.

Overweight children have a higher incidence of sleep apnea due to fatty tissue deposits in the soft palate, which decrease the size of the child's airway.

Does your child have a sleep-related breathing disorder? You can gather clues to report to your health professional by observing your child sleeping. Look for the following signs:

  • Snoring
  • Pauses in breathing
  • Chronic mouth breathing
  • Constant tossing and turning
  • Night panics
  • Bed-wetting

How is sleep apnea treated in children?

There are various treatments that can be very effective, depending on the cause. Enlarged tonsils and adenoids can be surgically removed. A therapy known as Continuous Positive Airway Pressure (CPAP) involves the use of a machine that delivers mild air pressure through a mask worn during sleep to keep the airway open.

How palatal expanders work.

Dentistry also can also play a role in treatment. For younger children who are still growing, the use of an orthodontic appliance called a palatal expander has proven helpful in some cases. A palatal expander gently widens the roof of the mouth (palate) over time by separating bones that don't permanently fuse together until puberty. It's most often used to create more room for crowded teeth, but the expansion can also increase airflow.

Older children who have stopped growing can sometimes benefit from Oral Appliance Therapy (OAT). This involves wearing a custom-made oral appliance designed to reposition the jaw during sleep so that the tongue is held away from the back of the throat, reducing the potential for obstruction.

The first step is to figure out what's keeping your child from getting the restful sleep that's so crucial to good health and well-being. For that to occur, and for your child to receive the best treatment, you will need to see a trained professional.

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