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Jennifer J. Cornell | DDS, FAGD
Caleb T. King | DMD

Category: Blog

Pediatric Sleep Disordered Breathing

Pediatric Airway: It is the basis of our adult airway when we grow up, but it also plays a huge role in our development. Today I was fortunate to be interviewed on Clarksville Now’s conversations podcast about this topic. Kiddos threshold for diagnosis is so much lower than an adult’s. Just one episode of a disruptive breathing episode per hour can give them a diagnosis and completely disrupt their sleep needed for their developing mind and body! Have you, like so many others, been told your child will grow out snoring, or grinding their teeth?  Yes, they might, but at what cost???  The child’s brain is full of activity and needs the best night’s sleep to do its job to develop normally and on time.  But what should parents look for, or how do they know its a problem? If a child sleep 8-10 hours a night we think, great! But how is that “quality” of sleep? The more serious signs to look for are; snoring, grinding their teeth, long periods of holding their breath or gasping for breath?

There are other signs and symptoms.  Dentists trained in what to look for, like us, can help! The most critical time for airway development in children is from the age of 2-8.  There is a lot going on in those little bodies during that time.  In children things like ADHD, bedwetting, restless sleep, nightmares/night terrors, poor school performance, daytime sleepiness and other issues may be related to underlying sleep disordered breathing.  Fortunately, simple a simple non-invasive sleep study at a sleep lab that tests children can rule in or out such a sleep disorder. 

As Dentists, we see most children for the first time around the age of two. We look at their face, developing jaws, tongue posture, teeth, and the back of their throat. Unlike adults, most children with an un-diagnosed airway issue do not appear “tired” it is the opposite. They can be be hyperactive, have attention issues, bouncing off the walls, and downright difficult! We might ask, do they snore, wake up multiple times a night, have night terrors, wet the bed etc.   We will look for signs of mouth breathing, poor tongue posture, proper jaw relationships, adequate spacing in primary teeth and take a good look at the back of the throat.  At the back of the throat, we look at the length and position of the soft palate, the roof of the mouth (which is also the floor of the nose) and not to forget the size and shape of the tonsils.  A trained Dentist will also ask the parents questions about their behavior, school performance, nighttime routines, etc.  Based on what we see we can assist in contacting the pediatrician for a referral to a sleep lab. 

Once there is a diagnosis of sleep disordered breathing the treatment should be based on the diagnosis.  1st line treatment for most kids is adenotonsillectomy-remove those tonsils and adenoids!  If surgery is too risky the option to have tonsils reduced with a less invasive laser might also be an option.  This is a same day surgery procedure with very little, if any, down time for children.

Other treatment options to help correct the situation might be a referral to a myofunctional therapist to help train the position of the tongue, feeding or speech therapist.  Habit appliances to help stop thumb sucking or use of a pacifier might be recommended.  Increasing in popularity lately would-be interceptive orthodontist.  This is the use of removable appliances that aid in proper development of the jaws and oral pharyngeal structures.  Kids tend to find these “retainer” type of appliances fun.  Traditional orthodontics such as palatal expanders or head gear might be in order.  Treatment should be based on the individual child’s needs, there is no one size fits all.  CPAP therapy is uses as a last option treatment due to the hinderance of the pressures on the growth of the midface. 

The healthiest form of breathing is nasal breathing.  If a child trends toward mouth breathing, there is most likely a bigger cause that should be evaluated and addressed.  It could be allergies, poor nasal development, or again those pesky tonsils and adenoids.  An ENT can be a great friend in the development of pediatric airway breathing. 

A child with a tongue tie will have difficulty posturing their tongue correctly. This becomes an issue not only with breast feeding but normal development of the floor of the nose or roof of the mouth.  A simple “frenectomy” with a laser is a quick and all but painless procedure for baby or young child with very little down time, but it can have a dramatic affect. 

A diagnosis of sleep disordered breathing in children and proper treatment based on that diagnosis can literally change the trajectory of that child’s life. It can affect their self-esteem, how they do in school, what career they pursue, who they marry, ultimately WHO THEY BECOME! This will in turn affect the hundreds of thousands of people who they touch throughout their life. The ripple effects are endless!

If you suspect a sleep disordered breathing in your child, follow your gut! Tell your child’s pediatrician your concerns, and if they don’t refer for your child to have a sleep study come see us. We will screen your patient and send the pediatrician a letter requesting the referral.

There is too much at stake to look to ignore or hope a child will grow out of these types of issues.  The health and well being of our kiddos should not be ignored!

Jennifer J. Cornell, DDS, FAGD
Owner of Back 2 Basics Dentistry and Dental Sleep Solutions of Clarksville

Why Your General Dentist Should Place Your Dental Implant

First, I want to say we are blessed with truly wonderful and talented dental specialists in our area.  I still refer to them for complicated dental implant cases.  When I make a referral to them it is because I want what is best for my patients.  I have not had the advanced training and experience they have, but I have had the training and experience necessary to place dental implants in the ideal situations.  What I hope to achieve with this blog is to inform patients that there is a lot of thought and planning that goes into placing a dental implant and restoring it.  It is not like putting a filling in a tooth.  As a General Dentist, I look at a patient with the restorative plan from the beginning.  I look at the end result from the beginning.  I plan the case with the end in mind.  If the implant is placed at an angle not conducive to the final crown or denture there will be issues with how a patient bites, or how the implant holds the denture or even how it looks to the patient’s eye.

We are blessed with outstanding technology in dentistry today that allows us to virtually plan a patient’s case from start to finish.  If the patient does not have ideal bone in the area that the dental implant needs to be to hold the final restoration in the correct way then we can refer to our wonderful specialists to build up that site before placing the implant.   Communication between the general dentist and specialist is key.  Planning the final outcome prior to making the referral is so important.  Many times, general dentist just refer out to the specialist, the specialist places the dental implant where there is ideal bone, releases the patient back to the general dentist to restore it and the general dentist gets frustrated because they have to spend extra time and money to alter the restoration to fit the angle or placement of the implant so that the final restoration looks and functions as it should.  It sounds exhausting, and from my experience it is!  That is why I began to take training course in dental implantology.  I now place my own dental implants in the sites that are ideal and I don’t expect complications.  I have invested in the technology to evaluate those sites and plan the final outcome virtually so that I know if this is a case I can do or should be referred out to my talented colleagues. 

Dental implants are becoming more and more affordable and more and more in demand.  They have the potential to last a patient their lifetime if done correctly.  They are the more permanent treatment.  Not everyone’s potential for success is the same.  If a patient is a smoker they have a lesser chance of the dental implant fully integrating and lasting its lifetime.  If a patient has certain medical conditions they may not be a candidate for dental implants.   A comprehensive dental exam and proper radiographs are a must to evaluate whether or not a patient can have dental implants.  Sometimes taking models of someone’s mouth is needed.  After evaluating the site for the implants we may need what is called a surgical guide that allows for accurate guided surgery of where that implant goes.  Dental implants come in all shapes and sizes but depending on where that implant needs to be placed, if we are off by 1mm it could mean the difference between success and failure.  A healthy mouth is also key.  If there is untreated gum disease the dental implant is more likely to fail.  If a patient has poor dental hygiene or sips on soda all day, the implant is more likely to fail. 

Dental implants are a process.  There will be ups and downs.  It will most likely take 6-10 months to get where you are going.  But having a good relationship with your general dentist and their team can help you through the process.

Dental implants can change a person’s life, especially if they are used to hold a lower denture.  But, proper evaluation and planning are key to their success.  This all starts with the dentist who is going to place that final restoration.  If you or someone you know is interested in dental implants, whether it is to replace one tooth or all their teeth a general dentist, with the proper training, is the first step.  At Back 2 Basics Dentistry we are ready to guide our patients through this process. 

Why Is Dentistry So Expensive?

Let’s face it everyone thinks dentists are rolling in the dough given how much it costs to get dental work done. But, what most people don’t understand is our overhead. Below is a link to a great news story giving a detailed explanation as to why dental work costs so much.

I feel like this article shines a light on what goes on within a dental office. A few points I feel are important to highlight:

“Dental care is not a commodity. It’s not laundry detergent or breakfast cereal or wireless minutes. Dentistry is a professional service that’s both art and a science. Yes, there are excellent dentists and not-so-great dentists. Often, you get what you pay for. Yet even great dentists have bad days. “I consider myself an awesome dentist,” Dr. W. told me. “And I’ve had failures.””

I had a patient recently compare what I do to purchasing parts at an automotive store and that I was trying to up-sell him because he could not get his “free” cleaning that came with his insurance. He had not been to the dentist in over 10 years. Obviously we attempted to educate him on his condition but unfortunately it fell on deaf ears and he chose to leave and go elsewhere in pursuit of his “right” to a free cleaning.

Dental insurance drives docs nuts and they wish they didn’t have to use it. “The number one most complicated aspect of running a dental office, bar none, is dealing with dental insurance. You wouldn’t believe how long it takes to get through to a rep, make sure the patient does have benefits, calculate a copay,” says Dr. M. And the largest insurance plans in the country discount most dentists’ fees by 10% to 20%. If you’re paying out of pocket, ask for a discount. (You might discover the dentist is giving you one already.)

Much of the time insurance are 20% less than our fee and then there is cost of hiring someone just to deal with these insurance companies. They are not always transparent in their coverage. Yet, we get caught in the middle when an insurance company lets us know something wasn’t covered completely or at all for some underlying fine print reason. When we inform the patient often times they are angry or defensive because they were given a “treatment plan” (with the word “estimate” all over it) and now we are trying to collect more than that printed plan. Alas, we spend weeks going back and forth attempting to explain and collect the additional co pay.

Dentists wish patients would value their teeth more. Teeth are a crucial part of health and appearance. Untreated gum disease, for instance, is linked to heart disease. (Would you choose a cardiologist based on price?) “With time, you will come to realize that shopping price is a minor concern when it comes to your health,” says Dr. W. “Any minor cost differences amortized out over a lifetime will become insignificant. You will get the best results and have the most long-term satisfaction getting care from someone you trust.”

This has to be the most frustrating fact for sure, at least for me. Your teeth and gums are actually connected to your body. There was a story recently on Facebook that went viral about a truck driver who died from an abscessed tooth. I was shocked to see the responses questioning what the dentist might have done wrong to cause this person’s death……it had nothing to do with a dentist, the person simply allowed his tooth to abscess for so long that the untreated infection killed him. We often feel pressed to “watch” a tooth or observe it because the patient may not feel anything wrong at the time, or there are other more pressing matters. But, the funny thing is, the situation of concern doesn’t get better. Decay continues to grow, marginal integrity of an older filling only keeps leaking, cracks continue to deepen. I have trained my team that when I mention we can just “watch” a tooth, they are to ask me “what will we watch it do doctor?”

I don’t expect anyone to feel sorry for me as a dentist, I chose this profession and I do love what I do. After 10 plus years of doing this kind of work I do get frustrated at times with the public perception of what I do. Dentistry is in a great era. 3D imaging is allowing us to see things we never saw before. CAD/CAM technology is allowing us to create beautiful restorations in a single day. Dental materials are stronger and more esthetically pleasing. Although this technology comes with a hefty price tag it is an exciting time to be a dentist. For those of us who are CE junkies, like myself, I can increase and define my skill level to better serve my patients more efficiently than ever before. Using this technology I was able to start planning and placing dental implants. Five years ago I added the exciting field of Sleep Dentistry to my practice. Oral appliance therapy (OAT) can be used to treat night time bruxism, snoring and obstructive sleep apnea. I have truly enjoyed this arm of my practice. Giving someone a good quality night sleep back is very rewarding.

As I watch yet another dental chain enter our community I can’t help but worry that patients will transfer in hopes of lower fees. Dental chains have buying power I don’t have as a private practice owner. But what they won’t find is the individual attention a private practice dental office can offer. What they won’t find is a dentist who 100% owns their own practice, is invested in the employees and community and truly cares what their patients think.

Next time you visit your dentist, whether it be my office or any other private practice office I hope this blog has given you a better appreciation of what goes on behind the scenes. Just like any other profession there will always be those who are in it for the wrong reason but for the most part we are all good people who go into dentistry to help people and make this world a better place one tooth at a time!

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