THE CONNECTION BETWEEN THE SPECIALTIES OF:
Pediatric Dental Medicine, Sleep Medicine & Orthodontics
Dr. Rishita Jaju, specialist in pediatric dentistry gives Dr. Calkins and our community her insight into the relationship between sleep-disordered breathing, pediatric dentistry and the specialty of orthodontics.
How early should parents take their children to you, as a specialist in pediatric dentistry?
Establishing care at young age is the best way to prevent childhood cavities. The American Academy of Pediatric Dentists recommends that children should have their first pediatric dental visit by their 1st birthday! This is the best chance to start on the path of prevention of oral dysfunction and decay. During this visit, the pediatric dentist will evaluate the health and development of the child’s teeth, gums, and craniofacial structures. The families are provided with the tools and guidance to set their child up for success in developing healthy oral hygiene habits.
Have you seen patients in need of screening for sleep-disordered breathing?
Yes! Just recently, I had a family come in for their regular dental health visit and it became apparent that the teeth were ‘worn out’ and the child’s tonsils were enlarged. Further discussion regarding sleep habits revealed that child grinds his teeth, mouth breathes, wakes up multiple times at night, snores loudly and does not seem ‘rested’ in the mornings. I encouraged Mom to talk about these ‘red flags’ with the pediatrician and request a sleep evaluation. Turns out he has moderate to severe sleep apnea. The parents are now taking the next steps to help resolve this problem. Which could involve early orthopedic intervention by orthodontics as early as 3 years old.
Why should parents visit a specialist in dental pediatric medicine, instead of general dentistry?
When a dentist specializes in pediatrics, they have additional training and education to provide the best care possible to children. Children’s dental anatomy and oral structures are very different from adults. They have an entirely different perspective on matters of management of growth and development, child psychology and cooperation techniques. An experienced pediatric dentist has the resources to provide care in a manner that is not only able to help children feel relaxed and enthusiastic about oral health, but also makes the most dental-phobic parent feel empowered.
What techniques do you use that are different from general dentistry?
When children visit a pediatric dentist, there are a few important differences to consider.
- The environment is different—Most modern general dentistry offices are set up to create a calm and soothing, quiet spa-like atmosphere, while a modern pediatric dental office is colorful and bright, has upbeat music to set a happy, fun-loving tone. It also offers distractions/entertainment for children including a children’s reception area. A play area and a theatre area for watching movies offer ways to engage children who are patients accompanying siblings. Children often have iPads and TVs at each dental chair, and there may be a toy car in the dental cleaning bay which serves as a low-threat way to start the appointment.
- The staff interaction and feel is different— In a general dentist’s office, the staff interaction is professional and terminology is straightforward, while in a pediatric office, the staff interacts with young patients in a playful manner, and uses language to help relax children. Instead of the term “suction tube,” we use “Mr. Thirsty,” the water laser is called the “rain brush,” and the handpiece drill is referred to as “Mr. Bumpy.” The “x-ray unit” is a “camera” and the “lead apron” is a “blanket.” My team and I let children take charge of their own dental experience. Conversation is focused on Disney and tween movie characters, or school sports and afterschool activities, rather than world news. Counting and nursery songs help the exam go by smoothly…even if it means they are not sitting in the actual dental chair!
- The technology is different—Besides the ever-popular electronic devices children use, equipment used for dental appointments differs in a pediatric dental practice. It includes digital x-ray imaging (reduces the radiation up to 90%), specially-sized equipment such as the pediatric-sized x-ray sensors, and small brush head-sized intra-oral camera. These allow us to educate parents and monitor cavity-susceptible areas more comfortably on a computer screen rather than inside little mouths. Topical gel and laser technology reduce or eliminate the need for a local anesthetic shot, so children can avoid the discomfort of numb lips, cheeks and tongues. They can return to normal activity—play or school—immediately after cavity fillings.
My hope is for children to see the dentist office as a inviting experience. Kids should be excited, not scared of their dental visits.
What is frenectomy and when do you see the need to perform it?
A frenectomy is a procedure to treat the conditions most commonly known as Lip-Tie or Tongue-tie. A normal frenum is a connective band bringing two pieces of the body together. In some cases, if that band connects too tight or too low it can restrict the range of motion of our lip or tongue. Possible obstacles related to lip and tongue ties include:
- Difficulty breastfeeding or bottle feeding
- Difficulty transitioning from breast milk to purees or table foods
- Difficulty managing liquids when drinking
- Poor speech clarity or articulation
- Poor oral health or being more susceptible to developing cavities
- Poor sleeping patterns due to developing sleep apnea symptoms
If a child’s lip or tongue tie impacts their physical ability to successfully achieve these different milestones, they should be evaluated for possible treatment.
What is your experience in referring your patients to a sleep study clinic? How is that information relevant to you?
My experience regarding referral to a sleep study clinic is pretty positive. My first priority is to educate the parents and provide them the guidance and information that they can share with their pediatrician. Sometimes, a direct referral to a sleep study clinic is extremely facilitated by the pediatrician’s involvement. The results and diagnostic imaging obtained during a sleep study help us determine our path of treatment. Sometimes it is a matter of tongue and oral posture concerns that can be helped by myofunctional exercises and appliances. Sometimes a decision to remove the tonsils and adenoids is needed. Sometimes the airway is not compromised by tonsils and adenoids, but the restriction of the tongue muscle movement, and a simple procedure such as a frenectomy can change the child’s ability to manage open airway. Many times, as you may imagine, collaboration between primary care physicians and specialists can help the child resolve the issue rather than continue a life-long struggle with sleep-related conditions.
When do you think the interaction with craniofacial orthopedics or orthodontics should start from your perspective as specialist?
Collaboration with craniofacial orthodontic providers in my practice starts as soon as a child exhibits any signs of oral dysfunction, potential growth and development concerns, or sleep-disordered breathing. I don’t believe that we should wait for a specific age before making the decision to include a specialist’s evaluation based on clinical signs and symptoms. When in the right hands, even young children can be helped by an orthodontist to prevent impending craniofacial growth deficiencies.
What important relationship exists between pediatric dental medicine and sleep medicine?
A pediatric dentist is an expert at assessing oral hygiene, function, and craniofacial growth & development. All of these components include evaluating the anatomical structures responsible for a healthy airway. A pediatric dentist can help assess the child’s anatomy and symptoms in order to provide the appropriate referral to treat any conditions affecting a child’s ability to sleep efficiently and safely. Children experience maximum benefits when there is a team approach to supporting their overall health, growth, and development. Each specialty is able to provide a different perspective to tease out any significant contributing factors and to allow well-rounded care.
What is message would you like the community to be aware of, relating to the specialty of pediatric dentistry.
My message to the community is always— children are not just little adults! Their anatomy and physiology is completely different during their key developmental years. As parents and caretakers, we have the ability to help them prevent potential disease and dysfunction that many of us have come to accept as a difficult part of our lives. We always want things to be better for our children than they were for us. At the expense of using a cliche phrase, I would like to remind our community—a drop of prevention is better than an ocean of cure!
Dr. Calkins and Dr. Rishita are members of the Northern Virginia Airway Group. Interdisciplinary interaction allows doctors to globally diagnose and implement treatment modalities according to patient’s needs in a comprehensive and systematic approach to our patients.