Physical Assessment in Pediatric Sleep Hygiene and Airway Health
In addition to plaque-mediated dental diseases of childhood, mainly early childhood caries (ECC) and gingivitis, recent evidence suggests that pediatric malocclusion is additionally being recognized as a serious public health dilemma per its frequent como
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Physical Assessment in Pediatric Sleep Hygiene and Airway Health Kevin L. Boyd
5.1
Introduction
In addition to plaque-mediated dental diseases of childhood, mainly early childhood caries (ECC) and gingivitis, recent evidence suggests that pediatric malocclusion is additionally being recognized as a serious public health dilemma per its frequent comorbid association with sleep and breathing disturbances. Specifically, retrognathic, narrow, excessively vertical, and deficient sagittal skeletal phenotypes in children are often associated with increased risk susceptibility for impaired nasal breathing [1–3].
5.2
Pediatric Sleep Hygiene and Airway Health (p-SAH)
In order to perform a clinically validated appraisal of pediatric sleep and airway hygiene (p-SAH) status in a clinical setting, one must collect accurate descriptive data about physical traits (e.g., malocclusion phenotypes) known to be commonly associated with p-SAH and behavioral traits known to be commonly associated with p-SAH [4], such as sleep-disordered breathing/obstructive sleep apnea (SDB/ OSA), parasomnias (e.g., night terrors, bruxism, restless legs, frequent arousals), bedwetting, and diaphoresis. With one exception being morning leg soreness, most p-SAH physical assessment phenotypes are located within the head and neck region, and thus the term craniofacial, an adjective referring to the parts of the head containing the brain and the face, is often used as a general address for where one might locate structural deficiencies that could possibly be associated with negative p-SAH. And while many anatomical structures essential to the proper functioning
K. L. Boyd (*) Lurie Children’s Hospital, Chicago, IL, USA Private practice, Dentistry for Children, Chicago, IL, USA © Springer Nature Switzerland AG 2019 E. Liem (ed.), Sleep Disorders in Pediatric Dentistry, https://doi.org/10.1007/978-3-030-13269-9_5
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Fig. 5.1 The craniofacial-respiratory complex (CFRC)
of a child’s respiratory apparatus are indeed located within and near to the craniofacial area (e.g., mandible, maxilla, anterior nares, nasal valves, nasal septum, tongue, hard palate, lips), other vital respiratory anatomical components are not located there (e.g., soft palate; posterior naso-, oro-, and laryngo-pharynx; posterior nares (choanae); hyoid bone; cervical spine; pharyngeal dilator muscles). So, in the interest of being more inclusive and scientifically accurate, it seems reasonable to suggest that the term craniofacial-respiratory complex (CFRC) (Fig. 5.1) rather than craniofacial alone would be a more inclusive and useful term for describing precisely where structural deficiencies associated with negative p-SAH might be located.
5.3
Normative Standards
Varieties of malocclusion phenotypes are nearly ubiquitous in industrialized cultures, but seldom seen in cultures that had not yet been exposed to cultural industrialization [5]; similarly, human malocclusion does not appreciably appear in
5 Physical Assessment in Pediatric Sleep Hygiene and A
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