Sleep Apnea and UARS in this group are of great importance. Because of the effects of sleep deprivation associated with these disorders, the physical and psychological effects can be substantial. The symptoms associated with pre-teens are seen as well in this group however this age group has access to things that no younger age group does. For example, a young driver with sleep apnea in this group is driving with the same degree of impairment as if they were intoxicated with alcohol. Reaction times are diminished as is concentration. Add blaring music and a few distracting friends and it is a recipe for disaster. When at the wheel of a 1.5 ton motor vehicle, these drivers present a serious risk to themselves, the passengers with them and other motorists and pedestrians. Add alcohol or recreational drugs to pre-existing OSA symptoms and you have a serious situation.
Physical changes that become very apparent as growth completes include:
- Forward head posture, scoliosis of the spine
- Retruded mandible
- Malocclusion, poor bite, difficulty chewing
- Slow noisy eating due to poor tongue posture and bad bite
- Muscle pain in the head, neck and shoulders
- Headaches (forehead, temples, jaws, neck and shoulders)
- Dental pain due to impacted wisdom teeth with no room
- Grinding of the teeth increases in this group during the day due to hormonal changes and stress levels
Psychological changes that can occur include:
- Apathy due to daytime fatigue
- Aggressive behavior
- Risk of experimentation with risky behaviors
- Withdrawal, depression
- Weight gain (which makes OSA much worse)
If the tonsils and adenoids are large and still have not been addressed, a consult with an ENT is recommended, to determine if there is an airway concern. If they have an orthodontic problem such as a narrow or constricted upper jaw, deep overbite, or retruded mandible (no chin) see an orthodontist and find out how this can be corrected. Many malocclusions can only be treated non-surgically when done during the growth of the child. Once they stop growing surgery may be the only option.
Braces can correct most malocclusions and are well accepted by this age group. Braces may be combined with expansion built in. The following image shows conventional braces with an A.L.F. (advanced light force) expansion wire. These are very effective at widening the palate, creating space to align the teeth and to increase the width of the upper jaw.
Braces typically take between 12 to 24 months, depending upon the severity of the malocclusion. Braces are available in silver, white (tooth colored) and with or without elastic ties to hold the wires in. It is preferable not to remove any upper teeth as this does not result in widening of the upper jaw.
OSA appliances such as the Luco Hybrid OSA Appliance are not indicated under the age of 18. CPAP/NPAP are good options and can significantly improve behavioral issues in some.
If they are 16 or have all their permanent teeth in, and are grinding their teeth causing headaches and dental damage, a lower hard bruxism appliance can be used at night to provide relief. The Luco Splint is a lower splint that is very effective for this and is well tolerated while sleeping. Lower appliances encourage the tongue to position up in the forward part of the roof of the mouth (normal posture). Upper bruxism appliances are not recommended as they force the tongue into an abnormal swallowing position. Soft bruxism appliances are also not recommended as they can actually lead to an increase in bruxism. Genetic research has identified gene mutations that may contribute to bruxism. Clinically, it tends to run in families.