Obstructive sleep apnea syndrome in the pediatric age: the role of the dentist

OBJECTIVE: Sleep disordered breathing in children designates a wide spectrum of respiratory disorders characterized by partial or complete obstruction of the upper air-ways. It ranges from primary snoring, its mildest clinical manifestation, to obstructive sleep apnea syndrome (OSAS): complete obstruction of the upper airways with cessation of airflow. The aim of this paper is to highlight the roles of the pediatric dentist and the orthodontist in the therapeutic approach to pediatric OSAS as a "sentinel" who can detect early signs of the disease for immediate referral to the otolaryngologist and as an active participant in therapy. MATERIALS AND METHODS: A literature review has been performed on the following topics: pediatric OSAS, orthodontic clinical aspects of pediatric OSAS, orthodontic therapy of pediatric OSAS, mandibular advancement devices and functional orthodontic devices in OSAS treatment. RESULTS: The role of the dentist in pediatric OSAS is essential to correct orthodontic alterations that may favor the development of the condition. Orthodontic treatment aims at reducing the severity of OSAS by increasing the airspace and improving airflow through orthopedic expansion of the upper jaw and mandibular advancement. Rapid palatal expanders and mandibular advancement devices are successfully used in the treatment of OSAS. CONCLUSIONS: Scientific evidence of a strong association between craniofacial growth and OSAS; the pediatric dentist and the orthodontist participate as sentinels, observing and identifying conditions requiring referral to the otolaryngologist and playing a pivotal role in the orthodontic treatment phase.