08/30/2023
The link between childhood behavior and breathing related sleep disorders.
Accelerated teeth grinding related dental wear, combined with airway reflux
Here’s a case of severe dental wear in a 6-year-old I saw today. And I’m sharing this to highlight, that we need to address root causes.
She was referred to us by a chiropractor for consultation regarding teeth grinding.
Both her regular dentist, and specialist pediatric dentist had made mum aware she had severe tooth wear due to grinding, and that she was prone to needing fillings. She has had multiple fillings, and sealants to protect her worn teeth.
Teeth grinding in children one of the strongest red flags that a child is having breathing difficulties during sleep. This is not something I was taught in dental school. We now understand it is often a stress response to a narrowing of the airway. The jaw muscles are recruited to re-open the airway which protects against sleep apnoea and oxygen deprivation. The only problem is that children don’t enter deep sleep, and this can be linked to restless and un-restorative sleep, and difficulties with emotional regulation, behaviour, sitting still, attention, and concentration. Some children in a constant fight-or-flight state due to the chronic stress of breathing difficulties may present with anxiety or have more troubles getting to sleep. Many children that I see are medicated with melatonin. The underlying airway problem is not addressed.
We often do not see significant tooth wear related to teeth grinding because enamel is the strongest substance in the body. It is even harder than bone.
When we see severe tooth wear, it’s important that we keep digging deeper as to find out why.
Many times, it is because there is airway reflux, and the pooling of aerosols of acid in the mouth. It is the combination of acid and teeth grinding that deteriorates the teeth quickly. The scooped our wear facets are examples of severe dental erosion of the inner softer and yellow dentine layer of tooth, from acid pooling in the mouth.
Airway reflux occurs when a child has increased efforts to breathe through a narrowed airway. This creates vacuum pressures that allow stomach acids to aerosolize into the throat and mouth. It can irritate and contribute to swelling of the adenoids and tonsils, or result in symptoms like chronic cough, throat clearing, post-nasal drip, or “spew burps.” Often it gets misdiagnosed as asthma, and children are medicated for this.
Whether it be the constant need for fillings, teeth grinding, behavioural problems, difficulties falling asleep, or asthma-type symptoms, let’s not overlook poor airway and breathing dysfunction as contributors.
I don’t necessarily need a sleep study to decide on treatment – in this case, there are very clear risk factors of poor airway, and it is clear to me that this child is not sleeping well, and her day-time function is suffering for it. To get to the bottom of this – we must check the jaw structures, tongue posture (including ruling out tongue-ties), and obstructions inside the nose and throat, and adopt a combination approach to manage all.
