By Jon W. Caulfield, DDS
While the public is increasingly aware of obstructive sleep apnea (OSA) in children, many in the dental field still see airway-centric pediatric care as a niche. However, I think that treating pediatric OSA should be more seamlessly integrated into all dental practices that accept children as patients.
By addressing sleep-breathing dysfunctions early, dentists can prevent or improve many orthodontic issues and wider health problems before they become more difficult to treat. At Epic Dentistry in Littleton, Colo, we focus on airway, sleep, and TMJ for both children and adults.
Clinical Red Flags for OSA in Children
At dental visits, every new and returning child should be screened for OSA risk factors.
Our team looks for:
- a lack of spacing or accelerated wear in primary or mixed dentition,
- narrow upper jaws,
- tethered oral tissues,
- enlarged tonsils,
- mouth breathing, and
- incorrect tongue posture.
These observations, combined with conversations with parents about sleep patterns and behavioral health, allow us to initiate further evaluation.
Utilizing sleep screening devices for both adults and children, and, when necessary, providing referrals for testing, can diagnose the type and severity of OSA.
Adjunctive Therapies for Children with OSA
I have found that it is rarely “one thing” that corrects the dynamic, multifactorial problems we encounter in children with OSA. Additional therapies and resources are crucial to treating many types of cases.
Adjunctive therapies for children that I find efficacious in certain cases include:
- Myofunctional training. I maintain dental hygienists who are also trained as myofunctional therapists for in-person treatment at our office. For remote needs and specific clinical situations, I utilize MyoSync and other online platforms to ensure continuity of care.
- Laser therapy. I use a Deka CO2 laser for airway interventions, including tonsillar treatment and soft tissue releases that improve breathing pathways.
- Habit correction. This encompasses lip seal exercises and specialized tools to train proper lip closure, tongue positioning during swallowing and eating, and comprehensive thumb-sucking cessation strategies with supportive adjuncts.
- Nasal hygiene and sleep habit optimization. Nasal hygiene forms the foundation of proper nocturnal breathing patterns. I recommend non-steroidal sprays and rinses to maintain nasal patency throughout the night. We teach children effective nose-blowing protocols and nasal airway optimization techniques for daily use, with particular emphasis on pre-bedtime routines. Additionally, I address dietary and environmental factors that may compromise nasal function or trigger tissue inflammation.
- Breathing re-education for patients and families. This intervention targets patients with carbon dioxide sensitivity—often resulting from chronic mouth breathing or underlying health conditions. The goal is to help their respiratory system adapt to normal CO2 levels without triggering compensatory over-breathing or increased respiratory rates. This promotes more consistent breathing patterns and improved airway dynamics. My approach is informed by Patrick McKeown’s methodology and Buteyko breathing certification training.
Building Medical-Dental Partnerships
Successful pediatric OSA care depends on strong medical-dental relationships. I work regularly with ENTs to address tonsils, adenoids, and other nasal airway disrupters. I have also worked with specialized chiropractors, tongue-tie practitioners, craniosacral therapy providers, myofunctional therapists, pediatricians, and other doctors.
Building these connections must be proactive. I strongly suggest contacting local providers directly—by visiting their offices or via email. Explain your processes, goals, and objectives for patients, and how the clinician can assist the patients in their care and progress.
The dentist can be a central provider to bring the many parts of the “village” together for comprehensive and successful care.
Feasibility of Pediatric OSA Care in Busy Dental Practices
At Epic Dentistry, we started by dedicating a half-day to airway/sleep cases. If no patients were booked, we used that reserved time for training and developing systems to improve our processes.
The fundamental shift involves asking different questions, seeking broader clinical insights, and understanding how to address breathing- and sleep-related issues. This approach requires a more medically-oriented exam and evaluation than what many dentists are familiar with.
Unfortunately, financial and logistical integration of pediatric OSA care are often huge barriers.
I have found that partnering with an oral appliance marketer for education, support, and assistance with training and implementation allows more dentists to be successful in adding OSA treatment to their practices. At Epic Dentistry, we partner with Vivos, which focuses on the root causes of airway and breathing issues. Vivos’ customizable curriculum offers courses that focus on children specifically.
Medical billing remains a challenge, but Vivos provided training and education outside of office hours, as well as systems and implementation strategies, that shortened the learning curve.
Improving Health of Pediatric Patients
Integrating pediatric OSA management in the dental office is not only feasible but increasingly vital. With structured education, deliberate partnership building, and strategic scheduling, dental practices can address this significant unmet clinical need. Doing so improves lifelong health for the youngest patients and grows the practice’s expertise and reach.
