Upper Airway Development and Its Connection to OSA

April 11, 2022

Did you know that 60 percent of a child’s face is developed by age six? By age 12, development reaches 90 percent. The way that a child looks, eats, and breathes is decided much earlier than we may expect. Clearly, an individual’s oral habits and behaviors in early childhood can play a significant role in the way that their face, mouth, and airway are developed. It may even influence the way that a person breathes, eats, and talks far into adulthood.

Children’s airways and facial structures are not always developed in the most healthy way. In fact, studies show that 3 to 12 percent of children snore, a sign that their upper airway and jaws may not be developing as they should.

According to the Mayo Clinic, loud snoring in children could be a symptom of a serious sleep disorder called obstructive sleep apnea (OSA). OSA is not only associated with debilitating daytime symptoms—excessive daytime sleepiness, difficulty concentrating, and behavior problems—but it has also been linked to bedwetting, an inability to thrive at school, ADHD, and bruxism.

It’s clear that proper development of the airway is absolutely crucial for overall health and wellness. So, let’s explore exactly what normal development looks like—including a breakdown of the structures in the upper airway, why OSA is on the rise, signs that your patients may be struggling with the sleep disorder, and how you can help.

Major Structures of the Upper Airway

The respiratory system is structurally divided into the upper and lower airways. The upper airway is made up of the nose, nasal cavity, and pharynx. This section of the respiratory system is the most common section of the airway that collapses in cases of OSA. Let’s explore three of these structures and how they may relate to obstructive sleep apnea.

The Nose

The nose is formed by a framework of bone, cartilage, and fibro-fatty tissue. Normally, the nose is straight from birth and typically stays that way as the rest of the face develops. Over time, however, the septum can begin to bend toward one side. This may lead to obstruction of the nasal cavity, which can make breathing difficult and even cause OSA as people sleep.

The Nasal Cavity

The nasal cavity contains a series of passages that include grooves and mucous membranes that work to deliver heat and moisture to the air before it travels to the lungs, acting as a barrier to help keep harmful microbes from entering the body. It also has special cells involved in the sense of smell. Many patients with OSA experience posterior nasal cavity obstruction due to a number of reasons.

The Pharynx

The pharynx is the pathway that connects the oral and nasal cavities to the esophagus in the neck. It also serves as the primary pathway for air and food. Research suggests that the pharynx may be one of the most important factors in OSA—especially its collapsibility. The majority of those with OSA have less-toned muscles in the pharynx than those without it.

The following pharyngeal structures are the most relevant areas of concern in those with OSA:

  • Adenoids: Located in the nasopharynx, adenoids are lymph tissues that sit between the nose and back of the throat. If adenoids become hypertrophied, it can lead to the development of OSA—especially in children.
  • Soft palate
  • Tonsils
  • Dental arches
  • Tongue

It’s clear that the major structures of the upper airway can play a role in the development of OSA. The question is this: Why has OSA become more common? Why aren’t the structures of the airway developing well enough to support healthy breathing?

The Rise of OSA

Sleep and breathing disorders are on the rise. One billion people are expected to have OSA worldwide. So, why are these breathing disorders becoming so common?

Western culture and modern eating habits may be two of the most significant reasons. More convenient food options have changed the way babies receive their food supply and consume their nutrients in the first years of life. Most significantly, a soft food diet, limited breastfeeding, and pacifier use have become the standard of childcare, preventing young children from using their muscles to practice sucking and chewing hard foods.

Research on the development of these disorders has been fascinating. For example, Weston Price, a famous dental practitioner, traveled around the world to study those who aren’t exposed to processed foods, white flour, and sugar. What he found was that individuals in these areas had broad jaws, fully formed faces, wide dental arches, naturally straight teeth, and no tooth decay.

He ultimately determined that the intake of nutrient-poor foods and lack of hard foods have caused a variety of health concerns. For example, narrow faces, poor nutrient absorption, tooth decay, crowded teeth, misalignment, mouth breathing, and even the development of allergies could be attributed to poorer eating habits.

Many people have come to accept dental and breathing issues as common, even normal, but this could not be further from the truth. It has become standard for teenagers and young adults to undergo orthodontic treatment to straighten their smiles.

At the end of the day, the truth is this: Poor breathing leads to poor living. So how do we identify and treat those who are already struggling to breathe and therefore sleep? Let’s discuss signs a patient may be struggling to breathe and how you can help them.

Signs a Patient Is Struggling to Breathe

Internal issues can manifest themselves in other areas of the body—not the source. By understanding this, we can take a broader approach and examine what the root cause of the issue may be.

In the case of OSA, the following are just a few of the signs and symptoms that can occur:

  • Loud snoring
  • Audible breathing during sleep
  • Periods during sleep that usually result in gasping and restlessness
  • Mouth breathing
  • Swollen tonsils and adenoids
  • Daytime fatigue
  • Irritability
  • Hyperactivity
  • Sleepwalking, night terrors, and bedwetting in children
  • Headaches or migraines, especially in the morning hours

The great news is that when properly trained, dentists like you can spot some of the biggest signs of OSA. That’s because many of these indications manifest themselves in the mouth and oral health.

For example, the following are some of the most telltale signs of the sleep disorder:

  • Bruxism
  • Overbite
  • Large tongue size
  • Deep palatal vault
  • Large neck circumference
  • Recessed chin
  • Microglossia
  • Scalloping on the tongue
  • Large tonsils
  • Eroded enamel

Because you’re in the perfect position to notice such signs and symptoms of OSA, you’ll be able to help patients get access to the treatment they need as soon as possible. In fact, according to the ADA, dentists are the best healthcare providers to screen for and treat OSA—especially with oral appliance therapy.

Providing patients with these services does more than benefit their overall health and wellness; it could also help you grow your practice. By integrating airway-centered dentistry into your practice, you can achieve major growth for your business as you serve more patients. Introducing a new stream of revenue, increasing your client base, and providing better service will serve to expand your business, and airway dentistry will allow you to do all three.