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Orthodontics in the multidisciplinary treatment of paediatric OSAS

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88 Phillip Street

Level 5

Sydney, NSW 2000

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The Crucial role of orthodontics in the multidisciplinary treatment of paediatric OSAS

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The Crucial role of orthodontics in the multidisciplinary treatment of paediatric OSAS

Abstract: This study (my PhD research) followed 3329 children between ages of 7-9 yo, who were referred to me for an orthodontic consultation by their general dentist. The purpose of the study was to see what combination of treatments would most reduce the impact of sleep disordered breathing, in the paediatric population.

Based on the signs and symptoms of sleep disordered breathing problems, 3326 patients had the standard orthodontic records of study casts, X-rays/CBCTs, extra oral and intra oral photographs, as well as a baseline sleep study (PSG) or an overnight pulse oximetry. Sleep studies revealed mild to moderate sleep aponea, or other symptoms of SDB. 21 patients PSG studies showed no SDB.

The patients were assigned to 1 of 4 treatment groups, plus a control group who did not receive any treatment (group 5): 1) ENT surgery only, or 2) ENT surgery and Myofunctional therapy, with a night time appliance (myobrace) (MFT) or 3) ENT surgery and orthopaedics/orthodontics, and 4) ENT surgery, orthopaedics/orthodontics, MFT and a night-time appliance (myobrace).

Sleep studies were performed for all patients, at baseline, and then after ENT intervention, after orthopaedic treatment, and finally after MFT. By comparing the results, the best outcome, for RDI reduction, was obtained when ENT surgery, myofunctional therapy and orthodontic therapy were used. Complete resolution of OSAs, in children, requires appropriate orthodontic treatment, such as maxillary development, maxillary protraction, and mandibular translation.

Learning outcomes:

1) Compare different combined treatment modalities for the treatment of paediatric OSAS

2) Include orthodontics in treatment plans for paediatric OSAS

3) Identify the relationship between malocclusions and SDB in children

4) Review the common ENT procedures that help restore nasal breathing in children

5) Summarize the most favourable dentofacial orthopaedic treatment outcomes for these children, once their nasal airway has been improved

6) Compare stability of their improved airway with and without MFT

Short bio:

Dr. Mahony is a Specialist Orthodontist who has been in private practice for over 30 years. He has built his practice, clinical teaching, and worldwide reputation in offering early interceptive orthodontic treatment. Dr. Mahony is an invited reviewer for many dental journals, in the field of facial development, and its association with nasal breathing. He has been involved in leading research linking maxillary arch expansion to a number of systemic disorders such as bed wetting and ADHD.

What I hope to answer from my 15 year research project…..

What are the appropriate criteria to define a pediatric dental sleep medicine patient? The medicolegal definition is birth until 18 years of age. Is this an appropriate definition to be applied to dental sleep medicine?

What are the diagnostic criteria and who is the appropriate clinician for the diagnosis of SDB in children? Are snoring, mouth breathing, or behavioural issues enough?

What is the dentist’s role in screening children for SDB?

What are the appropriate screening protocols based on evidence and what known risk factors should be used?

What is the best age for intervention, or is age the appropriate indicator?

What treatment options are available that have scientific basis?

What are the anticipated side effects of the proposed treatments and can they be managed?

Who is responsible for coordination of multiple aspects of pediatric patients with SDB?

What is the definition of treatment success?

What follow-up protocols exist?

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Date and Time

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Credabl Offices

88 Phillip Street

Level 5

Sydney, NSW 2000

Australia

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