ADHD – Attention Deficit Hyperactivity Disorder

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Attention Deficit Hyperactivity Disorder

Clinical symptoms of untreated Sleep Disordered Breathing (SDB) may include excessive daytime sleepiness, failure to thrive, bed wetting behavioural problems like ADD/ ADHD and in more advanced cases cardiac complications.

Children with ADHD Attention Deficit Hyperactivity Disorder are 2 ½ times more likely to be bed wetters. (Southern Medical Journal-1997)

According Dr Martha Cortes DDS –“IT’S NOT ADHD, it’s Sleep Apnea in Disguise Generally, children and adults with sleep disorders demonstrate different symptoms.

Unlike adults, who become tired with inadequate rest, children tend to experience hyperactivity when sleep is disrupted. Children are subject to unexpected behavioural changes, which may manifest as attention deficits, hyperactivity, aggression, crying and inappropriate behaviour.

These results of Sleep Apnea may be misdiagnosed as attention deficit hyperactivity disorder (ADHD) or Autistic Spectrum Disorder.

Although sleep apnea is associated with middle age, it is not uncommon in youth and behaviour resulting from the disorder is easily mistaken for hyperactivity rather than fatigue.

(Obstructive Sleep Apnea occurs when the upper airway is blocked during sleep, preventing adequate oxygen from reaching the brain. Normal sleep is disturbed when a person gasps and struggles to resume breathing.

Therefore, snoring is an informative symptom)

In children younger than five years, symptoms of Sleep Apnea include breathing from the mouth, sweating, restlessness and waking up frequently during the night.

Children older than five tend to experience hyperactivity, poor academic performance, hostility, bedwetting, slow growth, short attention span and may sleep in unusual positions (sitting up, legs crossed or slumped over a pillow).

Experts fear children are misdiagnosed with deficit hyperactivity disorder and are medicated to suppress the symptoms of Sleep Apnea while the underlying problem is left untreated.

When left untreated, Sleep Apnea can affect part of the brain involved in learning, thwarting cognitive function and academic performance. In addition, sleep apnea can alter normal growth patterns and can contribute to childhood obesity, as fatigued children are likely to seek carbohydrate-rich, high-calorie food.

( More alarming, new research reveals sleep apnea may lead to long-term health complications such as high blood pressure and heart disease that become present during adulthood. )

A new study has shown that brain abnormalities developed in children with obstructive sleep apnea are reversible with treatment

The studies are the first of its kind and have implications for the further study of ADHD and suggest children with psychological deficits should be carefully examined for sleep disorders. (Drooling and Snoring are indictors of Sleep Apnea)”.

If you would like to watch video

Dr Nina Shapiro on The Doctors: Childhood snoring can lead to behavioral problems.

Newsy Science: Snoring in kids linked to behavioral issue

Chronic ear problems, repeating ear infections

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Ear infection is the most frequent diagnosis made in physician offices for those under age 15.

Chronic middle ear infection also known as Otitis media and is often called an infection, but it is better defined as an inflammation of the middle ear.

Global studies indicate that up to 75% of “infected” ears are not infected as such, they do not show any bacteria or viruses present in them.

Otitis media can be a factor in associated hearing loss, learning disabilities, and secondary central nervous system complications.

The greatest cause of otitis media is an overclosed or improper dental bite. Otitis media can be successfully treated by using primary molars. (Loudon ME,Funct Orthod 1990)

Children with deep dental overbites are 2.8 times more likely to have ear tubes (ear grommets)placed or recommended by a pediatric otolaryngologist.

Many patients with inner ear dysfunction suffer from dental disorders.

Therefore, patients with inner ear dysfunction, of unknown cause, should have a dental exam. Dental treatment may improve ear symptoms. (HNO-1993)

Proximity of TMJ joint to middle ear is responsible for ears response to dysfunction in TM joint.

Continuous chewing pacifiers or teeth grinding can put constant pressure on jaw joint in cases when mandible is retruded (overbite) and a condyle is pushed back and very often high in the joint.

TMJ inflammation leads to a warm moist environment where ear bacteria can grow or ear can look and feel inflamed.

Use of pacifiers double the risk of developing otitis media in infants under 12 months of age.

Bottle-feeding increases the risk 5 times

Pacifiers in children under age of 3 are responsible for at least 25% of otitis media.

Ear and jaw anatomy varies between people and a nerve, a ligament and/or artery can pass through a small groove in the skull and physically connect the TM joint to the ear.

If the pressure on jaw joint persists can lead to ear fluid build-up, ringing in the ears (tinnitus), dizziness, vertigo, loss of balance and even loss of hearing.

Earwax build-up is a sign that a mandible is shifting out of balance toward one or both joints. (Dr D Page)

Dental treatment may improve ear symptoms. (HNO-1993)

Nocturnal bed-wetting

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Nocturnal Enuresis commonly called bed wetting occurs during sleep and is a common symptom among children with sleep apnoea and breathing problems such as nasal obstructions which cause children to breathe through the mouth instead of the nose.

Possible explanation can be that insufficient blood saturation with the oxygen decreases the production of antidiuretic hormone and affects the smooth muscles of the bladder.

Normal bladder control should occur by age 3-4. It is cindered medically abnormal when a child over age of 5 years chronically wets the bed.

From 15-20% of all5 year-olds and 10% of all 6-10 years olds chronically wet the bed. For unknown reasons boys do so more often than girls.

Children with ADHD Attention Deficit Hyperactivity Disorder are 2 ½ times more likely to be bed wetters. (Southern Medical Journal-1997)

However, many studies shown that by elimination or greatly reducing of nasal obstruction and restoration of nasal breathing, the symptoms of Sleep Apnea such as nocturnal enuresis, were reduced or totally stoped.

Used method was a rapid maxillary/palatal expansion, making top jaw bigger, as narrow maxilla causes the nasal airway obstruction.

A retrospective study reviled that children with nocturnal enuresis reduced or stoped their bed wetting habit, 1-4 months after maxillary expansion treatment with RME (rapid maxillary expansion).

Published in 1998 study revealed that 7 out of 10 non-responding to conventional treatments chronic bed-wetters age 8-13, improved within 1 month of rapid palatal expansion.(Angle Orthodontics-1998)

Some children “grow-out-of” bed wetting as their jaws and airway grow.

Early Functional Jaw Orthopaedic treatment, which turns about 80% of mouth breathers into nose breathers, can reduce or stop bed-wetting in about 80% of those from age 4-13.

Dental treatment may be 5-7 times more effective than doing nothing, considering that only 15% of bed-wetters spontaneously stop each year.

Research suggests the earlier FJO treatment starts, the more likely it will help.

Sleep problems (OSA), Snoring

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Obstructive Sleep Apnea (OSA), a form of sleep disorder starts when blocked airways cause low levels of oxygen, known as Hypoxia.

Hypoxia interrupts breathing patterns (apnea) and results in a broad range of chronic illnesses such as diabetes insulin resistance, hypertension, heart problems, stroke and full body changes.

sleep-childSnoring is often a cry for help, not just an embarrassing sound.

Snoring is a clear signal that an airway is blocked.

One of the reasons can be an underdeveloped, small upper jaw can results in small airways easily blocked during the sleep when lower jaw drops back, pulling tongue with it and compresses the throat tissue can result in chocking a sleeping child hundreds times a night.

Normal sleep is disturbed when a person gasps and struggles to resume breathing.

In children younger than five years, symptoms of Sleep Apnea include breathing from the mouth, sweating, restlessness and waking up frequently during the night.

Children older than five tend to experience hyperactivity, poor academic performance, hostility, bedwetting, slow growth, short attention span and may sleep in unusual positions (sitting up, legs crossed or slumped over a pillow).

Snoring has been found to be a predictor of poor school performance.

A study compared childhood snoring at 2 to 6 years of age to school performance at 13 to 14 years of age found children with lower performance in middle school were more likely to have snored during childhood.

The American Academy of Pediatrics issued guidelines in 2002 in attempt to diagnose and manage children with OSA Syndrome.

All children are to be screened for snoring.

Pediatric Obstructive Sleep Apnea (OSA) syndrome Screening Quiz

If your child have any of the following symptoms?

  •  continuous loud snoring
  • episodes of not breathing at night (apnea)
  • failure to thrive (weight loss or gain)
  • chronic mouth breathing
  • enlarged tonsils and/or adenoids (frequent sore throat infections)
  • problems sleeping, bed wetting, restless sleep, including sleep walking
  • excessive daytime sleepiness
  • frequent headaches
  • daytime cognitive and behaviour problems, including problem with concentration, aggressive behaviour and hyperactivity, which can lead to problems at school.

If any of these points sound familiar contact your Dentist or FJO Dentist.

If you would like to watch videos:


Dr Nina Shapiro on The Doctors: Childhood snoring can lead to behavioural problems.

Snoring children:


Speech problems, Tongue tie

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You, your child and your Speech Pathologist can get frustrated with the lack of progress or very slow one in speech disorder correction.

However, your child’s speech problem can be related to physical impairment such as narrow upper jaw where is no room for the proper function of the tongue (articulator) and/or Tongue tie preventing tongue from moving freely.

The expansion of the upper jaw will have impact on the progress of the speech pathology treatment.

Tongue tie

Tongue tie or “Ankyloglossia” are the terms used when the lingual frenum is short and restricts the mobility of the tongue.

Identification of tongue tied is very important especially in malocclusions where lower tongue position may contribute to excessive mandibular growth and at the same time a lack of stimulation for maxillary development.

The muscular impairment of the tongue function can also lead to tongue thrust and open bites.

Tongue tie has adverse effect on oromuscular function, feeding, swallowing and speech impairment specially with sounds such as “t”, ”d”, ”n” and tongue movements like difficulties with extension of the tongue beyond upper or lower lip.

Surgical indications to realise tongue tie are as follow: Breastfeeding difficulties, speech impediment, dental problems, medical (indigestion, snoring, OSA) and personal such as licking ice-cream.

Examples of difference length of the Lingual Frenum
Examples of difference length of the Lingual Frenum

From Normal, Short to Ankyloglossia where tongue movement is very restricted.

Finger or Thumb Sucking

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Few parents realize how malleable the facial bones of a six year old child are and how quickly things like ‘leaving the mouth open’ or ‘sucking the thumb’ can spoil a child’s appearance for ever.

Bottle, pacifier and finger sucking put backward forces on the jaws during one of the most important periods of rapid forward growth.

Thumb sucking together with other finger, dummy and blanket sucking habits will, if severe enough distort the growth of the face and teeth. It is very important that babies and young children are discouraged at every opportunity as it can cause severe damage to both the face and teeth (see below). Don’t accept it as a passing phase, be gentle but firm.

The sucking habits such as fingers and dummies (pacifiers) are strongly associated with crooked teeth and/or jaws (malocclusion). (Acta Odontologica Scandinavica -1993)

Research shows children breastfed about 1 year rarely develop dummy or finger sucking habits. (Swedish Dental Journal – 1998)

If thumb sucking persists after the primary teeth have erupted, it can change the growth patterns of the jaw, and cause significant misalignment of the teeth.

If this habit is left unchecked, it will cause instability of any future orthodontic treatment and make a good orthodontic result impossible.




If you would like to read more:



Mouth breathing

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Mouth breathing can deform jaws and airways, affects the face and whole body.

Nasal breathing obstruction may result in Craniofacial (skull and jaw) deformities, if present before or during puberty. (American Journal of Orthodontics and Dentofacial Orthopaedics. – 1997)

Chapped lips and gingivitis

If a child breathes mostly through the mouth the tongue will not be resting in the roof of the mouth and helping to develop it. This will create a small, narrow upper jaw set back in the skull.

A small upper jaw can hold back growth of the lower jaw.

Proper jaw development is the most critical factor influencing whether a malocclusion (bad bite) develops.

‘Mouth breathers’ not only develop small top jaws often resulting in crowded teeth, but they also become more susceptible to tonsillitis, colds, coughs and chest infections because mouth breathing bypasses body’s main filtration system (the nose) and drags large volumes of untreated air containing viral/bacterial matter into the sensitive lung passages.

Enlarged tonsils and adenoids

Enlarged tonsils and adenoids can make it difficult for a child to breathe through the nose. The scientists are not sure if they are the cause or the result of the mouth breathing, however their removal and lips muscles training will improve nasal breathing, which will result in enhancement of facial appearance and self-confidence.

Doctor G.Meredith MD in his book “Your child’s Airway and Dentofacial Development” multiple times describes harmful influence of the upper airway obstructions like hugely enlarge tonsils and adenoids, nasal passage obstructions on general development of children and benefits of using maxillary expansion in form of RME as non-surgical treatment to decrease or remove the nasal obstructions.

Some allergies such as to food (cow’s milk) or pollen (hay fever) can cause blocked nose, which consequences will be mouth breathing, ear infections, crooked teeth, enlarged tonsils, enlarged adenoids, sinusitis and later on unattractive faces.

Improper body posture results in poor breathing patterns which have a negative impact on jaw development and the position of the teeth. Adopting correct posture will not only enable you to breathe more effectively but will help keep your teeth straight

Mouth breathing, swallowing incorrectly, tongue thrust & poor lip seal are all examples of poor oral habits and muscle patterns that impact negatively and interfere with the normal growth patterns.

No child who has the lips apart at rest or who moves the lower lip when they swallow unconsciously will have straight teeth.

Early intervention is available to help correct these habits & enable your child to meet their full growth potential.

Open mouth posture and changes in a face profile as a consequence of mouth breathing.


If you would like to read more

Crooked teeth

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Problems to watch for in GROWING CHILDREN

Crooked teeth, malocclusion (“Bad bites”) like these illustrated below, may benefit from early diagnosis and intervention to prevent future complications of braces and extractions in their later years.

Bad Bites

In addition to above “bad bites” if you have noticed any of the following problems in your child, check with your dentist or FJO dentist.

  • Early or late loss of baby teeth
  • Difficulty in chewing or biting
  • Mouth breathing
  • Jaws that shift or make sounds
  • Biting the cheek or the roof of the mouth
  • Facial imbalance

Grinding (Bruxism) or clenching of the teeth

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Grinding teeth during the sleep or “Nocturnal bruxism” is a sign of the upper airway obstruction and specifically called as Sleep Disordered Breathing (SDB), one of forms of Obstructive Sleep Apnea (OSA) Syndrome, which is common problem affecting the general health of children.

Dental signs of SDB are extreme wear of the dentition as a result of the night time grinding, evidence of cheek biting, retrognathism (overbite), narrow dental arches and abnormal tongue swallow pattern.

Clinical symptoms of untreated SDB may include apart of grinding also excessive daytime sleepiness, failure to thrive, bed wetting, behavioural problems like ADD / ADHD and in more advanced cases cardiac complications.

As 85% of the nasal airway is made up of the maxilla (top jaw), the maxillary expansion plays very significant role in treatment of the upper airway obstruction.

Grinding in young children is an indication for upper arch expansion, as a part ofan Early Intervention Orthodontic treatment

Based on the results of the current study done inTufts University School Of Dental Medicine, 2011, sleep bruxism-related tooth wear is a clinical indicator for paediatric sleep disordered breathing (SDB), as measured by the RDI, allowing the dental practitioner to make prompt referral of the child to appropriate medical specialists concerned with the early diagnosis and management of this condition.