Missing teeth and pediatric obstructive sleep apnea.
BACKGROUND
Missing teeth in early childhood can result in abnormal facial morphology with narrow upper airway. The potential association between dental agenesis or early dental extractions and the presence of obstructive sleep apnea (OSA) was investigated.


METHODS
We reviewed clinical data, results of polysomnographic sleep studies, and orthodontic imaging studies of children with dental agenesis (n = 32) or early extraction of permanent teeth (n = 11) seen during the past 5 years and compared their findings to those of age-, gender-, and body mass index-matched children with normal teeth development but tonsilloadenoid (T&A) hypertrophy and symptoms of OSA (n = 64).


RESULTS
The 31 children with dental agenesis and 11 children with early dental extractions had at least 2 permanent teeth missing. All children with missing teeth (n = 43) had clinical complaints and signs evoking OSA. There was a significant difference in mean apnea-hypopnea indices (AHI) in the three dental agenesis, dental extraction, and T&A studied groups (p < 0.001), with mean abnormal AHI lowest in the pediatric dental agenesis group. In the children with missing teeth (n = 43), aging was associated with the presence of a higher AHI (R (2) = 0.71, p < 0.0001).


CONCLUSIONS
Alveolar bone growth is dependent on the presence of the teeth that it supports. The dental agenesis in the studied children was not part of a syndrome and was an isolated finding. Our children with permanent teeth missing due to congenital agenesis or permanent teeth extraction had a smaller oral cavity, known to predispose to the collapse of the upper airway during sleep, and presented with OSA recognized at a later age. Due to the low-grade initial symptomatology, sleep-disordered breathing may be left untreated for a prolonged period with progressive worsening of symptoms over time.
Stanford University Sleep Medicine Division, Stanford Outpatient Medical Center, 450 Broadway Street, Pavilion B 2nd floor, MC 5730, Redwood City, CA, 94063-5730, USA. cguil@STANFORD.EDU.
Christian
C
Guilleminault
Stanford University Sleep Medicine Division, Stanford Outpatient Medical Center, 450 Broadway Street, Pavilion B 2nd floor, MC 5730, Redwood City, CA, 94063-5730, USA.
Vivien C
VC
Abad
Stanford University Sleep Medicine Division, Stanford Outpatient Medical Center, 450 Broadway Street, Pavilion B 2nd floor, MC 5730, Redwood City, CA, 94063-5730, USA.
Hsiao-Yean
HY
Chiu
Stanford University Sleep Medicine Division, Stanford Outpatient Medical Center, 450 Broadway Street, Pavilion B 2nd floor, MC 5730, Redwood City, CA, 94063-5730, USA.
Brandon
B
Peters
Department of Orthodontics, University of California San Francisco Dental School, San Francisco, USA.
Stacey
S
Quo
D000234:Adenoids / Q000473:pathology; D000848:Anodontia / Q000150:complications*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006984:Hypertrophy; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology; D017286:Polysomnography; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000209:etiology*; D014081:Tooth Extraction
Alveolo-dental growth; Dental agenesis; Obstructive sleep apnea; Oral-facial development; Upper airway collapsibility