2/12/2022: I wanted to share a commentary I wrote in response to a posting on a professional
pediatric dental social media site (not an “airway” site) about the usefulness of fabricating night-
guards for children that grind their teeth while sleeping.
I usually do not leave comments on these group’s pages (although I often want to) because I feel
it is more important to listen sometimes than to talk. Plus, I learn a lot from others by paying
attention and listening to other professional’s experiences and knowledge.
But this time I felt I had a responsibility to speak-out to my fellow professional peers (pediatric
dentists) because I want more of us, in more communities to be able to effectively treat our
patients in need, and for the families that are seeking answers and looking for help.
I felt this post about nighttime tooth grinding in children and the discussion of using oral
appliances with the goal of protecting the teeth from excessive wear opened the door to having a
bigger discussion about how we can better serve our patient’s health by addressing the root
causes of symptoms (such as nighttime tooth grinding in children) and not just the symptom in
Fortunately, this has started very encouraging conversations among the group, which hopefully
will open some more minds and possibilities for helping more kids!
Lauren Yarmosky Ballinger
I usually do not comment on social media posts (I am mostly a silent lurker;) however I feel compelled to speak to
the opportunity (dare I say responsibly) we have as pediatric dentists here. Here goes my treatise and call to action to
the best group of dental specialists that exist !
Nighttime bruxism (grinding) is well established in the dental and medical literature of being associated (if not
diagnostic) with sleep disturbed breathing and airway problems (SBDs).
SBD's cause nighttime symptoms such as grinding and also restless/fragmented sleep.
Fragmented sleep can cause irreversible neurocognitive damage in growing children's precious brains, especially
ages 2-5. In fact, it has been documented that the biggest predictor of children ages 7 and 8 in a special education
program or with a ILP (individualized learning plan) is how well the breathed during the night, and if they experienced
restless/fragmented sleep between the ages of 2-5 years.
According to pediatric medical and pulmonary sleep literature, in children the biggest risk-factor for the development
of OSA is CRANIO-FACIAL structure. And they name pediatric dentists as being major healthcare players in the
screening and treatment of it!
It is important to keep in mind that while some children do have OSA, most do not. They have the earlier stages of it.
OSA is largely an END-STAGE disease on the entire spectrum of SBD's: on the left-side of the spectrum of disease
is MOUTH-BREATHING, then progressing to snoring, then to UARS (upper airway resistance syndrome), then to
OSA on the right side/end of the spectrum.
Adults do not just wake up with OSA one day ...they started their "journey" as children with poor growth of the
The bones and structures of the craniofacial complex not only include the upper and lower jaws and teeth, but they
also make up the boarders of the upper respiratory system -the airways.
The palate is the same bone of the floor of the nose (if the palate is narrow, the nasal cavity is also narrow). The
positions of the maxilla and mandible relative to the cranial base, along with the space posterior to the tongue and
soft palate make up the anterior boarder of the upper airway space...so we are really taking about the craniofacial-
respiratory structure and its growth and development that is in OUR wheelhouse.
This growth is about 50% complete by age 4, 75% by age 7 and by age 12, over 90% of the growth is DONE. The
potential for real change is over!
Of course, teeth can be "straightened out" this age, but the chance to make real change in-terms of improving the
entire craniofacial respiratory structure has passed!
We are left with "what could have been" and now have to deal with what is: compensated function and a
compensated life...unless we want double jaw surgery. Ask me how I know...
WE PEDOS are the WATCHDOGS and PROTECTORS of this growth!
KIDS with the earliest SYMPTOMS such as bruxism and worn-down primary teeth that were "missed", GREW-INTO
adults that are now using CPAP. These kids did NOT out-grow these issues, their issues got worse over time.
This is what happens when you have a “watch and wait” mentality. We must ask ourselves: what are we waiting for?
For things to get worse.
I ask you, who else in the healthcare field is better placed than PEDIATRIC DENTISTS to be able to pick up the
SIGNS AND SYMPTOMS of poor craniofacial respiratory growth and development that go hand in hand with pediatric
airway and sleep disturbances??
Who are the king and queens and everything in-between of kids/littles/yum-yum’s oral-facial growth and development
and the PREVENTION of dental and oral disease?? WE ARE!
I truly believe with all my heart and soul that pediatric dentists can (and we do, but we can do MORE) change the
course of a child's life's NOW and lead them on to having a better adult health-span (not just lifespan, HEALTHSPAN
being increased longevity with less need for medical/pharmaceutical management of modern day diseases such as
diabetics, obesity , HBP, stroke , Alzheimer's ...all co-morbidities of end stage OSA) .
There are so many contributions that pediatric dentists make in the lives of children-we are magical unicorns. .
I ask us as a specialty to look further into the roles we can play in a child's life when we move beyond treating just
symptoms and asking WHY!!?! Why are we seeing the symptoms in these children in the first place?
How many times a day do I lament about "wishing I knew then what I do know now?" For my OWN children's
It was right there in front of me the whole time...staring back at me in the face! I just didn't know to look beyond the
Now the reason show up to work every day is to make sure I give back by making the contribution of knowledge and
skill to families NOW THAT I DO KNOW!
The SYMPTOMS that we see in our littles everyday like tooth decay, mouth breathing, can't lay down all the way in
the chair, can't tolerate x-rays, gagging, hyperactivity/ADHD, runny crusty noses, chapped lips, dark circles under the
eyes, frequent use of antibiotics for ear infections, smaller stature or over-weight kids, grinding/worn down teeth…
…then look at their FACES! What is going on with their craniofacial structure? What do we see…
a narrow palate?
no spaces or crowding of primary teeth?
an under-bite? (Which is really an underdeveloped maxilla, not an overdeveloped mandible.)
a tongue that has a restriction?
These are some of the ROOT CAUSES and issues that can affect the way are children SLEEP and BREATHE and
THRIVE in life!
Based on your observations of these signs and symptoms, consider asking the parents and care-givers of these
children more questions about what is going on in their lives…ARE THEY THRIVING IN LIFE, OR JUST
As pediatric dentists we are the gatekeepers of this! It's both a gift and a curse.
It's our gift to step into the role of true comprehensive prevention and early intervention that WE, as a specialty can
bestow upon our most precious population!
It also a curse because once you see it, you CANNOT unsee it!
You see it everywhere!
Then you realize that this is a pandemic of another sort that you can jump in on and help change the course of its
In fact, you understand the responsibility that you have as a pediatric dentist to not UNSEE, but to SEE and DO
something about it.
We can make a difference in a child's life more than we ever imagined we could.
OK-the end!! If you made it here, you win a COOKIE!