Dental Sleep Medicine

As health care providers, our priority is keeping you and your family healthy.

During each new patient and oral hygiene exam, Dr. Viernes will conduct an airway/sleep screening. First, parents/patients will have a short sleep questionnaire to fill out in addition to the medical history forms which will be used as part of the dental exam. During the oral dental exam, the dentist performs an airway exam and checks the tonsils and tongue size as it relates to the pharyngeal size. A Brodsky and Mallampati score are recorded which can indicate the need for further assessment due to the severity.

The answers on the sleep questionnaire and clinical findings may prompt a referral to the ENT- ear, nose & throat or PCP-primary care physician. If a referral is needed to the ENT doctor, we will fill out a referral form and fax it to the doctor to get an appointment set up for the patient.

What is Pediatric Sleep Apnea?

Pediatric obstructive sleep apnea (OSA), sometimes also referred to as sleep disordered breathing is a sleep disorder where a child’s breathing is partially or completely blocked repeatedly during sleep due to narrowing or blockage of the upper airway. Due to the significant correlation between healthy sleep and healthy oral growth our dentist may recommend the use of oral appliance therapy.

The underlying cause for OSA in most children is enlargement of the adenoids and tonsils. Early diagnosis and treatment are important to prevent complications that can affect your child’s growth, cognitive development and behavior. Many children diagnosed with attention deficit hyperactivity disorder (ADHD) may actually be sleeping poorly as the behavioral signs are similar – poor performance in school, difficulty paying attention, repeated daytime drowsiness, hyperactivity and even poor weigh gain.

Parents should monitor their child’s breathing habits during the day and encourage them to breathe through their nose during most normal daily activities. While sleeping at night, watch to see if your child has trouble keeping their lips together. If so, there may be a restriction. Observe whether there are any indications from the symptoms list below. If you do see any of these signs or suspect your child may have a issue with pediatric OSA, Dr. Viernes and the detail Dental Kids team are here to help.

How your child breathes is important.

Nasal breathing (breathing through the nose) is especially important while your child is sleeping. For both children and adults, this type of breathing allows the lungs to take in more oxygen and allows the nose to act as a filter to prevent small particles from getting into the lungs. With the exception of illness, breathing through the nose is preferred and should be encouraged.

If your child has airway restrictions like enlarged adenoids or tonsils, it can make it harder to breathe and lead to mouth breathing. This type of breathing allows cold, dry and unfiltered air into the lungs. The  most obvious sign of pediatric OSA is mouth breathing. Read on to better understand the signs your child may have pediatric OSA.


  • Snoring—or noisy breathing during sleep.
  • Periods of not breathing— although the chest wall is moving, no air or oxygen is moving through the nose or mouth into the lungs. The duration of these periods is variable and measured in seconds.
  • Mouth breathing—in some cases the nasal passage may be completely blocked by enlarged tonsils and adenoids this can lead to the child only being able to breathe through the mouth.
  • Restlessness during sleep— stop and go breathing can lead to frequent arousals or “tossing and turning” throughout the night.
  • Sleeping in odd positions— some children hyperextend or arch their neck backward in order to open the airway.
  • Behavior problems or sleepiness— this can include irritability, crankiness, frustration, hyperactivity, and difficulty paying attention.
  • School problems— children may do poorly in school, even being labeled as “slow” or “lazy.”
  • Bed wetting— also known as nocturnal enuresis, although there are many causes for bed wetting besides sleep apnea.
  • Frequent infections— may include a history of chronic problems with tonsils, adenoids, and/or ear infections.
  • Sweating, teeth grinding or Waking up frequently– are all signs your child is not resting peacefully, might be experiencing sleep-disordered breathing and should be evaluated for OSA.