Most children who snore do not have sleep apnoea, but a small number do, and some of the clues show up during an ordinary dental check-up. Because children usually see a dentist or oral health therapist every six to twelve months, the dental team has repeated chances to notice a mouth that is always open, large tonsils or a narrow upper jaw. The dental role is to spot and refer. Diagnosis and treatment of obstructive sleep apnoea sit with the child's GP, paediatrician, ENT surgeon or sleep physician.
What a dental check can pick up
Looking in a child's mouth shows more than teeth. Findings that can prompt a conversation about sleep include:
- lips apart and breathing through the mouth while sitting quietly in the chair
- large tonsils that fill much of the back of the throat
- a narrow, high upper jaw, or a crossbite where upper back teeth sit inside the lower ones
- dry, puffy gums at the front of the mouth, which can go with mouth breathing
- worn baby teeth from grinding, although grinding is common in children and has many causes
None of these proves a breathing problem during sleep. They are reasons to ask parents a few more questions. Our article on mouth breathing in children covers that habit in more depth.
Signs at home that matter more than snoring
Snoring on its own, especially during a cold or hay fever season, is very common. What raises concern is snoring most nights together with other signs: pauses in breathing, gasping or snorting, very restless sleep, sleeping with the neck stretched back, or sweating at night. During the day, children with disturbed sleep are more often irritable, inattentive or hyperactive than obviously sleepy, and some have bedwetting that returns after they had been dry. If you notice this pattern, it is worth raising with your GP whether or not a dentist has mentioned it.
Breathing and jaw growth are linked, but not simply
When the nose is blocked, for example by large adenoids or allergies, children tend to breathe through the mouth and rest the tongue low. Research has found associations between long-term mouth breathing and a narrower upper jaw and longer lower face. How much one causes the other is still debated, and genetics plays a large part in facial shape. What is clear is that a narrow upper jaw with a crossbite is easier to correct while a child is still growing, which is one reason early dental and orthodontic checks are useful. Our guide to the right age for a first orthodontic check explains the timing.
Diagnosis needs a doctor and a sleep study
If a dentist is concerned, the usual next step is the child's GP, who may refer to a paediatrician, an ENT surgeon or a paediatric sleep service. An overnight sleep study measures breathing, oxygen levels and sleep, and confirms whether obstructive sleep apnoea is present and how severe it is. A questionnaire or a parent's video of the child sleeping can help the doctor decide how urgently a study is needed.
Tonsils and adenoids usually come first
In otherwise healthy children, enlarged tonsils and adenoids are the most common cause of obstructive sleep apnoea, and removing them is the main treatment where they are the problem. Other approaches, such as nasal steroid sprays for milder cases or treatment of allergies, may be used depending on the child. These decisions are made by the medical team.
What expanders can and cannot do
A palatal expander widens a narrow upper jaw by separating the two halves of the palate along the midpalatal suture. In children with a narrow arch or crossbite, that is a well-established orthodontic treatment, described in our guide to palate expanders for kids. Widening the upper jaw also widens the floor of the nose, and several studies have reported improvements in sleep study results in selected children afterwards. Systematic reviews, however, rate the evidence as low in quality, and recent randomised trials have given mixed results, including one that found no difference in sleep study results compared with simply monitoring. An expander is therefore planned for the bite, with any breathing benefit seen as possible rather than expected, and it does not replace medical assessment and treatment.
What parents ask
Will my child grow out of it?
Tonsils and adenoids naturally shrink as children get older, and some children improve on their own. That cannot be assumed, particularly if symptoms are frequent or affecting behaviour, so an assessment is the safer path.
Should I record my child sleeping?
A short phone video of typical snoring or breathing pauses, along with notes on how often it happens, can be very helpful for the GP.
At Lumi Dental, our oral health therapists Sabrina Tran and Jennifer Nguyen see children and families for check-ups and prevention, and eligible children can be bulk billed under the Child Dental Benefits Schedule. If something about your child's breathing or jaw development has been raised, we can explain what was noticed and write to your GP. Book through our general dentistry page or see current offers.
