sympathetic tone in vascular smooth muscle (vasoconstriction), blood pressure increases by 25 percent (hypertension), which increases intracranial pressure and decreases cerebral blood flow. This puts the adult patient at risk for recurrent exposure to apnea-induced pathophysiological hemodynamic and hypoxic events, including daytime sleepiness, fatigue, poor work performance, headache and diminished libido and impotence, impaired memory and concentra-tion, automobile and work-related accidents, and finally, CVA (cere-brovascular accident) stroke. Depending on the individual risk profile, other patients may instead be at risk, due to the decreased pO 2 in alveolar air sacs, for chronic pulmonary diseases including pulmonary vasculature constriction and pulmonary hypertension and hypoxemia. These lead to hypoxic vagus nerve stimulation and resultant bradycardia (slowed heart rate), decreased cardiac output, increased risk of and death from atherosclerosis of intracranial and or carotid arteries (calcified atheromas), heart failure, nocturnal cardiac dysrrhythmias, cardiac emboli and myocardial infarc-tion (heart attack), sudden death, ischemic stroke, and diabetes mellitus, which is a disease of the microvascula-ture. And, for the patient who is at risk for mitochondrial metabolic dysfunctions, their risk includes depression. [Hyman] Needless to say, no matter what the risk for a given patient, their profile includes stressed relationships and difficulty coping with the stresses of life. [Friedlander] Before the child patient becomes the adult patient, a referral to a competent ENT is a life-saving referral. Let’s look at the chronicity of disease. Mark Hyman, M.D. writes that chronic disease is rooted in the genetic predispositions of each person, along with the toxic environ-ment, nutrient-deficient diet, and resultant disruptions in normal energy metabolism and ATP produc-tion, resulting in mitochondrial dysfunction and impairment in criti-cal regulation of oxidative stress and breakdown in the methylation and sulfation. These metabolic processes gone awry put the patient at risk for 28 March/April 2011 JAOS whatever chronic presentation their genetic risk predisposition allows first. It was coffee break time in Las Vegas, at a continuing education conference on pediatric dentistry. After the lecture on airway pathol-ogy, a young dentist came up to me and asked if he could please speak to me. He led me to a quiet corner of the hotel where he said, almost apologetically, “I have all the symp-toms you just reviewed – even the bedwetting.” My heart went out to the young man, as he continued to explain, “It’s truly hard on my marriage, even though it happens only once in a while, and I was wondering if an ENT referral would possibly be a good idea.” My response – “Run, don’t walk, to the ENT, as soon as possible.” dentist can be the lifesaver, the life-transformer. The young general dentist’s husband was an editor for the Washington Post. Two smart cook-ies, truth be told, their precious 6 year old was failing first grade – if one can fail first grade. Indeed, little Keagen was disruptive, unable to focus on his work, and unable to get even one gold star on his papers. He never completed his papers. His parents were devastated when told that their son would have to leave the traditional public school and go to the alternative school. They knew this signaled the end of hope for their son to live a normal life. He faced a potential future in a group home or institution. Even his four psychotropic medications were not helping. The pediatric psychiatrist held out no hope either. The parents made a difficult decision not to have any more children, with the bleak future they saw for their little boy. Keagen’s mother heard my lecture about airway pathology, went home and called the pediatric psychiatrist. “Kay, I know you are desperate and looking for anything you can find,” he said, “But I wouldn’t hold out any hope for a solution as simple as the airway diagnosis and treat-ment.” Kay made the appointment anyway. The young ENT said, “Your child’s tonsils are huge, even though he has no signs of airway problems. The literature is pouring in, and those tonsils need to go.” Two months after the tonsillectomy and adenoidectomy, Keagen’s teacher asked the parents, “What did you do? This is a different child.” And sure enough, Keagen was bringing home gold stars on completed, beau-tiful school papers. Off all but one of the psychotropic meds, and wean-ing off that one, Keagen gave his parents hope again. Within a year, Kay was pregnant, and happy to be! Can you even imagine that a child who has behavioral, emotional problems and cannot live life as most children, could perhaps avoid being medicated for 18 or more years, and become “normalized” just through interventions that allow good nasal breathing? You can provide that miracle to your child patients. It’s a lot easier to “see” the prob-lem in a child who has snoring, “In a child with airway pathophysiology, expansion should be rapid and just short of buccal crossbite, to open the airway as much as possible.” Not a month later, I received a call to let me know that his symptoms were greatly diminished, and that included the enuresis! In fact, he was dearly hoping the fact he hadn’t had one episode in the month, meant that his enuresis was gone for good. No matter the symptoms, airway pathophysiology is not fun for the at-risk patient. However the future is even more bleak than the difficult present. And the
Journal of the American Orthodontic Society March-April 2011: Page 28
