Sleep Disordered Breathing: Not Just for Grown Ups

By Jenna Katz Schwibner, DMD, FAGD

June 12th, 2020

The American Academy of Sleep Medicine estimates that 12% of the U.S. adult population has obstructive sleep apnea (OSA), creating a $149.6 billion drag on the economy each year and increasing risks for hypertension, heart disease, diabetes and depression.

When we don’t properly breathe while sleeping, the lack of oxygen produces a “fight or flight” response within the body. The consequences are the aforementioned major health risks as it increases inflammation and inhibits the body’s ability to heal. Links have also been made to things like early on-set dementia, stroke and even nighttime trips to the restroom – something previously just thought of as a symptom of getting old.

Dentists are the first line of defense in identifying the risk indicators associated with both OSA and its many milder forms referred to generally as sleep disordered breathing (SDB). The warning signs of a restricted airway include acid-eroded teeth, tongue ties, scalloped boarders around the tongue and a poorly developed jaw.

Solutions for OSA and SDB range from oral appliances to CPAP machines. However, these are band-aids to the symptoms, never actually treating the cause. With a complete dental evaluation our aim is to not only treat breathing issues at night, but for the entire day as well. Through a partnership with other medical specialists, there are a variety of treatments available to restore proper nasal breathing and reduce harmful airway constrictions.

What was once thought to be a condition stereotyped for overweight Sleep Disordered Breathing: Not Just for Grown Ups individuals over the age of 50 is now known to be prevalent across all ages and body types. Sadly, over 40 million children also suffer from SDB with studies linking to ADD/ADHD, delayed and stunted growth, aggressive behavior, speech impediments, poor academic studies and much more. The nighttime bathroom trips suffered by some adults are also often realized as bed wetting among children.

Evolution, genetics, bottle feeding and adolescent diets are all causing increased incidents of SBD in children. Thankfully, new evidence-based research suggests that through interceptive orthodontic techniques a dentist may help develop the jaw properly and decrease the chance of a child developing SDB and OSA. So, while we continue to make advancements on the treatment of these disorders for adults, we are also learning how to correct the underlying cause from an early age… something I look forward to sharing more of in my next article.

Dr. Schwibner, is the practice owner of Dental Partners of Vero Beach and Dental Buddies of Vero Beach. For additional information about this topic or any other topic related to dental care please call 772.569.4118 or visit VeroBeachDentist.com.

Dr. Schwibner’s article “The Inflammation Connection” is part of a series of articles written for Heartbeat of the Treasure Coast, A Local Health, Wellness and Fitness Digest.  As a special feature writer, Dr. Schwibner is featured 3 times a year as a dental professional.
Heartbeat Volume 138

Written by: Tom Lloyd  for 32963

March 24, 2020

Doctor Helps Spread Word About Pediatric Sleep Apnea

Dr. Jenna Schwibner [Photo: Denise Ritchie]

As if parents didn’t have enough to worry about, the Mayo Clinic, Johns Hopkins All Children’s Hospital and local dentist Dr. Jenna Schwibner of Dental Partners of Vero Beach all agree obstructive sleep apnea is something that should be added to every parent’s and grandparent’s check list.

And maybe even to their “worry” list.

The Mayo Clinic says “pediatric obstructive sleep apnea is a sleep disorder in which your child’s breathing is partially or completely blocked repeatedly during sleep. The condition is due to narrowing or blockage of the upper airway during sleep,” and the consequences can be dire.

“Early diagnosis and treatment,” says the Clinic, “are important to prevent complications that can affect children’s growth” and health.

Indeed, it goes on to say “children with sleep apnea might perform poorly in school; have difficulty paying attention; have learning problems; have behavioral problems, poor weight gain or be hyperactive.”

Or, as the American Sleep Apnea Association puts it, “the evidence is steadily growing that untreated pediatric sleep disorders, including sleep apnea, can wreak a heavy toll,” on any child.

The ASAA points out that “as many as 25 percent of children diagnosed with attention-deficit hyperactivity disorder may actually have symptoms of obstructive sleep apnea and that much of their learning difficulty and behavior problems can be the consequence of chronic fragmented sleep.”

Hopkins is equally blunt when it says “sleep apnea in children may be difficult to recognize and diagnose and may show up as daytime behavioral problems or bedwetting,” and it adds “there are differences between pediatric obstructive sleep apnea and adult sleep apnea.

“While adults usually have daytime sleepiness, children are more likely to have behavioral problems.”

Schwibner says “we’re seeing 90 percent of kids showing one kind of sign or symptom of sleep-disordered breathing.”

She adds that does not mean 90 percent of children have obstructive sleep apnea, but the statistic does draw attention to some caution flags; one of the most common of those flags is persistent mouth-breathing.

“What we’re seeing,” Schwibner continues, “is that nasal breathing is extremely important; that’s well documented. Everybody, all the doctors, know that the nose is the important filtration system of the body. The nose purifies, moistens and warms the air as we are breathing it. So, if we breathe it through our nose, we’re getting proper filtering. What happens when we mouth-breathe is all those toxins are going into our tonsils and adenoids causing [them] to become really swollen because our nose isn’t filtering it.”

And, moving on to a more traditional area of dental expertise, Schwibner adds, “we were taught in dental school that some mild grinding of the teeth in kids is just something normal that you grow up and you grow out of. But now they’re showing that 70 percent get worse and only 30 percent will self-correct. So [most of those teeth-grinding children] are not just going to get better on their own.”

While pediatric sleep apnea is clearly a hot-button issue for Schwibner, she says “when it comes to sleep apnea, I’m not diagnosing it.” She is, however, ready, willing and able to help pediatricians, otolaryngologists and ENTs screen for it.

“One of my plans is to partner with a lot of the [pediatric] physicians in town, because this isn’t something that is well known. We have great pediatricians in town, and I have some great relationships with them. So, part of our goal is to do some educational evening events. Once they know more about it, they’re going to start seeing these things” in their pediatric patients.

To bolster her current effort to spread the word about pediatric sleep apnea, Schwibner says she’s planning to open a new, separate office in June of this year aimed at children.

In Schwibner’s eyes, a parent’s best bet is to talk with their child’s pediatrician or otolaryngologist if they notice their child snoring, tossing and turning in their sleep or consistently breathing through their mouth instead of their nose.

She can provide parents a sleep questionnaire to fill out or help arrange a take-home sleep study. She can also provide orthotic devices a child can wear at night that help train them to breathe through their nose.

“As long as they don’t have an anatomical reason why they can’t breathe through their nose,” says Schwibner, “it’s going to retrain them to breathe properly through their nose,” and that may just be the key to reducing obstructive sleep apnea in children.

Dr. Jenna Katz Schwibner is the practice owner at Dental Partners of Vero Beach. Her main office is at 3790 7th Terrace, Suite 201. The phone number is 772-569-4118. The office geared for young patients is scheduled to open in June.

The Inflammation Connection

by Jenna Katz Schwibner, DMD, FAGD

Flip through the pages of your favorite lifestyle magazine and you are bound to come across the topic of Inflammation, which we now understand is at the root cause of almost all ailments and diseases. But what is inflammation, anyway?

Turns out it’s your body’s natural response to fix an injury or infection. However, when an issue persists and is too severe to resolve on its own it can become chronic. One of the most prevalent examples is Periodontitis, commonly known as Gum Disease, and this is highly correlated to other major health conditions. Therefore, it turns out that a major source and/or identifier of inflammation throughout the entire body is in your mouth.

As a graduate and ambassador of The Dawson Academy (www.findadawsondentist.com) I have been trained to be a problem solver. I focus on the “Why” and identify how to correct problems at their source and prevent them from reoccurring. Patient exams at my office can last up to an hour, where we dive deeper to practice what we call “Complete Dental Care for Complete Health”.

There is a strong connection between oral health and overall health; problems within your mouth can often be warning signs as either the cause of other ailments or a sign that one already exists. By taking time to uncover the bigger picture we can do our best to ensure the prescribed treatment will be the most effective one and hopefully decrease the need for re-treatment; ultimately offering opportunities to partner with your other medical professionals and improve your overall health in a collaborative manner.

The basics include the prevention of cavities, which lead to broken and abscessed teeth and then progress to root canals and extractions. The not so obvious are things like enlarged tonsils and adenoids, acid reflux, grinding of teeth and oral cancer. All of these and more should be screened for through a comprehensive oral exam, as they are precursors to more serious issues like diabetes, high blood pressure, cardiovascular disease and sleep apnea.

The scientific relationship between oral health and your overall wellness is strong. A properly trained dentist, focusing on comprehensive care, should be your first line of defense against all inflammation-related disorders and diseases.

Dr. Schwibner’s article “The Inflammation Connection” is part of a series of articles written for Heartbeat of the Treasure Coast, A Local Health, Wellness and Fitness Digest.  As a special feature writer, Dr. Schwibner is featured 3 times a year as a dental professional.

Heartbeat Volume 137

Dental Partners of Vero Beach Opens New Practice In Style

January 28th, 2020

Dr. Jenna Katz Schwibner and her husband Jeremy of Dental Partners of Vero Beach hosted a Grand Opening Celebration, on January 28th , of their new dental practice located at 3790 7 th Terrace in Vero Beach. The Schwibner’s were joined by The Indian River County Chamber of Commerce’s President Dori Stone for at a ribbon-cutting ceremony. During the event patients, colleagues, friends, family and neighbors enjoyed socializing and touring the new state of the art practice.

Jenna Katz Schwibner expressed her excitement about opening the new office and said she is looking forward to providing the best possible dental care for all of her patients in the new space.

In The News!

Oct. 29, 2019

Dental Partners of Vero Beach recognized by The Chamber as Business of The Year

We are honored and thrilled to have been chosen to be the 2019 Minority Owned Business of the Year by the IRC Chamber. Each year businesses are presented Industry Appreciation Awards for various achievements. Our award recognizes our company’s employee recognition and support, community and philanthropy support and overall success with our contribution to the county. Thank you to the chamber, the economic development committee, our employees, who are the best team in the profession and our patients who contribute to our success by allowing us to provide your complete dental care for your complete health. Thank You!

Dr. Jenna wins “Top Dog” of the year for restoring the most implants in her team

For the second year in a row Dr. Jenna has been awarded the “top dog award” for restoring the most implants in her ASIRD (American Society of Implant and Reconstructive Dentistry) team. Dr. Jenna restored over 120 implants this year! A big thank you to Dr. Andrew Colgan, our oral surgeon, for making the experience seamless for our patients and for doing the placement so perfectly. Dr. Brad Purcell teaches ASIRD teams throughout America and said he was extremely impressed as there are no other doctors in any of the other teams that restore even close to 120. His other top docs are restoring around 60 implants! Wow!

Dentists Become First Line of Defense Against Sleep Apnea

 

Written by: Tom Lloyd for 32963

Everybody knows – or thinks they know – what to expect from a trip to the dentist. But Dr. Jenna Katz Schwibner at Dental Partners of Vero Beach is quick to point out there’s a lot more to modern dentistry than just a twice-a-year cleaning and filling cavities.

Like, for instance, saving your life.

Life-saving and dentistry might sound like a big slice of hyperbole pie from an American Dental Association advertising campaign, but it’s not.

According to the Centers for Disease Control, more than a quarter of the U.S. population suffers from some kind of sleep disorder, and the National Institutes of Health estimates about 18 million Americans have a potentially lethal affliction called “obstructive sleep apnea,” or OSA.

The American Journal of Respiratory and Critical Care has linked OSA to an increased risk for developing diabetes, depression, memory loss or confusion, sexual dysfunction, high blood pressure, weight gain and, yes, fatal strokes.

“OSA occurs when your throat muscles over-relax, causing the airway to collapse, blocking proper airflow, and temporarily preventing you from breathing,” according to toothwisdom.org, a website specializing in oral care for older adults. “When breathing is interrupted your body reacts by increasing your heart rate in order to maintain proper oxygen levels. Over time, this may cause other changes to your body and lead to poor breathing and increased carbon dioxide levels.”

And it turns out dentists are in a good position to spot the signs and symptoms of this serious condition that doctors might not always pick up on.

“It’s getting to the point now where dentists are becoming part of the first line defense with sleep apnea,” Schwibner says. “We’re one of the primary practitioners to help with it.”

Schwibner continues: “When people see their medical doctor, it’s often more of a sick visit. They see their doctor only when they’re not feeling well. But the majority of our patients aren’t in pain when they come in. They’re just getting their teeth cleaned and getting maintenance and so we see people a lot longer.”

Schwibner says patients “don’t typically think that they’re sick when they have sleep apnea. A lot of times they have no idea they have it. It’s a silent killer, if you will. If we can notice these things on regular check-ups, that’s a really big advantage, and then we can get them in to see their doctor.”

The diminutive Schwibner is quick to add “a dentist cannot tell a patient or diagnose that they have sleep apnea. You always need a sleep study to confirm the diagnosis,” but there are signs a dentist is likely to spot that a primary care doctor, a cardiologist or other specialist might not notice immediately.

For example, “a lot of people, they stick out their tongue and they actually have little indentations on the side of their tongue. We call that a scalloped tongue. It goes into the indentations all around the teeth on the inside and 81 percent of people who have that have some form of sleep apnea. And that’s something that only a dentist would see.”

Likewise, people who grind their teeth at night; Schwibner says teeth grinding is “a big sign for us” that they might well have OSA.

And while OSA is most common in men, it is something of an equal-opportunity health threat. Especially as we age. Postmenopausal women, says Schwibner, are at as high risk as men and the problem is often compounded by the use of sleeping pills.

“The sleeping pill keeps you from waking up due to sleep apnea. It’s actually hurting you even more because your body is trying to wake you up for a reason. It’s trying to warn you, like, ‘Hey, wake up. Breathe.’ And if you’re taking sleeping pills, that response isn’t there anymore.”

While Continuous Positive Airway Pressure or CPAP machines are “always the first line” of defense for OSA patients, according to Schwibner, fully half of patients find they cannot tolerate using those devices.

Fortunately, dentists like Schwibner who are trained in sleep apnea management can provide an alternative: a “mandibular repositioning dental appliance.” The American Academy of Dental Sleep Medicine calls these “an effective treatment option for snoring and obstructive sleep apnea,” for those who cannot tolerate a CPAP machine, but there is an important caveat here.

TV commercials have begun offering devices people can order by phone or online, but Schwibner warns not only are these not custom-fitted, they’re “not something that has any medical research backing or any studies showing [their] efficacy. It’s definitely not something that we recommend.”

Schwibner, whose local roots run through Sebastian River High School, Vanderbilt University and Nova Southeastern’s College of Dental Medicine, is the daughter of longtime Vero Beach physician Dr. Edward Katz.

Dr. Jenna Schwibner is with Dental Partners of Vero Beach at 3755 7th Terrace, Suite 303. The phone number is 772-569-4118.

Reference Article

Dental Partners of Vero Beach Bringing Beautiful Smiles to Hope for Families Center’s Families

 

Written by: Jamie Jackson, For Luminaries

Because dentistry is a large expense for families struggling to get back on their feet, the team at Dental Partners of Vero Beach wanted to make a difference in a big way.

They had previously assisted with dental cases at the Hope for Families Center, and following careful research of several nonprofits, they agreed the center’s mission was one that was aligned with their vision to provide the greatest level of community impact.

“We were inspired to serve the families at HFC because we saw parents who are actively engaged in establishing a foundation of stability for their children and good dental health for the family is an essential part of that equation,” said Dr. Jenna Katz Schwibner. “A beautiful smile instills confidence in a job interview. Children without tooth pain do better in school and have fewer sick days. And good dental health prevents many health risks such as heart disease and asthma.”

The center’s mission is to break the cycle of homelessness by providing the foundation for a sustainable life for families with children. They accomplish this through the Shelter Program that includes 21 family rooms with two twin bunkbeds each. Families share bathing, laundry, dining, parking and recreational areas within the center. A resident family’s average stay is 89 days.

As part of the program, motivated parents agree to drug and alcohol testing, establishing employment, creating a household budget and saving 75 percent of income (or three months’ rent). Specialized case managers work with parents to identify and secure permanent housing, navigate services needed by the family from within the community and to facilitate children’s enrollment in school, child care or school break camps.

Families that successfully complete the first 30 days of the Shelter Program are eligible to access free dental care through a program that Dental Partners of Vero Beach recently introduced.

“Our collaboration with Dental Partners of Vero Beach is a perfect example of how local businesses can make a huge difference in a family’s life,” said Dr. Diana Grossi, the center’s executive director.

Dental Partners will provide a comprehensive scope of general dentistry services including, but not limited to, cleanings, fillings, implants, cosmetic dentistry and dentures. But, they aren’t stopping there. They are working on developing partnerships with other providers to provide dental and healthcare services, which are outside their scope of expertise. Also going beyond dental care, the team is working on recruiting local hair stylists that can provide free cuts to prepare parents for job interviews and children for school.

The Hope for Families Center, a 501(c)3 nonprofit organization, is a United Way of Indian River County agency partner, which also is supported locally through private philanthropy and grants from Indian River Community Foundation, the Leo and Peggy Pierce Family Foundation, John’s Island Community Service League, John’s Island Foundation and Grand Harbor Community Outreach.

To learn about the center’s Shelter Program or Dental Partners of Vero Beach visit hopeforfamiliescenter.org or verobeachdentist.com.