← Children 0–12
Most children never receive an orthodontic airway assessment. Has your child had one? Early screening can change their development, sleep and health for life.
2022
The year the AAPD officially introduced its screening tool
WHY IT MATTERS
A child’s airways take shape from the very first years of life
The way your child breathes – through the nose or the mouth – affects jaw and facial development, the bite, sleep quality and concentration. A paediatric airway assessment is not just dentistry. It is an investment in your child’s overall health.
For years there was no standardised screening tool. In 2017, the scientific community formally recommended including airway assessment in routine dental care for the first time. Five years later, the American Academy of Pediatric Dentistry (AAPD) created an official screening form.
SCIENTIFIC BACKGROUND
Two landmark documents
2017
Airway Screening as Part of Routine Pediatric Dental Care
Landmark research published in 2017 formally recommended, for the first time, including airway assessment in standard dental care for children. The authors noted that paediatric dentists are uniquely positioned – they see the child regularly, often before clinical symptoms of sleep-disordered breathing appear. Particular attention was given to assessing the palatine tonsils and the Mallampati classification as part of the routine oral examination.
American Academy of Pediatric Dentistry – Policy on Obstructive Sleep Apnea (OSA), Reference Manual of Pediatric Dentistry 2017
2022
The official AAPD Screening Form – Pediatric Airway Assessment
In 2022, the American Academy of Pediatric Dentistry (AAPD) published the first official, standardised airway assessment form for children. The tool covers a general history, daytime indicators (mouth breathing, irritability, daytime sleepiness), sleep history (snoring, apnoea, teeth grinding) and clinical elements of the physical examination. The form is part of the official Reference Manual of Pediatric Dentistry and is available to all paediatric dentists as a practical tool.
AAPD – Pediatric Airway Assessment Form, Reference Manual of Pediatric Dentistry 2022–2023
6 warning signs
Mouth breathing
– during the day, at night or at rest. May lead to a narrow palate and malocclusion.
Snoring and restless sleep
– loud snoring and tossing at night – possible signs of paediatric sleep apnoea.
Teeth grinding (bruxism)
– night-time bruxism is often a response to micro-arousals caused by obstructed breathing.
Difficulty concentrating
– sleep-disordered breathing can mimic or intensify ADHD symptoms.
Daytime sleepiness
– a child who sleeps a lot yet is still tired may not be reaching the deep, restorative stages of sleep.
Narrow palate / malocclusion
– a high-arched palate, crossbite or open bite directly affects the space available for the airways.
Why an orthodontist, not a paediatrician?
An orthodontist sees the child regularly – the oral examination, X-rays and craniofacial assessment create a unique opportunity for early screening. The AAPD explicitly points to paediatric dentists and orthodontists as specialists uniquely positioned to detect breathing disorders.
Screening is painless, quick and can change your child’s entire childhood.
The Mallampati classification – a visual assessment of throat structures
The higher the class, the greater the risk of airway obstruction and sleep-disordered breathing.
Class I
Tonsils, palatal arches and uvula fully visible. Minimal risk.
Class II
Arches and uvula visible, tonsils partly hidden. Low risk.
Class III
Only the soft palate and the base of the uvula visible. Elevated risk.
Class IV
Only the hard palate visible. High risk – a consultation is indicated.
The Brodsky scale – degree of palatine tonsil enlargement
The higher the grade, the greater the risk of airway obstruction and paediatric sleep apnoea.
Grade 0
Tonsils removed or not visible.
Grade 1+
Tonsils hidden behind the palatal arches.
Grade 2+
Tonsils reach the palatal arches.
Grade 3+
Tonsils extend beyond the palatal arches.
Grade 4+
Tonsils meet at the midline – complete obstruction.
Screening is painless, quick and can change your child’s entire childhood.
Sources: AAPD Policy on Obstructive Sleep Apnea (2017); AAPD Pediatric Airway Assessment Form, Reference Manual of Pediatric Dentistry 2022–2023, pp. 666–667; De Ridder L. et al., Int J Environ Res Public Health, 2022; AAO – first orthodontic examination at age 7.
Keep it simple, smile.
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