Orthodontists are specialists in straightening teeth and fixing bites. As doctors, we are always looking for the best ways to give our patients the most attractive, healthy smiles possible. If there is a treatment that is better, faster, or less expensive, we want to provide that treatment. At the same time, we have an obligation not to imply that we can prevent or cure disease if there is no proof supporting that claim. Doctors also have a responsibility to make sure the treatment we provide does not harm our patients now nor in the future. An essential part of being a doctor is the ability to evaluate the science behind various treatment approaches and not be swayed by clever marketing or popular trends.
Is There a Relationship Between Orthodontics and Obstructive Sleep Apnea?
One area of medicine that has been of particular interest to orthodontists in the past two decades is Obstructive Sleep Apnea (OSA). Because the teeth are close to the airway, it is not surprising that some have suggested a relationship between their position and the prevalence of this disorder. If science could prove that some orthodontic techniques either prevent or cure OSA, we would want to provide that treatment. Additionally, if we knew that specific techniques cause or worsen the condition, we would want to avoid those. For these reasons, the orthodontic specialty (through the American Association of Orthodontists) performed a two-year review of over 4,000 scientific studies to determine what, if any relationship exists between orthodontics and OSA. The results of this study were published in 2019 and are the basis for my four blog posts addressing the relationship between orthodontics and sleep apnea. I am not an expert on OSA. This post merely reports the findings of the AAO task force that WAS comprised of experts, so please don’t kill the messenger.
Why Do Some Believe that Orthodontic Procedures Can Cure Sleep Apnea?
The idea that orthodontic treatment might be used to treat obstructive sleep apnea arises from the belief that “bigger is better” when it comes to the airway. At first glance, it is logical to conclude any procedure that increases the size of the airway may improve or eliminate breathing problems in treated patients. The only two things an orthodontist can affect in this area are the sizes of the palate (and the nasal cavity above it) and the oral cavity. The theory is that anything that increases the sizes of oral or nasal cavities could improve or eliminate sleep apnea.
Which Orthodontic Procedures Have Been Credited with Curing Sleep Apnea?
Whether anchored to the teeth, the soft tissue, or the underlying bone, palatal expanders can broaden the dental arches and increase the volume of the oral and nasal cavities. Orthodontic alignment that makes the arches wider or moves the front teeth forward also increases the size of the oral cavity. Arch expansion occurs in most routine orthodontic treatment with or without extractions. Proponents of orthodontic treatment to treat sleep apnea believe that non-extraction treatment moves the front teeth forward allowing the tongue to move away from the back of the throat, thereby increasing the size of the airway.
Is There Any Evidence That Orthodontic Procedures Cure Sleep Apnea?
There are clearly examples of patients who received orthodontic treatment and experienced an improvement in or the elimination of their sleep apnea. To date, however, there have been no definitive studies demonstrating that palatal expansion or non-extraction treatment improve or eliminate obstructive sleep apnea. As explained in my post on the prevention of sleep apnea however, there has yet to be any research that take into account the normal growth that occurs in all patients during the ages these studies were conducted (specifically, there were no control groups). So, while there may be studies that show improvement, they have not been able to show that the improvement is due to the orthodontic treatment. Remember that obstructive sleep apnea is a multi-factorial disease that occurs when the soft-tissue airway at the base of the tongue collapses. The sizes of the oral and nasal cavities are only two of the variables.
Orthodontists Can Be Part of a Team That Treats Sleep Apnea
Although orthodontists cannot diagnose or treat sleep apnea on their own, they can be part of a team of doctors who work together to treat this condition. If the sleep team, led by a sleep physician, feels that an orthodontic procedure is required as part of an overall treatment plan, an orthodontist is the most qualified to provide that service. Examples of such procedures include palatal expansion (in patients with true upper jaw underdevelopment) and orthodontic treatment required as part of jaw advancement surgery (coordinated with an oral surgeon). There is also a branch of dentistry devoted to constructing the oral appliances used by sleep doctors to treat sleep apnea. While these appliances do help patients sleep better when they are worn, they do not cure the condition.
The Role of the Orthodontist in the Treatment of Sleep Apnea
At Jorgensen Orthodontics, we recognize our role in the treatment of sleep apnea. We are not experts in sleep apnea, but we are experts in orthodontics, and we want to provide the best, safest care to our patients. If there are procedures that help our patients, we want to provide those. If there are procedures that are not beneficial, we will avoid those. In accordance with the position paper of the American Association of Orthodontists, we do not believe that we can diagnose, prevent, or cause sleep apnea in our patients. We do feel that we can screen our patients to identify those who are at risk and refer them to a qualified sleep physician who has the appropriate tools to diagnose and their condition. If the physician feels that the patient would benefit from orthodontic treatment, we can provide that service.
NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa. Dr. Jorgensen’s 29 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is provided to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.