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. For this reason, all orthodontic specialists are all required to conduct research and use statistics as part of their training.
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 Prevent Sleep Apnea?
The idea that orthodontic treatment might prevent 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 could be beneficial to and maybe even prevent future breathing problems in treated patients. The two things an orthodontist can affect in this area are the dimensions of the palate (and the nasal cavity above it) and the oral cavity. The theory is that anything that increases the size of oral or nasal cavities would reduce the prevalence of sleep apnea.
Which Orthodontic Procedures Theoretically Prevent Sleep Apnea?
Orthodontic treatment can increase the size of the palate (along with the overlying nasal cavity and the underlying oral cavity) through palatal expansion. 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. Those who believe that non-extraction treatment prevents sleep apnea argue that moving the front teeth back any amount pushes the tongue towards the back of the throat, restricting the airway. Conversely, non-extraction treatment could theoretically prevent apnea by not pushing the tongue backward.
Is There Any Evidence That Orthodontic Procedures Prevent Sleep Apnea?
Those who claim to prevent sleep apnea through orthodontic treatment routinely reference studies that show that the prevalence of sleep apnea decreases in patients who have had palatal expansion during orthodontic treatment. Regrettably, these studies do not account for the natural growth that occurs at this age in all children (there was no non-treated group for comparison). In other words, natural nasal cavity growth (2 cm3 per year) may be responsible for the reduced prevalence of sleep apnea with or without palatal expansion. Similarly, there have been no definitive studies supporting the idea that moving the front teeth towards the tongue causes the tongue to close the airway. In fact, during most apnea “episodes,” the mouth is wide open, and the teeth are not touching the tongue at all.
No Orthodontic Procedure Prevents Sleep Apnea
To date, there is no scientific evidence that expanding the palate or keeping all the teeth prevents the future development of obstructive sleep apnea. As I explained in a previous blog post, obstructive sleep apnea occurs when the soft-tissue airway located at the back of the throat collapses. This collapse is multi-factorial, meaning it has more than one cause. Although anatomy may contribute (i.e., large tonsils or adenoids, obesity, etc.), tonicity problems due to muscular and nerve issues are usually independent of airway size. Many who suffer from breathing difficulties have normal or large airways. Current research does not justify the routine expansion (including non-extraction treatment) of all patients for the prevention of future obstructive sleep apnea.
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 OSA, but we are experts in orthodontics, and we want to provide the best care to our patients. Following the position paper of the American Association of Orthodontists, we do not believe that we can diagnose, prevent, or treat sleep apnea, nor do we cause it. We do feel that we can screen our patients to identify those who are at risk and refer them to qualified sleep physicians who have the appropriate tools to diagnose and treat their conditions. If a physician feels that a 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.