Orthodontic Therapies for Breathing Disorders

Introduction

Sleep-Disordered Breathing (SDB) is a condition that impairs airflow during sleep. These can lead to fragmented sleep, behavioral changes, cardiovascular strain, and developmental concerns in children.

For severe obstructive sleep apnea (OSA), the gold standard treatment is CPAP (Continuous Positive Airway Pressure). However, individuals with severe OSA who cannot tolerate CPAP, and those with mild to moderate OSA, may benefit from orthodontic therapies. It’s important to note that orthodontists do not diagnose or treat OSA. Instead, they provide supportive airway devices in collaboration with sleep physicians to improve outcomes.

Common Symptoms:

Snoring

Mouth breathing

Grinding (bruxism)

Daytime fatigue or sleepiness

Restless sleep

Difficulty concentrating

Hyperactivity

Morning headaches

Dental Signs:

Narrow, high-arched palate

Crowded or misaligned teeth

Retrognathic (retruded) mandible

Large overjet or open bite

Tongue thrust or low tongue posture

Dental Causes:

Maxillary constriction

Mandibular retrusion

Enlarged adenoids or tonsils

Nasal obstruction

Orthodontic Therapies

1. Rapid Palatal Expansion (RPE)

Purpose: Widen the upper jaw to increase nasal cavity volume and improve nasal airflow.

Evidence: Increases nasal and nasopharyngeal volume in children. Benefits are most notable in the short term (Niu et al., 2020).

2. Mandibular Advancement Devices (MADs)

Purpose: Reposition the lower jaw forward during sleep to prevent airway collapse. Primarily for adults with mild to moderate OSA or those with severe OSA intolerant to CPAP.

Evidence: Effective as a CPAP alternative in improving AHI and sleep quality (Sharples et al., 2016).

3. Functional Orthopedic Appliances (e.g., Bionator, Twin Block, Herbst). Purpose: Advance the mandible in growing children, correcting skeletal discrepancies and enlarging airway volume.

Evidence: Randomized trials show improvements in oropharyngeal dimensions and breathing in Class II children (Radwan et al., 2024).

Conclusion

Orthodontic interventions such as Rapid Palatal Expansion (RPE), Mandibular Advancement Devices (MADs), and functional orthopedic appliances offer promising avenues for managing SDB. These treatments not only address dental and skeletal discrepancies but also play a crucial role in enhancing airway dimensions and improving respiratory function. Early consultation with an orthodontist and coordination with a sleep physician ensures the best outcomes for patients with compromised airway.

References

Niu X., Di Carlo G., Cornelis M.A., Cattaneo P.M. (2020). Three-dimensional analyses of short- and long-term effects of rapid maxillary expansion on nasal cavity and upper airway: A systematic review and meta-analysis. Orthod Craniofac Res; 23(3):250–276. https://doi.org/10.1111/ocr.12378

Sharples L.D. et al. (2016). Meta-analysis of randomized controlled trials of oral mandibular advancement devices and CPAP for OSA-hypopnea. Sleep Med Rev; 27:108–124. https://doi.org/10.1016/j.smrv.2015.05.003

Radwan E.S., Maher A., Montasser M.A. (2024). Effect of functional appliances on sleep-disordered breathing in Class II division 1 malocclusion children: A randomized controlled trial. Orthod Craniofac Res; 27(1):126–138. https://doi.org/10.1111/ocr.12696

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