Orthodontic Therapies in the Context of Breathing Disorders

Introduction

Sleep-disordered breathing (SDB) refers to a spectrum of conditions characterized by impaired airflow during sleep. These conditions may be associated with disrupted sleep architecture, daytime fatigue, behavioral changes, cardiovascular strain, and developmental concerns, particularly in children. Medical diagnosis and management of SDB, including obstructive sleep apnea (OSA), are directed by physicians and are commonly established through sleep studies.

For individuals with moderate to severe OSA, continuous positive airway pressure therapy remains the primary treatment. In selected cases, including individuals with mild to moderate OSA or those unable to tolerate CPAP, adjunctive dental or orthodontic interventions may be considered as part of coordinated care. Orthodontists do not diagnose or treat OSA. Their role is limited to addressing craniofacial and dental factors that may influence airway anatomy, in collaboration with sleep physicians when indicated.

Clinical Features Commonly Associated With SDB

Children and adults with sleep-disordered breathing may present with snoring, habitual mouth breathing, nocturnal bruxism, daytime sleepiness, restless sleep, difficulty concentrating, hyperactivity, or morning headaches. These features are non-specific and require medical evaluation for diagnosis.

From an orthodontic perspective, associated dental and craniofacial findings may include a narrow, high-arched maxilla, dental crowding or malalignment, mandibular retrusion, increased overjet, open bite, and altered tongue posture. These findings may coexist with breathing concerns but do not establish causation.

Anatomical and Airway-Related Considerations

Craniofacial factors that may be associated with airway restriction include maxillary constriction and mandibular retrusion. Upper airway obstruction may also relate to enlarged adenoids or tonsils and nasal obstruction, which fall within medical scope and require physician assessment.

Orthodontic Interventions Considered in Coordinated Care

Orthodontic and orthopedic interventions may be considered to address dentofacial anatomy that is associated with airway dimensions. These approaches are supportive in nature and are not a substitute for medical diagnosis or management of sleep disorders.

Rapid Palatal Expansion

Rapid palatal expansion is used in growing patients to address maxillary constriction. Expansion of the maxilla may be associated with short-term increases in nasal and nasopharyngeal volume. Reported effects on airway dimensions vary among individuals, and long-term respiratory outcomes are not uniform.

Mandibular Advancement Devices

Mandibular advancement devices are prescribed under the direction of a sleep physician, primarily for adults with mild to moderate OSA or for individuals with severe OSA who cannot tolerate CPAP therapy. These appliances function by repositioning the mandible anteriorly during sleep to reduce airway collapse. Their use and effectiveness are determined through medical oversight.

Functional Orthopedic Appliances

Functional orthopedic appliances may be used in growing patients to guide mandibular position and address skeletal discrepancies. In selected pediatric populations, these appliances have been associated with changes in oropharyngeal dimensions. Effects on breathing are variable and must be interpreted within the context of growth, skeletal pattern, and medical evaluation.

Conclusion

Orthodontic and orthopedic interventions may play a supportive role in the multidisciplinary management of sleep-disordered breathing by addressing dentofacial anatomy associated with airway dimensions. These approaches do not diagnose or treat sleep apnea and are implemented only in coordination with sleep physicians and other medical providers. Early orthodontic evaluation may assist in identifying craniofacial patterns relevant to airway assessment, while treatment decisions remain individualized and guided by medical diagnosis and growth status.