Last year, the American Journal of Orthodontics published a white paper which has summarised a long-time debate on obstructive sleep apnea (OSA) and the role of the orthodontist in its management. OSA is a serious health issue, which in its severe forms can become life-threatening.
The paper is written by Rolf G. Behrents, the editor-in-chief of the journal, and a number of medical and dental experts in sleep medicine. This is the paper every orthodontist should read, analyse and come up with his or her own conclusions. Here are mine…
- The prevalence rates of OSA are relatively significant, 14% for men and 5% for women.
- OSA can be diagnosed only by a physician, however the orthodontist should screen his patients for the symptoms and risk factors.
- A sleep questionnaire is a useful screening tool.
- Symptoms of OSA may include sleepiness and fatigue during the day as well as breath holding and choking at night.
- The most common risk factors are hypertrophic tonsils/adenoids and obesity. As a result, these conditions should be addressed as the first line of treatment.
- The golden standard for OSA diagnostic is polysomnography.
- Neither 2D nor 3D imaging of the airways should be used to diagnose OSA. This is firstly because of the differences when the patient is asleep versus awake, and secondly because such images are just snapshots of a specific moment of the breathing cycle.
- Conventional orthodontic treatment has never been proven to be an etiologic factor in the development of OSA.
- Studies reveals no difference between extraction and non-extraction treatment in relation to the airway volume.
- There is some evidence that rapid maxillary expansion in mixed-dentition can alleviate the symptoms of OSA both short and long term, however should not be used as prophylaxis.
- Surgical maxillary advancement is a viable method to help adult patients with severe OSA.
- There is not enough evidence to suggest that miniscrew-assisted rapid maxillary expansion should be used in the management of OSA patients.
I am finishing this post with an extraction case of mine. Obviously, the changes in the teenager’s airways should not be ascribed to my treatment.