Orthodontic Treatment of OSA

1. In the pediatric population, it is well established that enlarged tonsils and adenoids contribute to sleep disordered breathing and malocclusion.
2. The literature is rich with scientific evidence that maxillary expansion is often curative in children as treatment for sleep-disordered breathing.
3. The capability of bony expansion of the facial bones in adults is controversial within the orthodontic field.
4. Singh et al (2014) has shown promising results with adult nonsurgical expansion in treating sleep disordered breathing (SDB).  They demonstrated that their expansion device technology (the DNA Appliance) improved the AHI scores by 65% in 10 adult patients.
5. The improvement in SDB demonstrated by Singh is attributable to the remodeling of the mdfacial bones and the upper airway in these subjects and this was demonstrated on CBCT scanning.  This method of expansion for the treatment of SDB was shown to be successful regardless of age or gender.
6. There appears to be ample evidence that the extraction of bicuspids for orthodontics narrows the arches and predisposes adults to SDB later in life.  Adults with normal BMI’s and SDB often have had 4 bicuspids extracted for orthodontic reasons.
7. The Damon system of fixed orthodontics has been shown to widen the dental arches and reduce the severity of OSA.
8. Adult orthodontics may have the potential to adequately treat OSA with or without other additional modalities (such as Oral Appliances).