Orthodontic treatments should not be used as preventive or standalone interventions for sleep-disordered breathing, according to a white paper published by the American Association of Orthodontists (AAO).
The paper by researchers across the USA and Canada found no evidence supporting the use of interventions such as maxillary expansion or functional appliances to prevent sleep-disordered breathing (SDB), including obstructive sleep apnoea, across a patient's lifespan.
The researchers also concluded there is no evidence linking routine orthodontic procedures, including dental extractions, to an increased risk of developing sleep-disordered breathing.
The review, published in the American Journal of Orthodontics and Dentofacial Orthopedics, updates a 2019 white paper from the AAO on the relationship between orthodontics and SDB.
In the latest paper, the authors said diagnosis and treatment planning for SDB should remain medically led, with polysomnography and clinical assessment continuing to represent the gold standard for diagnosing obstructive sleep apnoea.
The paper recommends orthodontists use structured screening and risk assessment approaches before referring patients for medical evaluation. Suggested tools include the Paediatric Sleep Questionnaire for children and the STOP-Bang questionnaire for adults.
It concluded: ‘Current evidence does not support that any orthodontic intervention, such as maxillary expansion or functional appliances, can prevent the development of SDB. There is no evidence to support the prophylactic use of pediatric palatal expansion as a preventive measure for SDB at any age.
‘As such, orthodontists should continue to base their treatment decisions primarily on underlying skeletal discrepancies, collaborating closely with physicians when SDBs are present.’
Researchers also advised against using cone beam CT scans or cephalometric imaging for screening, diagnosing or assessing treatment outcomes in sleep-disordered breathing, concluding that they have no diagnostic value for SDB.
The review found there is insufficient evidence to support routine frenectomy procedures for the prevention or treatment of sleep-disordered breathing, and said current research does not support ankyloglossia as a direct cause of obstructive sleep apnoea.
According to the paper, no specific craniofacial phenotype can reliably identify patients with sleep-disordered breathing, and airway dimensions observed on imaging should not be used as a substitute for medical diagnosis.
However, the paper found stronger evidence for the use of mandibular advancement devices in adult patients with obstructive sleep apnoea.
A meta-analysis of 33 studies involving 1,883 patients found that these devices improved the apnoea-hypopnoea index by 48-67% across different severity levels, though the authors noted long-term side effects, including irreversible tooth movement and occlusal changes, require careful consideration.