The use of Orthodontics in the prevention and treatment of OSA

Conditions such as a retruded mandible, narrow arches, and high palate all contribute to an increase in sleep apnea. If these jaw characteristics increase the risk of sleep apnea, then the treatment and prevention of these conditions, especially at a young age, should decrease the severity of obstructive sleep apnea and in some patients completely eliminate it. For the purpose of this discussion, we will focus on the retruded mandible.

A retruded mandible restricts the airway. When the B point on a lateral ceph is more posterior compared to the A point this indicates a skeletal class II division I malocclusion. This can severely impact the airway and these patients may be ideal candidates for a mandibular advancement appliance. Typically these patients have a higher AHI/RDI when sleeping in a supine position as the supine position causes the lower jaw to retrude even further. Avoiding sleeping in a supine position will help these
patients.

Can the use of orthodontics help with the prevention or treatment of sleep apnea? We all know that Orthodontics is not just the application of straightening teeth. It is also the art of correcting the skeletal relationship as well. Orthodontics can be done in two phases. Phase 1 orthodontic treatment allows for treatment before all the adult teeth have erupted. Phase 2 or adult orthodontic treatment is done when all the adult teeth have already erupted.

In phase 1 orthodontic treatment, we have the best chance in correcting a retruded mandible. The use of functional appliances on a child such as Twin Block for patients under the age of 11 can be very useful to advance the mandible orthodontically. For
patients over the age of 11, a fixed appliance like the MARA (Mandibular Anterior Repositioning Appliance) may be used along with the fixed Herbst appliance. The use of mini implants with fixed functional appliances has become a popular and predictable way
in treating severe skeletal class II occlusions.

Orthognathic surgery to advance the mandible can be used with adult patients who have already gone through their growth spurt. These patients are considered to be in Phase 2 orthodontic treatment and require full braces to compliment the skeletal correction.

Whether one does traditional orthodontics in their practice or not, we as dentists have a duty to discuss these options with our patients and their parents. We need to inform our patients that orthodontic treatment can help reduce the risk of obstructive sleep apnea at a young age. Together we can heal our patients, comprehensively, with compassion and skill.

Dar Radfar DDS practices in Thousand Oaks California. Dr. Radfar is accredited by the American Academy of Dental Sleep Medicine. Since 2007, he has been treating Sleep Apnea and Snoring patients. He provides professional lectures on the practice of Obstructive Sleep Apnea dentistry, how to screen for the condition, types of appliances to use, and how to get reimbursed for the services provided through medical insurances. For information on these lectures http://conta.cc/1iLSdMG

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