Airway Orthodontics

When most people think about orthodontics, they think about straight teeth and a beautiful smile. And while those are certainly important parts of orthodontic treatment, orthodontics is also about function—how the teeth, jaws, tongue, muscles, and airway work together.

As an airway-aware orthodontic practice, we believe it is important to look at the whole picture. That doesn’t mean that every child needs an expander or that orthodontics alone can treat sleep apnea. Instead, it means being aware of the signs of sleep-disordered breathing and working with other healthcare professionals when concerns arise.

Part 1: Pediatric Sleep Apnea

Could your child’s sleep be affecting their health?

Sleep is incredibly important for growing children. During sleep, their bodies and brains are developing, growing, and recovering. When a child has obstructive sleep apnea (OSA), their airway repeatedly becomes partially or completely blocked during sleep. This can cause disruptions in normal sleep, even if the child doesn’t fully wake up or realize anything is wrong.

Some signs parents may notice include:

• Loud or frequent snoring

• Mouth breathing

• Restless sleep

• Pauses in breathing or gasping during sleep

• Difficulty waking up in the morning

• Morning headaches

• Daytime sleepiness

• Difficulty concentrating

• Behavioral changes or irritability

• Bedwetting in some children

Untreated pediatric OSA has been associated with problems including impaired growth, learning difficulties, and behavioral problems, which is why recognizing potential sleep-disordered breathing is so important.

Orthodontics is one piece of the puzzle that can improve pediatric sleep apnea. An expander in conjunction with upper and lower braces or Invisalign can help widen the top jaw and expand the dental arches, increasing the size of the airway and giving the tongue more room to move. 

In order to properly diagnose and treat pediatric sleep apnea, we must work with a team of providers. That team may include:

The pediatrician: Your child’s pediatrician can help evaluate overall health and symptoms and determine what additional medical evaluation may be appropriate. 

A dentist or pediatric dentist: A dentist can help identify symptoms of pediatric sleep apnea and work in conjunction with other specialists to determine the next steps. https://www.aapd.org/research/oral-health-policies–recommendations/obstructive-sleep-apnea/

An ENT: Enlarged tonsils and adenoids, nasal obstruction, allergies, and other anatomical issues can contribute to airway problems. An ENT can evaluate these areas and determine whether medical or surgical treatment may be appropriate.

A sleep physician: When sleep apnea is suspected, a sleep study may be recommended to properly evaluate what is happening during sleep. The AAPD recommends medical referral when pediatric OSA is suspected.

A myofunctional therapist: The tongue and muscles of the mouth play an important role in breathing, swallowing, chewing, and oral posture. When appropriate, myofunctional therapy can be one component of a larger treatment plan.

The orthodontist (Dr Best): At Best Orthodontics, we evaluate the development and relationship of the jaws, palate, dental arches, tongue position, and bite. In certain children, orthodontic treatment may be one part of addressing anatomical factors that contribute to airway function. The AAPD specifically notes that orthodontic treatment or expansion may be considered in selected children as part of a multidisciplinary approach.

Part 2: Airway and Sleep Apnea in Adults

Adults can also develop obstructive sleep apnea, and the causes are often complex.

The anatomy of the jaws, tongue, palate, and upper airway can all play a role. Other factors—including weight, age, nasal obstruction, and soft tissue anatomy—can also contribute.

Where can orthodontics fit in?

For some adults, orthodontic treatment may be one part of a larger strategy to improve oral and airway function. Dr. Best looks at the entire oral and facial picture, rather than simply asking, “How can we straighten these teeth?”

This may include:

Expanding the airway

When an adult has a narrow dental arch or palate, orthodontic treatment may sometimes be used to improve the width and form of the dental arches. We evaluate whether expansion is appropriate for that individual and what can realistically be accomplished within the limits of their anatomy and bone. This may include expansion with braces or Invisalign, or if the palate is very narrow, may involve mini-screw assisted expansion (MARPE) or jaw surgery. 

Considering tongue space and restriction

The tongue is a major part of the airway system. Its position, size, posture, and ability to move can all be important considerations.

When there are concerns about tongue mobility or restriction, we may work with other professionals like a myofunctional therapist to determine whether this is contributing to functional problems and whether additional evaluation or treatment is appropriate.

Being thoughtful about extractions

There are situations where removing teeth is appropriate during braces or Invisalign treatment. However, when airway is a concern, we try to minimize extractions even more, especially if teeth can be aligned within the physiological limits of the supporting bone without compromising their integrity.

Sometimes orthodontics alone isn’t enough. Depending on the patient’s needs, we may work alongside sleep physicians, ENTs, myofunctional therapists, oral surgeons, physicians, dentists, and other specialists. Some patients may benefit from CPAP, an oral appliance, ENT treatment, myofunctional therapy, and/or another medical or surgical approach like jaw surgery. 

Our goal is to put the teeth and jaws in the best possible position for long-term function, while considering the airway and the individual patient’s anatomy and needs. By working with a team of specialists, we can come up with the best plan to improve how your entire mouth, face, and airway function together.