Sleep-Disordered Breathing and Orthodontics: Understanding the Update

The update also places greater emphasis on physician diagnosis and interdisciplinary care. The white paper reminds orthodontists that SDB is a medical condition; definitive diagnosis remains outside the orthodontist’s scope of practice. Although orthodontists may play an important role in screening patients at risk and identifying craniofacial contributors, the update reinforces that SDB management should be conducted in collaboration with sleep physicians and other medical specialists.

Perhaps the most significant update involves cone-beam computed tomography (CBCT) imaging and airway measurements. The update takes a much firmer position on the idea that airway dimensions on CBCT scans or lateral cephalograms should not be used to diagnose SDB or predict treatment success. SDB is a dynamic medical condition influenced by neuromuscular function, sleep state, body position, and multiple nonanatomic factors. Merely increasing airway size does not necessarily translate into improved breathing during sleep.

The sections on palatal expansion and functional appliances were also rewritten using more cautious, nuanced language. Although these treatments may influence airway dimensions or breathing patterns in select patients, the document emphasizes that they should continue to be based primarily on appropriate orthodontic and skeletal indications, with any airway benefits considered secondary rather than guaranteed outcomes. Simply put, expanders and functional appliances have not been shown to prevent future SDB.

The white paper also addresses several controversial topics increasingly associated with airway-focused treatment, including frenectomy, extractions, and distalization mechanics. Current evidence does not support routine frenectomy for prevention or treatment of SDB, nor does it support claims that orthodontic extractions or distalization mechanics cause airway obstruction. Despite their growing popularity in social media parenting groups, online forums, and continuing education courses, these theories remain largely speculative.