Relationship Between Orthodontics and Snoring and Sleep Apnea

Relationship Between Orthodontics and Snoring and Sleep Apnea

from How Early Orthodontic Treatment can Prevent Temporomandibular Dysfunction, Snoring, and Sleep Apnea: 2 Different Treatment Philosophies.  Full article can be seen at http://www.biojva.net/AC08/rondeau.pdf

By Brock Rondeau, DDS

Snoring is caused when the tongue partially blocks the airway. Snoring is not dangerous to a person’s health, but it can be extremely detrimental to one’s relationship with his or her spouse. Obstructive sleep apnea (OSA) is caused when the tongue completely blocks the airway for 10 seconds or more, at least 35 times per night. (17, 18)

There is a direct relationship between OSA and cardiovascular diseases, including high blood pressure, heart attacks, strokes, hypercapnia (increase in carbon dioxide), and cardiac arrhythmias.  OSA also has been linked to type 2 diabetes and gastroesophageal reflux. When OSA causes a patient to stop breathing, sometimes 40 times per hour, the amount of oxygen in
the blood is reduced, which poses serious health risks. Patients with class II division 1 skeletal malocclusions with retrognathic mandibles are prime candidates for snoring and OSA later in life. The cause of OSA is the retruded tongue, which occurs naturally when the mandible is retruded. As many patients grow older, they gradually gain weight, increasing the fat in their necks and lessening the muscle tone, which reduces the size of the airway. Women with a neck size > 16 in and men with a neck size > 17 in are candidates for snoring and OSA. (19) It has been estimated that the prevalence of sleep apnea in North American is approximately 15% of men (53 million) and 5% of women (19 million). (20)  In the author’s opinion, OSA is one of the most dangerous and underdiagnosed conditions worldwide.

 When bicuspids are extracted in class II division 1 skeletal patients and the maxillary teeth are subsequently retracted, the patient may be predisposed to snoring and sleep apnea later in life. Before treatment, the mandible and tongue are in a retruded
position. When the maxillary teeth are retracted, the tongue and the mandible are prevented from obtaining their normal forward position. (21-23) The treatment of choice would be to bring the lower jaw forward with a functional jaw orthopedic appliance,
which repositions the lower jaw forward to its proper position. Appliances used in orthodontics for this purpose include the Twin-Block, Herbst, and MARA. When the lower jaw is brought forward nonsurgically with these functional appliances, the tongue comes forward and opens the airway, which prevents snoring and sleep apnea.

For cases of severe sleep apnea, the medical profession recommends a continuous positive air pressure (CPAP) device, which forces air up the nose all night using an air compressor. Many patients with less severe OSA, especially those with mild to moderate sleep apnea, cannot tolerate this device.(24)  Patients much prefer to wear an oral appliance that comfortably moves the lower jaw and tongue forward and opens up the airway to prevent snoring and OSA. The dental profession is in the position not only to prevent snoring and sleep apnea by using functional appliances when children are growing, but also to solve the problem in adults using oral appliances.(25)

Conclusion

As mentioned at the beginning of this article, it is critical that the correct diagnosis and treatment plan be implemented for our younger patients with Class II skeletal malocclusions and underdeveloped lower jaws. The ideal treatment is to utilize some
type of functional jaw orthopedic appliance such as the Twin Block or MARA Appliance to reposition the lower jaw forward. This improves the health of the TMJ by moving the condyles downward and forward, thus decompressing the TM Joint. It helps solve or
prevent snoring and obstructive sleep apnea by moving the lower jaw and tongue forward, which opens up the airway.

 References

17. Mooe, T., et al, Sleep-disordered Breathing in Men with Coronary Artery Disease,1996, Chest 10, 659-63.

18. Shahar E., et al. Sleep-disorder Breathing and Cardiovascular Disease: Crosssectional

Results of Sleep Heart Health Study, 2001, American Journal of Respiratory and Critical Care Medicine. 163, 19-25.

19. Lavie, Peretz, Restless Nights Understanding Snoring and Sleep Apnea. 2002, 96-97.

20. Lavie, Peretz, Restless Nights Understanding Snoring and Sleep Apnea. 2002, 88.

21. Clark, William J. Twin Block Functional Therapy Applications, Dentofacial Orthopedics, 2nd edition, 2002,18-19.

22. Paulsen, Hans V., Papodapoulos, Mosohos A., The Herbst Appliance,Orthodontic Treatment of the Class II Noncompliant Patient. 2006, 41-42.

23. Eckhart, James E., The Mandibular Anterior Repositioning Appliance, 107-109.

24. Lavie, Peretz, Restless Nights Understanding Snoring and Sleep Apnea. 2002.

25. Lowe AA. Efficiency of oral appliance therapy as an adjunct to CPAP. American Academy of Dental Sleep Medicine. Convention, Baltimore Maryland, June 8, 2008.