Interdisciplinary Role of Orthodontist in Screening and Managing Obstructive Sleep Apnea in Children and Adults

Abstract

Obstructive sleep apnea (OSA) can affect children and adults, if left untreated, and could have a major impact on the general and overall well-being of the patient. Dental health care providers and orthodontists have a interdisciplinary role in screening patients at risk for OSA and make a referral to establish a definitive diagnosis by sleep physician. The gold standard of diagnostic testing is polysomnography. The adeno-tonsillar hypertrophy is the primary cause of sleep apnea in children; therefore, adeno-tonsillectomy must be the first line of treatment. Post adeno-tonsillectomy, if there is residual OSA due to underlying skeletal discrepancy, the patient may be referred to an orthodontist for appropriate management. In adults, the gold standard for managing OSA is Positive Airway Pressure (PAP) therapy; however, adherence to this treatment is rather low. The oral appliance (OA) therapy is an alternate for PAP intolerant patients and for mild to moderate OSA patients. The OA therapy has to be administered by a qualified dentist or orthodontist after careful examination of dental and periodontal health as well as any pre-existing joint conditions. The OA therapy could cause OA-associated malocclusion and patients have to be made aware of prior to initiating treatment. In patients with severe OSA, surgical maxilla-mandibular advancement (MMA) is highly effective. Additionally, in patients with residual OSA MMA could be a treatment of choice or surgically assisted rapid maxillary expansion or mini-implant assisted maxillary expansion could be considered if there is a transverse discrepancy. Orthodontists do have an interdisciplinary role in managing pediatric and adult OSA. There is no evidence in the literature to support prophylactic growth modification in children would prevent OSA.