Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper

Behrents, Rolf G.; Shelgikar, Anita Valanju; Conley, R. Scott; Flores-Mir, Carlos; Hans, Mark; Levine, Mitchell; McNamara, James A.; Palomo, Juan Martin; Pliska, Benjamin; Stockstill, John W.; Wise, John; Murphy, Sean; Nagel, Norman J.; Hittner, Jackie

doi:10.1016/j.ajodo.2019.04.009

Cited by 284Obstructive Sleep Apnea ResearchOrthodontics and Dentofacial OrthopedicsTemporomandibular Joint Disorders

Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper

Behrents, Rolf G., Shelgikar, Anita Valanju, Conley, R. Scott, Flores-Mir, Carlos, Hans, Mark, Levine, Mitchell, McNamara, James A., Palomo, Juan Martin +6 more·2019·American Journal of Orthodontics and Dentofacial Orthopedics

DOI 10.1016/j.ajodo.2019.04.009

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Abstract

The Board of Trustees of the American Association of Orthodontists asked a panel of medical and dental experts in sleep medicine and dental sleep medicine to create a document designed to offer guidance to practicing orthodontists on the suggested role of the specialty of orthodontics in the management of obstructive sleep apnea. This White Paper presents a summary of the Task Force's findings and recommendations.

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Mandibular advancement appliances (MAAs) can reduce AHI, as concluded by the American Society of Orthodontists' White Paper.
“The main outcome index, AHI, validated the conclusion of the American Society of Orthodontists’ White Paper [26] that MAA can reduce AHI.”
From Airway morphology, hyoid position, and serum inflammatory markers of obstructive sleep apnea in children treated with modified twin-block appliances (2025) · cites this paper as [26]

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An Update on Obstructive Sleep Apnea Syndrome—A Literature Review
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“These secondary effects may improve OSA [72] and support the significant improvements observed in the current SR, concerning respiratory outcomes (both AHI and SaO2%) at different time-points.”
BackgroundResult
PATIENT-REPORTED OUTCOMES WHILE MANAGING OBSTRUCTIVE SLEEP APNEA WITH ORAL APPLIANCES: A SCOPING REVIEW
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Self-citation
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MethodSelf-citation
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“As cephalometry is routinely performed in orthodontic practice, orthodontists are strongly recommended to screen their patients for sleep breathing disorders and AH in clinical practice [35].”
Background
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“As OSA is a multifactorial syndrome [36], a multidisciplinary approach should be taken to treat OSA in children.”
Background
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Background
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“Outcome ---- Primary outcome was the apnea-hypopnea ndex (AHI); secondary outcomes were (1) oxygen saturation evel, (2) sleep quality (SQ), (3) improvement on sagital relationship between the maxilla-mandible measured by ephalometric data; and (4) upper-airway space.”
Background
The role of orthodontics in management of obstructive sleep apnea
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“Therefore, dentists must record patients’ height, weight, and neck circumference (Behrents et al., 2019).”
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Self-citation
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“75 For example, RME may be effective in the management of paediatric OSA, 76 and it can be considered in cases of transverse maxillary deficit.”
Background
Screening of obstructive sleep apnea (OSA) risk in adolescent population and study of association with craniofacial and upper airway morphology
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“These parameters include vertical growth, steep mandibular plane angle, long and narrow face, mandibular retrognathism, narrow and deep palate, anterior open bite and lower hyoid position.(14) However, they emphasize that the strength of the relationship of these parameters with development of OSA requires further exp…”
Result
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“Morning head-aches, sleep enuresis, and hyperextended neck posture while sleeping are also common ﬁndings (Marcus et al., 2012, Alexopoulos et al., 2014, Behrents et al., 2019) (Fig.”
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Heit, T., Tablizo, B. J., Salud, M., Mo, F., Kang, M. S., Tablizo, M. A., & Witmans, M. (2022) · Children · doi:10.3390/children9071057 · Cited by 20 · see citing works
Does rapid maxillary expansion enlarge the nasal cavity and pharyngeal airway? A three‐dimensional assessment based on validated analyses
Niu, X., Motro, M., Will, L. A., Cornelis, M. A., & Cattaneo, P. M. (2021) · Orthodontics and Craniofacial Research · doi:10.1111/ocr.12526 · Cited by 19 · see citing works
Wearable Orofacial Technology and Orthodontics
Prasad, S., Sivakumar, A., Boillat, T., Ghoneima, A. A. M., Gandedkar, N. H., & Diar-Bakirly, S. (2023) · Dentistry Journal · doi:10.3390/dj11010024 · Cited by 26 · see citing works
“Orthodontists are well positioned to perform obstructive sleep apnea (OSA) screening assessments and refer at-risk patients for a diagnostic evaluation [78].”
Background
Effects of bicuspid extractions and incisor retraction on upper airway of Asian adults and late adolescents: A systematic review
Ng, J. H., Song, Y. L., & Yap, A. U. (2019) · Journal of Oral Rehabilitation · doi:10.1111/joor.12854 · Cited by 18 · see citing works
Accuracy of convolutional neural networks-based automatic segmentation of pharyngeal airway sections according to craniofacial skeletal pattern
Cho, H.-N., Gwon, E., Kim, K., Baek, S., Kim, N., & Kim, S. (2022) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2022.01.011 · Cited by 18 · see citing works
Prevalence of adenoid hypertrophy among 12-year-old children and its association with craniofacial characteristics: a cross-sectional study
Tse, K. L., Savoldi, F., Li, K. Y., McGrath, C. P. J., Yang, Y., & Gu, M. (2023) · Progress in Orthodontics · doi:10.1186/s40510-023-00481-4 · Cited by 18 · see citing works
“Especially, given that AH may predispose children to sleep-disordered breathing [1], screening for this condition is advisable during treatment planning [20].”
Background
Association between adenotonsillar hypertrophy and dentofacial characteristics of children seeking for orthodontic treatment: A cross-sectional study
Zhao, T., Yang, Z. K., Ngan, P., Luo, P., Zhang, J., Hua, F., & He, H. (2023) · Journal of Stomatology Oral and Maxillofacial Surgery · doi:10.1016/j.jormas.2023.101751 · Cited by 18 · see citing works
Effect of premolar extraction on upper airway volume and hyoid position in hyperdivergent adults with different mandibular length
Ning, R., Guo, J., & Martín, D. (2022) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2021.01.027 · Cited by 17 · see citing works
Novel three-dimensional methods to analyze the morphology of the nasal cavity and pharyngeal airway
Niu, X., Madhan, S., Cornelis, M. A., & Cattaneo, P. M. (2021) · The Angle Orthodontist · doi:10.2319/070620-610.1 · Cited by 17 · see citing works
“In addition, orthodontists have a broad patient population, with contact maintained over a long time; they are therefore in a unique position to screen for SDB, as clearly emphasized recently.(1) Cone beam computed tomography (CBCT) is becoming the first choice for three-dimensional (3D) imaging in dentistry because i…”
Background
Correlation between craniofacial changes and respiratory improvement after nasomaxillary skeletal expansion in pediatric obstructive sleep apnea patients
Kim, J., Hwang, K.-J., Kim, S. W., Liu, S. Y., & Kim, S. (2021) · Sleep And Breathing · doi:10.1007/s11325-021-02426-9 · Cited by 16 · see citing works
A clinical trial on 3D CT scan and polysomnographyc changes after rapid maxillary expansion in children with snoring
Bariani, R. C. B., Bigliazzi, R., Badreddine, F. R., Yamamoto, L. H., Tufik, S. B., Moreira, G. A., & Fujita, R. R. (2022) · Brazilian Journal of Otorhinolaryngology · doi:10.1016/j.bjorl.2022.04.004 · Cited by 16 · see citing works
Obstructive sleep apnea: a review for the orthodontist
Palomo, J. M., Piccoli, V. D., & de Menezes, L. M. (2023) · Dental Press Journal of Orthodontics · doi:10.1590/2177-6709.28.1.e23spe1 · Cited by 18 · see citing works
“(2) Pontifícia Universidade Católica do Estado do Rio Grande do Sul, Faculdade de Odontologia (Porto Alegre/RS, Brazil).”
BackgroundSelf-citation
Dimensional analysis of the upper airway in obstructive sleep apnoea syndrome patients treated with mandibular advancement device: A bi‐ and three‐dimensional evaluation
Marco‐Pitarch, R., García‐Selva, M., Plaza‐Espín, A., Puertas, F. J., Agustín‐Panadero, R., Fernández‐Julián, E., Marco‐Algarra, J., & Fons‐Font, A. (2021) · Journal of Oral Rehabilitation · doi:10.1111/joor.13176 · Cited by 15 · see citing works
Sleep-disordered breathing and orthodontics: An American Association of Orthodontists white paper update
Palomo, J. M., Cohen-Lévy, J., Flores‐Mir, C., Khosravi, R., Levine, M., Pickard, M., Hittner, J., Callahan, J., & Siegel, S. M. (2026) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2026.01.014 · Cited by 16 · see citing works
Self-citation
Critical issues concerning biocreative strategy in contemporary temporary skeletal anchorage device orthodontics: A narrative review
Park, K., Choi, J., Kim, K., Kim, S., Chung, K., & Kim, S. (2020) · Orthodontics and Craniofacial Research · doi:10.1111/ocr.12444 · Cited by 14 · see citing works
Upper airway changes in Class III patients using miniscrew-anchored maxillary protraction with hybrid and hyrax expanders: a randomized controlled trial
Miranda, F., Garib, D. G., Pugliese, F., Bastos, J. C. D. C., Janson, G., & Palomo, J. M. (2021) · Clinical Oral Investigations · doi:10.1007/s00784-021-03989-3 · Cited by 14 · see citing works
“The airway volumetric increase after maxillary advancement can benefit the OSA management in growing subjects [29].”
BackgroundSelf-citation
Changes in behavioral and cognitive abilities after rapid maxillary expansion in children affected by persistent snoring after long-term adenotonsillectomy: A noncontrolled study
Bariani, R. C. B., Bigliazzi, R., Medda, M. G., Micieli, A. P. R., Tufik, S., Fujita, R. R., de Mello, C. B., & Moreira, G. A. (2023) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2023.10.011 · Cited by 14 · see citing works
Medium-term effects of rapid maxillary expansion on nasal cavity and pharyngeal airway volumes considering age as a factor: A retrospective study
Ronsivalle, V., Leonardi, R. M., Lagravère, M. O., Flores‐Mir, C., Grippaudo, C., Bonetti, G. A., & Giudice, A. L. (2024) · Journal of Dentistry · doi:10.1016/j.jdent.2024.104934 · Cited by 14 · see citing works
Self-citation
Obstructive sleep apnea: What is an orthodontist’s role?
Kazmierski, R. H. (2024) · Progress in Orthodontics · doi:10.1186/s40510-024-00524-4 · Cited by 14 · see citing works
“The American Association of Orthodontists (AAO) white paper on obstructive sleep apnea (OSA) and orthodontics stands as the definitive statement on this subject [1].”
Influential
Impact of oral appliance therapy on quality of life (QoL) in patients with obstructive sleep apnea — a systematic review and meta-analysis
Rangarajan, H., Padmanabhan, S., Ranganathan, S., & �Kailasam, V. (2021) · Sleep And Breathing · doi:10.1007/s11325-021-02483-0 · Cited by 14 · see citing works
“These appliances work by holding the mandible and the associated tissues forward, thereby increasing the caliber of the upper airway [6].”
Background
Craniofacial treatment protocol for a pediatric patient with obstructive sleep apnea and skeletal Class III malocclusion: A 13-year follow-up
Kim, K., Lee, K., Kim, J., Cho, H.-N., Yoon, H. J., & Kim, S. (2022) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2021.02.028 · Cited by 13 · see citing works
Dental and Occlusal Changes during Mandibular Advancement Device Therapy in Japanese Patients with Obstructive Sleep Apnea: Four Years Follow-Up
Ishida, E., Kunimatsu, R., Medina, C. C., Iwai, K., Miura, S., Tsuka, Y., & Tanimoto, K. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11247539 · Cited by 13 · see citing works
Differences in the effects of orthodontic treatment on airway-craniocervical functional environment in adult and adolescent patients with skeletal class II high-angle: a retrospective pilot study
Shen, Y., Li, X., Feng, X., Yu, L., Weng, L., Zhang, C., Shang, Y., & Lin, J. (2023) · BMC Oral Health · doi:10.1186/s12903-023-03328-w · Cited by 13 · see citing works
“As revealed by recent research, OSHAS patients are getting younger, i.e., an increasing number of adolescents are subjected to narrowed airways [13–15].”
Background
Analysis of nasal airway symmetry and upper airway changes after rapid maxillary expansion
DiCosimo, C. J., Alsulaiman, A. A., Shah, C., Motro, M., Will, L. A., & Parsi, G. K. (2021) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2020.06.038 · Cited by 15 · see citing works
The effect of orthodontic vertical control on the changes in the upper airway size and tongue and hyoid position in adult patients with hyperdivergent skeletal class II
Liu, Y., Chen, W., Wei, Y., Zhang, G., Zhang, X., Sharhan, H. M., & Cao, B. (2022) · BMC Oral Health · doi:10.1186/s12903-022-02580-w · Cited by 13 · see citing works
“obstructive sleep apnea-hypopnea syndrome (OSAHS), craniofacial deformities, arrhythmia, and increased blood pressure [1].”
Background
Impacts of using orthodontic appliances on the quality of life of children and adolescents: systematic review and meta-analysis
Vidigal, M. T. C., Mesquita, C. M., de Oliveira, M. N., Vieira, W. D. A., Blumenberg, C., Nascimento, G. G., Pithon, M. M., & Paranhos, L. R. (2022) · European Journal of Orthodontics · doi:10.1093/ejo/cjac003 · Cited by 12 · see citing works
Explainable artificial intelligence to quantify adenoid hypertrophy-related upper airway obstruction using 3D Shape Analysis
Mattos, C. T., Dole, L., Júnior, S. L. M., Cury-Saramago, A. D. A., Bianchi, J., Oh, H., Evangelista, K., Valladares‐Neto, J., Ruellas, A. C. D. O., Prieto, J. C., et al. (2025) · Journal of Dentistry · doi:10.1016/j.jdent.2025.105689 · Cited by 12 · see citing works
The effects of rapid maxillary expansion on persistent pediatric snoring post-tonsillectomy
Bariani, R. C. B., Bigliazzi, R., Guimarães, T. M., Tufik, S. B., Moreira, G. A., & Fujita, R. R. (2022) · Sleep And Breathing · doi:10.1007/s11325-022-02724-w · Cited by 14 · see citing works
“Supporting evidence suggests that maxillary constriction and mandibular retrusion predispose children to snoring and OSA [11, 12].”
Background
Obstructive sleep apnea and early orthodontic intervention: How early is early?
Kandasamy, S. (2024) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2023.12.005 · Cited by 13 · see citing works
The Occlusal Side Effects of Mandibular Advancement Device Therapy in Adult Sleep Apnea Patients: A Systematic Review
Rana, A., Raut, A., & Mathur, A. (2023) · Cureus · doi:10.7759/cureus.48682 · Cited by 12 · see citing works
“Untreated sleep apnea has been reported to cause morbid effects on the affected individual’s health [3].”
Background
Impact of adenotonsillectomy and palatal expansion on the apnea‐hypopnea index and minimum oxygen saturation in nonobese pediatric obstructive sleep apnea with balanced maxillomandibular relationship: A cross‐over randomized controlled trial
Magalhães, M. C. M. M., Normando, D., Soares, C. J., Araújo, E., Novaes, R. M. O., Teodoro, V. V., Flores‐Mir, C., Kim, K. B., & Almeida, G. D. A. (2024) · Pediatric Pulmonology · doi:10.1002/ppul.27239 · Cited by 12 · see citing works
“However, several studies, 4,6,9,28 – 34 have emphasized that conclusions regarding the secondary effect of rapid palatal expansion (RPE) in cases with pediatric OSA should be considered with caution due to limitations such as inconsistent diagnostic criteria, poor inclusion and exclusion criteria,…”
Self-citation
Mandibular advancement device as treatment trial for catathrenia (nocturnal groaning)
Yu, M., Hao, Z., Xu, L., Wen, Y., Han, F., & Gao, X. (2021) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.9290 · Cited by 11 · see citing works
“21 However,patientswith catathreniahadcraniofa-cial characteristics that were different from those in patients with OSA 22 ; therefore, the differences in the application of the MAD for catathrenia should be evaluated.”
Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review
Cozzi-Machado, C., Albertini, F. R., Silveira, S., & Machado-Júnior, A. J. (2023) · Sleep Science · doi:10.1055/s-0043-1776747 · Cited by 10 · see citing works
Rapid maxillary expansion may increase the upper airway volume of growing patients with maxillary transverse deficiency
Zhao, T., Hua, F., & He, H. Y. (2021) · Journal of Evidence Based Dental Practice · doi:10.1016/j.jebdp.2021.101579 · Cited by 10 · see citing works
Assessment of pharyngeal airway in Korean adolescents according to skeletal pattern, sex, and cervical vertebral maturation: A cross-sectional CBCT study
Elagib, T., Kyung, H., Hung, B. Q., & Hong, M. (2022) · The Korean Journal of Orthodontics · doi:10.4041/kjod21.267 · Cited by 10 · see citing works
Orthodontic treatment: Getting the timing right
Fleming, P. S., & Andrews, J. (2023) · Seminars in Orthodontics · doi:10.1053/j.sodo.2023.03.003 · Cited by 10 · see citing works
Mouth breathing and orthodontic intervention: Does the evidence support keeping our mouths shut?
Kandasamy, S. (2025) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2025.02.005 · Cited by 10 · see citing works
Making Sense of the Noise: Toward Rational Treatment for Obstructive Sleep Apnea
Kezirian, E. J., Simmons, M., Schwab, R. J., Cistulli, P. A., Li, K. K., Weaver, E. M., Goldberg, A. N., & Malhotra, A. (2020) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202005-1939pp · Cited by 10 · see citing works
Obstructive sleep apnea-related knowledge, attitude, experience, and behaviors among orthodontic professionals: a survey
Lin, L., Zhao, T., Ngan, P., Zhuang, Y., Qin, D., Hua, F., & He, H. (2023) · Sleep And Breathing · doi:10.1007/s11325-023-02852-x · Cited by 11 · see citing works
Comparison of screening methods for obstructive sleep apnea in the context of dental clinics: A systematic review
Rossi, C., Templier, L., Miguez, M., Cruz, J. D. L., Curto, A., Albaladejo, A., & Lagravère, M. O. (2020) · CRANIO® · doi:10.1080/08869634.2020.1823104 · Cited by 10 · see citing works
“This, together with the use of simple screening questions, questionnaires and/or techniques, means that dentists are ideally placed to perform OSA screening and to identify potential patients [6,21,22].”
Background
Advanced interdisciplinary treatment protocol for pediatric obstructive sleep apnea including medical, surgical, and orthodontic care: a narrative review
Kim, S., Ahn, H., & Kim, S.-W. (2020) · CRANIO® · doi:10.1080/08869634.2020.1839722 · Cited by 10 · see citing works
Pediatric Obstructive Sleep Apnea: Knowledge and Attitudes of Medical and Dental Students and Fresh Graduates from Saudi Arabia
Alharbi, L. N., Alsaikhan, M. A., Ali, S. N. A., & Farah, R. I. (2021) · Children · doi:10.3390/children8090768 · Cited by 10 · see citing works
Oral appliance–generated malocclusion traits during the long-term management of obstructive sleep apnea in adults:
Karadeniz, C., Lee, K. W. C., Lindsay, D., Karadeniz, E. İ., & Flores‐Mir, C. (2021) · The Angle Orthodontist · doi:10.2319/041921-316.1 · Cited by 10 · see citing works
Self-citation
The role of orthodontists in the multidisciplinary management of obstructive sleep apnea
Faber, J., Mota, A., Ho, L.-I., & Darendeliler, M. A. (2024) · Progress in Orthodontics · doi:10.1186/s40510-024-00541-3 · Cited by 9 · see citing works
“Treatment with MAA begins with obtaining a bite registration with the mandible advanced, typically set at about 50–75% of the maximum advancement potential [32, 33].”
Background
Intra-individual variation of upper airway measurements based on computed tomography
Zhou, N., Ho, J. T. F., Klop, C., Schreurs, R., Beenen, L. F. M., Aarab, G., & de Lange, J. (2021) · PLoS ONE · doi:10.1371/journal.pone.0259739 · Cited by 9 · see citing works
“As recommended by the American Association of Orthodontists White Paper [36], three-dimensional imaging of the airway is a snapshot of a specific moment of the breathing cycle and such technique currently does not represent a proper and reliable risk assessment tool for OSA.”
Background
Are multi-detector computed tomography and cone-beam computed tomography exams and software accurate to measure the upper airway? A systematic review
Templier, L., Rossi, C., Lagravère, M. O., Pujol, R. F., Muwanguzi, M., & Gianoni‐Capenakas, S. (2023) · European Journal of Orthodontics · doi:10.1093/ejo/cjad060 · Cited by 8 · see citing works
Hyoid Bone Position and Upper Airway Morphology of Children With Obstructive Sleep Apnea: A Systematic Review and Meta‐analysis
Li, Y., Zhao, T., Ngan, P., Yi, S., Wei, Z., Hua, F., & He, H. (2024) · Orthodontics and Craniofacial Research · doi:10.1111/ocr.12873 · Cited by 8 · see citing works
“If untreated, it can adversely affect growth, cognitive function and cardiovascular health in children [6].”
Changes in upper airway airflow after rapid maxillary expansion considering normal craniofacial development as a factor: a retrospective study using computer fluid dynamics
Giudice, A. L., Polizzi, A., Lagravère, M. O., Flores‐Mir, C., Isola, G., Ronsivalle, V., & Leonardi, R. M. (2024) · European Journal of Orthodontics · doi:10.1093/ejo/cjae077 · Cited by 8 · see citing works
Self-citation
Screening sleep-disordered breathing (SDB) in the everyday dental office – Pediatric and adult patients
Oh, H., Arab, M., Kim, E., Vaughan, M. A., Park, J., & Yoon, A. J.-S. (2025) · Seminars in Orthodontics · doi:10.1053/j.sodo.2025.03.005 · Cited by 8 · see citing works
Management of Paediatric Obstructive Sleep Apnoea: From a Multidisciplinary to an Interdisciplinary Care Model
Arab, M., Ansari, Y. S. E., Pelayo, R., & Yoon, A. J.-S. (2025) · Orthodontics and Craniofacial Research · doi:10.1111/ocr.12930 · Cited by 8 · see citing works
Effect of functional appliances on the airway in Class II malocclusions
Padmanabhan, S. (2020) · Journal of the World Federation of Orthodontists · doi:10.1016/j.ejwf.2020.08.006 · Cited by 8 · see citing works
Aerodynamic characteristics in upper airways among orthodontic patients and its association with adenoid nasopharyngeal ratios in lateral cephalograms
Feng, X., Chen, Y.-C., Cai, W., Lie, S. A., Hellén‐Halme, K., & Shi, X. (2021) · BMC Medical Imaging · doi:10.1186/s12880-021-00659-4 · Cited by 8 · see citing works
Treatment of a high angle protrusion case optimized with interdisciplinary approaches and TSADs
Liaw, J. J. L., Park, J. H., Shih, I. Y. H., Yang, S. Y. H., & Tsai, F. F. (2021) · AJO-DO Clinical Companion · doi:10.1016/j.xaor.2021.08.001 · Cited by 8 · see citing works
Comparison of nasal cavity changes between the expander with differential opening and the fan-type expander: a secondary data analysis from an RCT
Teixeira, R. E., Massaro, C. D. S., & Garib, D. G. (2023) · Clinical Oral Investigations · doi:10.1007/s00784-023-05213-w · Cited by 8 · see citing works
Association between the Obstructive Sleep Apnea and Cephalometric Parameters in Teenagers
Manrikyan, G., Vardanyan, I., Markaryan, M. M., Manrikyan, M., Badeyan, E. H., Manukyan, A. H., Gevorgyan, M. A., & Khachatryan, S. G. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12216851 · Cited by 8 · see citing works
“For pediatric patients, treatment may include non-surgical maxillary expansion and orthodontic functional appliances [24,25].”
Background
Evaluation of upper airway characteristics in patients with and without sleep apnea using cone‐beam computed tomography and computational fluid dynamics
Desai, R., Komperda, J., Elnagar, M. H., Viana, G., & Galang‐Boquiren, M. T. (2023) · Orthodontics and Craniofacial Research · doi:10.1111/ocr.12728 · Cited by 8 · see citing works
“12 The relationship between minimal cross-sectional area (min CSA) or total volume and OSA remains unclear, and there is a lack of robust CFD studies comparing non-OSA and OSA subjects.”
Novel Therapies for Preventing, Managing and Treating Obstructive Sleep Apnea and Snoring in Pediatric and Adult Patients
Sheats, R. D., Massé, J.-F., Levine, M., Aarab, G., Cruz, M. G. M. E., Simmons, M., Stauffer, J., Carstensen, S., Chiang, H. K., Galang‐Boquiren, M. T., et al. (2024) · Journal of Dental Sleep Medicine · doi:10.15331/jdsm.7332 · Cited by 8 · see citing works
Self-citation
Dentists’ role in obstructive sleep apnea: A more comprehensive review
Alrejaye, N. S., & Al-Jahdali, H. H. (2024) · Sleep Epidemiology · doi:10.1016/j.sleepe.2024.100073 · Cited by 8 · see citing works
Airway morphology, hyoid position, and serum inflammatory markers of obstructive sleep apnea in children treated with modified twin-block appliances
Duan, J., Xia, W., Li, X., Zhang, F., Wang, F., Chen, M., Chen, Q., Wang, B., & Li, B. (2025) · BMC Oral Health · doi:10.1186/s12903-025-05528-y · Cited by 8 · see citing works
“The main outcome index, AHI, validated the conclusion of the American Society of Orthodontists’ White Paper [26] that MAA can reduce AHI.”
Association between knowledge and attitudes towards pediatric obstructive sleep apnea and dental specialty
Díaz, M. F. D., Arrieta, X. S., Caballero‐García, S., & Palti, D. G. (2023) · CRANIO® · doi:10.1080/08869634.2023.2281286 · Cited by 7 · see citing works
“The most common symptoms of POSA include snoring, paradoxical breathing, excessive daytime sleepiness, hyperactivity/behavioral problems [2,4,6,7].”
The Relationship between Nocturnal Enuresis and Obstructive Sleep Apnea in Children
Andreu-Codina, M., Jovanovic, D. N., Esteller, E. C. I., Clusellas, N., Artés, M., Moyano, J., & Pérez, A. P. (2024) · Children · doi:10.3390/children11091148 · Cited by 7 · see citing works
“The prevalence of childhood OSA diagnosed by varying criteria was reported to be 1% to 4% [3].”
BackgroundInfluential
Three-dimensional pharyngeal airway space changes after bimaxillary advancement
Rocha, T. L., Lima, L. M., Pinzan, A., Sant’Ana, E., Nogueira, R. L. M., Bronfman, C. N., & Janson, G. (2021) · Dental Press Journal of Orthodontics · doi:10.1590/2177-6709.26.5.e2119364.oar · Cited by 9 · see citing works
Translation and cross-cultural adaptation of the sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire into Danish language
Niu, X., Yung, A. K. C., Strickertsson, T. I. B., Stoustrup, P. B., Cornelis, M. A., & Cattaneo, P. M. (2022) · Acta Odontologica Scandinavica · doi:10.1080/00016357.2021.2023755 · Cited by 7 · see citing works
“The recommendation for SDB screening has also been supported in the white paper published by the American Association of Orthodontists in 2019, aiming at offering guidance to the orthodontist about his/her role in the clinical risk assessment for management of obstructive SDB, where the PSQ/SRDB was recommended as a p…”
BackgroundMethodInfluential
Development and validation of predictive models for skeletal malocclusion classification using airway and cephalometric landmarks
Marya, A., Inglam, S., Chantarapanich, N., Wanchat, S., Rithvitou, H., & Naronglerdrit, P. (2024) · BMC Oral Health · doi:10.1186/s12903-024-04779-5 · Cited by 7 · see citing works
“In 2019, the Board of Trustees of the American Association of Ortho-dontists (AAO) published a white paper utilizing inputs from experts in dental sleep medicine [27].”
Background
Is malocclusion a risk factor for obstructive sleep apnea and temporomandibular disorders? An orthodontic point of view
Paradowska-Stolarz, A. M. (2025) · Dental and Medical Problems · doi:10.17219/dmp/194232 · Cited by 7 · see citing works
Relationship between craniofacial and dental arch morphology with pharyngeal airway space in adolescents
de Oliveira, I. C. V., Santos, R. T. P., Freitas, B. V., Reher, P., & Rodrigues, V. P. (2022) · Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie · doi:10.1007/s00056-022-00403-9 · Cited by 7 · see citing works
Oropharynx and hyoid bone changes in female extraction patients with distinct sagittal and vertical skeletal patterns: a retrospective study
Guo, R., Wang, S., Zhang, L., Li, L., Yu, Q., Huang, Y., & Li, W. (2022) · Head & Face Medicine · doi:10.1186/s13005-022-00334-1 · Cited by 7 · see citing works
“It is also important to note that there is no direct link between a narrow airway and OSA.”
BackgroundInfluential
Dental Sleep Medicine Education Amongst Accredited Orthodontic Programmes in Thailand
Peanchitlertkajorn, S., Chalidapongse, P., Jiansuwannapas, T., Surinsirirat, N., Khamphuang, P., Boonyai, P., & Sipiyaruk, K. (2023) · International Dental Journal · doi:10.1016/j.identj.2023.10.020 · Cited by 7 · see citing works
The enigma of sleep
Thomas, D. C., Somaiya, T. S., Cruz, M. G. M. E., Pitchumani, P. K., Ardeshna, A. P., Ravi, A., & Prabhakar, S. (2024) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2024.05.007 · Cited by 6 · see citing works
Practices and Perception of Paediatric Obstructive Sleep Apnea Among Orthodontists and Paediatric Dentists in Brazil: A Mixed‐Methods Study
Fagundes, N. C. F., Bastos, R. T. D. R. M., Perez, A. J., Flores‐Mir, C., & Normando, D. (2024) · Orthodontics and Craniofacial Research · doi:10.1111/ocr.12866 · Cited by 6 · see citing works
Self-citation
Sleep‐disordered breathing in children seeking orthodontic care—an Australian perspective
Wellham, A., Kim, C., Kwok, S., Lee, R., Naoum, S. J., Razza, J. M., & Goonewardene, M. (2022) · Australian Dental Journal · doi:10.1111/adj.12945 · Cited by 6 · see citing works
Impacts of mandibular setback with or without maxillary advancement for class III skeletal correction on sleep‐related respiratory parameters: A systematic review and meta‐analysis
Honglertnapakul, Y., Peanchitlertkajorn, S., Likitkulthanaporn, A., Saengfai, N. N., Chaweewannakorn, C., & Boonpratham, S. (2024) · Orthodontics and Craniofacial Research · doi:10.1111/ocr.12798 · Cited by 6 · see citing works
3D analysis of upper airway morphology related to obstructive sleep apnea severity
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Multidisciplinary Approach in a 12-Year-Old Patient Affected by Severe Obstructive Sleep Apnea: a Case-Report
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“In fact the long-term results of these therapies are not yet certain and therefore it is important that the therapeutic objective is twofold: orthodontic and directed to solve the OSAS in the period of development [12].”
Background
Follow-up observation of patients with obstructive sleep apnea treated by maxillomandibular advancement
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Self-citation
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Sleep-disordered breathing and orthodontics: An American Association of Orthodontists white paper update
Palomo, J. M., Cohen-Lévy, J., Flores‐Mir, C., Khosravi, R., Levine, M., Pickard, M., Hittner, J., Callahan, J., & Siegel, S. M. (2026) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2026.01.014 · Cited by 16 · see citing works
Self-citation
[Interpretation of "Obstructive sleep apnea and orthodontics: an American Association of Orthodontists White Paper"].
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Deciphering orthodontist's role in obstructive sleep apnoea management
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Obstructive sleep apnea: What is an orthodontist’s role?
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Obstructive sleep apnea and the orthodontist.
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Authors: Behrents, R. G., Shelgikar, A. V., Conley, R. S., Flores-Mir, C., Hans, M., Levine, M., McNamara, J. A., Palomo, J. M., Pliska, B., Stockstill, J. W., Wise, J., Murphy, S., Nagel, N. J., & Hittner, J.
Affiliations: Saint Louis University (US)
University of Michigan (US)
University at Buffalo, State University of New York (US)
Case Western Reserve University (US)
University of Tennessee Health Science Center (US)
University of British Columbia (CA)
Fresno City College (US)
American Association of Orthodontists (US)
Corresponding author: Behrents, Rolf G.
ORCID: Shelgikar, Anita Valanju
Conley, R. Scott
Hans, Mark
McNamara, James A.
Pliska, Benjamin
Nagel, Norman J.
Venue: American Journal of Orthodontics and Dentofacial Orthopedics
Publisher: Elsevier BV
Published: 2019-07
Volume: 156
Issue: 1
Pages: 13-28.e1
ISSN: 0889-5406 (ISSN-L)
DOI: 10.1016/j.ajodo.2019.04.009
OpenAlex: W2954751744
Cited by: 284
References: 54
Citations by year: 2026: 39 · 2025: 37 · 2024: 50 · 2023: 44 · 2022: 51 · 2021: 45 · 2020: 15 · 2019: 3
FWCI: 19.55
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: American Journal of Orthodontics and Dentofacial Orthopedics (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
Keywords: obstructive sleep apnea, orthodontics, dental sleep medicine, sleep medicine, clinical guidelines
MeSH terms: Academies and Institutes, Orthodontists, Humans, Orthodontic Appliances, Orthodontics, Physicians, Radiography, Dental, Risk Factors, Severity of Illness Index, United States, Prevalence, Treatment Outcome, Polysomnography, Sleep Apnea, Obstructive, Surgeons

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Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper

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