Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 49

Presentation Summary

chin position, and tipping back of upper incisors.1
She briefly touched on treatments using RME for
adult patients, which could reduce the severity of
SDB but not completely eliminate the symptoms.2
To treat the SDB, the gold standard is using CPAP;
however, if the patient is CPAP intolerant, then
using MADs is recommended. It has been shown
that MADs are the most effective treatment for
improving blood pressure, quality of life, AHI, and
reducing the cardiovascular mortality rate. As of
October 2017, there are 159 types of MAD approved
by FDA; they function similarly by increasing the
volume of the pharyngeal airway space, mostly in
a lateral position.
Evaluating Effectiveness
Dr. Sheats argued that lateral cephalograms are
not the best images for evaluating the effectiveness of the treatment on the airway; also,
because lateral cephalograms and any other
imaging techniques are not taken in a supine
position, the volume of the airway is not measured correctly. She mentioned that there are side
effects to MAD, such as temporomandibular joint
(TMJ) dysfunction or intraoral tissue damage,
occlusal changes, damage to teeth, and appliance
issues. Damage to the TMJ is one of the main
side effects of MAD usage that can be decreased
by monitoring the appliance usage, as well as
use of analgesics, a soft diet, and stretching.3
Occlusal changes may arise with long-term
usage of the MAD: decreased overjet or overbite;
mild retroclination of upper incisors; mild
increase in proclination of lower incisors;
decrease or loss of posterior occlusal contacts;
and anterior repositioning of mandible or dentition. Dr. Sheats mentioned that it is important to
screen patients who use MAD for side effects; to
reduce any side effects, patients can use morning
repositioning appliances, chew gum, and/or stop
use of the appliance.
Lastly, Dr. Sheats discussed pediatric OSA, for
which risk factors include enlarged tonsils and
adenoid, preterm birth, obesity, phenotype

Winter 2017  PCSO Bulletin

Doctors

(male>female), snoring, and ethnicity. The normal
AHI for children is fewer than one episode per
night, because their brains are more susceptible
to hypoxemia.4 She observed that CPAP is effective
in treating OSA; however, in compliant children
with craniofacial conditions it may cause deficiency in anterior and vertical maxillary development; these children may need jaw surgery in
the future.5 RME is another effective treatment
modality; it shows an increase in the width of
the lower third of the nasal cavity and all the
dimensions in the oropharynx area.6 Dr. Sheats
remarked that the prevalence of OSA is not
significantly different between extraction and
non-extraction patients.7 
References
1. Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA.
Craniofacial changes after 2 years of nasal continuous
positive airway pressure use in patients with obstructive sleep apnea. Chest 2010;138:870-874.
2. Cistulli PA, Palmisano RG, Poole MD. Treatment of
obstructive sleep apnea syndrome by rapid maxillary
expansion. Sleep 1998;21:831-835.
3. Doff MH, Veldhuis SK, Hoekema A, et al. Long-term
oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side
effects. Clin Oral Investig 2012;16:689-697.
4. Huynh NT, Desplats E, Almeida FR. Orthodontics
treatments for managing obstructive sleep apnea syndrome in children: a systematic review and metaanalysis. Sleep Med Rev 2016;25:84-94.
5. Roberts SD, Kapadia H, Greenlee G, Chen ML. Midfacial and dental changes associated with nasal
positive airway pressure in children with obstructive
sleep apnea and craniofacial conditions. J Clin Sleep
Med 2016;12:469-475.
6. Ribeiro AN, de Paiva JB, Rino-Neto J, Illipronti-Filho E,
Trivino T, Fantini SM. Upper airway expansion after
rapid maxillary expansion evaluated with cone beam
computed tomography. Angle Orthod 2012;82:458-463.
7. Larsen AJ, Rindal DB, Hatch JP, et al. Evidence supports
no relationship between obstructive sleep apnea and
premolar extraction: an electronic health records
review. J Clin Sleep Med 2015;11:1443-1448.

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2017