Join me for a summary of two lectures from this year’s international orthodontic symposium (IOF), looking at mouth breathing and paediatric obstructive sleep apnoea, by Hong He and Carlos Flores Mir. The lectures explore this controversial area in both medicine and orthodontics and review the current understanding of the topic, the relationship with facial features and current recommendations for orthodontists.
OSA is defined disruption to breathing American Academy of Sleep Medicine
Adult > 5 apnoea/hour & 10 seconds
Child apnoea for duration of 2 breaths 1
Defining mouth breathing at airflow over 25% through the mouth
Evidence of craniofacial effects
Mouth breathing
Retrusive maxilla -1.33o (SNA -2.03 -0.63)
Retrusive mandible -1.4 (SNB -2.20—0.6) Zhang 2020 SR
Increased mandibular angle 3.38o (2.77-3.98)
But is mouth breathing pathological?
pOSA
no craniofacial difference in pOSA vs controls SR Fagundes 2022
Recent study by Carlos Flores Mir, combine factors
Demographics, lifestyle, craniofacial features and sleep features. Investigating effects of treatment on these categories
Treatment
Twinblock improves pOSA AHI 14.08 to 4.25 in the short term, severe to mild Zhang 2012
MARPE increases cross sectional area, by 40% oropharynx, 7% nasopharynx Zhao 2020
RME increases nasal airway volume initially of 1604 mm3, but reduce to 579mm3 after 3-5 months and non-significant SR Zhao 2021
Tonsillectomy
Does not stop mouth breathing, even if OSA resolved Bae 2020
Conclusions
Breathing involves complexity of 3D structures and fluid dynamics is not well understood
Mouth breathing does seem to have craniofacial influence, however OSA does not
Orthodontists role in OSA
screening for OSA
Refer to physician if risk factors present
Refer adenoid hypertrophy to ENT
Contributions
Contents and video editing – Shanya Kapoor
Editing and Production – Farooq Ahmed
