Airway-focused orthodontics remains one of the more debated areas of modern practice.
As awareness around sleep-disordered breathing continues to grow, orthodontists are increasingly encountering patients who may present with signs of airway dysfunction. At the same time, questions remain around where the orthodontist’s role begins, and where it should end.
An updated white paper published in the American Journal of Orthodontics and Dentofacial Orthopaedics revisits this topic, building on the AAO’s earlier 2019 consensus statement. The paper re-examines the current evidence surrounding screening, diagnosis, airway assessment, orthodontic intervention, and interdisciplinary care in patients with sleep-disordered breathing (SDB).
Our Summary
The updated white paper reinforces that orthodontists play an important role in screening for sleep-disordered breathing, but not in diagnosis.
Routine orthodontic assessments may help identify risk indicators including mouth breathing, snoring, craniofacial disharmony, and obesity. The paper also encourages the use of validated screening tools, including the Pediatric Sleep Questionnaire and STOP-Bang, to support risk assessment and referral decisions.
Importantly, the review challenges several common assumptions around airway-focused orthodontics.
Current evidence does not support a causal relationship between orthodontic extractions or distalisation mechanics and the development or worsening of sleep-disordered breathing. This directly challenges assumptions that continue circulating within parts of orthodontic discussion online and in clinical education.
Similarly, while CBCT imaging may visualise airway anatomy, it should not be used alone to assess airway function or diagnose SDB. The paper reinforces that airway dimensions visible on imaging do not necessarily correlate with airway function during sleep.
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The Findings
The paper highlights that orthodontists are well-positioned to recognise potential signs of airway dysfunction during routine assessment and refer appropriately when concerns arise.
It also reviews several orthodontic interventions commonly associated with airway management.
Maxillary expansion may improve nasal airway dimensions in growing patients, although outcomes remain variable when used as a standalone intervention. Mandibular advancement devices continue to show more predictable results in selected adult patients with obstructive sleep apnoea, though careful monitoring remains important due to the potential for occlusal change over time.
A major emphasis throughout the paper is the importance of interdisciplinary collaboration between orthodontists, sleep physicians, otolaryngologists, and other healthcare professionals when managing these patients.
The review repeatedly reinforces that orthodontists are contributors to screening and supportive care within a medically guided framework, rather than primary managers of sleep-disordered breathing itself.
Clinical Interpretation
One of the more valuable aspects of this paper is its balanced approach.
Airway-focused orthodontics continues attracting significant attention clinically, academically, and online. In many discussions, however, strong claims are often made despite limited or evolving evidence bases.
This review attempts to clarify where evidence currently exists, where uncertainty remains, and where orthodontists can contribute meaningfully without overextending the scope of practice.
For clinicians, the paper reinforces the importance of maintaining airway awareness during routine orthodontic assessment while recognising the limits of orthodontic diagnosis and intervention in isolation.
Study Limitation
While the paper provides updated guidance and a broad review of current evidence, many areas of airway-focused orthodontics still rely on variable or developing evidence bases, particularly regarding long-term treatment outcomes and airway interventions.
About Dr. Jamal
Dr. Jamal Giri is an orthodontist and associate professor at B.P. Koirala Institute of Health Sciences in Nepal. He obtained his orthodontic training from the Institute of Medicine, Tribhuvan University, Nepal, in 2014.
Currently pursuing a PhD at the University of Adelaide, Dr. Jamal’s research focuses on the genetic and environmental factors influencing malocclusion development. He also holds a postgraduate certificate in clinical education from the University of Edinburgh and a master’s in medical education from the University of Nottingham.
Dr. Jamal teaches on the Diploma in Orthodontics & Dentofacial Orthopaedics at the London Dental Institute.
Read More
Palomo JM, Cohen-Levy J, Flores-Mir C, Khosravi R, Levine M, Pickard M, Hittner J, Callahan J, Siegel SM. Sleep-disordered breathing and orthodontics: an American Association of Orthodontists white paper update. American Journal of Orthodontics and Dentofacial Orthopaedics. 2026;169(4):419-427.
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