Orthodontic treatment in children to prevent sleep-disordered breathing in adulthood

Abstract

The purpose of this article is to review human craniofacial growth and development, especially the growth of the mandible, to clarify the relationship between obstructive sleep apnea (OSA) syndrome and craniofacial abnormality, and finally, to propose the hypothesis that negative pressure produced in the chest of the OSA child inhibits the growth of the mandible. Recently, the development of diagnosis and treatment of OSA syndrome has progressed rapidly; however, the prevention of OSA syndrome was merely seen. Craniofacial abnormality is reported as one of the causes of OSA syndrome. If craniofacial abnormality is determined only by genetics, it is difficult to manage the craniofacial skeleton to prevent OSA syndrome. The role of epigenetic factors on craniofacial growth and development is still controversial. However, if we stand on the functional matrix hypothesis, we can manage not only growth of the mandible but also the craniofacial skeleton as a whole. The author proposes the hypothesis that the negative pressure produced in the chest prohibits the growth of the mandible even if the patients have a capacity for growth and development; therefore, if this negative pressure disappears because of the removal of the tonsil and/or adenoids or by an orthodontic treatment to make a patency of the airway, the mandible may grow normally, and we can prevent or reduce a number of OSA syndromes in the future.

Influence of pharyngeal airway respiration pressure on Class II mandibular retrusion in children: A computational fluid dynamics study of inspiration and expiration

“…The importance of this obstruction during childhood is being increasingly recognized . Backward or downward growth of the mandible is influenced by the strong negative pressure of the chest that is produced in children with OSAS . The posterior and inferior direction of such mandibular growth may lead to malocclusion and future OSAS.…”

Beyond the functional matrix hypothesis: a network null model of human skull growth for the formation of bone articulations

“…; Breitsprecher et al. ; Kikuchi, ) and some morphological features of the head (Festa et al. ; Richards & Jabbour, ), in particular the integration between brain growth and skull shape (Moss, ; Fields et al.…”

“…1). This hypothesis has been broadly used to explain many craniofacial disorders (Mulliken et al 1989;Breitsprecher et al 2002;Kikuchi, 2005) and some morphological features of the head (Festa et al 2010;Richards & Jabbour, 2011), in particular the integration between brain growth and skull shape (Moss, 1975;Fields et al 1978;Richtsmeier et al 2006;Lieberman, 2011a;Richtsmeier & Flaherty, 2013). Other epigenetic factors that affect the formation of sutures include hormonal signals (Karsenty, 1999) and biomechanical mechanisms (Shwartz et al 2012;Khonsari et al 2013).…”

Three‐dimensional pharyngeal airway changes in orthodontic patients treated with and without extractions

“…The debate on permanent teeth extractions is ongoing, only now, it is not only the esthetics and stability that are discussed, but also temporomandibular joint problems and upper airway volumes . One of the main issues of the current dispute is the dilemma on whether extracting teeth, therefore reducing the length of the dental arch, would deprive tongue of its essential space and affect the upper airways .…”