Dentists, Myofunctional Therapists, and Sleep Apnea – Part 2

(NOTE: This is the second of three articles on dentists, myofunctional therapy, and sleep apnea. Click HERE for Part 1)

Anecdotal evidence doesn't prove what is responsible for the improvement
A second justification doctors and dentists offer for providing treatment not supported by scientific research is "anecdotal evidence." This rationalization is frequently accompanied by statements like "I have seen great results in my patients" or "Patients report their symptoms went away." Without research that separates variables to examine the actual benefits, there is no way to tell if a given therapy was responsible for the reported improvement or if it was due to growth, placebo effect, coincidence, or some other unrelated variable.

A theory or hypothesis is only the first step in finding effective treatments
The third justification for suggesting treatment not supported by research is that "it just makes sense." This is also known as theory-based treatment. Other common rationalizations that fall into this category include "the research just hasn't caught up with the technology" or "sometimes you just have to act in faith until the research is available." While evidence-based treatment requires proof that a procedure is safe, effective, and necessary, theory-based treatment must only "make sense" to the clinician providing it. History is full of examples of once-held theories that were later proven false. Examples include the earth being the center of the solar system and using leeches and bloodletting when someone is not feeling well. Theory, or hypothesis, is merely the first step in scientific research, not a replacement for it.

Lasers and better X-ray machines have led to dentists offering more procedures
Over the past three decades, two technological advancements have increased dentists' interest in treating OSA - soft-tissue lasers and cone beam computed tomography (CBCT). Soft tissue lasers made it easier for dentists to perform procedures like frenectomies, tongue releases, and laser procedures at the back of the throat. CBCT technology created three-dimensional images of facial structure, including the airway, which formed the basis for many new airway procedures.

Soft-tissue lasers are effective tools for many dental procedures
Soft-tissue lasers are effective tools that allow dentists to perform tissue reshaping, tissue removal, and palliative (pain-reducing) procedures for their patients. Common laser procedures in the dental office include removing tissue over an unerupted tooth, removing swollen or unnecessary gum tissue, and preparing the tissue around a tooth that will receive a crown.

Some dentists claim to treat OSA using lasers
Some dentists who use lasers attempting to prevent, manage, or cure OSA believe that cutting tissues attached to the lips and tongue will change their movements and improve a patient's breathing. Others use lasers at the back of the throat, believing that removing extra tissue from the area (ablative) or inducing scarring (non-ablative) reduces the likelihood of those tissues collapsing and closing the airway.

CBCT machines provide images that are useful in dentistry
CBCT is an amazing X-ray technology that provides orthodontists and other dental professionals with a 3D view of facial structures, improving their ability to treat bad bites, impacted teeth, extra teeth, etc.

CBCT images are not diagnostic for OSA
One feature of the software provided with these x-ray machines is the ability to trace and measure the airway size at the back of the mouth. Although the results look impressive, study after study has shown that the measurements taken from these images are not diagnostic for OSA. The reasons why (described in more detail in numerous other papers) include differences in posture (laying down), alertness (not asleep), tonicity (can't determine how collapsable a structure is), etc. Additionally, the studies where airways were measured using CBCT rarely considered the average growth that also occurs during the interval treatment was provided (no control groups).

A 2024 paper examined the effectiveness of seven "new" OSA treatments
In a 2024 paper entitled "Novel Therapies for Preventing, Managing and Treating Obstructive Sleep Apnea and Snoring in Pediatric and Adult Patients," the American Academy of Dental Sleep Medicine (AADSM) reported on a consensus conference examining the effectiveness of "emerging therapies" in the treatment of OSA and snoring. These novel therapies included functional appliances, myofunctional orthodontics, expansion, myofunctional therapy, lingual and buccal tongue releases, and ablative and non-ablative tongue procedures. They also reviewed the most current research to revisit the relationship between extractions and OSA.

Over 2000 research projects were evaluated to determine procedure effectiveness
The AADSM brought together specialists in the fields of dental sleep medicine, pediatric dentistry, oral facial pain, prosthodontics, orthodontics, sleep medicine, pediatric otolaryngology, and speech-language pathology to review the current research literature and determine the effectiveness and, therefore, appropriateness, of seven procedures currently being promoted as a treatment for OSA and snoring. This group of experts reviewed over 2000 scientific articles to evaluate the appropriateness of these procedures to prevent, manage, or cure OSA and snoring. Here is what they found:

(NOTE: This is the second of three articles on dentists, myofunctional therapy, and sleep apnea. Click HERE for Part 3)

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist in the private practice of orthodontics in Rio Rancho and Albuquerque, New Mexico. He was trained at BYU, Washington University in St. Louis, and the University of Iowa. Dr. Jorgensen's 30+ years of specialty practice and 10,000+ finished cases qualify him as an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in New Mexico. He cannot diagnose cases described in comments nor select treatment plans for readers. Copyright laws protect the opinions expressed here and can only be used with the author's permission.