Dr. Marc Ackerman made good points in his February JADA cover story, "Evidence-Based Orthodontics for the 21st Century." However, as a general dentist who has been treating patients with sleep apnea and other sleep disorders for nearly 20 years, I have concerns regarding lack of use of rapid palatal expansion, and extraction versus nonextraction cases.
The evidence presented by Dr. Ackerman has to do with correcting anterior crowding, not with the airway. Rapid expansion of the palate at an early age not only increases oral width and volume, but also cross-sectioned nasal volume. Extraction of bicuspids leads to a decreased oral volume. The relative size of the tongue to the oral cavity (that is, tongue box) has a great deal to do with snoring and sleep apnea.
These factors must be taken into account, as even simple snoring in children is considered problematic by the pediatric community today, and apnea and hypopnea may be related to attention deficit disorder, attention deficit hyperactivity disorder and other behavioral disorders.
I see a large number of adult apnea patients, many of whom have had four-bicuspid extractions, or who would have benefited from widening of the nose and/or mouth as children. The common finding is a large tongue in a small-volume mouth. The airway blockage most often occurs at the base of the tongue, and surgical procedures are sometimes used to anteriorize and reduce tongue volume.
Why not make the mouth wider, and reduce the problem? Before making conclusions on evidence-based dentistry, let’s look at all of the evidence relating to health, and not just crowding of lower anterior teeth.
