One of the more contemporaneous theories about OSA is that extraction of teeth or other orthodontic treatment during the development of the facial skeleton leads to alteration of bony growth and therefore alteration of the final result. There is evidence for example that removing large numbers of teeth during childhood for crowding will lead to a reduced jaw size as an adult. Retrognathism is well known to contribute to OSA and snoring, hence this is the tenuous link that gave birth to this theory. This article attempts to collate the available evidence and present it in a coherent way. Unfortunately this was always going to be an uphill battle. There is little in the way of standardised regimes in orthodontic treatment as all management is individualised, more or less. Also there are changing trends in treatment, and so different generations have been subjected to an incalculable number of variations in management options. Also the lag time from childhood to adulthood and the ethical ramifications of these studies makes them rather unpalatable. The authors have made a good attempt at categorising these treatment modalities and assessing the results. The outcome measure they used was airway dimensions and a reduced upper airway size was taken to be a possible precursor for OSA. Sadly even with these criteria there was little consensus in the studies reviewed, and no meta-analysis was possible due to the heterogeneity of treatments offered. Inevitably this article concluded in a similar manner to most reviews; there isn’t enough data available to make concrete statements and more evidence is required in the form of high quality trials. The authors did suggest however that there was some evidence that extraction of the four premolars on each side lead to a significant reduction in airway size.
Linking tooth extraction and snoring
Reviewed by Vik Veer
The effect of teeth extraction for orthodontic treatment on the upper airway: a systematic review.
CONTRIBUTOR
Vik Veer
Royal National Throat, Nose & Ear Hospital and Queens Hospital, Romford, UK.
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