The American Dental Association And The American Academy of Dental Sleep Medicine Do Not Support Trendy Sleep Apnea Treatments 

The most recent American Dental Association (ADA) and American Academy of Dental Sleep Medicine (AADSM) consensus, summarized in JADA, underscores the point: no emerging dental therapy currently meets criteria as a first-line treatment for OSA based on validated physiologic outcomes. .

Dentistry gravitates towards anatomic explanations for complex disorders. Teeth, jaws, and oral soft tissues are tangible, measurable, and visually persuasive. Obstructive sleep apnea (OSA), however, is not primarily an anatomic disorder. It is a sleep-state–dependent condition driven by upper-airway collapsibility, neuromuscular tone, ventilatory control, arousal threshold, and sleep architecture. While craniofacial anatomy can contribute to risk, it does not reliably predict disease presence or severity. The most recent American Dental Association (ADA) and American Academy of Dental Sleep Medicine (AADSM) consensus, summarized in JADA, underscores this point: no emerging dental therapy currently meets criteria as a first-line treatment for OSA based on validated physiologic outcomes.¹ Their guidelines are consistent with what I have blogged about before on frenectomy, palatal expansion and airway dentistry.

Frenectomy in adults and children has received particular attention in recent years, often promoted as a treatment for OSA, temporomandibular disorders (TMD), and a range of other conditions. The ADA/AADSM consensus categorizes frenectomy for OSA as having insufficient evidence, citing a lack of high-quality randomized controlled trials demonstrating durable improvement in apnea–hypopnea index (AHI), oxygen saturation, cardiovascular outcomes, or validated quality-of-life measures.¹ The lingual frenum is not a primary determinant of upper-airway patency during sleep, and adult OSA is not explained by a static soft-tissue restriction. While frenectomy has established indications, particularly in infant feeding and select functional limitations, its routine use as an airway intervention in adults is not supported by current evidence.²,³

Myofunctional therapy occupies a more nuanced position. Oropharyngeal exercises may improve awareness of oral posture and nasal breathing habits and can serve as a useful adjunct in selected patients. However, systematic reviews and meta-analyses consistently demonstrate modest and variable reductions in AHI, most often limited to mild OSA, but with uncertain long-term durability.⁴⁻⁶ Accordingly, the ADA/AADSM consensus places myofunctional therapy in an adjunctive role rather than as a definitive treatment for sleep-disordered breathing.¹ Effort and engagement are valuable, but they should not be conflated with disease-modifying efficacy. However, I personally do not object to myofunctional therapy as it does not cause irreversible structural changes to a patient's anatomy like frenectomy and palatal expansion can.

Palatal and maxillary expansion has also been proposed as a treatment for adult OSA, based largely on the assumption that increased airway volume translates to improved airway function. Multiple studies using cone-beam computed tomography (CBCT) and polysomnography have demonstrated weak or inconsistent correlations between static airway dimensions and OSA severity.⁷⁻⁹ While expansion is an established orthodontic modality for transverse deficiencies and may influence breathing patterns in pediatric populations, current evidence does not support its routine use as a treatment for adult OSA or TMD. The ADA consensus appropriately characterizes orthodontic expansion as an area requiring further research, emphasizing the absence of validated sleep outcomes.¹ Anatomy, particularly when assessed in the awake and upright patient, remains an imperfect surrogate for sleep physiology.

These conclusions are not an argument against innovation or interdisciplinary involvement in sleep care. On the contrary, dentistry plays a critical role in screening, risk assessment, oral appliance therapy, and collaborative management of sleep-related breathing disorders. The issue is not whether innovation is welcome, but whether claims outpace evidence. The ADA/AADSM consensus provides much-needed guardrails, helping clinicians distinguish between established therapies, adjunctive approaches, and interventions that remain investigational.¹

Innovation matters as does progress and newer treatment modalities. But until the data change, prudence matters too. I am not anti-innovation; I am simply comfortable waiting for evidence before trading in my current approach. For now, that means I may also be driving my 2022 Toyota RAV4 Hybrid for a while.

References

1. Simmons MS, et al. Emerging dental therapies for sleep disorders: Evidence synthesis from the American Academy of Dental Sleep Medicine 2024 consensus. J Am Dent Assoc. 2026;157(1):1-20.

2. Walsh J, Tunkel D. Tethered oral tissues and airway claims: A critical review. Otolaryngol Clin North Am. 2020;53(6):1027-1042.

3. Guilleminault C, Huang YS, Monteyrol PJ, et al. Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med. 2013;14(6):518-525.

4. Camacho M, Certal V, Abdullatif J, et al. Myofunctional therapy to treat obstructive sleep apnea: A systematic review and meta-analysis. Sleep. 2015;38(5):669-675.

5. Guimarães KC, Drager LF, Genta PR, et al. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179(10):962-966.

6. de Felício CM, da Silva Dias FV, Trawitzki LV. Obstructive sleep apnea: Focus on myofunctional therapy. Nat Sci Sleep. 2018;10:271-286.

7. Huynh NT, Morton PD, Rompré PH, et al. Associations between CBCT-derived airway dimensions and apnea–hypopnea index. Sleep Breath. 2011;15(4):745-752.

8. Iwasaki T, Saitoh I, Takemoto Y, et al. Relationship between pharyngeal airway and obstructive sleep apnea severity assessed by CBCT and PSG. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;126(1):e12-e20.

9. Rossi RC, Rossi NJ. Rapid maxillary expansion and obstructive sleep apnea: A systematic review. Sleep Med Rev. 2021;56:101409.

10. Balasubramaniam R, Klasser GD, Cistulli PA. Sleep bruxism, sleep-disordered breathing, and temporomandibular disorders: An evidence-based review. J Dent Sleep Med. 2014;1(1):27-37.