It is well established that tooth loss or extractions associated with orthodontic treatment can lead to changes in the oral environment that can increase risks of sleep apnea. Pulling back of front teeth can restrict tongue space and lead to a more retracted resting tongue position and often a reduction of the upper airway. In adolescents, extraction treatment can restrict the normal downward and forward mandibular growth that occurs during puberty.

A retrusive lower jaw is a risk factor for pediatric and adult sleep apnea. Orthodontic intervention including functional growth modification can promote proper lower jaw growth.

Often times, just improving the oral environment through expansion and mandible growth is not enough to change improper resting posture and mouth breathing. Many patients need therapy or oral appliances to improve muscle tone and motor skills necessary to sustain these oral changes long term.