“Airway Orthodontists” are now as common as “Cosmetic Dentists,” often with the same absence of proof. No rule keeps any dentist from claiming to be either.

“I expand — therefore I’m an Airway Orthodontist.”

Is that enough to qualify?

Three Questions Every Orthodontist Must Answer

More than a decade ago, I asked three questions during a lecture to a university alumni association with over 400 attendees.

Question 1: Can Retraction Cause Obstructive Sleep Apnea?

Is it possible to retract enough to cause OSA?

All agreed it was possible to retract enough to cause obstructive sleep apnea.

Question 2: Where Is the Line Between Safe and Unsafe Retraction?

How far can you retract before “safe retraction” becomes “unsafe retraction”?

Not one person — including me — knew the answer.

Question 3: Can Retraction Be Ethical Without Knowing the Risk Threshold?

If you don’t know where “safe” retraction becomes “unsafe,” how can you ethically and morally retract at all?

Silence.

The Same Questions. The Same Silence.

I’ve asked these same questions in dozens of lectures over the years and received the exact same responses.

Do you agree or disagree?

If you agree, what are you doing in your practice to prevent retraction?

Common Orthodontic Practices That May Involve Retraction

Consider the following — and ask yourself how you know retraction is not occurring.

Extractions and Space Closure

• Do you extract bicuspids and retract?
• Do you close missing lateral incisor spaces and believe no retraction occurs?
• How do you know you are not retracting?

Elastics and Bite Correction

• Do you use Class II elastics to make teeth fit?
• Do you use Class III elastics to make teeth fit?

Functional Appliances and Jaw Growth Claims

Do you use “functional appliances” to “grow the mandible” and assume you are not retracting the maxilla?

• Herbst
• MARA
• Twin-Block
• Twin-Force Bite Corrector
• Forsus
• Bionator

How do you know you are not retracting?

How do you identify the exact skeletal and dental changes you see?

Space Management and Tooth Reduction

• Do you close generalized spacing in the arches?
• Is that retracting?
• Do you reproximate (Slenderize, Air Rotor Strip) and believe no retraction occurs?

Expansion Alone Does Not Equal Airway Treatment

Is your knee-jerk reaction when treating a patient with OSA to expand, expand, expand?

The late Harvard-trained sleep physician John Remmers stated that obstructive sleep apnea would not exist if our jaws were forward, like our ancestors.

So ask yourself:

• What tools do you have to develop both jaws forward?
• Do you truly believe lateral expansion alone will win the battle?

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