Newly updated guidance from the American Association of Orthodontists (AAO) on sleep-disordered breathing (SDB) has been welcomed by leading London orthodontist Dr Asif Chatoo, who says the document brings much-needed clarity to one of dentistry’s most debated areas.
The AAO’s latest White Paper on SDB, published in March 2026, builds on its 2019 predecessor and reflects the most current scientific evidence. According to Dr Chatoo, an orthodontist based in London’s West End and former Chairman of the European Society of Lingual Orthodontists (ESLO), the update provides clear direction for clinicians navigating the complex relationship between orthodontics and sleep health.
“The AAO has addressed with precision the scientific and clinical uncertainties surrounding sleep-disordered breathing, one of the controversial issues of our age,” said Dr Chatoo.
Importantly, the updated White Paper confirms that there is no evidence to support orthodontic interventions, such as maxillary expansion or functional appliances, as primary preventive treatments for SDB. It also finds no evidence that routine orthodontic procedures, including extractions, increase the risk of developing the condition.
Key guidance for orthodontic teams
Dr Chatoo highlights several key points from the updated recommendations for dental professionals:
- No intervention for SDB should take place without a formal diagnosis and treatment plan from a physician. Polysomnography and clinical assessment remain the gold standards for diagnosing obstructive sleep apnoea (OSA).
- Referral to a physician should follow structured risk assessment, including comprehensive history-taking, clinical examination, and use of validated screening tools such as the Paediatric Sleep Questionnaire (children) or STOP-Bang questionnaire (adults).
- Cone beam CT (CBCT) and cephalometric imaging should not be used for screening, diagnosing, or assessing treatment outcomes for SDB, marking a significant shift from earlier guidance.
- Routine frenectomy is not recommended for the prevention or treatment of SDB, and current evidence does not support ankyloglossia as a direct cause of OSA.
- No specific craniofacial phenotype can reliably identify SDB, and airway size or volume seen on imaging should not be used as a diagnostic substitute.
Despite these limitations, Dr Chatoo emphasised the important role dental professionals can still play.
“It’s good news that the AAO recognises that dental professionals can play a crucial role in screening, risk assessment, and collaborative care,” he said.
The overarching message, he notes, is clear: dental and orthodontic treatments should be guided by established dental and craniofacial needs – not positioned as standalone solutions for preventing sleep-disordered breathing.
Dr Chatoo also highlighted potential differences in how such guidance may be adopted in the UK.
“It remains uncertain whether UK regulators will issue guidance as explicit as the AAO’s. Our system progresses more gradually, requiring broader consensus before formal recommendations are made. Nonetheless, UK practice is likely to align with similar principles: maintaining clear professional boundaries, establishing safe referral pathways, and practising within recognised competence.”
