Obstructive Sleep Apnea Syndrome (OSAS) is a frequently occurring childhood malady, whose is incidence is largely underestimated, that can lead to serious complications. Because of their understanding of the anatomy and physiology of the masticatory apparatus and of the upper airways, orthodontist are in a strategic position to detect in their young patients developing disorders in these regions; accordingly when they suspect the existence of OSAS they should ask systematic and well targeted questions of parents who may not be aware of the relationship between certain symptoms their children display and sleep breathing problems. The goal of this article is to provide practitioners with a better understanding of the symptoms and the physio-pathological mechanics of OSAS so that they can spare their afflicted patients the complications it provokes by seeing that early treatment is undertaken.

Snoring and Obstructive Sleep Apnea (OSA) are caused by repetitive dynamic closure of the oropharyngeal airway. There exists substantial and growing epidemiologic evidence that OSA is associated with a variety of systemic conditions, including but not limited to, systemic hypertension, stroke, congestive heart failure, increased motor vehicle accidents, impaired quality of living and mortality. There is an equal amount of literature on the use of dental appliances as a treatment modality for OSA. The object of this report is to review the literature in regards to three vital aspects of this disease: a) the etiology and sequela of OSA; b) the dental management of the condition and its mode of action; and lastly, c) the positive and negative outcomes/risks, of dental management.

Orthodontists, thanks to their keen appreciation of facial morphology and their skills in making functional examinations, are ideally placed to detect breathing problems in their patients that can require an ENT assessment, with special attention paid to the evaluation of sleep patterns. After a site of obstruction, resulting from a soft tissue anomaly and/or a narrowing of the airway passage through bone, has been established, orthodontists may be called upon to undertake corrective treatment sometimes in conjunction with a surgical procedure.

Treatment of severe cases of adult obstructive sleep apnea Syndrome is a life-long process. Consisting of every-night wear of a continuous pressure ventilation mask or the use of an oral appliance, side effects can appear a constraint and lead to progressive abandon of treatment.

Maxillo-mandibular advancement surgery allows a global and stable treatment of pharyngeal collapsus. Patient selection for this surgical procedure is difficult; a multidisciplinary team approach is mandatory, gathering a sleep physician, an orthodontist and surgeon. Occlusal analysis is associated with a cephalometric study, to look for skeletal abnormalities that could favour obstruction of the pharynx; the chosen protocol then aims at simultaneous treatment of apneic events and orthognathic abnormalities.