AN ASSESSMENT OF CURRENT CLINICAL ORTHODONTICS: CLINICIAN KNOWLEDGE, IDENTIFICATION AND TREATMENT PLANNING OF RESTRICTED AIRWAY

Abstract

Objectives: The naso- and oropharyngeal airways are influenced by a myriad of factors: jaw shape and position, tongue shape and position, lymphoid tissue, sleep apnea, chronic mouth breathing, and swallowing patterns. It is unknown if the relationships of these factors are recognized and routinely assessed in clinical orthodontics. This cross-sectional study sought to determine the proportion of participating orthodontists whom: 1) Are knowledgeable about airway restriction and its etiology, 2) Learned about these topics in post-graduate orthodontic education, 3) Consider airway restrictions in orthodontic treatment planning. Methods: A survey was administered through an online survey management platform, and sent to the email listings of 2,084 active American Association of Orthodontists (AAO) members. Survey questions are evidence-based and developed from findings in current literature. The questionnaire results were analyzed by coding and cleaning data through SAS 9.3 software. Univariate and bivariate analyses were performed to assess responses. Results: The survey received responses from 117 orthodontists. Most received their orthodontic certification from a two-year program (71.82%). The majority were knowledgeable about tongue adaptations, swallowing mechanisms, mouth breathing, and sleep apnea. Respondents were less confident about the relationship airway patency has with lymphoid tissue and with jaw position. Only half (50.51%) were taught about restricted naso- and oropharyngeal airway in post-graduate orthodontic education. A low majority, 66.32%, reported that they refer for medical consultation to the appropriate clinician before they begin treatment if a patient presents with restricted airway. Conclusions: Although the majority of respondents are knowledgeable about factors that influence airway patency, the survey identified areas in which understanding of and education in certain topics (lymphoid tissue, jaw position) may be lacking. Further emphasis should be placed on these topics to improve patient care. Orthodontics nationwide would benefit from more thorough post graduate orthodontic residency curriculum and general guidelines for clinical management of patients that present with airway obstruction.