What This Guide Covers
Many people search for "can braces help sleep apnea" after a dentist mentions their jaw, or after they hear about expanders for kids. This guide gives a plain answer. It explains what an orthodontist can and cannot do for obstructive sleep apnea, for adults and for children.
Obstructive sleep apnea, or OSA, happens when the throat narrows or closes again and again during sleep. Each pause cuts airflow and breaks up sleep. A physician diagnoses OSA with a sleep study and sets the treatment plan.[1][4]
This page leans on the AAO's 2019 white paper on OSA and orthodontics. A panel of medical and dental sleep experts wrote it to guide orthodontists on their role.[1] In 2026 the AAO published an update to that white paper.[2]
Orthodontics and dentofacial orthopedics is an ADA-recognized dental specialty. Dental sleep medicine is not a recognized dental specialty.[11] For a look at airway marketing claims, see our page on airway orthodontics. For signs of OSA in kids, see sleep apnea in children.
Can Braces Help Sleep Apnea?
Short answer: braces on their own are not a treatment for sleep apnea. Braces move teeth into better positions. That can improve your bite and smile, but straight teeth do not keep the throat open at night.
The AAO white paper names two orthodontic steps in growing children that may change the upper airway. The first is rapid maxillary expansion, which widens a narrow upper jaw. The second is a jaw-guiding appliance that brings a small lower jaw forward. Even for these, the paper says the main goal must be to fix a real jaw or bite problem. Better breathing at night is a possible bonus, and no orthodontist should promise it.[1]
For adults, the orthodontic options are different. They include a custom oral appliance worn at night and, for some people, orthodontic work before and after jaw surgery.[1] Adult expansion is being studied, but the sleep study evidence is thin.[1][8]
Braces also do not cause sleep apnea. The AAO white paper says no orthodontic treatment has been shown to cause or increase the likelihood of OSA. A large records study found that adults missing four premolars had about the same rate of OSA as matched adults with no missing teeth. The study concluded that pulling teeth was not a cause of OSA.[1]
What an Orthodontist Can and Cannot Do
The AAO white paper draws clear lines. Here is a simple summary of what it says.[1]
What an Orthodontist Can Do
- Ask about snoring, sleepiness, and breathing during sleep at regular visits. Short questionnaires can help flag risk.[1]
- Refer you or your child to a physician for a diagnosis, with a sleep medicine physician preferred.[1]
- Refer to an ENT surgeon when there are signs of nasal blockage or large tonsils and adenoids.[1]
- Fit, adjust, and monitor an oral appliance after a physician prescribes it.[1][3]
- Watch for bite changes from long-term appliance wear and, in some cases, treat them.[1]
- Correct a true narrow upper jaw or small lower jaw in a growing child.[1]
- Prepare the teeth for jaw surgery when there is an orthodontic reason for it.[1]
What an Orthodontist Cannot Do
- Diagnose OSA. That is a physician's job.[1]
- Diagnose OSA from an X-ray or 3D scan. The AAO says airway images cannot diagnose sleep apnea and are not a proper screening method on their own.[1]
- Manage OSA alone. The AAO says a shared effort with physicians is preferred.[1]
- Prevent future sleep apnea with early expansion or jaw-guiding appliances. The AAO found no indication in the research that this works.[1]
- Promise that orthodontic treatment will cure OSA.[1]
How Sleep Apnea Is Diagnosed
Diagnosis comes before any treatment. The AAO recommends that OSA treatment not start without a referral from a physician.[1]
For adults, a physician orders a sleep study. This may be an overnight study in a sleep lab, called polysomnography. Many adults with no other major health problems can use a home sleep apnea test instead. The American Academy of Sleep Medicine says questionnaires alone should not be used to diagnose OSA.[4]
The sleep study gives an apnea-hypopnea index, or AHI. This is the number of breathing pauses and shallow breaths per hour of sleep. It helps the physician judge how severe the OSA is and whether a treatment is working.
For children, the American Academy of Pediatrics recommends an overnight sleep study (polysomnography) for a child who snores and has other signs of OSA.[5] The AAO notes that home sleep tests are not indicated for patients under 18.[1]
Orthodontic Options for Adults
For adults, the AAO calls positive airway pressure (PAP), such as CPAP, the gold standard treatment. A physician prescribes it.[1] If CPAP does not work for you, the options below may come up. Our guide to CPAP alternatives covers the full list.
Mandibular Advancement Devices
A mandibular advancement device is a custom mouthpiece worn at night. It holds the lower jaw a little forward. This pulls the tongue and soft tissue away from the back of the throat.[1]
Sleep medicine guidelines recommend that sleep physicians consider an oral appliance for adults with OSA who cannot tolerate CPAP or who prefer another option. When a sleep physician prescribes one, the guideline suggests a qualified dentist use a custom device that can be adjusted, rather than a store-bought one.[3] That dentist may be a general dentist or a dental specialist such as an orthodontist or prosthodontist.
The device is usually set at first to about two thirds of how far your jaw can move forward. It is then moved forward in small steps based on how you feel and sleep. After that, the physician usually orders a sleep study with the device in place to check that it works.[1][3]
Oral appliances do not work for everyone. The AAO reports that they fully control OSA in about 36% to 70% of cases.[1] Read more on oral appliance therapy and how it compares in oral appliance vs. CPAP.
Bite Changes With Long-Term Use
Oral appliances for sleep apnea move teeth, and orthodontists are trained to manage bite problems.[1]
The AAO lists typical changes. The upper front teeth may overlap the lower ones less. The lower front teeth may end up in front of the upper ones, called an anterior crossbite. The back teeth may stop touching, and face height may change. These changes grow with ongoing use.[1]
A study of 77 adults who wore an appliance for an average of about 11 years found that the bite changes kept going. They did not reach a stopping point.[9]
If an orthodontist treats these changes, you usually cannot wear your appliance during that time, so you may need CPAP for a while. If you go back to the appliance later, the bite change may return.[1] One 2024 commentary by an orthodontist goes further and calls long-term appliance use a choice of last resort because of these effects.[10] Sleep medicine guidelines still recommend oral appliances for adults who cannot use CPAP or prefer another option.[3] Talk through the tradeoffs with your sleep physician and dentist.
Sleep medicine guidelines suggest that a qualified dentist follow every adult who uses an oral appliance, to check for dental side effects and bite changes.[3] The AAO suggests checkups at least every six months in the first year, then once a year.[1]
Adult Palate Expansion: Limited Evidence
In adults, the upper jaw has stopped growing. Widening the palate usually takes surgery or special anchors placed in the bone.[1]
The AAO white paper says there is much less data for surgically assisted rapid maxillary expansion, called SARME. It says mini-implant supported expansion has very limited sleep study evidence for OSA, and that more research is needed.[1]
A 2016 review found only six adult studies of expansion, with 36 patients in total. AHI dropped on average, but the authors said there were too few studies to draw firm conclusions.[8]
Some adult expansion devices are sold under brand names with strong claims. MSD does not endorse any system. If expansion is offered to you for sleep apnea, ask for a sleep study before and after, and ask your sleep physician about options with stronger evidence.
Jaw Surgery and Orthodontics
Maxillomandibular advancement, or MMA, is a surgery that moves both jaws forward. An oral and maxillofacial surgeon performs it. The AAO says it is generally reserved for adults with severe OSA who cannot tolerate PAP, and for those who also have an orthodontic reason for surgery.[1]
Orthodontic care is usually a helpful part of the plan, so the teeth fit together well once the jaws move.[1] See our pages on maxillomandibular advancement and oral surgery for sleep apnea.
Orthodontic Options for Children
Sleep apnea in children is a different problem from sleep apnea in adults. The AAO white paper says information on treating children is much more limited than for adults.[1]
Tonsils and Adenoids Usually Come First
Large tonsils and adenoids are the most common risk factor for OSA in children. Surgery to remove them, called adenotonsillectomy, is usually the first treatment.[1] The American Academy of Pediatrics recommends it as first-line treatment for children with enlarged tonsils and adenoids. If surgery is not done or OSA remains after it, the AAP recommends CPAP.[5]
An ENT surgeon performs this surgery. An orthodontist's role is to spot warning signs and refer.[1]
Rapid Maxillary Expansion
Rapid maxillary expansion uses an appliance attached to the upper back teeth. It slowly widens a narrow upper jaw while the child is still growing. The main reason to do it is to fix a narrow jaw and the bite problems that come with it. A wider nasal passage is a possible side benefit.[1]
A 2017 review of 17 studies covered 314 children with narrow palates and OSA. Their average age was under 8. AHI fell by about 70% on average. But only about 26% of the 90 children with full data were cured, and children with large tonsils improved less.[6]
A 2023 review found similar short-term gains but rated the evidence low to very low, mostly from studies with no comparison group. It said expansion should not be offered as an OSA treatment by itself, that a true orthodontic reason is needed, and that results need careful monitoring.[7] The AAO adds that normal growth changes the airway far more than any orthodontic appliance does.[1]
Jaw-Guiding Appliances
For a child with a small or set-back lower jaw, an orthodontist may use an appliance that guides the jaw forward as the child grows. A few studies show a drop in AHI. The AAO notes that long-term stability has not been studied and that untreated comparison groups were usually missing.[1][7]
The AAO recommends using these appliances only when there is a real jaw problem. It found no clear sign that using them early prevents sleep apnea later.[1]
Setting Realistic Expectations
The AAO says better sleep apnea should be described as a "possible" result of orthodontic treatment in children, and that no orthodontist should promise OSA will go away.[1] A sleep study before and after treatment, ordered by your child's physician, is the way to know whether treatment helped.[10]
How Orthodontists Work With Sleep Physicians and ENTs
The AAO describes OSA care as a shared effort. Here is how that usually works.[1]
- Screening. The orthodontist or your general dentist notices signs such as loud snoring, daytime sleepiness, or a narrow jaw, and asks screening questions.[1]
- Referral. The orthodontist refers you to a physician. A sleep medicine physician is preferred. Children with nasal blockage or large tonsils, and adults with the same signs, are referred to an ENT surgeon.[1]
- Diagnosis and plan. The physician orders a sleep study, makes the diagnosis, and decides on treatment.[1][4]
- Orthodontic role, if any. The physician may prescribe an oral appliance or refer back for orthodontic care to address a jaw problem.[1]
- Follow-up. The physician checks results, often with a repeat sleep study. The dentist or orthodontist checks the teeth, jaw, and appliance at regular visits.[3]
Cost and Insurance Factors
Costs vary by region, by the type of appliance or treatment, by how many visits are needed, and by whether jaw surgery or full braces are part of the plan. Ask each office for a written estimate.
Because OSA is a medical condition, oral appliance therapy is often billed to medical insurance rather than dental insurance. Medicare is one example. It covers a custom oral appliance when a physician or other medical practitioner sees you in person and your sleep test meets set criteria. That practitioner must order the device after reviewing the test, and a licensed dentist must provide it.[12] Orthodontic care for a jaw or bite problem may fall under dental benefits instead. Coverage rules vary by plan, so check with both insurers. Our guide to oral appliance cost and insurance has more detail.
Questions to Ask an Orthodontist
These questions can help you judge an office's approach.
- Has a physician diagnosed sleep apnea, and do I need a sleep study first?
- Is this treatment for a jaw or bite problem you can show me, or only for my airway?
- How will we know if it works? Will my physician order a repeat sleep study?
- How do you share updates with my sleep physician or my child's ENT?
- What bite changes might happen with a nightly oral appliance, and how often will you check?
- What are the total costs, the time in treatment, and the plan if it does not help?
Find an Orthodontist Who Works With Sleep Physicians
Start with a physician. Sleep apnea is diagnosed by a physician through a sleep study, in a lab or at home. A dentist or orthodontist can screen you and refer you, and can make an oral appliance once a physician prescribes one.[1][4]
If you or your child also needs care for a jaw or bite problem, look for an orthodontist who screens for sleep apnea and works with your physician. You can search the MSD provider directory or browse our orthodontics page. To find dentists who provide oral appliance therapy, browse our sleep apnea dentists list, grouped by state. When you call, ask how the office screens for sleep apnea and how it works with sleep physicians and ENTs.
Search Orthodontists in Your Area
