Obstructive sleep apnea (OSA) is a clinical disorder within the spectrum of sleep-related breathing disorders (SRDB) which is used to describe abnormal breathing during sleep resulting in gas exchange abnormalities and/or sleep disruption. OSA is a highly prevalent disorder with associated sequelae across multiple physical domains, overlapping with other chronic diseases, affecting development in children as well as increased health care utilization. More precise and personalized approaches are required to treat the complex constellation of symptoms with its associated comorbidities since not all children are cured by surgery (removal of the adenoids and tonsils). Given that dentists manage the teeth throughout the lifespan and have an important understanding of the anatomy and physiology involved with the airway from a dental perspective, it seems reasonable that better understanding and management from their field will give the opportunity to provide better integrated and optimized outcomes for children affected by OSA. With the emergence of therapies such as mandibular advancement devices and maxillary expansion, etc., dentists can be involved in providing care for OSA along with sleep medicine doctors. Furthermore, the evolving role of myofunctional therapy may also be indicated as adjunctive therapy in the management of children with OSA. The objective of this article is to discuss the important role of dentists and the collaborative approach between dentists, allied dental professionals such as myofunctional therapists, and sleep medicine specialists for identifying and managing children with OSA. Prevention and anticipatory guidance will also be addressed.

The purpose of this study is to evaluate the safety and efficacy of a non-permanent orthodontic oral appliance intermittently worn in reducing the signs and symptoms of pediatric obstructive sleep apnea (OSA). A non-randomized interventional pre-post study was conducted in 2018–2021 with up to 24-month follow-up at five US and Canadian sites. Participants were 55 enrolled OSA-diagnosed children, fit with a customized device worn in the evening and while sleeping to provide slow maxillary expansion. Participants were assessed for treatment efficacy by three co-primary endpoints, the Pediatric Sleep Questionnaire (PSQ), apnea-hypopnea index (AHI), and intermolar width; and two secondary endpoints, the PSQ Sleep-Related Breathing Disorders (SRBD) subscale scores and airway volume by cone-beam computed tomography (CBCT) scans. Forty-seven participants were included in the analytic dataset following trial completion after 12–24 months. PSQ symptom scores decreased 31.0% with a posttreatment-pretreatment difference score mean±SE and 95% CI of −0.13 ± 0.019 [−0.17, −0.09]; AHI decreased 29.3% (−3.47±1.015 [−5.52, −1.42]). All participants showed an intermolar width increase, averaging 13.0% (4.03 ± 0.421 [3.18, 4.88]). PSQ SRBD subscale scores decreased 57.8% (−0.178 ± 0.031 [−0.24, −0.12]). Airway volume by CBCT scans increased 67.8% (4053.78 ± 885.433 mm³ [2265.62, 5841.95]). There were no safety concerns. Conclusion: Participants showed objective and subjective OSA improvement, and all demonstrated maxillary expansion. Seventy-nine percent of participants showed AHI improvement, with 61.7% improving by 50% or more, and 17% resolved their OSA. Seventy-seven percent with moderate or severe OSA improved by 50%, while 93% with severe OSA achieved this milestone. This is the first study demonstrating that slow maxillary expansion by this device is safe and efficacious in treating children with OSA. Trial registration: ClinicalTrials.gov ID NCT05661747 (https://clinicaltrials.gov/ct2/show/NCT05661747) Registered: December 14, 2022, retrospectively registered. What Is Known: • Adenotonsillectomy is the primary treatment for pediatric obstructive sleep apnea (OSA) but is invasive and has proximal and long-term risks. Secondary treatments include rapid maxillary expansion that has numerous adverse effects due to its 24/7 use and treatment speed, and positive airway pressure that is limited by patient intolerance and nonadherence. What Is New: • This oral appliance is the first one FDA cleared for OSA treatment in children, and this study showed that slow maxillary expansion by this device was safe and efficacious for treating pediatric OSA. It is also the only pediatric non-permanent orthodontic device that is removable and intermittently worn to treat OSA. Graphical