The profession of orthodontics is pushing for a more evidence-based approach to treating patients, which means more emphasis is being given to research that answers common orthodontic questions such as:

• What are the advantages and disadvantages of early phase-one treatment?
• What are the advantages and disadvantages of expanding my jaw and/or teeth? 
• How long should I wear my retainer?

We have included some research publications that address these questions. Although the profession is making large strides toward understanding the hidden truths of orthodontic treatment, there is still much that remains unknown.

Regardless, our hope is that we can provide you with the best evidence and scientifically supported information out there to improve your ability to make better treatment decisions.

If you have specific questions, feel free to ask at any time!

What are the advantages and disadvantages of early phase 1 treatment? 

Advantage:

• Preserving space for permanent teeth can resolve mild crowding and allow for a more natural eruption of these teeth. (1)
• You may feel like your top teeth stick out. If they stick out a considerable amount in front of your bottom teeth, they may chip or fracture during rough-housing or other activity common among children. Early treatment can reduce the potential for this dental trauma. (2)

Disadvantage:

• Early treatment is not the same as comprehensive treatment. If an early phase of treatment is undertaken, a later, more comprehensive phase (when all or most of the permanent teeth have come in) is commonly needed to enhance the appearance of and way the teeth fit together. Two phases are often more expensive and will require a greater time commitment than just one phase. In specific cases, the results obtained through just one comprehensive phase as opposed to an early and a later phase may be similar. (3)

What are the advantages and disadvantages of expanding my jaw and/or teeth?

Advantage:

• Expansion is a common term in orthodontics. It is a technique used to help change the position of teeth and jawbones. Sometimes teeth and jaw bones deviate from normal development patterns. This can interfere with biting and/or it can lead to crowding and a “narrow” smile. Expansion can provide needed space to resolve certain degrees of crowding, improve your bite, as well as “broaden” your smile. (4)

Disadvantage:

• You know how expansion can widen your smile? Well, too much can have a negative effect on your appearance (this is subjective, though). This may not be the only adverse side effect. Expansion moves teeth toward the edge of your jawbones. There is a great deal of individual variability, but the closer your teeth get to the edge of the bone, especially at older ages, the higher you may be at risk for experiencing irreversible damage to teeth, bones, and gums.

How long should I wear my retainer?

Moving teeth and bones in any way alters their equilibrium. This means there is an imbalance. For example, your gums, tongue, cheek, and lips all push on your teeth. They never stop, not even after you’ve had braces.

Since your face continues to change throughout life, no matter how slowly, your teeth will feel those changes and may succumb to a physiologic process of adaptation. Essentially, your teeth move to a different position to reestablish balance.

Basically, your best bet for straight teeth in the long-term is with long-term retainer wear. (5) With this in mind, the idea that you may need to purchase new replacement retainers at some point due to normal wear and tear, breakage, and/or lost retainers may appear more reasonable.

References:

1. Effects of lingual arch used as space maintainer on mandibular arch dimension: A systematic review, American Journal of Orthodontics & Dentofacial Orthopedics. Volume 138, Issue 4, Pages 382.e1-382.e4, October 2010 Azzurra Viglianisil.

2. Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma. Results of a Cochrane systematic review, American Journal of Orthodontics and Dentofacial Orthopedics, Volume 148, Issue 1, Pages 47–59, July 2015 Badri Thiruvenkatachari, et al.

3. Tulloch JF, Proffit WR, Phillips C: Outcomes in a 2-phase randomized clinical trial of early class II treatment. American Journal of Orthodontics and Dentofacial Orthopedics, 125(6): 657-667, June 2004.Volume 135, Issue 5, Pages 573-579, May 2009 Kevin O’Brien, et al.

4. Rapid Maxillary Expansion Followed by Fixed Appliances: A Long-term Evaluation of Changes in Arch Dimensions, The Angle Orthodontist, Volume 73, Issue 4, Pages 344-353, August 2003 James A. McNamara, et al.

5. An evaluation of changes in mandibular anterior alignment from 10 to 20 years postretention, American Journal of Orthodontics & Dentofacial Orthopedics, Volume 93, Issue 5, Pages 423-428, May 1988 Robert M. Little, et al.

 

Temporomandibular Disorders (TMD's) - Jaw Pain & Dysfunction

What are Temporomandibular Disorders (TMD's)?

TMD's are a group of conditions causing pain and problems in the jaw joint (TMJ), jaw muscles, and surrounding stuctures. They can be influenced by stress, genetics, posture, teeth grinding, and othe factors-not just "bad bite."

Modern Understanding (Updated Consensus):

Recent international guidelines emphasize a biopsychosocial approach - looking at the whole person (physical, psychological, and behavioral factors)  rather than focusing on fixing teeth or jaw position.

Key Takeaways for Patients:

Common Symptoms:

• Jaw Pain or clicking/popping
• Difficulty chewing or opening of the mouth wide
• Headaches, ear pain, or neck pain
• Teeth grinding or clenching (often at night)

Actionable Recommendations:

• Report an jaw discomfort of clicking to your orthodontist or dentist early.
• Start with conservative, non-invasive treatments first:
• Soft diet and avoiding extreme jaw movements (eg big bites, gum chewing)
• Jaw relaxation exercises and gentle stretching
• Nightguard or splint if grinding is an issue
• Avoid unnecessary invasive procedures (eg extensive dental work or surgery) unless clearly needed.
• Follow up regularly - most TMD symptoms improve with time and conservative care. 

Important Note: TMD management is best done through collaboration.  Your orthodontist can help with screening and suportive care, but complex cases may involve physical therapists, pain specialists, or other providers.

Reference: International consensus on TMD care (American Journal of Orthodontics and Dentofacial Orthopedics, 2026)

 

Emerging Dental Therapies for Sleep Disorders
What the Latest Evidence Says

Dentistry is playing an increasingly important role in sleep health, particularly in the management of obstructive sleep apnea (OSA) and snoring. A 2024 consensus report from the American Academy of Dental Sleep Medicine (AADSM), synthesized in a 2026 review published in the Journal of the American Dental Association, examined newer and emerging dental approaches for these conditions.

Here is a clear overview of the findings and what they mean for patients and orthodontic care.

Key Takeaway

No emerging dental therapy currently qualifies as a first-line (stand-alone) treatment for OSA or snoring.

Proven options—such as custom mandibular advancement devices (oral appliances), continuous positive airway pressure (CPAP), and selected surgical procedures—remain the primary recommended treatments.

Some of the newer approaches may still offer value as adjunctive (add-on) therapies or for carefully selected individual patients when standard treatments are not tolerated or fully effective.

Emerging Therapies Reviewed

Myofunctional Therapy
Daily oral and tongue exercises (typically 30–60 minutes) to improve muscle tone and posture. This is a low-risk option that may help manage OSA or snoring, especially when used alongside other treatments. It is not shown to prevent or cure these conditions.

Functional Appliances & Myofunctional Orthodontics (primarily for growing children)
Removable appliances combined with exercises to guide jaw growth and airway development. Evidence is uncertain. There may be possible benefit in children during growth periods, but these are not recommended as first-line therapy.

Orthodontic Expansion
Widening of the upper jaw to create more tongue space. Evidence is limited and uncertain. It may provide short-term benefit in selected pediatric cases or for adult OSA management in specific situations, but it is not considered first-line treatment.

Frenum Release (Tongue-Tie or Lip-Tie Release)
Surgical release of restrictive tissue under the tongue or lip. This is not recommended for treating OSA or snoring. It is appropriate only for established medical reasons (such as breastfeeding or speech difficulties).

Ablative Laser Therapy
Laser removal or reshaping of soft tissues in the airway. There is insufficient evidence and notable risks. This approach is generally discouraged.

Nonablative Laser Therapy
Non-surgical laser treatment intended to stiffen soft tissues. Evidence is preliminary. It may offer possible temporary improvement for adult snoring in limited cases, but it is not supported for OSA.

Orthodontic Tooth Extractions
Removal of premolars to relieve crowding. There is no evidence that extractions cause OSA or snoring, or that they treat these conditions. Arch dimensions and relationships appear more relevant than extractions alone.

Important Limitations in the Research

• Children of all ages were often studied as one group, despite major differences between infants, young children, and teenagers.
• Success was frequently measured mainly by the apnea-hypopnea index (AHI) and oxygen levels. These do not always capture how patients feel day-to-day (energy, mood, concentration, school performance, or quality of life).
• Many studies were small, varied in methods, and under-represented women, younger patients, and diverse populations.

What This Means for Orthodontic Patients

• Established treatments should be the foundation of care.
• Emerging therapies may be considered in specific situations—particularly as complementary options—after thorough discussion of the current evidence and with informed consent.
• Early evaluation of jaw growth and airway development in children remains valuable and is an active area of ongoing research.
• Collaboration between orthodontists, dentists with sleep medicine training, and medical sleep specialists provides the most comprehensive approach.

Looking Ahead

Researchers emphasize the need for:

• Better-defined age groups in children
• Broader measures of success (including quality of life, cognition, and behavior)
• Longer-term studies on whether early orthodontic guidance of airway growth can play a preventive role
• Standardized, objective ways to measure snoring

Dentistry continues to contribute meaningfully to multidisciplinary sleep care. As stronger evidence becomes available, some of these emerging approaches may expand treatment options. Until then, decisions should be guided by the best available data, clinical expertise, and individual patient needs.

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Source
Simmons M, Sheats R, Meira e Cruz M. Emerging dental therapies for sleep disorders: Evidence synthesis from the American Academy of Dental Sleep Medicine 2024 Consensus. J Am Dent Assoc. 2026;157(1):10-19. doi:10.1016/j.adaj.2025.10.010