Exploring the Relationship Between Obstructive Sleep Apnea and Premolar Extraction

Objectives: A controversy exists concerning the relationship, if any, between obstructive sleep apnea (OSA) and the anatomical position of the anterior teeth. Specifically, there has been speculation that extraction orthodontics and retraction of the anterior teeth contributes to OSA by crowding the tongue and decreasing airway space. This retrospective study utilized electronic medical and dental health records to examine the association between missing premolars and OSA.
Methods: The sample (n = 5,584) was obtained from the electronic medical and dental health records of HealthPartners in Minnesota. Half of the subjects (n = 2,792) had one missing premolar in each quadrant. The other half had no missing premolars. Cases and controls were paired in a 1:1 match on age range, gender, and Body Mass Index (BMI) range. Ages were grouped in ranges of 40-49 years, 50-59 years, and 60-70 years. BMI was grouped by normal, overweight, obese, and unknown. The outcome was the presence or absence of a diagnosis of OSA confirmed by polysomnography. A generalized estimating equations approach tested the association between missing premolars and OSA.
Results: Of the analytical sample, 24% were obese, 43% were aged 40-49, 40% aged 50-59, and 17% aged 60-70. Women comprised 65% of the analytical sample. Of the subjects without missing premolars, n = 267 (9.56%) had received a diagnosis of OSA. Of the subjects with four missing premolars, n= 299 (10.71%) had received a diagnosis of OSA. The prevalence of OSA was not significantly different between the groups [OR=1.14, p = .144].
Conclusions: The presence or absence of four premolars (one from each quadrant), and therefore by inference extraction orthodontic treatment, does not increase the probability of an OSA diagnosis. This suggests that premolar extraction does not increase the risk of OSA.