title: Evidence Supports No Relationship between Obstructive Sleep Apnea and Premolar Extraction: An Electronic Health Records Review.
abstract: OBJECTIVE
  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. The outcome was the presence or absence of a diagnosis of OSA confirmed by polysomnography.
  
  
  RESULTS
  Of the subjects without missing premolars, 267 (9.56%) had received a diagnosis of OSA. Of the subjects with four missing premolars, 299 (10.71%) had received a diagnosis of OSA. The prevalence of OSA was not significantly different between the groups (OR = 1.14, p = 0.144).
  
  
  CONCLUSIONS
  The absence of four premolars (one from each quadrant), and therefore a presumed indicator of past "extraction orthodontic treatment," is not supported as a significant factor in the cause of OSA.
authors.affiliation: The University of Texas Health Science Center at San Antonio School of Dentistry, San Antonio, TX.
authors.forename: Ann J
authors.initials: AJ
authors.lastname: Larsen
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN.
authors.forename: D Brad
authors.initials: DB
authors.lastname: Rindal
authors.affiliation: The University of Texas Health Science Center at San Antonio School of Dentistry, San Antonio, TX.
authors.forename: John P
authors.initials: JP
authors.lastname: Hatch
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Kane
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Asche
authors.affiliation: University of Minnesota School of Dentistry, Minneapolis, MN.
authors.forename: Chris
authors.initials: C
authors.lastname: Carvalho
authors.affiliation: The University of Texas Health Science Center at San Antonio School of Dentistry, San Antonio, TX.
authors.forename: John
authors.initials: J
authors.lastname: Rugh
mesh_terms: D000328:Adult; D000368:Aged; D001641:Bicuspid; D015984:Causality; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D017286:Polysomnography; D015995:Prevalence; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D014081:Tooth Extraction / Q000706:statistics & numerical data*
keywords: airway space; obstructive sleep apnea; orthodontic treatment; polysomnogram; premolar extraction