Nasorespiratory obstruction has been purported to influence dentofacial growth adversely. This has sparked considerable debate for decades with a resurgence in interest in “airway friendly orthodontics” among both general and specialist dental practitioners. This critical review aims to evaluate the current literature relating to two questions: does nasorespiratory obstruction alter dentofacial growth, and does early intervention targeted at alleviating nasorespiratory obstruction improve dentofacial growth? The strength of association between nasorespiratory obstruction, mouth breathing and a long face is weak. The common methodological flaws in research include unblinded and cross-sectional study designs, a lack of adequate controls, inadequate follow-up, subjective assessments and inadequate statistical power. Vertical dentofacial growth has a strong genetic influence, which implies a relatively minor contribution of environmental factors including airway obstruction. The current evidence does not support recommending procedures, such as adenotonsillectomy and maxillary expansion, with the singular aim of negating a hyperdivergent (vertical) dentofacial growth pattern. In light of low-quality evidence, both the World Health Organization guidelines and ethical principles dictate that greater emphasis is placed on avoiding harm and wastage of resources over alternative options.
These findings call for quality improvement in undergraduate and postgraduate curricula and continuing professional development for health professionals.


Article in Australian Dental Journal · May 2021


Juen-Long Sunny Cheung* Craig Dreyer**
Sarbin Ranjitkar**†

*Private Practice, Melbourne

**Adelaide Dental School
University of Adelaide, Adelaide SA 5005

†Department of Dentistry and Oral Health La Trobe Rural Health School
La Trobe University, Bendigo Vic 3550

Corresponding author
Dr Sarbin Ranjitkar
Adelaide Dental School
University of Adelaide, Adelaide SA 5005 Australia

T: +61 8 8313 6788
 Email: [email protected]