Lack of evidence is NOT evidence...also don't believe everything you read online.

Ya'll I love research. I wish I could go back to school and write research papers again. Huge huge fan. And I believe high quality research and studies are an incredibly important part of good medicine.

BUT...

A lack of definitive evidence does NOT automatically mean something is not true.

Science is constantly evolving, and history is full of examples where clinical observations, anatomy, physiology, and real-world patient experiences were recognized LONG before large-scale research caught up.

The absence of strong evidence is not the same as evidence of absence. Sometimes it simply means the research is incomplete, difficult to study, underfunded, or still developing. In these cases, critical thinking and common sense are imperative. We should absolutely continue researching rigorously, but we should also be cautious about dismissing ideas outright simply because the highest level of evidence has not yet fully formed.

Let's look at some examples.

I have been seeing people throw around this recent orthodontic white paper claiming there is currently no strong evidence that orthodontic interventions alone can reliably prevent or treat sleep disordered breathing (SDB) or obstructive sleep apnea (OSA). This includes discussions surrounding routine palatal expansion for prevention, functional appliances, tongue tie releases for airway-related sleep concerns, and CBCT airway measurements as standalone diagnostic tools.

People have then used this paper to try to “debunk” prominent airway dentists, ENTs, myofunctional therapists, and other airway-focused providers online.

But there is a MASSIVE difference between saying “there is insufficient strong evidence”and "this has been proven ineffective.”

Those are NOT the same statement.

And honestly, one of the biggest ironies is that throughout the paper itself, the authors repeatedly emphasize the importance of a multidisciplinary approach to sleep-disordered breathing care, which is literally what any quality airway-focused provider has been saying all along.

That is not some radical “debunking” of airway dentistry.That is confirmation that these issues are complex and multifactorial.

The reality is most legitimate airway providers are NOT claiming that one expander, one tongue tie release, or one appliance magically cures every case of sleep apnea. In fact, most would strongly agree that these patients often require a team approach involving ENTs, orthodontists, airway dentists, myofunctional therapists, bodyworkers, etc.

If anything, this paper reinforces the idea that sleep-disordered breathing is complex and cannot be reduced to a one-size-fits-all model.

At the same time I do agree research matters immensely. High-quality studies matter. We absolutely should continue investigating these treatments critically and honestly. But people also need to stop acting as though absence of perfect evidence automatically means something is biologically impossible or clinically irrelevant.

A lack of high-level evidence does not invalidate:

• anatomy

• physiology

• biologic plausibility

• clinical observation

• developmental biology

• or patient outcomes

  
  

Many of the biggest advances in medicine began long before perfect randomized controlled trials existed. Clinicians noticed patterns. They understood structure and function. They listened to patients. And the research came LATER.

Sleep-disordered breathing, craniofacial growth, oral posture, tongue function, nasal breathing, and airway development are extraordinarily complex systems. These are not simple variables that can always be isolated easily in reductionist research models.

And yet some people online view the absence of large-scale definitive trials as proof these factors suddenly do not biologically matter. THAT IS NOT SCIENCE.

More importantly...people need to stop believing every oversimplified “debunking” post they see online (preaching to myself here somedays, honestly!!) Again, critical thinking and common sense.

Another example: I recently had someone ask me for research proving that valved-straws are not ideal (compared to valveless straws).

This specific research does not exist (to my knowledge), but that does not make it untrue.

What we do understand is the mechanics of a mature swallow and healthy oral function. In a mature swallow:

• the tongue rests against the roof of the mouth

• the lips remain sealed

• the facial muscles work in a coordinated way

• the swallow becomes more sip-based rather than suck-based

Valved straw cups require stronger suction to release liquid. Because of this, most children rely on an infant-like sucking pattern, jaw bracing, or biting for stability rather than practicing the more mature oral movements we ultimately want to encourage over time. Non-valved straws generally allow for a more natural sipping pattern and better support lip seal, tongue elevation, oral muscle coordination, and mature swallowing mechanics.

So while yes, long-term research would absolutely be valuable, we do not necessarily need decades of outcome data to understand basic biomechanics and oral function. We already know what a mature swallow pattern looks like…and we have eyes...

If valved straws require excessive suction, jaw bracing, or biting to access the liquid, it is not unreasonable to question whether that is truly supporting the most ideal oral mechanics long-term.

Additionally - in this particular topic, research is incredibly difficult. Oral development is multifactorial. Genetics, airway health, tongue posture, nasal breathing, diet, oral habits, muscle function, and more all play a role. Maybe not Impossible?? Idk I'm not a medical researcher...but I would imagine researching JUST the role of valved vs valveless straws would be a difficult thing to do.

And IMO designing a true long-term study on this topic would be challenging ethically. You would essentially need one group of children using what many providers already believe to be the more developmentally supportive option, while another group continued using a less ideal pattern for years. What parent is going to want to sign up for that? Not me.