Dentaltown July 2018 - 48

message board

know of no other studies, but he warns others to be careful. Young children are like PlayDoh. I personally have treated as young as 4 years old with a Crozat (removable w arch),
which I feel gave the same response with far less forces but no research available.
6. Like the other poster stated ... don't only think in terms of expansion but AP also.
Cheers and good luck. ■
3/28/2018

drrick

T&A removal first.
It is often amazing the changes made from just this treatment. ■

Member Since: 03/19/00
Post: 5 of 46

3/28/2018

fesdds
Member Since: 05/22/08
Post: 6 of 46

I agree with David's thoughts. On a side note, my wife went to a CE course that I did not
attend. It was mostly about sleep and breathing issues. She said that they were saying that some
patients benefit from the T&A more than from the RPE, but that in some patients the RPE is
making the bigger difference. I don't know if this was any true research and I have no articles to
cite. Has anyone else heard that there is solid research on the RPE actually helping more than
the T&A in patients? ■
3/28/2018

CLT-DMD
Member Since: 12/07/09
Post: 7 of 46

Thanks for your thoughts. We are going to wait until after the T&A have been addressed
before going through with the expansion, as the ortho said. ■
3/29/2018

Dr Nagy DDS MS
Member Since: 01/06/18
Post: 8 of 46

We have had several patients under age 7 diagnosed with OSA. We just had a 5-year-old
patient diagnosed in October.
What I have found is that most kids under 8 have mild OSA, and when the ENT does the
T&A and we redo the sleep study the test is negative with no orthodontic intervention.
If the arches are very small with transverse problems, and if there is a AP problem (often
maxillary retrognathism) often those children score mod or severe on OSA, and after T&A their
scores are still high. We have 2-3 kids on CPAP even at a young age. In many of these cases, we
often do RPE and face mask therapy at age 7-9 to correct the ortho problems and in 80 percent
of the cases the OSA clears up by ages 12-14.
We also just had a patient recently who was diagnosed with OSA at age 6, had T&A, and
was put on a CPAP per mom. Her OSA has remained and the same for years. After age 13ish,
we did not do anything special, she just had mild crowding, so we just leveled and aligned the
teeth, and finished as normal. One day before we were done with her ortho treatment she was
clear of OSA. Totally unrelated to the ortho treatment, but her OSA just went away. She has had
four follow-ups now and two hospital sleep studies since and still no OSA.
Personally, unless you see orthodontic reasons I would not do any expansion at this young
age of 5 to treat OSA alone. See the ENT, have them do their thing, and have the parents do a
follow-up sleep study. If the kid has orthodontic problems, deal with that a bit later after the 6s
are out solid. Just my two cents. ■
4/5/2018

dr-tique
Member Since: 11/20/01
Post: 10 of 46

At this age I would use a Nite-Guide after T&A. Select one a half-size large to start and
within two months it will be too small transversely. Trains the tongue to do the expansion.
Worth a try. ■
4/6/2018

JULY 2018 // dentaltown.com

http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown July 2018