Dentaltown July 2018 - 50

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tonsillar sac but there is only a 6 percent regrowth rate for these cases. Much less traumatic and
very rapid healing time. ■

4/6/2018

Dr Nagy DDS MS
Member Since: 01/06/18
Post: 15 of 46

I don't know if you guys have seen this, but during the past three months we had three
patients whose insurance mandated a sleep study or they were not going to cover the T&A.
I spoke to our ENT group that we work with and they said that they see more insurance
companies require a sleep study before T&A.
Correct ... RPE with no transverse issue makes no sense. ■

4/6/2018

solarsteve
Member Since: 11/06/05
Post: 20 of 46

I have a case where there is a buccal tilt of U6s, and lingual tilt of L6s. So, if the teeth were
uprighted, he will have a posterior crossbite. Patient is 8 years old with breathing issues and loud
snoring. I'm considering bonded Hyrax to improve his breathing first, then T&A if necessary. ■

4/10/2018

justinudm
Member Since: 09/29/14
Post: 22 of 46

Other way around, solar!
Steps to be taken:
1. Sleep study first to diagnose severity of sleep apnea, and to get documentation so T&A will
be covered by medical insurance.
2. T&A, followed by follow-up sleep study.
3. If still sleep apnea, then consider expansion in the case you describe.
I would be careful varying from the previous protocol recommended by the sleep docs. ■
4/11/2018

Dr Nagy DDS MS
Member Since: 01/06/18
Posts: 23 and 25 of 46

Just be careful. There have been some issues with this, because doing an expander to
improve breathing comes very close to practicing medicine without a license, according to some
dental/medical boards.
If you are correcting dental, or orthodontic malocclusion with full records and dx/tx, that
is a different story. But if you are doing expansion to improve OSA and/or breathing, one could
easily make the case for practicing medicine.
To treat OSA, you would need a diagnosis by a MD with a sleep study before, and follow the
MD's instructions. Also, with kids, the liability is very high to get into this. There are very few
take-home sleep studies that are FDA approved for diagnosing sleep apnea in patients younger
than 18. For most kids, you have to do it in a sleep center because kids are very active sleepers
and the signal quality is poor often with kids.
I think with all the childhood obesity, the reduced chewing forces and airway problems, facial
skeletal retroganthism will get worse. Just in the past 15+ years you can see how kids' Mx/Mn
are more retrognathic and more transverse-constricted than were before. I think this trend will
progress, unfortunately. I do worry about some of the upper expansions that I see now, where it is
not done with coordination with the lower transverse dimension ... but that's another topic.
For adults, I think there is a bigger need for surgical skeletal correction of nongrowing adults
than is realized. ■

4/11/2018

How should pediatric sleep apnea patients be treated?
Search: "Expander Before"
A Townie's son was diagnosed with sleep apnea, and now this doc is asking the community for
advice on how to proceed with treatment. To see this entire conversation, go to dentaltown.com
and under message boards, search "Expander Before." This thread will be one of the top results.

JULY 2018 // dentaltown.com

http://www.dentaltown.com/messageboard/thread.aspx?a=11&s=2&f=135&t=309702&g=1 http://www.dentaltown.com

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