Orthotown October 2017 - 45

continuing education

Fig. 8

incorporate mandibular expansion (tipping
of teeth), either through a removable
Schwartz appliance (Figs. 9 and 10) or a
dual-arch expander.

Timing
Very frequently, expansion takes place
before the eruption of the maxillary lateral
incisors, between ages 7 and 8. (That's not
to say that children would not benefit from
earlier expansion; it just so happens that
this is the typical age at which we see our
initial consults.)
After completing expansion, the lateral
incisors may or may not have erupted into
the arch. If the laterals have erupted, we
will bond the maxillary 2-2 and complete
treatment within six months of the placement
of the expander and retain with a palatal
coverage retainer.
If the laterals have not erupted, we remove
the expander after six months, retain with
a palatal coverage retainer and continue to
observe the patient until the laterals have
erupted. Then we bond the 2-2 and retain.

Summary
Our ultimate findings are that we have
helped our patients in two major ways:
1. Aided the eruption of adult dentition so
comprehensive treatment is simpler and faster.
2. Changed the life of the patient by
potentially reducing airway resistance and

Fig. 9

Fig. 10

improving life quality for the long term.
We find that when we have the correct
understanding of how we can truly help
our patients, and then ask the right questions, we most benefit our patients and
the community. This has helped us build
our practice to one where we continue to
get referrals from ENTs, pediatricians and
general dentists who want to best serve their
patients in a comprehensive, effective and
life-changing way. n

References
1.
Policy of Sleep Apnea, 2016, AAPD
2.
American Academy of Pediatrics. Clinical practice guideline. Diagnosis and management of childhood obstructive
sleep apnea syndrome. Pediatrics 2012;130(3):576-684.2
3.
Padmanabhan V, Kavitha PR, Hedge AM. Sleep disordered
breathing in children-A review and the role of the pediatric dentist. J Clin Ped Dent 2010;35(1):15-21.3
4.
Chan J, Edman JC, Koltai PH. Obstructive sleep apnea in
children. Am Fam Physician 2004;69(5):1147-54
5.
"Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome." Carole L. Marcus, Lee
Jay Brooks, Kari A. Draper, David Gozal, Ann Carol
Halbower, Jacqueline Jones, Michael S. Schechter, Stephen
Howard Sheldon, Karen Spruyt, Sally Davidson Ward,
Christopher Lehmann and Richard N. Shiffman Pediatrics
2012;130;576; originally published online Aug. 27, 2012;
DOI: 10.1542/peds.2012-1671
6.
Sleep Med Clin. 2009 Sep; 4(3): 393-406.
7.
American Academy of Pediatrics. Clinical practice guideline. Diagnosis and management of childhood obstructive
sleep apnea syndrome. Pediatrics 2012;130(3):576-684.2
8.
Padmanabhan V, Kavitha PR, Hedge AM. Sleep disordered
breathing in children-A review and the role of the pediatric dentist. J Clin Ped Dent 2010;35(1):15-21.3
9.
AJODO September 2008 Volume 134, Issue 3, Pages
370-382 Relationship between rapid maxillary expansion
and nasal cavity size and airway resistance: Short- and
long-term effects Nanci Lara Oliveira De Felippe, Adriana
C. Da Silveira, Grace Viana, Budi Kusnoto, Bonnie
Smith,Carla A. Evans

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