Good morning. This is More Than Teeth. The newsletter that helps dental sleep professionals get 1% better every week.

In this week’s issue:

• The Potential of Expansion in Treating OSA

• Expand or Wait: A Systematic Review

• Myofunctional Therapy Effect on OSA: Meta-Analysis

• Free - 2 CE Hour Course

• The Art of Saying ‘No’

This is a 7-minute read today. Let’s dive in👇

Clinical Corner

🥼Use the clinical corner as your secret weapon to impress your colleagues and patients!

1/ Re-Thinking Pediatric OSA: The Hidden Potential of Rapid Palatal Expansion (RPE)🔍

Pediatric obstructive sleep apnea (OSA), often triggered by adenoid and tonsillar hypertrophy, is a challenging condition, with tonsillectomy being the standard recommendation. However, a recent study reveals Rapid Palatal Expansion (RPE) might offer a less invasive and equally effective solution.

🔬 The Study at a Glance

A retrospective cohort study explored the impact of RPE on adenoid and tonsil sizes in 60 children with tonsillar hypertrophy. Divided into a control group (n = 20) and an expansion group (n = 40), the expansion group underwent RPE treatment using a conventional Hyrax expander.

The results? Measured via 3D volumetric analysis of CBCT scans, both adenoid and tonsil volumes significantly decreased in the expansion group post-RPE.

💥 Key Findings

The expansion group experienced a significant reduction in adenoid and tonsil volume - 90.0% and 97.5% of patients respectively. On average, adenoids shrunk by 16.8%, and tonsils reduced by 38.5%. Some patients even saw up to 51.6% and 75.4% reduction in adenoid and tonsil size, respectively. Additionally, Pediatric Sleep Questionnaire (PSQ) scores showed a significant drop post-RPE.

🌟 The Takeaway

The evidence is clear: RPE can notably reduce the size of adenoids and tonsils, revealing its potential as an effective, non-invasive treatment option for pediatric OSA patients with adenotonsillar hypertrophy. This groundbreaking study is the first to quantify these changes following RPE, providing dental sleep professionals a fresh perspective in their fight against pediatric OSA.

2/ Systematic Review: Rapid maxillary expansion vs watchful waiting in pediatric OSA

The Study

OSA can be a real nightmare for kids, and it's most severe in sleep-related disordered breathing (SRDB). Treatments have been diverse and, frankly, inconsistent. In a world where diagnostic criteria are far from standardized, and treatment cure rates swing wildly from 25% to 79%, there's clearly room for some fresh thinking.

Enter Maxillary Expansion (M.E.)

Typically, M.E. is an orthodontic treatment for maxillary constriction. But some bright professionals have suggested it might also help tackle pediatric OSA, improving upper airway functionality. While European guidelines have welcomed M.E. as a treatment option for kids with OSA, American guidelines have been more cautious.

The big question this systematic review wanted to answer was: Does M.E. genuinely improve sleep study outcomes for children with OSA compared to other treatments or no treatment at all?

The Findings

The review pulled together data from 1219 records, eventually whittling them down to 5 studies for qualitative analysis. These studies used M.E. to treat pediatric OSA, with treatment ranging from T&A (tonsillectomy and adenoidectomy) to medical therapy and watchful waiting.

However, the findings? Well, they're not as clear-cut as we'd like.

Several studies reported uneven distribution of pediatric OSA risk factors, making it hard to genuinely compare the results of M.E. with other treatments. Furthermore, the studies varied widely in their methodologies and patient selection processes.

One intriguing find from a crossover randomized controlled trial (RCT) was a cure rate of 86-100% for both T&A and M.E. after initial treatment failure. But this impressive result hasn't been replicated elsewhere, and the reasons for such a drop in AHI (Apnea-Hypopnea Index) in self-resolving pediatric OSA remain unknown.

The Bottom Line

After wading through the data, the review concluded that there's no convincing evidence of a significant benefit of M.E. treatment over watchful waiting in patients with pediatric OSA. Comparisons with other treatments were hindered by a non-homogeneous distribution of confounders and suboptimal designs.

In short, the jury's still out on the effectiveness of M.E. in treating pediatric OSA. Future randomized controlled trials (RCTs) should aim to compare the results of treatment with M.E. with the natural progression of pediatric OSA.

So, what does this mean for you, the sleep professional? It's a call to stay vigilant, to keep questioning, and to remain open to new research as it emerges. And as always, we'll be here to help you make sense of it all.

3/Study Review: Myofunctional Therapy in Treating Obstructive Sleep Apnea🔬

The Elevator Pitch: Myofunctional Therapy (MT), an exercise regimen for the muscles in our lips, tongues, and soft palates, can significantly reduce symptoms of Obstructive Sleep Apnea (OSA) in both adults and children. It's all about working those oral and oropharyngeal structures to combat sleep apnea, and recent research has some promising results.

The Details: This study delved into a series of exercises designed to target the soft palate, tongue, and facial muscles. The outcomes? MT reduced the Apnea-Hypopnea Index (AHI) by about 50% in adults and 62% in kids. 💪

Snoring, another nighttime nuisance, also saw a marked decrease, both from the patient's perspective and those likely relieved partners. Snoring went from a roar to a purr. 😴

Cherry on Top: Feeling foggy during the day? MT also helped with that. ESS scores, which measure daytime sleepiness, dropped from 14.8 pre-treatment to 8.2 post-treatment.

Bottom Line: MT isn't just about getting your face fit - it's a promising, non-invasive treatment for OSA. So, let's get our patients exercising those muscles and enjoying better sleep!

2 CE Credits Free

Master the art of screening, testing, treating, and billing for sleep apnea in just 2 hours with our power-packed course. Improve your skills, streamline your practice, and earn 2 CE credits.

Business of Sleep

📈Better businesses = more lives saved!

Unlock Your Leadership Power-Up: Mastering the Art of 'No' 🚀

The Boss Level: Ever feel like leadership is a video game, and the hardest boss level is saying "No"? You've leveled up because "Yes" was your power move. But saying "Yes" too often can lead to game over, as you burn out from juggling too many quests.

Here's the power-up you need: the art of crafting a strategic "No" that validates their request while safeguarding your energy and focus.

Your Power-Up Guide: 5 Strategies for 5 Scenarios in 5 Minutes:

1. 🛡️ Boss Battles: Remember, you're a leader, not a time wizard. Construct a capacity model linking core outcomes to your team and potential improvements. Showcase how adding quests affects your outcomes. The model does the heavy lifting, gracefully declining projects that don't level up the team.

2. ⛔ Team Tactics: Maintain your team's creative flow even when you're the gatekeeper. Setting clear quests and cultivating a team culture will do the trick. For challenging encounters, use "Not Yet" as your shield, clarifying the path to turn that into a "Yes."

3. 🚫 Self-Stoppage: Leaders often fall for "shiny object syndrome". Here's a cheat code from Warren Buffett: Write your goals, select the top 5, and keep your eyes on the prize. Everything else is a distraction until you've completed a goal from your priority list.

4. ❌ Favor Fend-off: Requests that seem aligned with your character class can lure you away from your main quests. Decode the problem they're trying to solve and guide them to a superior route that doesn't involve your energy.

5. 🚷 Stranger Shields: Your growing reputation will attract more side quests from strangers. Set a significant milestone for them to reach before you grant them a "Yes", reducing low-quality asks while keeping doors open for worthy opportunities.

Quest Complete: Navigating the "No" level in leadership isn't about closing doors, but about crafting a "No" that respects your time and mission while acknowledging others. With these strategies, you'll be ready to level up

Something Sweet

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