Needing info on how to choose an orthodontist for an 8 year old with mild sleep apnea despite a years-prior tonsillectomy in the Austin/San Antonio corridor. Trying to get the most extra room possible for his tongue as we have also been dealing with speech issues for years, mouth breathing, and now myofunctional therapy.

We've gotten several quotes and they are all different in techniques and price from Bee Caves Orthodontics down to Solana Orthodontics in San Antonio.

Some were:
1. Upper and lower traditional expanders with reverse pull headgear and braces.
2. Upper and lower traditional expanders without reverse pull headgear and then braces. (Solana)
3. Just upper traditional expander with braces on front 4 top teeth.
4. Invisalign expander on top for about 3 months followed by a full set of Invisalign on top and bottom. (Bee Caves)
5 Traditional expander on top followed by braces to align teeth and using braces on bottom to move teeth.

Has anyone actually had experience with the Invisalign expanders? I had a set of Invisalign aligners in my 20s, but not sure how the expanders work with kids, and how the benefits/drawbacks play out on Invisalign in general with kids. Yes, you can take out to brush and floss but also have risk of loss.

Only a couple of the providers had their own cone beam CT machine. One of these providers was the one that suggested the sleep study. The Pedi ENT after the sleep study referred us to the provider that is suggesting the Invisalign route.

We already deal with cavities despite daily brushing. I know the bottom jaw doesn't open up like the top does via expanders.

His bite is fine now, and UT Dentistry in SA said they wouldn't do anything based on his mouth now without an ENT saying something needs done (before we got sleep apnea diagnosis). Just a slight overbite, which is why #1 wanted to do reverse pull now vs.#2 wanting to watch how he develops and possibly do reverse pull later if she thinks he needs it later on.

Any experiences with the two places I mentioned by name, or someone else I should consider? Willing to travel within this corridor for the right solution.

Thanks!

I can't speak on the functionality of Invisalign expansion but I will say compliance is a battle that you will likely lose going that route. Invisalign has to be worn "23 hours a day" to work and your life will be following around your child to make sure they are wearing it and then making sure they don't lose it. I would go traditional all day long with a kid that age. I don't think there is a wrong answer on the reverse head gear now vs later. I would go with the provider you feel the most comfortable and confident in. Expansion and development might lessen the "overbite" but I bet it does not bring in back to what would be called class 1 occlusion which is probably what you are looking for overall. If Bloyce Britton or Tyler Ferris is still around those areas they are both very sharp guys, good people and excellent and thorough clinicians. Bloyce actually is on the ortho faculty at UTHSCSA dental school,

How bad is the residual sleep apnea? Do you have a post op AHI, ODI, or percentage O2 saturation below 90%? Flonase, nasal saline, and Singulair have all been shown to help mild apnea. There are anecdotal reports of mood changes and even suicidal ideation in children on Singulair, predominantly children who already had mood disorders, so those warnings need to be taken. Rapid maxillary expansion definitely plays a role with residual apnea, particularly in a child with a high, arched palate and/or dental crowding.

We went in hoping to see Bloyce as I have a friend who had him for class there. The guy we saw wasn't too helpful and I haven't found Bloyce in private practice.

AHI of 3.1.

O2 is good. Nadir of 93. No hypoxemia.

He does have high arch. One ortho said large soft palate.

Myofunctional was recommending expansion even before apnea diagnosis.

He had tonsils out at 2.5. This was first/only sleep study.

OK, good. Not too bad. No chance adenoids regrew (either a scope or films done). Not overweight? Palatial expansion should definitely help. I have zero input as to the preferred technique. But don't ignore nasal saline just before bedtime and daily Flonase (timing doesn't matter but consistency does with Flonase). I would also do a little Azelastine or Astepro at night 1 puff per side. It works quickly but isn't addictive. Every little bit helps Good luck

He has been to 2 ENTs in past few months and neither mentioned regrowth of adenoids as issue. CBCT at orthodontist and they didn't mention it. Would it show on that?

He is 90% height and slightly off the chart on weight but pedi not worried about being overweight (I asked).

Trying to get him to grow into weight he carries

Ironically a SLP at a kid's bday party last week noticed I have a tongue thrust when talking about issues and weather apnea is hereditary.

Definitely it can be an issue, particularly in a kid with significant recurring sinusitis, allergies, bad reflux, etc. Generally, if your child breathes well through his nose, though, adenoid regrowth is not likely to be a significant issue. Nasal sprays as I outlined, maxillary expansion, and lowering BMI will all help. With regards to the genetics of apnea, craniofacial structure is obviously genetic, and thus in a way predilection for sleep apnea can be genetic. You're on the right track(s).

Thanks.