Orthodontists all over the country are being asked for a lower expander and refusing, on the grounds that there's no suture to open. This is the full conversation about why that's wrong, and the cases that prove it.

Dr. Kevin Goles is an airway-focused dentist, my co-instructor on 3 Days to Airway, and the person I go to when a case doesn't add up.

Expect to learn:

→ Why the orthodontic literature itself shows phase one treatment doesn't change where patients end up, and what that means if you're only expanding 3-4mm

→ The 38mm intermolar width threshold, Ben Miraglia's 35-39mm for 28 teeth, and why we expand to at least 40

→ How you expand a lower jaw that has no suture to open, and why alveolar remodelling works the way bone responds to load anywhere else

→ Why an orthodontist at Dr. Goles' training suggested glossectomy instead of expansion, and appeared unaware the TMJ exists

→ What the 1982 study everyone cites against expansion actually says: 28 patients, a fixed appliance, a periodontal probe, and subjects who weren't growing

→ Why Dr. Goles doesn't accept Dave Singh's mesenchymal-cell explanation, and what he thinks is really happening to the palate and nasal floor

→ How a 10-year-old went from 1.9 cubic centimetres of airway to 9.8, with the narrowest point going from 15.7 square millimetres to 135.9

→ Why a Bay Area family spent five years in treatment, still symptomatic, and was offered a third upper expander

→ Why Invisalign can't do this: 150-micron models, plastic that loses force in four hours, and a scalloped tray that forces attachments onto every tooth

→ Why ENTs reach for nasal steroids then tonsillectomy without anyone trying expansion first

→ Dr. Audrey Yoon's finding that a hyrax expander at around 12mm produces a 51 to 75 percent reduction in tonsil and adenoid size

→ Why only six children in ten years still needed their adenoids out after expansion

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ABOUT THE SHOW

awAIR Unfiltered — Dr. Hilary Fritsch, 20 years in dentistry, Diplomate of the International Academy of Sleep, covering airway, sleep and breathing for the clinicians treating it.

This channel is clinical discussion between practitioners. It isn't medical advice.

#airwaydentistry #orthodontics #sleepapnea