Tonsil and adenoid removal is 15% of every pediatric surgery performed in the United States, about 530,000 kids a year. And the research says 60 to 70% of those children still have obstructive sleep apnea after the surgery. Dr. Kevin Goles and I go through why that happens, and why upper and lower expansion shrinks tonsils and adenoids without a child going under anesthesia.

Dr. Kevin Goles is the other half of awAIR Unfiltered and my co-instructor on 3 Days to Airway.

CHAPTERS

0:00 Why tonsil and adenoid removal is 15% of all pediatric surgery in the US

3:26 The research: 60 to 70% of kids still have sleep apnea after the tonsils come out

6:30 Nitric oxide and the three lines of immune defense a mouth breather skips

9:37 Dr. Audrey Yoon's Stanford study: 51% adenoid and 75% tonsil reduction from palatal expansion

13:44 Why an upper-only expander is the equivalent of not doing an expander

17:02 530,000 tonsillectomies a year, and how many of those kids get a sleep study first

21:47 CBCT before and afters: adenoid and tonsil shrinkage after six months of expansion

29:42 How a high vaulted palate creates a deviated septum, and why MARPE is wrong for a growing child

38:01 ToothPillow appliances vs fixed expanders: how to choose for a child

43:16 Bedwetting, teeth grinding, and an airway from 1.8 cc to 10.9 cc

STUDIES MENTIONED

Dr. Audrey Yoon and Dr. Clete Kushida, Stanford Sleep Medicine

The adult expansion case shown at 35:29 is published in the book Beautiful Faces.

Dr. HILARY FRITSCH

Instagram: https://instagram.com/hilaryfritschdmd

TikTok: https://www.tiktok.com/@hilaryfritsch.dmd

Dr. KEVIN GOLES

Instagram: https://www.instagram.com/airway_goles/

TRAIN WITH ME

3 Days to Airway — the hands-on course Dr. Kevin Goles and I teach for doctors adding airway to their practice: https://www.3dayairway.com/

WORK WITH ME

Book a 30-minute 1:1 consult: https://tr.ee/Sxn_v17K9G

Book at Saddle Peak Dental: https://saddlepeakdental.com/contact/

Everything else: https://linktr.ee/hilaryfritschdmd

LISTEN INSTEAD

Spotify: https://open.spotify.com/show/033v3dzI7lf95VkfTAzvQC

BUSINESS INQUIRIES

DM me on Instagram: https://instagram.com/hilaryfritschdmd

ABOUT THE SHOW

awAIR Unfiltered is a podcast and YouTube channel hosted by Dr. Hilary Fritsch and Dr. Kevin Goles, two airway dentists on the front lines of nonsurgical sleep and breathing solutions.

Tune in for research breakdowns, in-office insights, honest takes on CPAP and sleep studies, interviews with others in the space, and the kind of clinical candor you rarely hear anywhere else.

This channel is clinical discussion between practitioners. It isn't medical advice, and nothing here is a reason to delay treatment your child's doctor has recommended.

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

FOLLOW DR. HILARY

Instagram: https://instagram.com/hilaryfritschdmd

TikTok: https://www.tiktok.com/@hilaryfritsch.dmd

DR. KEVIN GOLES

Instagram: https://www.instagram.com/airway_goles/

TRAIN WITH ME

3 Days to Airway — the hands-on course Dr. Goles and I teach for doctors adding airway to their practice: https://www.3dayairway.com/

WORK WITH ME

Book a 30-minute 1:1 consult: https://tr.ee/Sxn_v17K9G

Book at Saddle Peak Dental: https://saddlepeakdental.com/contact/

Everything else: https://linktr.ee/hilaryfritschdmd

LISTEN INSTEAD

Spotify: https://open.spotify.com/show/033v3dzI7lf95VkfTAzvQC

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

A normal AHI is the most reassuring number in sleep medicine, and it is hiding apnea in your patients right now. Kevin Goles and I go through four different ways that number lies.

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. This is the full conversation.

Expect to learn:

→ The 30-second in-chair screening test Kevin has his referring practices running on every patient, and why straight teeth tell you nothing

→ The Journal of Clinical Medicine study on intermolar distance and palatal height, and the 38mm line where obstructive sleep apnea effectively disappears

→ Why the roof of the mouth is the floor of the nose, and how a four-year-old ends up with a moderately deviated septum without ever being hit in the face

→ Why acrylic coverage on a fixed expander stops the palate dropping and caps the width you can create

→ Why young and middle-aged women are the most underdiagnosed population in sleep, precisely because their AHI reads normal

→ How progesterone and estrogen protect the airway, why incidence triples at menopause, and when a hormone complaint is really a breathing problem

→ What happened when I tested a CPAP patient with the machine on and with it off, and why nothing changed but his deep sleep

→ Why the AHI a CPAP reports is estimated by an algorithm rather than measured by oximetry, and the gap that opens against a SleepImage ring

→ How REM sleep regulates the amygdala, and what Matthew Walker's puppy analogy explains about anxiety and depression

STUDY MENTIONED

Correlation Between Severity of Obstructive Sleep Apnea and Dental Arch Form in Adults — Journal of Clinical Medicine, 14(20), 7183

https://www.mdpi.com/2077-0383/14/20/7183

BOOK MENTIONED

Why We Sleep — Matthew Walker

KEVIN GOLES

Instagram: https://www.instagram.com/airway_goles/

TRAIN WITH ME

3 Days to Airway — the hands-on course Kevin and I teach for doctors adding airway to their practice: https://www.3dayairway.com/

WORK WITH ME

Book a 30-minute 1:1 consult: https://tr.ee/Sxn_v17K9G

Book at Saddle Peak Dental: https://saddlepeakdental.com/contact/

Everything else: https://linktr.ee/hilaryfritschdmd

LISTEN INSTEAD

Spotify: https://open.spotify.com/show/033v3dzI7lf95VkfTAzvQC

BUSINESS INQUIRIES

DM me on Instagram: https://instagram.com/hilaryfritschdmd

ABOUT THE SHOW

awAIR Unfiltered — 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, and nothing here is a reason to stop using a device your doctor prescribed.

#airwaydentistry #sleepapnea #dentistry