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

The conversation delves into the frustration and emotional impact of slow progress in orthodontic treatment, particularly in relation to the use of expanders and the reluctance to embrace new methods. The focus is on the impact of orthodontic treatment on airway, breathing, and sleep quality, with a strong emphasis on the need for open-mindedness and a willingness to challenge traditional orthodontic practices. The conversation covers a range of topics related to orthodontic treatment, airway health, and the impact of expansion on patients. It also delves into the challenges and misconceptions surrounding orthodontic and airway treatments.

Takeaways

• Orthodontic treatment has a significant impact on airway, breathing, and sleep quality
• Open-mindedness and willingness to challenge traditional orthodontic practices are crucial for progress Orthodontic expansion can have a significant impact on airway health and can lead to life-changing improvements in breathing and sleep.
• The conversation highlights the importance of a comprehensive approach to orthodontic treatment, considering airway health, nasal breathing, and myofunctional therapy.

Chapters

• 00:00 The Emotional Impact of Slow Progress
• 07:30 Challenging Traditional Orthodontic Practices
• 14:20 The Frustration of Closed-Mindedness
• 21:06 The Reluctance to Embrace New Methods
• 27:21 Orthodontic Expansion and Tooth Pillow Guide
• 33:26 Challenges with Invisalign and Aligner Systems
• 39:00 Orthodontic Treatment and Airway Health Considerations

This conversation delves into the intricate relationship between dental health and sleep disordered breathing, particularly obstructive sleep apnea (OSA). The discussion highlights the significance of the cotton roll test in assessing airway space, the correlation between dental arch form and OSA severity, and the importance of palatal height and intermolar width in maintaining proper airway function during sleep. The speakers also explore the role of dental practices in identifying and managing sleep health issues, as well as the complexities of sleep stages and their impact on apnea events. In this conversation, Hilary Fritsch, DMD, and Kevin Goles, DDS discuss various aspects of dentistry, particularly focusing on sleep disordered breathing and its implications for patient care. They explore personal experiences in dentistry, the impact of hormones on sleep apnea, the effectiveness of CPAP machines, and the critical role of REM sleep in mental health. The discussion emphasizes the need for a more nuanced understanding of sleep disorders and their treatment, particularly in underrepresented populations such as young to middle-aged females.

Takeaways

The cotton roll test is essential for assessing airway space.

Narrow intermolar distance correlates with higher OSA probability.

Palatal height affects the ability to breathe during sleep.

Dental arch form is linked to obstructive sleep apnea severity.

Proper airway space is crucial for REM sleep quality.

Dental practices play a vital role in sleep health management.

Understanding sleep stages helps in diagnosing apnea events.

Airway collapse often occurs during REM sleep due to muscle paralysis.

The cotton roll test simplifies the screening process for sleep issues.

Expanding the palate can improve airway function and sleep quality. Most doctors are also the worst patients.

Young to middle-aged females are drastically under treated for sleep disorders.

CPAP machines may not always be effective and can sometimes harm patients.

Quality of REM sleep is crucial for mental health and emotional regulation.

Hormonal changes, especially around menopause, significantly impact sleep apnea severity.

Patients often report drastic improvements in quality of life after treatment for sleep disorders.

The AHI measured by CPAP machines may not accurately reflect a patient's condition.

Sleep studies should evaluate more than just the presence of apnea events.

REM sleep is essential for processing traumatic events and emotional healing.

Many patients do not remember their dreams, indicating poor sleep quality.

Chapters

00:00 Introduction to Sleep Disordered Breathing

02:56 Understanding the Cotton Roll Test

06:03 Correlation Between Dental Arch and Sleep Apnea

08:57 Palatal Height and Intermolar Width

11:53 The Role of Dental Practices in Sleep Health

15:04 Analyzing Sleep Stages and Apnea Events

17:53 The Importance of Airway Space in REM Sleep

21:06 Navigating Personal Experiences in Dentistry

22:53 Understanding Sleep Disordered Breathing

24:43 The Impact of Hormones on Sleep Apnea

26:05 Evaluating CPAP Effectiveness

30:07 The Limitations of CPAP and Alternative Solutions

35:28 The Connection Between REM Sleep and Mental Health