It is easy to get euphoric when you first enter the airway orthodontics arena to help people sleep and breathe better. It is exciting to join others doing something new, with the possibility of making a profound improvement in someone’s quality of life and potentially improving their healthspan.
When positive changes occur, it is easy to believe we have all the answers and that little thinking is required.
That is where problems begin.
Too many people fail to think deeply and assume airway treatment is a simple service to add to an existing practice without substantial training, guidance, and mentorship. When I started down this path decades ago, there were no mentors in the airway arena. I had the privilege of making many mistakes and learning from them.
Making mistakes is often the best way to learn. Unfortunately, those mistakes can be embarrassing and, in some cases, can destroy a practice. Having a mentor can dramatically reduce mistakes and help a doctor build a successful, effective, and rewarding airway focused practice.
Below are some of the most common and consequential mistakes I see repeated far too often.
Handing out preformed, one size fits all appliances to children and assuming it is great treatment with no downside is a serious error.
Wouldn’t it be wonderful if a simple preformed appliance could grow both jaws forward, improve facial balance, and enhance the airway? Many are told that certain appliances do not have a headgear effect or cause retraction.
Retraction is always a negative in airway treatment.
Do you believe everything you hear in advertisements? If so, you probably should not be practicing in the airway arena. In our mentorship, we provide two simple tools that allow doctors to determine for themselves whether an appliance truly produces forward growth or actually causes retraction.
Do not get angry if you discover that what you thought was helping may actually be doing the opposite.
Tongue tie releases are being performed everywhere. I have been involved in this area for a long time, but only after my myofunctional therapy mentors helped me fully understand their importance.
I am a strong advocate for tongue tie releases when they are appropriate and when they are performed in conjunction with myofunctional therapy. These cases should never be handled in isolation. You should be working closely with a knowledgeable myofunctional therapist and functioning as a coordinated team.
Most orthodontists are taught that maxillary expansion should be used only to correct a posterior crossbite. Many are taught it should not be used to address crowding, and almost all are taught that mandibular expansion should never be done.
With more than forty years of experience in airway focused orthodontics, we have a very different perspective. We teach this extensively in our mentorship.
We also have long term clinical examples of successful expansion of both arches, including my own sons, now forty eight and fifty years old. My seventeen year old grandson has undergone ten millimeters of lateral expansion and has never worn or needed full braces.
In every malocclusion, Class I, Class II, or Class III, the first thing that changes is the upper anterior teeth drifting down and back from their ideal position in the face.
Every expansion treatment must create sufficient room for all incisors, permanent cuspids, and bicuspids. This is the only way to achieve maximum development of tongue space and airway.
In nearly all cases, this requires advancing the anterior teeth after both arches have been expanded. In our mentorship, we provide tools and guidelines to accomplish this accurately and predictably.
Some clinicians fail to retain expansion because they have been told that retention restricts growth.
Ask anyone making that claim to show you a specific case from the scientific literature where this actually occurred.
With more than forty years of experience expanding cases, I retain every case. I also refer patients for myofunctional therapy. Patients who adopt proper oral rest posture tend to have remarkably stable results, but we do not live in a perfect world.
I have seen practices that do not retain these cases. They often lose patients to practices that do.
You decide which group you want to be in.
It is easy to want to help everyone. We understand the consequences of doing nothing. We also teach what conventional orthodontic treatment will do when early airway focused development is not addressed.
Our students are motivated to do good. However, one of the most important things we teach is how to recognize red flags that will cause long term problems.
You will never regret not treating someone. You may regret treating someone if they return years later with legal consequences.
Enough said.
“I just wanted to get some expansion.”
These are famous last words.
Starting treatment without specific goals and a recognizable end point is a recipe for failure. Would you take off in an airplane without a flight plan or knowing whether you have enough fuel to reach your destination?
“Getting some expansion” is not a treatment plan. It is a great way to create unhappy parents, disappointed patients, and a doctor who looks unprepared.
Do you really want the judge and jury of Instagram deciding your professional reputation?
As an early adopter of functional appliances more than forty years ago, I know the difference between the promises and the reality. I learned the hard way and, unfortunately, served as an unwitting beta test site for several of these appliances.
It took me years to recognize the enormous gap between marketing hype and clinical reality.
In our mentorship, we provide two tools to measure the true effectiveness of these appliances. I use no functional appliances today and would not recommend them for a family member.
Be critical. Measure results. Make up your own mind. That is how real learning happens.
Words matter.
It is bad enough when you do not promise a result and a parent thinks you did. It is far worse when you explicitly promise outcomes in a biological system you cannot fully control.
I have learned never to promise any specific result to anyone.
“I am an Eagle Scout, and I promise to do my best. That is the only promise I will ever make.”
If you love lawyers, feel free to promise results.
