If you practice pediatric sleep dentistry, you’ve probably wondered: Does T&A surgery really help children have better outcomes, or do we refer too many children to surgery? And how much does the timing matter for outcomes? A new Australian study looked at whether the surgery was helpful, and whether sooner was always better.
The study, published in the journal Pediatrics, conducted a randomized controlled trial (RCT) on a group of children referred for T&A surgery. Some of the children received immediate surgery, and some were required to wait a year. The groups of children were assessed at 12 and 24 months on measures such as academic performance and sleep benchmarks.
At the 12-month mark, the group that received immediate surgery had improved dramatically. The group whose surgery was delayed had not grown out of their problems and received surgery. At the 24-month mark, there was no significant difference between the two groups. The second group caught up to the first once they had T&A surgery.
As a dentist who practices pediatric sleep dentistry, this study tells me a few important things:
• One reason T&A remains the first-line treatment for young children who don't have abnormalities like tongue-tie or a high palate is that it works. There was a substantial improvement in both groups after they received the surgery.
• On the other hand, waiting a year for surgery didn’t cause lasting damage to the children. This tells me that in a case where we feel a child may not tolerate surgery – perhaps they’re small for their age and we’re worried about anesthesia, perhaps the family can’t immediately schedule surgery or time off work – needing to wait is not a crisis. We can work with families to meet their children’s needs without frightening them.
• A dental practice needs to have a good, working relationship with a skilled ENT, especially for our smallest patients. These children and their families benefitted from surgery, and we need to be able to connect families with care.
If you’d like to know more about the effects of OSA on children, my recent book Airway is Life is a good introduction intended for general audiences. If you’d like to learn more about adding pediatric sleep dentistry to your practice, consider attending my Sleep Summit this October in Houston.