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Orthodontic widening of the palate may provide a cure for selected children with therapy-resistant enuresis

By T. Neveus, L. Leissner, S. Rudblad, and F. Bazargani.

Acta Paediatrica, International Journal of Paediatrics, Volume 103, Issue 11, pages 1187–1191, November 2014

Editor’s comments:

The idea of rapid maxillary expansion and the possible positive effect on bedwetting is not new.  However, it creates the impression that this might be a solution to solve the problem of bedwetting, but it doesn’t.  Rapid maxillary expansion can be a treatment for an obstructive airway, but it should not be used as a primary treatment for children who wet their beds.

Abstract
Aim: 

According to a number of small case series, orthodontic treatment may have anti-enuretic effects. Thus, we evaluated whether widening of the palate can alleviate enuresis and whether prognostic information can be gained from examining children's nocturnal respiration and nasal airway dimensions.

Methods:
Children with therapy-resistant enuresis underwent polysomnography, focusing on nocturnal respiration, and had their nasal airways examined. Rapid maxillary expansion was performed, widening the maxilla by approximately 0.5 cm. The dental appliance was removed after 6 months. Enuresis frequency was evaluated four times: at baseline, with the orthodontic apparatus in situ, after completed maxillary expansion and 1 year post-treatment.

Results:
Of the 34 children recruited, one dropped out due to oral discomfort. The numbers of wet nights per week on the four assessment occasions were 5.48 (plus or minus) 1.48, 5.12 (plus or minus) 1.73, 3.09 (plus or minus) 2.49 and 2.63 (plus or minus) 2.81; p < 0.001. The proportions of responders, intermediate responders and non-responders during treatment were 21.2%, 27.3% and 51.5%, respectively. Responders were found to have a lower enuresis frequency at baseline (p = 0.001) and to have larger nasal airway dimensions (p = 0.01).

Conclusion:
Orthodontic widening of the palate may be curative in a subgroup of children with therapy-resistant enuresis. (copyright)2014 Foundation Acta Paediatrica.

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