I. Introduction

• Dr Amanda from StraightSmile Solutions adds a final topic to her liability series: Phase 1 airway and expansion cases.
• This area is becoming a subtle but growing source of complaints.
• The rules are still nebulous, but you need to know them.

II. The ADA/AAPD Joint Statement (2017)

• Dentists must screen pediatric patients for signs of deficient growth, development, or airway risk factors during routine exams.
• Every 6-12 months. Every child.
• Failure to screen or refer is a potential lawsuit.

III. Failure to Refer: The Big Risk

• If you suspect a breathing disorder, you must refer to a physician (ENT or sleep specialist) for a definitive diagnosis.
• You cannot simply “do an expander” and assume it will fix the airway.
• Even if the expander helps symptoms, you have no medical diagnosis on paper. That’s a liability.

IV. You Can Treat Ortho Problems, Not Sleep Problems

• Sleep disordered breathing is a medical diagnosis. Only a physician can diagnose and treat it.
• You are allowed to treat orthodontic problems (narrow palate, crossbite, tongue space) that may also improve the airway.
• But you cannot treat “sleep problems” alone without a medical referral and diagnosis.

V. Timing of Expansion

• The correct time to expand is when the first molars erupt. That is standard of care.
• “Pre-expansion” before that is not standard of care and could be a risk.
• While lawsuits are unlikely now, if records are audited later, you could be found non-compliant.

VI. The Bottom Line

• Screen every child for airway risk. Document it.
• If you see red flags, refer to ENT or a sleep specialist. Get a diagnosis in writing.
• Do expansion only for orthodontic indications—not as a standalone airway treatment.
• Follow the standard of care on timing. Protect yourself now before the rules tighten further.