Should you do a RPE on a Pediatric Patient with Daily Nosebleeds
I. Introduction
Dr. Amanda from StraightSmile Solutions answers a question she received regarding whether it is safe to use an expander for orthodontic treatment in a child who experiences regular nosebleeds. She explains that daily nosebleeds are not normal and the child should first be seen by their primary care physician to rule out any underlying pathology. She notes that there are many potential causes of nosebleeds, ranging from dry climate to allergies to mouth breathing. However, before proceeding with any orthodontic treatment involving expanders and distraction osteogenesis, which breaks the jaw, the nosebleeds must be evaluated and cleared by the primary care doctor or ENT. Dr. Amanda stresses the importance of following this chain of command before orthodontic treatment so as not to put the child at risk if there is an unidentified bleeding disorder or condition present. She advises against treating these patients without clearance from the primary care physician first.
II. Medical Concerns
A. Distraction osteogenesis and its relation to breaking the jaw and forming new bone
B. Potential dangers if there is an existing pathology or regular hemorrhaging
C. Collaboration with a friend, a dentist with extensive experience in pediatric orthodontics and interaction with ENTs
III. Expert Response
A. Daily nose bleeding is not considered normal in children
B. Primary physician as the first point of contact
1. Referral process and follow-up
2. Importance of keeping the primary care physician informed
C. Dry climates and commonality of daily nose bleeds, influenced by humidity
D. Medications, constipation, diet, congestion, post nasal drip, allergies, and mouth breathing as potential causes
IV. Diagnostic Measures
A. Nasal patency test to assess airflow through the nose
B. Lateral symmetric X-ray to identify adenoids
C. Panoramic x-ray for assessing turbinates and septum issues
D. CBCT for airway analysis and sending to specialists for further examination
E. Sleep pediatric SDB questionnaire to identify potential sleep-related issues
F. Referral to an allergist if congestion or allergies are suspected
V. Professional Recommendations
A. Priority is given to physiologic concerns over orthodontic expansion
B. Advice to stick to the Primary Care First, Ortho second approach
C. Importance of obtaining proper releases from primary care or ENT before proceeding with orthodontic treatment
D. Discouraging treatment if parents fail to follow recommended procedures
VI. Conclusion
Dr. Amanda from StraightSmile Solutions provides invaluable insights into a complex query about children with nosebleeds and the use of expanders for orthodontic reasons. Emphasizing the importance of recognizing daily nosebleeds as abnormal, she wisely advises a systematic approach. Collaborating with a knowledgeable friend with extensive pediatric orthodontic experience, she underscores the significance of involving primary physicians and ENT specialists in the decision-making process. Dr. Amanda’s prudent guidance, rooted in patient safety, reinforces the necessity of addressing medical concerns before pursuing orthodontic interventions, showcasing her commitment to comprehensive and responsible healthcare.