Palatal expander, low S position, cribs and rakes

I have a new referral who I recently saw who is about to embark on some orthodontic treatment (a palatal expander ).    In addition to a tongue thrust swallow she also presents with an articulation component with an interdental pattern for alveolars and sibilants.  She is quite stimulable for the correct sound production with a  tongue tip down position rather than tongue tip up which I’ve seen more and more by the way What is your opinion regarding the initiation of tx with orthodontic appliances in place, and whether or not we should wait before starting her program.  Because she was so stimulable for her sound production (and she is 8)  I was inclined to get that going, but  would like your opinion about  participating in the program with braces or appliances.   I also have had several encounters with local orthodontists who have felt strongly about the use of these appliances for the tongue thrust correction.  I have tried to counsel them on the efficacy of what theyre doing but it’s been difficult at times,    They seem to think that we can continue with the program while these kids are wearing cribs, balls, and whatever else they are using!!!!!!!    Thanks for your feedback. 

Dr. Mason, author of texts and articles, feels that some people can be taught the tongue down position.  I personally have found that once they have maximized their abilities on prof exam #1, they are able to use the ideal up position for the sounds unless there is bimaxillary protrusion, other issues anteriorly, etc.    As you might expect, there could be pages and pages in my response since there are so many factors to be considered.  With the expander in, it wouldn’t be fair to work on artic most of the time, in my opinion.    In the ideal world, I prefer to see the patient and do a full evaluation before orthodontic appliances of any type are placed.  I determine which initial exercises to give and usually it is to have them pass the Proficiency Exam #1 of the Myo Manual program.  Often certain of the lip exercises are also given. If you have her pass prof #1, you have then set the stage for later therapy, especially if you are careful that lingual-mandibular-labial movements are independent.   Then the expander is placed and I might see them once or twice until it is removed, just to be sure they have maintained their lingual abilities from Prof exam #1.    Please see this page to read the info for orthodontists/dentists regarding habit appliances as well as other info that will help your cause. https://orofacialmyology.com/wp-content/uploads/2018/10/orofacial-myology-position-statement-regarding-appliance-use-for-oral-habit-patterns.pdf