Rapid Palatal Expander so wait or not for tx

Hi T, Your question was good and it is important for others to know about this situation.     Years ago, if a DDS sent me a patient with an RPE, I assumed that I should take him/her.  I didn’t realize that as an orofacial myologist, I might actually be the better judge of the timing for therapy.  The dentist needed for me to let him know what had to be done from my perspective.  Thus, early on, I failed both the patient and the referral source.  Here is how I would handle that situation today. Based on my thorough orofacial examination, I would categorize those areas of “weakness” that are unaffected by, and unrelated to, the presence of the expander.  For example, if the patient has open lip posture and/or is a mouth breather, that might possibly be doable at the get-go.  However, you have to be sure that the patient has the ability to close the lips somewhat naturally, without struggle or without excessive tension to the mentalis muscle.  (Also, of course, we always want to ascertain that it is safe and correct to recommend nose breathing for any given patient…by ruling out nasal obstruction, uncontrolled allergies, enlarged T & A, etc.) I might also have the patient do the parts of the proficiency exam training that are unrelated to suctioning, i.e., broad/narrow; bowl; tts, etc.  Although I have found patients who could do a reasonable suctioning in spite of the RPE, it doesn’t make much sense to prescribe such exercises because the capacity for the tongue to fit within the palatal arch is going to improve from the expansion; thus, better to leave it until such time as that. In the case of speech pathologists, I would give additional information about which sounds would be “fair” to pursue and which should wait. I hope this helps   Sandra