Nocturnal enuresis and maxillary expansion: A narrative review.

Abstract

Background: Nocturnal enuresis (NE) may occur in children experiencing poor sleep secondary to an underlying sleep disorder such as obstructive sleep apnea. A causal link between an underlying sleep disorder and NE has been suggested. Maxillary expansion has been proposed to improve nasal airway patency and airflow, with the aim of reducing or resolving NE in affected children.

Types of studies reviewed: The authors examined the historical and contemporary approaches to managing NE with maxillary expansion. The source material for this review came mainly from literature searches using PubMed as the primary database; various search terms combined with Boolean operators (AND/OR) were used as well as Medical Subject Heading terms, when applicable. Three systematic reviews on this topic were identified, although only 2 included a single randomized placebo-controlled trial. The single randomized controlled trial used a placebo control with a sham maxillary expander in place. The remaining available evidence came from clinical studies. Overall, sufficient evidence was available for critical appraisal.

Results: Based on the literature, the pathophysiology of NE, and the medical standards for diagnosing and managing this condition, it is clear that maxillary expansion is not an evidence-based treatment for NE.

Conclusions and practical implications: There is no evidence to support routine maxillary expansion for children with NE. Expanding in the absence of a transverse discrepancy is unsubstantiated in the literature. Dental care professionals should be well informed about the evidence-based approaches for the diagnosis and management of NE, guiding families to access the right care from the relevant health care professionals such as pediatricians or pediatric urologists.