Chicago Enuresis Update 2015:

A new article (abstract below) in the Angle Orthodontist Journal reports complete overnight dryness in 19 patients aged 6-15 years old following Rapid Maxillary Expansion. This improvement was shown to last for at least 3 years. There was also improvements in Breathing Function. Rapid Maxillary Expansion is a procedure used to enlarge the nasal airway thru expansion of the Maxilla.

This shows that it is the upper airway problem that is likely causing the enuresis problems and correcting the airway corrects the problem.

The Perfect Start System is designed to grow larger airways in children and can  help children as young as two grow larger maxillas and larger airways.

The first step is a habit corrector that can be worn as young as two years old.

This study concluded that “This study demonstrates that RME causes complete dryness in all patients, with significant effects on pathophysiological mechanisms related to Nocturnal Enuresis”

I have also included an abstract from 2014 That showed some patients benefit from REM in decreasing enuresis.  Response was dependent on initial size of airway.

PubMed Abstract below:
Angle Orthod. 2015 Jan;85(1):102-8. doi: 10.2319/031014-172.1.
Effect of rapid maxillary expansion on monosymptomatic primary nocturnal enuresis.
Al-Taai N1, Alfatlawi F, Ransjö M, Fakhry S.
Author information
To evaluate the effects of rapid maxillary expansion (RME) on nocturnal enuresis (NE) related to the nasal airway, nasal breathing, and plasma osmolality (as an indicator for antidiuretic hormone).
Nineteen patients with monosymptomatic primary NE, aged 6-15 years, were treated with RME for 10-15 days. To exclude a placebo effect of the RME appliance, seven patients were first treated with a passive appliance. Computed tomography of nasal cavity, rhinomanometric, and plasma osmolality measurements were made 2-3 days before and 2-3 months after the RME period. RME effects on NE were followed for three more years.
Two to three months after the expansion there were significant improvements in the breathing function and a decrease in the plasma osmolality. NE decreased significantly in all patients after the RME period, and all patients showed full dryness after 3 years.
This study demonstrates that RME causes complete dryness in all patients, with significant effects on pathophysiological mechanisms related to NE.
Antidiuretic hormone; Nocturnal enuresis; Rapid maxillary expansion


Acta Paediatr. 2014 Jul 15. doi: 10.1111/apa.12749. [Epub ahead of print]

Orthodontic widening of the palate may provide a cure for selected children with therapy-resistant enuresis.



According to a number of small case series, orthodontic treatment may have anti-enuretic effects. Thus, we evaluated whether widening of the palate can alleviate enuresis and whether prognostic information can be gained from examining children’s nocturnal respiration and nasal airwaydimensions.


Children with therapy-resistant enuresis underwent polysomnography, focusing on nocturnal respiration, and had their nasal airways examined. Rapid maxillary expansion was performed, widening the maxilla by approximately 0.5 cm. The dental appliance was removed after 6 months. Enuresis frequency was evaluated four times: at baseline, with the orthodontic apparatus in situ, after completed maxillary expansion and 1 year post-treatment.


Of the 34 children recruited, one dropped out due to oral discomfort. The numbers of wet nights per week on the four assessment occasions were 5.48 ± 1.48, 5.12 ± 1.73, 3.09 ± 2.49 and 2.63 ± 2.81; p < 0.001. The proportions of responders, intermediate responders and non-responders during treatment were 21.2%, 27.3% and 51.5%, respectively. Responders were found to have a lower enuresis frequency at baseline (p = 0.001) and to have larger nasal airway dimensions (p = 0.01).


Orthodontic widening of the palate may be curative in a subgroup of children with therapy-resistant enuresis.

©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.


Enuresis; Polysomnography; Rapid maxillary expansion; Respiration; Rhinometry