So you’ve been told by your dentist or orthodontist that your child needs a palatal expander. Your first thought is probably – what the heck is an expander and why does my son or daughter need one?
We use palatal expanders frequently in our office, and the benefits are tremendous for a variety or reasons – we’ll get to those later. First, lets discuss what an expander is, what it does, and why your child may benefit from one.
A typical palatal expander in our office attaches to two bands on the molars in the back, and rests against the inner surface of the adjacent teeth. In the middle is a small hole where a key will be placed, and turned daily at home for several weeks. Turning the key activates a spring that separates the two arms of the expander, which in turn widens the upper jaw gradually. The amount of expansion needed is determined by the individual needs of the patient’s treatment plan. In our office we used ‘fixed’ expanders, which means it is not removable. Expanders stay in place for 4-6 months typically, occasionally longer if more expansion is needed. Removable expanders do exist, however they introduce the likelihood of being misplaced or no longer fitting – so we used ‘fixed’ expanders.
A palatal expander works by widening the upper jaw (maxilla), which is actually two bones separated by a midline (midpalatal) suture. Palatal expansion is successful in young children because the maxillary suture is immature and not completely fused. Until the age of approximately 14-16 years, the upper jaw can be gently and slowly separated. Palatal expansion is more comfortable and best achieved between the ages of 8-11, as more immature bones are more pliable.
There are several reasons why your child may benefit from a palatal expander, the most common are:
- A narrow upper jaw (maxilla)
- A posterior crossbite
- Severely crowded teeth
- Insufficient space for unerupted permanent teeth
- Some airway issues (decreased nasal air flow, sleep apnea, poor tongue posture)
Many of our patients present with several of the issues above. Let’s look at some clinical examples from our office.
The patient below was a 9 year old with a posterior crossbite on her left side. A normal bite should fit together like shoebox – where the upper teeth rest on the outside of the lower teeth. As you can see, this patient’s bite on the left is in crossbite. If left untreated, chewing with a posterior crossbite can cause premature wear of the teeth, and also jaw asymmetries. This patient’s crossbite was corrected with a palatal expander over the course of 4-5 months. The expander was then removed and her growth and development is monitored over the next several years while the remaining permanent teeth erupt.
The patient below was a 10 year old with a posterior crossbite on her right side, and also an anterior crossbite of the upper right lateral incisor. Due to the presence of the anterior crossbite, this patient was treated with a palatal expander and upper braces to align the upper front teeth. Anterior crossbites can risk trauma and enamel wear to the front teeth, so they are best treated early.
The patient below was a 9 year old with insufficient space for his maxillary lateral incisors. Normally the lateral incisors erupt at age 7-8. He lost his baby teeth at the appropriate age, but the larger adult teeth had no room to come down. This patient was treated with a palatal expander and partial upper braces to align the anterior teeth.
So what should I be prepared for if my child needs an expander?
Expanders may look frightening, and the idea of turning a key at home may seem intimidating at first. When the expander is first placed, your child may feel like they have more saliva than usual and initially think swallowing feels funny. This improves very quickly and most kids get used to the feeling in just a few days. Speech can be affected initially as well as your child adapts to having an expander touching their tongue. When the expander is turned, some patients say they feel slight pressure on their teeth, upper jaw and even nasal area. This is normal and dissipates in a few minutes. Eating softer foods like yogurt, macaroni and cheese and ice cream can help with initial discomfort.
After several days of turning, you may notice a space between the upper front teeth developing. This is completely normal and the response we hope to see! That means the upper jaw is widening as expected. When we stop turning the expander, the front teeth will gradually drift back together, and the upper jaw will remain at the correct width. Expanders typically remain in place 4-6 months after we stop turning, because we have to wait for the immature bone in the suture to ‘harden’ for stability. After an expander is removed, most patients are seen over the next several years to monitor growth and the eruption of the remaining permanent teeth.
Hope that helps!
If you have any questions, you can reach me at firstname.lastname@example.org, or reach out to us on Facebook at https://www.facebook.com/shorelinebraces/