What to expect if your child needs a palatal expander

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.

RPE
Standard design of a fixed palatal expander

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.

Example 1

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.

Beforehanna

Afterhanna after

Example 2

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.

Beforewien before

Afterwien after

Example 3

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.

Beforedom anterior

Afterdom after anterior

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 shorelinebraces@gmail.com, or reach out to us on Facebook at https://www.facebook.com/shorelinebraces/

No More Impressions!

gagging

Remember that feeling?  If you had braces I’d be willing to bet you do.  I had braces over 20 years ago – and the most vivid memories I have of my four year journey are of impressions (or molds).  The goop. The gagging.  Just waiting for it to be over.

Our office is proud and excited to announce that we have embraced the most modern impressionless technology – Trios digital scanning by 3Shape.

trios

Digital scanning works by taking real-time video of the teeth with a small camera, and a computer generates a perfect three-dimensional representation of the patient’s teeth.

Scanning a patient’s teeth takes less than 5 minutes, and is incredibly easy and comfortable.  Having a three-dimensional representation of the patient allows me to study and treatment plan the patient’s case without having the patient in the chair.  We can use the digital model to make any orthodontic appliance we need – retainers, space maintainers, and even specialized treatment modalities like Invisalign and lingual braces. The possibilities are endless.

Check out this patient’s experience with the Trios Scanner.

No more goop.  No more gagging.

We couldn’t be more excited to embrace this technology, and we think our patients will love the new addition to the office!

Invisible Treatment: Invisalign and Lingual (hidden) Braces

If you had braces more than 15 years ago – like I did – it’s possible you remember feeling (and looking) like this….

headgear

me-4th-grade
Dr. Fisk in 1993

What a tremendous addition to those awkward teenage years!   From the looks of my puffy gums, I think I should I had listened to my orthodontist and brushed my teeth a little better.  From the looks of that hairstyle, I think I should have purchased a better comb to help keep those ridiculous golden waves under control.

Due to dramatic improvements in technology, three-dimensional digital imaging, and dental materials, getting ‘braces’ no longer needs to be uncomfortable or unsightly.  In fact, it is now possible to experience completely invisible treatment.   The two most popular types of invisible orthodontic treatment are clear aligners like Invisalign, and lingual braces (behind the teeth).

Invisalign

invis2

Invisalign is a customized series of removable clear plastic trays (or aligners) that gently move your teeth into position.  The aligners are worn 22 hours per day, and the patient changes the aligners on weekly or biweekly intervals.   Although not completely invisible, Invisalign is certainly more discreet than traditional braces.  Because the aligners are removable, it is also easier to brush and floss your teeth, and there are no dietary restrictions!  Orthodontists are experts in Invisalign treatment, and are able to correct many of the orthodontic problems that years ago only braces could correct.   Many people think that Invisalign is only for adults, but our office provides Invisalign Teen to many of our younger patients!

 

Lingual Braces (Dr. Fisk uses the Harmony System)

Lingual braces are customized brackets and wires that are placed on the inside of the teeth.  Lingual braces are the only completely invisible treatment option, and use the most advanced modern technology available.  Modern technology like 3D scanning and CAD-CAM fabrication of personalized brackets are leading to shorter treatment times and better results.   In 2017, you can literally walk around with braces on your teeth and no one will know!

harmony

 

Invisalign or Lingual Braces – Which is right for you?

There are advantages and disadvantages both Invisalign and Lingual Braces.  In many cases, both treatment options will provide the same results.   More complicated cases often require braces.   The main differences between the two relate to lifestyle questions the patient has to ask him/herself.

Do I want something removable?

Will I be happy to wear aligners 22 hours a day or would I prefer a ‘set it and forget it’ approach with lingual braces?

Do I want completely invisible treatment or am I okay with clear trays covering my teeth?

Many of my patients are candidates for both  Invisalign and Lingual Braces, and in most cases the patient is free to choose which option they will be happier with.

Gone are the days where big, bulky metal brackets are the only treatment option….the same cannot be said for awkward teen haircuts unfortunately.

What’s the deal with wisdom teeth?

Not a day passes without me having a conversation with a parent or patient about wisdom teeth.  I get questions and comments all the time about wisdom teeth!

  • What are wisdom teeth anyway, and where are they?
  • Do I have my wisdom teeth?
  • Are mine ‘impacted’, and what does impacted even mean?
  • Do they have to be extracted?
  • I heard getting wisdom teeth pulled is worse than childbirth!

You get the idea.  Since wisdom teeth seem to strike a nerve (pun intended!) in the general population, I thought I should dedicate my first blog post to discussing wisdom teeth – or more specifically, third molars.

What are wisdom teeth?

Wisdom teeth are the third set of molars, and typically erupt between the ages of 17 and 25.  Most people are born with all four third molars, but many people are missing one or several of them.  In fact, third molars have the highest frequency of being congenitally missing of all the teeth.

Are mine impacted?

Seen below is a patient (Myself!) with two impacted third molars on his right side (encircled in red). The teeth are considered impacted because they are trapped and unable to erupt.  The most frequent reason for a third molar to become impacted is because we simply don’t have enough space in our jaws for all of our teeth.  If you’ve ever played musical chairs, you know that whoever is last to arrive doesn’t get a seat – the same thing happens with third molars.  Third molars erupt last and often get trapped in strange angulations.

thirds

Do I need to have them extracted?

The answer to this question relies on a whole host of factors, to name only a few:

  • Is there enough space for them?
  • Are there any symptoms?
    • Pain, swelling, infection, cavities or destruction of adjacent teeth or bone?
  • Are they partially erupted?
  • Can the patient adequately brush and floss in the area?
  • How badly impacted are they?
  • How old is the patient
  • How healthy is the patient
  • Where exactly are they located?
    • There may be critical anatomical structures (like nerves!) nearby

You may have noticed the yellow line on the X-ray passing below the lower wisdom tooth.  That line represents my Inferior Alveolar Nerve, which provides sensation the lower right side of my face.  In my particular case, the surgical procedure of removing an impacted third molar in close proximity to the nerve presented too high a risk for nerve damage.  Because these teeth are asymptomatic, I decided (after discussions with my dentist!) that I will leave them for now.  However, I did have the wisdom teeth on my left side removed when I was 18 years old!  But that’s just me, your situation could be very different.

The decision to extract or keep wisdom teeth is always made on an individual basis between the patient, the dentist and possibly an oral surgeon – because every patient is different.

I hope that helps!

If you have any questions you can always reach me at shorelinebraces@gmail.com