Teeth Need Space to Erupt and Grow
A narrow palate reduces the space available for adult teeth to erupt properly. The good news is that more space can be created! That’s because the upper jawbone actually develops as two separate halves. Before the halves fuse together after puberty, they can be gently separated over a period of time to widen the jaw and create more room.
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A Palatal Expander Widens the Jaw
A rapid palatal, or palate, expander (RPE) is a device that widens a patient’s upper (maxillary) arch or jaw. It is placed on the roof of the mouth and is typically worn for at least 6 months. The device applies gradual pressure, via an adjustable expansion screw, on the upper molars to move the upper jaw bones apart and create a wider palate.
A palatal expander allows more space for future teeth to grow into, creates a more aesthetically pleasing smile and better aligns the upper and lower teeth. Contrary to the myth, a palatal expander does not break the upper jaw bone.
Once placed, the device is then adjusted at home by an adult, according to a schedule that we develop. As with all orthodontic treatment plans, the better our plans and recommendations are followed, the better the device will perform, the faster the device can be removed and the better the overall outcome.
Other expanders, like a quad helix expander, are used when mild to moderate expansion of the upper jaw is required and in some very young patients. These expanders require in-office activation only.
Severe Crowding and Crossbites Typically Require a Palate Expander
Palatal expanders are usually recommended for younger patients who do not have enough room for future teeth or adult teeth currently erupting. They are also recommended for younger patients with a narrow upper arch or a crossbite.
Palate expander treatments are sometimes the sole treatment in a Phase I interceptive treatment plan. Other times, palatal expander treatment can be one part of a more comprehensive plan that also includes braces. As part of our initial assessment, we will determine the best plan and approach for your child.
Palatal Expander Results Are More Predictable in Younger Patients
We see the best results from palate expanders in children and teens who have not yet hit puberty. The jawbones are still pliable at these younger ages.
Once puberty starts, the bones become mature and begin to fuse, making palatal expanders more difficult to use and less predictable in results for teens and adults.
For older teens and adults, we will recommend the best treatment plan depending on their situation.
We Recommend the Best Palatal Expander Type for Your Child
With many types of palatal expanders available, we recommend the type best fitting your child’s specific needs. The most common types of palate expanders we use are:
- Bonded expander
- Hyrax expander
- Quad helix expander
A palatal expander can be modified with features that provide additional support for a variety of issues like open bites, anterior crossbites, thumb or finger-sucking habits, tongue thrusts and more.
Palate Expanders Can Be Uncomfortable, but Not Usually Painful
The device itself should not cause pain. Your child may experience some discomfort and difficulty speaking and eating in the first few days after the palatal expander is initially placed and after each tightening. Eating soft foods and taking smaller bites may help relieve discomfort. Over-the-counter pain medications can also be used to treat mild discomfort if needed.
Adjusting, or Turning, a Palatal Expander Is Easy
Adjusting an expander may seem daunting, but it’s actually easy with these simple steps:
Step 1Have your child lay on their back, tilting their chin up and opening their mouth as wide as possible.
Step 2Using a good light source (smartphone flashlights work well), find the front keyhole (closest to their front teeth) in the expander screw and insert the provided key completely. You will feel the key stop once it’s positioned correctly; it stops inserting at the safety bend, so you will not accidentally poke your child in the roof of their mouth.
Step 3Push the key straight back towards their throat until you see the next keyhole advance. You will feel some resistance as the screw turns, and your child will feel pressure on their teeth and roof of mouth.
Step 4Remove the key by pulling straight down. Do not pull forward, otherwise you will reverse the expansion you just made and will not be able to complete the next turn.
Step 5Repeat steps 3 and 4 for each additional turn, according to your child’s plan.
Complete the number of turns per day as per your child’s treatment plan. If you miss a day’s turn, simply stay on your provided schedule. The missed day’s turns will be made up at a future appointment in the office.
As turning can lead to some discomfort, we recommend turning before bedtime versus in the morning. It’s easier to turn at night and provide a small dose of over-the-counter pain medicine to help ensure a better sleep, versus having your child try to deal with the discomfort during school.
Palatal Expanders Are Typically Worn 6-12 Months
Actual length of wear varies by patient, but a palate expander is typically worn for 6-12 months. We will discuss your child’s duration as part of their treatment plan. We will also discuss how to adjust your child’s expander and the schedule for adjustments. It is important to follow our at-home schedule and instructions for adjusting the device to ensure the device can be removed as soon as possible.
Palatal Expanders Require Special Care
Just like any orthodontic device, a palatal expander isn’t difficult to take care of, but does require some extra time and attention. Improper care can damage the device, lengthen orthodontic treatment and create additional costs.
Eating with a Palate ExpanderAvoid hard, sticky, crunchy or chewy foods to prevent dislodging, damaging or breaking the device. Eat soft foods, particularly if teeth and/or gums are uncomfortable from a recent adjustment.
Cleaning a Palatal Expander
Palate expanders should be cleaned daily. Food can become trapped in both the space between the expander and the roof of the mouth, and also in the keyhole.
Small proxy brushes can be inserted between the expander and roof of the mouth to push trapped food out. A water flosser can easily dislodge any trapped food also.
Once trapped food is removed, brush the expander with a toothbrush. As with braces, we recommend removing food particles and brushing after each meal and each morning and night.
A Broken or Loose Palate Expander Is an Orthodontic Emergency
Jaw expansion can relapse quickly if a palate expander breaks or becomes dislodged/loose, so we consider these situations to be orthodontic emergencies.