Did your orthodontist just tell you that they’re going to glue this scary metal device in your child’s mouth?
Well don’t worry, in this blog post, we will cover palatal expanders in detail as well as go over all the questions we get daily so that we can calm your fears and you can know exactly what to expect.
What is an orthodontic expander?
A rapid palatal expander also known as a Hyrax Expander, is an appliance that is used to widen a narrow upper jaw. There are many variations in the design of expanders, but the most common design has bands that fit around the upper 1st molars anchoring the device into place with metal arms that extend forward. The expander has a jackscrew in the middle that is turned with a key. Every turn of the jackscrew widens the expander, putting pressure on the upper teeth and jaw.
What does an expander do?
The upper jaw, also known as the maxilla, develops as two separate bones that fuse over time. If an expander is used at the appropriate age, the outward pressure of the expander on the maxilla will separate the two halves of bone and your body will create bone to fill in between. The end result is a wider upper jaw.
Why is an expander needed?
The most common reason to use an expander is to correct a crossbite. A posterior crossbite is typically caused by a narrow upper jaw which leads to a bite where the upper arch sits within the lower arch. The crossbite can develop on one side (unilateral crossbite) or on both sides (bilateral crossbite).
This kind of issue can be genetic or can develop through bad habits such as thumb sucking or pacifier use into a late age. If left untreated, sometimes crossbites can lead to jaw pain and TMJ issues, asymmetric growth of the jaws, and excessive wear on the teeth.
Patients who have narrow upper jaws may also have a constricted airway and have difficulty with nasal breathing. Using an expander can potentially increase the nasal airway and can help alleviate these symptoms and promote better nasal breathing.
Another reason for an expander is to create room for crowded teeth. Because we are expanding the upper jaws or widening the upper arch, this creates more space for teeth that are crooked.
One more reason to use an expander is to prevent canines from getting stuck in the bone or what we call an impaction.
Impacted canines can be a major problem because they require a surgical procedure called an expose and bond and braces to correct. If caught early enough, an expander can sometimes be used to redirect a canine by creating extra room for it to come down.
When is the best time for an expander?
Age is the biggest factor when deciding if an expander will be effective. As I mentioned earlier, the upper jaw develops as two bones that fuse as we finish growing. This suture can be split safely and predictably in growing patients up to 14-15 for girls and 15-16 for boys.. After those ages, the suture becomes fused and cannot be split predictably with just an expander alone.
If an adult needs an expander a regular expander will not work because their suture has already fused. Instead, a MARPE or a SARPE procedure must be used to split the suture and achieve expansion and we will cover those topics in another blog post.
What kind of sensations/pain or side effects should I expect?
This is the part where I can reassure you – most patients don’t feel much discomfort at all! Expanders have been used safely by orthodontists for many years. Most patients can expect to feel some pressure in your nose and palate after you turn the expander and some sore teeth.
When an expander is banded around the teeth, we use separators to create space for the bands. Most patients find that the soreness from this step is the most uncomfortable part of the entire process. At our practice, we use a customized 3D-printed expander that starts with a digital scan and fits perfectly on top of your teeth so we can avoid separators completely.
One common side effect from the expander is developing a gap between your upper teeth! This means that the expansion is working and don’t worry, this gap is temporary. Oftentimes, it will close up on its own or your trusted orthodontist will put braces on to close it!
You may have a slight lisp during the first week, but your tongue will adapt and it should go away. Just keep talking and practicing so your mouth can get used to it quickly!
How long do I need to have an expander?
Keep the expander in place for at least 6-12 months after completing the expansion. The longer you keep it in, the better, as removing it too early may cause relapse and result in losing the achieved expansion.
Are there any eating restrictions?
We generally recommend avoiding any hot foods that can get trapped in your expander and potentially burn your palate.
How do I keep it clean?
Always keep your expander clean! Floss and brush regularly to prevent swollen and painful gums, which can make it difficult to remove the appliance if the gums grow over it. Brush around the bands and floss nightly. If anything gets stuck in the metal arms, rinse the appliance with water or use a proxabrush.
How long does the expander stay in?
To prevent relapse of the achieved expansion, leave the expander in for at least 6 months. This allows your body to fill in bone between the two halves of the upper jaw after the expansion is complete.
Any tips on turning the expander?
I would suggest having your child or teen lay down on the floor or a couch and hold a light so you can see the screw holes. Then you can position the key so you can turn straight towards the back of the throat. Check out our video on expanders to see how!
One key mistake to avoid is UNTURNING the expander as you withdraw the key. You must withdraw the key towards the back of the mouth or you risk unturning the expander. If you do not complete the turn, you will not see the next keyhole. You will need to re-insert the key in the first hole to complete the turn, which can be difficult.
Conclusions
You should not FREAK YOURSELF OUT BEFORE THIS APPT. We have some patients who love to read horror stories and watch lots of videos before their appointment because they are nervous and those stories make them even more anxious! Most patients achieve excellent results with this procedure, so there’s little to fear!
I hope this video was informative and helpful! If you have any other questions or comments regarding expanders or if I missed anything, please comment below! As always, please like and subscribe for more orthodontic tips and information. Thanks for supporting our channel! See you in the next video!
NOTE: The author, Dr. Phillip Ha, is a board-certified orthodontist who serves patients at his private practice, Rise Orthodontics, in Modesto, California. He was trained at Loma Linda University in Loma Linda for both his dental and orthodontic specialty training. Dr. Ha is an expert in two-phase treatment, extraction, non-extraction, clear aligners (Invisalign, Angel, uLab), and multiple brackets such as Stride Custom Braces and Traditional Metal Twin braces. This blog provides information to help consumers understand important orthodontic topics.