Contemporary Orthodontics & Dentofacial Orthopedics
James
R. Waters,
DDS, MSD , PA
Board Certified Treatment for Children, Teens and
Adults
My child needs a Palatal Expander, what
is it
and what can I expect?
I have discussed the rationale for and the various types of
expanders in previous articles so I will limit this discussion to the types of
expanders and what to expect when your child comes home for the first week.
First of all, remember that expanders should only be placed
on the upper arch since they are meant to move bones; the upper arch (maxilla)
is formed from several pieces that do not fuse together until the mid to late
teens. The lower jaw pieces fuse around
birth so you cannot “expand” the lower jaw; an expander on the lower jaw will push
the lower teeth out of the bone leading to relapse as well as a significant
risk of recession.
“The lower jaw fuses at or around
birth so you cannot “expand” the lower jaw: and expander on the lower jaw will
push the lower teeth out of the bone leading to relapse as well as a
significant risk of recession.”
Expanders are made up of a hyrax screw and some type of
anchorage system to attach the screw to the upper teeth (they will use erupted
teeth as anchorage). The screw is fairly
universal, all expanders will have a similar mechanism where a “key” is used to
turn the screw which then expands the two sides of the expander apart.
Removable Expander |
Banded Expander |
Bonded Expander
These are the three types of expanders; note the screw is
the same in each.
|
The Removable Expander is generally not used by specialists since it has been shown to
only tip teeth and not truly expand the bone.
Besides the obvious problems associated with all removable appliances
(compliance and loss being the two most common), any “expansion” from a
removable expander will be mostly dental and not skeletal and is therefore
going to cause extrusion of molars, tipping of the back teeth outward and
opening of the bite which will lengthen the face and have a tendency to open
the bite.
The Banded Expander is
the most common expander used though it also will cause tipping in most cases,
especially when used in younger patients with a mix of primary teeth and only
the permanent molars. As in the case
above, note that the screw is already turned but the front of the arch remains
narrow and tapered. When you look
closely you will that only the molars where the expander is attached have moved
out but the bone remains narrow. This
expander also can allow molars to tip outward which in turn leads to relapse
and can open the bite and the bands are difficult to clean around leaving areas
that can become decayed if oral hygiene is not stellar.
The Bonded Expander is
the most specialized and efficient of the three expanders. It includes a clear acrylic plate over the
back teeth which is more rigid and stable than either of the other
expanders. It also acts as a bite splint
to de-program any shift in the jaw which is commonly present with
crossbites. Vertically, although the
forces from the expansion will want to extrude the back teeth out of the bone,
the acrylic overlay prevents this by allowing the occlusion from lower teeth
push the upper teeth back into the bone throughout treatment. Finally, the bonded expander covers not only
the permanent molars but also the primary molars for added stability and
protection against cavities. They have
to be custom made for each patient and fit to accommodate individual occlusions
so they are a bit more difficult for the orthodontist.
For the reasons above, I will not include further
information on the Removable Expander but
will instead focus on the remaining accepted Banded and Bonded Expanders.
The first thing you need to know is that YOU will be turning the expander at
home. Since we want gradual movement,
you will need to activate or turn the expander, usually once to twice per day
(see below).
Rapid Palatal Expander
Instructions
Step 1: In a well-lit area tip the patient’s
head back.
Step 2: Place the key in the hole until
it is firmly in place.
Step 3: Pushing the key towards the
back of the mouth, you will notice the fender will rotate and the new hole will
appear. The rotation stops when the key meets the back of the expander.
Step 4: By pushing back and down
towards the tongue, remove the key. The next hole for insertion of the key
should now be visible. This counts as one turn.
I often use the analogy of placing scotch tape on the pad of
a cat’s foot and watching him refuse to walk, that is until he overcomes the
mental block of feeling a foreign item on his paw. The expander will be similar but your child,
like mine, will be able to eat just about anything within a day or two.
You will need to expect an adjustment period to be able to
fully understand your child. It takes a
day of talking (and speaking more slowly) for your child to learn to talk
around an expander, usually with their “s” sounds. Have them practice counting slowly from “60”
to “70” swallowing between every 3 to 4 numbers. Do this until they can say “Mississippi” like
a southerner. Another great tool is to
have them read a Dr. Seuss book the first evening. A little “Cat in the Hat” goes a long way to
restore speech. Finally, make sure you
actually make them talk, don’t let them slide by nodding and grunting.
Lastly, let your child’s teachers know that they may be
talking a little funny for the first week; if they don’t know what an expander
is, you may have them “Google” it or they can visit this site so they know what
to expect. If you have an older child in
band or choir, talk to the band instructor and assure them your child will be
back to 100% with whatever instrument within a week or so.
Two final bits of advise I will share have to do with
keeping the gums healthy and the teeth clean.
First, make sure your child always has water after every snack/drink/meal. Plaque takes hours to form so a good rinsing
with water will clean most of the food and sugar away from the teeth and the
appliance. Add a daily rinse with a
Fluoride rinse like Listerine’s Total Care or Act with Fluoride; this not only
provides fluoride to help re-mineralize teeth each day but also keeps the gums
healthier and will usually prevent the gums from “puffing up” during treatment.
Last but not least, brush twice daily
and after brushing their teeth, make sure your child re-brushes their gums
above and around the expander.
So there you have it, a crash course in rapid palatal
expansion. Just remember that expansion
can prevent removal of permanent teeth later, can reduce risks of impaction to
teeth that are blocked due to a narrow upper jaw, can reduce the time in
treatment for orthodontics later and can even prevent braces in some cases.
If you have questions or comments concerning this or any
orthodontic question, please feel free to make a complimentary new-patient
appointment at either my Steiner Ranch location or my North-central Austin
location on West 35th street and MoPac.
Dr. James R. Waters is
a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of
Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian
graduate from the prestigious Saint Louis University Orthodontic Program
receiving the J.P. Marshall award for clinical excellence in 2001. He holds a Bachelor’s Degree in Science,
Doctorate in Dental Surgery, a post-doctorate certificate in Advanced
Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics
and a Master of Science Degree in Orthodontics.
Dr. Waters and his wife of 19 years live in Austin, TX with their 4
children where he has a thriving, multi-faceted Specialist practice with
locations in Steiner Ranch and North-Central Austin. You can learn more about Dr. Waters at
BracesAustin.com.
Central Austin
1814 W. 35th
Street
Austin, TX 78703
(512) 451-6457
Steiner Ranch
4302 N. Quinlan Park
Austin, TX 78732
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