One of the most common
orthodontic appliances used in young and growing children is the palatal expander. These
appliances can look a little intimidating and barbaric at first to patients and
parents and the very thought of having to “do the turns” every day at home can
seem scary to a lot of parents. Trust me, they are not as bad as they
seem. I have been using expanders successfully
in my practice for years and have been thrilled at how well they work for my
patients. So I wanted to share some
things with those of you who might have just received, or will be receiving your
expander on what can you can expect of having an expander as part of your orthodontic
treatment? 
Arch expansion is one of
the most common ways to eliminate crowding and correcting crossbites in growing
patients. I call it a game changer in the realm of
orthodontics. Expanders can easily solve
some orthodontic problems that were difficult to solve in orthodontic cases of
the past. Expanders have greatly reduced the need for routine extractions, and
have eliminated the need for many jaw surgical procedures.
To work successfully, palatal
expansion requires that the growth plate in the roof of the mouth (specifically,
the mid-palatal suture) has not yet fused. Typically, this fusion usually
occurs between 12 and 16 years of age, and usually occurs earlier in girls than
in boys.
An expander is attached
to the upper arch by bands placed around the upper first molar teeth. There are
many variations of expanders being used today in modern orthodontic offices, but at Wheeler Orthodontics we prefers the “HYRAX”—which is short for HYgenic RApid eXpander. Although there are removable expanders on the
market, glued in ones have a very important advantage in that they cannot be
lost, taken out, or forgotten. Hyrax-expanders are easily cleaned! Also
important is that glued in expanders like the HYRAX maintain an intimate contact
with the teeth, and the gentle force of the expansion does not overpower the
ability of a removable expander to maintain its position in the mouth, where removable ones can be easily dislodged.
While there may be some
initial discomfort right after an expander has been placed--just because there
has never been anything like that attached to the teeth before--for the most
part upper arch expansion is painless. Patients report that they feel a little “pressure”
on the teeth, in the roof of the mouth, behind the nose, and even between the
eyes as their expander is activated. This pressure fades within minutes. And
keep in mind that an expander does its job in about 3-4 months, then it is removed,
so it is not in the mouth for a long time.
Besides pressure, you
can also expect your child to speak a little funny for the first couple of days—which
will quickly pass. Additionally, you may
hear them slurping as their mouth creates extra saliva after expander
cementation. One of the most visible signs that the suture is opening (the
desired effect) is the appearance of a space between the upper central
incisors. The space is created as the expander pushes the two halves of the
palate in opposite directions. Once you have stopped activating the expander,
it is normal for the space to close quickly. This occurs by active closing
forces that the braces will provide, combined with the help of elastic fibers
in the surrounding gum tissues together working to return the teeth together
and to close the gap.
To make the first couple
of days more bearable for your child as they adapt to their new expander, you
may want to find some fun foods for them to eat that don’t require a lot of
chewing. Examples include yogurt, pudding, mashed potatoes, ice cream, etc. A
day or two after their delivery appointment, the expander will feel natural in
their mouth and normal eating will resume. While expanders are more forgiving
of hard and sticky foods than are braces, it is still recommended that patient
avoid anything that would get stuck in the expansion screw. However, we got you covered that situation, as
we will give you a gadget that will help you remove anything that gets
accidentally stuck around the expander.
Because there is always a
potential relapse (movement back towards the original size) if expansion is
made to fast, Dr. Wheeler recommends that the expander is only turned once every
other day. This allows for a nice,
continuous, and harmonious rate of expansion that is biologically compatible
with the tissue of the growth plate and your child’s inherent rate of growth.
One really cool thing expanders
can do, besides the obvious effect of making room for the eruption of permanent
teeth and in creating jaw harmony, is the ability an expander has of widening
the nasal passages and upper airway. The
bone of the palate, is the same bone that makes the floor of the nasal
passages. So orthodontically widening
the palate also widens the nasal airway. So you might see this nice
side-effect: Improved nasal breathing in
your child. This improvement can be
significant! This can have a life-long improvement in reducing the risk of
sleep apnea, sinus and ear infections, mouth-breathing, and snoring, especially as your child moves into
adulthood. Sleep can be improved!!
