Palatal Expanders: What are they, how do they work, and when are they indicated?
Many orthodontic patients receive treatment that includes more than just braces or aligners. While braces and aligners do a great job at aligning teeth, orthodontists often need to use additional appliances, such as palatal expanders, when the upper jaw is too narrow to accommodate all the adult teeth and does not fit properly with the lower jaw when biting down. But what are they and when are they used?
Palatal expanders sit on the roof of the mouth and work to move the upper jawbones apart, resulting in skeletal expansion. There are three main types of expanders: spring loaded expanders like the quad helix, screw-activated expanders like the rapid palatal expander (RPE), and the removable Invisalign Palatal Expander (IPE). Quad helix expanders are activated prior to placement in the mouth. Once the appliance is glued into place, the springs are compressed, and overtime slowly start to move the two palatal bones in the roof of the mouth apart at the suture. RPEs work similarly, but they have a tiny screw that is turned, which opens the expander and moves the palatal bones apart until the desired expansion is reached. The IPE works differently, in that it uses a series of removable devices that are changed every other day. Each subsequent device applies gentle and incremental pressure to gradually widen the jaw.
Once expansion is complete, the expander will remain in place until new bone can grow in to ensure a stable result. Standard palatal expander wear can be anywhere from six to nine months, with about three to six months of that involving active expansion.
Some of the common orthodontic issues that warrant expander usage include:
- Crowding
- Crossbites
- Narrow nasal airways in mouth breathers
- Chewing issues
- Impacted teeth
- Excessive tooth wear
- Jaw asymmetry due to bite shifting
- Teeth grinding
Some people are born with narrow upper jaws or jaws that just aren’t big enough to fit their teeth, which results in crowding and misalignment. Habits like thumb sucking also cause narrowing of the upper jaw. These issues are corrected using a palatal expander in children with jaws that are still growing. Because the two palatal bones haven’t fused, the orthodontist can widen the upper jaw to ensure a properly aligned smile. On average, the upper jaw is about 90% developed by age 10, so treating patients while they are young is ideal and ensures a stable long-term result. Expansion after palatal suture fusion is much more painful and difficult to achieve with expanders alone, and most often requires mini-screw assisted or surgical expansion.
Some patients may receive a palatal expander before having their braces placed to allow the patient to acclimate to the expander first. For other patients, this can occur at the same time as their braces. Your orthodontist will decide which is the best course of action for your child.
Palatal expanders are one of the many treatment options available to correct jaw alignment and create stable, properly functioning bites. This is important for a patient’s overall oral health. An aligned bite that works well can prevent problems such as chipping or cracked teeth, as well as TMJ issues later on. Many recent studies have also shown that expansion at an early age is effective in increasing the nasal airway passages, subsequently reducing mouth breathing, snoring, and sleep apnea concerns.
Palatal expanders can correct a variety of malocclusions as well as breathing issues. While braces focus on the correct tooth position, the expander corrects skeletal issues. The best way to determine if your child’s smile could benefit from an expander is through a consultation with an orthodontist.
Dr. Heather Desh is a board-certified specialist in Orthodontics and Dentofacial Orthopedics. She graduated from one of only two Ivy League dental schools, The University of Pennsylvania and completed her orthodontics residency training at Temple University School of Dentistry. Dr. Desh is dedicated to providing exceptional care that puts you in the center. If you’re ready to discover the HD Orthodontics difference, schedule your complimentary consultation today by calling 562.283.6590.
