Does my child need a palatal expander?

Some parents are concerned when seeing many crooked teeth in their child’s mouth, and often ask if a palatal expander would be beneficial. The answer is, it depends. A child should be seen by an orthodontist to evaluate the size, shape, and bite of the mouth to determine if an expander is indicated.

What is an expander? It is a custom-fitted dental device that is made by 2 metal halves joined together by a small screw. When turned, the screw opens slowly to widen the width of the upper jaw.

  

When is palatal expander used? A palatal expander can be used on a child or an adult to correct a bad bite, sometimes referred as a "cross-bite." It is also used to widen the maxilla. Anatomically, the upper jaw and roof of mouth are together know as a maxilla. In some individuals the maxilla is narrower than normal and causes the upper teeth to fit abnormally inside the lower teeth when biting down known as a "cross-bite." A cross-bite may restrict the amount of space available for the permanent teeth to erupt. A cross-bite can also cause the lower jaw to shift lopsided when biting down creating facial asymmetry.

In a child, there is a window of opportunity to correct a cross-bite non-surgically. Since the maxilla is made up by 2 pieces of bones connected in the middle by a seam of cartilage, this cartilage is soft and can be stretched by a palatal expander. Once puberty hits, on average round age 12-14; this cartilage hardens into bone. The 2 pieces of maxilla bones fuse together and cease to expand. Any expansion has to be done through surgery.

In adults, jaw expansion works through jaw surgery via a cut through the roof of the jaw, then a palatal expander separates the bones, bone fills in the expansion gap, and finally bone healing occurs 3-4 months later to stabilize the new jaw.

Why is palatal expander used? The expander is used to correct a one-side cross-bite or two-side cross-bites and to widen the roof of the jaw. In a child, the expander fixes the bad bite, prevents unsymmetrical facial growth, prevents uneven wearing of teeth, and gains space to allow ease of eruption of permanent teeth. In adults, using an expander establishes balanced occlusion, prevents uneven enamel wear, and corrects facial asymmetry.

Does it hurt to wear an expander? Insertion of an expander does not hurt except for turning the appliance. One can feel some tight pressure around the base of the nose and the roof of mouth a few minutes after the expander has been turned. An expander does alter speech and swallowing for 1-2 weeks until the tongue adjusts to the new device.

How long is the expander turned? In general the expander is turned for 1 to 2 weeks while being monitored by an orthodontist. After that, the expander is left in the mouth for an average period of 6 months for bones and tissues to adapt.

In summary, a palatal expander is beneficial when indicated. Although it is non-invasive to separate the maxilla bone with an expander, it must be done before puberty. Discovering this type of malocclusion early is one of the many reasons the American Association of Orthodontists recommends a child to see an orthodontist by the age of 7. It is much easier for parents to have a consultation with an orthodontist to survey their child's bite problem, discuss options, and plan the course of treatment early than dealing with complicated options which may require pain and surgical intervention later on.

At Care Orthodontics, we are here to help. Dr. Nancy Phan can provide a complimentary consultation to answer your questions at (408) 971-2885. You can also find other beneficial information on our website at www.CareOrthdontics.com.