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Palate (palatal) expanders are orthodontic appliances that create more space in a child's mouth by widening the palate (roof of the mouth) over time. The goal of palatal expansion is to widen narrow palates in children and correctly align the upper teeth and jaw. This treatment can only be completed before the jaw fully develops.
The most effective way to prevent bad bites, crowded teeth, and other misalignment issues is to invest in palatal expansion at a young age.
Expanders are uniquely made for each patient based on their dental arch and palate size. The devices come in fixed and removable forms. Common types of expanders include:
The rapid palatal expander can correct narrow palates, crowding, and crossbites. The appliances fit over a few back teeth in the upper jaw with a screw in the middle. To activate an RPE, you turn the screw a small amount each day with a special key to create tension between the two palatal bones.
The goal is to widen the maxilla (upper jaw), expand the dental arch, and move the teeth within the bone. Over time, the two palatal bones move apart and the jaw widens. Most orthodontists also leave the appliance in for a few months after the desired expansion is achieved to allow new bone to form. In most cases, palate expansion treatment takes 3 to 6 months.
RPEs can widen the upper jaw at a rate of 0.5mm per day. Slow palate expansion can also be achieved by widening the upper jaw at a rate of 0.2mm per week.
An orthodontist typically indicates a removable expander when a patient only needs minor jaw widening. These appliances are similar in appearance to acrylic retainers, except they are chrome.
Mature adolescents typically require implant-supported expanders. Once the jaw is almost fully developed, heavier forces are necessary to successfully widen the jaw and palate. This expansion treatment consists of four mini-implants that apply force directly to the maxillary bone, instead of the teeth.
Once an individual reaches full maturity (puberty), they typically have a fully developed jaw. Although, some jaws do not fully mature until age 21 to 25. If this is the case, an orthodontist must surgically insert an expander into the mid-palatal suture (palate bone).
The three most common circumstances that typically indicate the need for maxillary expansion include:
When a tooth is stuck under the gums and blocked by other teeth, it is an impacted tooth. Dentists recommend extractions to reduce the chance of disease and jaw misalignment. Palate expanders can help widen the jaw and allow for the proper eruption of permanent teeth.
A crossbite is when the upper and lower teeth do not align correctly when biting down. Crossbites occur when some bottom teeth are located outside the upper teeth when the two jaws are closed. This type of malocclusion can sometimes be corrected with palate expansion treatment.
Over-retained teeth refer to baby teeth that have loosened but then tighten back into the gums, preventing the eruption of permanent teeth. If the primary teeth are not extracted, dental crowding commonly develops, which is a condition that occurs when there is not enough space for teeth to grow in. Palate expanders eliminate the need for extractions and create space for permanent teeth to grow in.
Before a child's adult teeth grow in, orthodontists can see how much room is available in his or her mouth. If a child's jaw seems too narrow, palate expansion may be necessary to prevent dental crowding as the permanent teeth grow in.
Maxillary expansion can also improve breathing ability, which helps prevent mouth-breathing and dry mouth (xerostomia).
Maxillary expansion also treats Class III orthodontic problems. Class III problems are primarily genetic and may include:
Palate expanders also treat maxillary transverse deficiency. Patients with this condition usually have a narrow palate and posterior crossbite. Other indications of maxillary transverse deficiency include:
Before the end of an adolescent’s growth spurt, palate expansion can be done. Although, depending on the patient’s age, expansion techniques vary. For example, treatment is different for adolescents in the primary dentition phase (baby teeth), early mixed dentition phase (mix of baby teeth and permanent teeth), and early permanent dentition phase (all permanent teeth).
Treatment is most effective when the patient’s jaw is still growing. As baby teeth fall out, permanent teeth start to erupt around the same time (age 6). When the mouth consists of some primary teeth and permanent teeth, it is called the “mixed dentition phase.” If a child has a crossbite or crowded teeth during this phase, palate expansion may be necessary.
As a child reaches the late mixed dentition phase, which is when there are more permanent teeth in the dental arch than primary teeth, palatal expansion is more difficult. During this phase, the jaw isn’t growing as quickly. It is typically necessary to wait until the first premolars erupt to begin expansion treatment.
As an adolescent’s growth spurt ends, palatal expansion may not be possible because the jaw is almost fully developed. Implant-supported or surgically assisted palatal expansion is typically the only treatment option at this stage because heavier force is needed to expand the jaw. Expansion is more likely to be successful in young children rather than those who have reached mid or late adolescence.
Pain and discomfort are common side effects of treatment. However, patients typically get used to the pain after a few weeks. Other possible side effects of palatal expansion include:
No, fixed and removable palate expanders do not hurt. Once you activate the device, your child may feel some pressure for a few minutes.
However, implant-supported and surgically assisted expanders may cause discomfort for a few days post-op
Orthodontists do not recommend palate expanders for adults because jaws and palates fully develop in the early 20s (at the latest). Expanders are most effective when the bone sutures have not fully formed yet.
All types of expanders, including removable expanders, are completely safe to eat with. In fact, chewing forces increase the effectiveness of palate expanders. Although, orthodontists recommend cutting food into small pieces because eating large pieces of food can lead to choking.
For the best results, most patients brush their appliance and teeth in between meals. Antimicrobial mouthwash can also help remove any food and bacteria stuck under the expander.
The cost of treatment depends on your location and the orthodontist you visit. In most cases, a palate expander costs anywhere between $2000 and $3000. Since palatal expansion is medically necessary, most insurance plans cover most or all of the treatment costs.
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Koch Göran, et al. Pediatric Dentistry: a Clinical Approach. John Wiley & Sons Inc., 2017.
“Palatal Expansion.” Wikipedia, Wikimedia Foundation, 4 Sept. 2019, https://en.wikipedia.org/wiki/Palatal_expansion.
Proffit, William R., et al. Contemporary Orthodontics. Elsevier/Mosby, 2019.