In certain situations, a palatal expander is needed to address a constriction of the upper jaw. It is often called an orthodontic expander, rapid palatal expander, or Hyrax.
When is a palatal expander needed?
A palatal expander is necessary to address a constriction of the upper jaw. There are genetic and environmental factors that may cause or be associated with an upper jaw that is not wide enough.
First, a patient may inherit a genetic makeup that predisposes him or her to develop a narrow upper jaw. In these cases, parents commonly remember having a palatal expander when they were younger. Furthermore, if one child needs palatal expansion, siblings often need expansion as well.
Environmental factors can also be contributory. Patients who suck their thumb or use a pacifier until a late age typically have a constricted upper jaw. Kids who primarily breathe through their mouth, instead of through their nasal cavity, also characteristically have a narrow upper jaw.
What is the process of making an expander and actually completing the expansion?
In our offices in Norwalk and Westport, an expander is a fixed appliance, which means the patient does not take it in and out like a retainer. The expander is supported by four upper teeth: two on the right and two on the left.
Typically, the right and left six-year molars serve as the supporting teeth in the back of the mouth, and the right and left first premolars serve as the supporting teeth in the front. If the first premolars have not erupted yet, primary (baby) teeth may be used for support.
The first step is a quick appointment to place separators (also known as spacers) in front and behind the supporting teeth. At the following appointment a couple days later, the orthodontist places stainless steel rings that fit around the four teeth.
After the fitting, an impression is taken. We have a dental laboratory on-site in both of our Connecticut offices that makes all of our palatal expanders. Production takes two to three weeks, on average.
When the lab finishes production of the expander, we replace the spacers. A few days later, the expander is cemented by the orthodontist onto the four supporting teeth utilizing a special dental adhesive that contains fluoride. We allow the patient to become accustomed to the expander for one week before actually starting expansion.
One week after inserting the expander, we demonstrate to the parents how to turn the expansion screw. We begin with two turns per day: one in the morning and one at night. We check the patient each week to see if further expansion is necessary.
Expansion is completed in two to three weeks, on average, based on the extent of the initial constriction. When expansion is complete, the expander stays in the mouth for three to four months for stability, which allows bone fill.
Does an expander cause discomfort?
Most patients take a few days to get used to the expander. Many find they generate an excessive amount of saliva initially, because their mouth mistakes the appliance for food.
Also, we typically recommend an over-the-counter pain medication, such as Tylenol or Ibuprofen, over the first few days for discomfort. Many patients choose to eat softer foods during this time, like mashed potatoes, yogurt, pasta, etc.
I started turning the expander, and I now have a big gap between my two front teeth. Why?
During the expansion process, a space between the upper front two teeth will develop. This tends to worry patients but is actually completely normal and signals that the expansion process is working as desired.
The upper jaw actually consists of two bones that join together in the middle of your palate. As you expand, these two bones gradually separate, which causes the space to develop between the two front upper teeth.
How old should you be when you receive an expander?
The decision about when to begin expansion is made on an individual basis, and depends on the eruption of the permanent teeth, any other skeletal discrepancies, your bite, and numerous other factors.
Can you be too old for an expander?
The upper jaw actually consists of two bones that join together in the middle of your palate. This junction is called a “suture.” As you age, this suture becomes denser.
When growth is complete, the suture completely fuses together and cannot be opened with an expander alone. In this particular situation for adults, the only way to achieve necessary expansion is a surgical procedure performed by an oral surgeon to “re-open” the suture.
Typically, an expander is placed in the mouth and then the patient sees the oral surgeon for the surgical procedure. After the surgery, the expansion process can begin.