What is a Palatal Expander?
A palatal expander is a dental device that widens the upper jaw to create more space for teeth. It’s custom-made to fit over several top teeth on the roof of the mouth.
Dentists or orthodontists may use a palatal expander, also known as an orthodontic expander, before placing traditional dental braces.1
What Does a Palatal Expander Do?
A palatal expander widens the roof of the mouth by gradually pushing apart the palatal bones. They’re helpful when someone has a:
- Narrow upper jaw
- Narrow palate
- Misalignment between the upper and lower teeth
Expansion creates more room for teeth. It can also correct other potential issues, such as overlapping teeth.2
Dentists may recommend an expander before braces to ensure the orthodontic treatment is as effective as possible.
Who Needs a Palatal Expander?
Not everyone needs a palatal expander before braces. Dentists recommend palatal expanders for people with:
Malocclusion (Crossbite)
Malocclusion refers to a scenario in which the top and bottom teeth do not meet correctly. Palatal expanders can correct crossbites, a type of malocclusion where the upper teeth sit inside the lower teeth.
Narrow Maxilla (Upper Jaw)
A maxilla (upper jaw) that’s too narrow may not give the teeth enough room to erupt in the correct position. As a result, teeth may overlap or become crowded and crooked.
They may also block other teeth from emerging (impacted teeth). Palatal expanders can create more space for a child’s permanent teeth.
A palatal expander opens nasal passages, thereby promoting better airflow and improving speech patterns.
If a narrow maxilla is left untreated, a person can experience other complications, such as:
- Crowded teeth
- Eating and chewing difficulties
- Speech problems
- Narrow smile
“Palatal expanders are the gold standard when it comes to correcting crossbites in children. A proper occlusion will prevent potential jaw joint issues, sleep disordered breathing issues, and speech problems.
Dr. Nandita Lilly, one of NewMouth’s in-house dentists
Cleft Palate
A cleft palate is a common defect that involves a split or opening in the upper lip or palate. A palatal expander can be helpful during the repair process.
Once cuts have been made in the bone surrounding the palate, an expander may be placed to create space for new bone tissue to grow.
How Does a Palate Expander Work?
Palate expanders resemble retainers, though they’re typically made from chrome metal. They have two halves that attach to the upper teeth on each side.
An expansion screen connects the two halves in the middle of the palate. You’ll turn this screw periodically with a palate expander key on a schedule from your orthodontist. Turning it maintains gentle pressure on either side of the jaw, slowly widening the palate.
Once you reach the desired jaw width, you’ll wear the expander for several months. This additional time allows new bone to form in the gap, stabilizing palatal expansion.
How Long Does a Palate Expander Stay In?
A palatal expander usually remains in the mouth for at least 6 months and up to a year. If the expander comes out too early, the bones may gradually relapse to their original position.
An orthodontist may remove the original expander after 6 months and replace it with a smaller appliance.5
What’s the Best Age for a Palate Expander?
The best age for a palatal expander to be effective is between 5 and 16. Some orthodontists recommend children who need palatal expanders get them at 7 or 8.
Since jawbones don’t fully form until after puberty, the palatal bones of children under 16 have not yet fused together. Therefore, children may see results from palatal expanders more quickly than adults.4,5
Success Rates of Palate Expanders
Palatal expanders have high success rates in children and adults. Studies have shown a success rate of between 84 and 88%.8,9
One study noted complications are much less likely if palatal expansion occurs slowly and carefully.9
Types of Palate Expanders
There are several types of palate expanders, including:
Removable Palatal Expander
Your orthodontist may recommend a removable palate expander If your upper jaw requires minimal expansion. Always wear the expander, even though it’s removable, except while eating, playing sports, or brushing your teeth.
With a removable palatal expander, you’ll need to turn the screw two or three times a week, depending on your doctor’s recommendations.
Hyrax Rapid Palatal Expander
The Hyrax is the most common fixed palate expander. It consists of two metal wings with bands that fit snugly around individual back molars. The orthodontist glues the bands onto those molars, securing the expander.
You’ll need to turn the central screw on a regular schedule. Your orthodontist will provide the key and instructions on how to use it.
Because the Hyrax consists of only bands and wires with no acrylic covering, it’s easy to keep clean. Another advantage is that it doesn’t irritate the palatal mucosa. This is because the teeth bear the pressure.6
Haas Expander
The Haas design resembles the Hyrax but incorporates acrylic. It’s bonded to the back molars and exerts positive pressure on the palate and teeth.
Like the Hyrax, it has a central screw that requires periodic turning.
Quad-Helix Appliance
A quad-helix expander offers the benefit of not needing adjustments once it’s in place. It’s designed to expand on its own.
Instead of a turnscrew, this expander has four active helix springs. The orthodontist glues it onto the back molars in a compressed position. It then gradually expands without the need for manual adjustments.
How Much Does a Palate Expander Cost?
By itself, treatment with a palate expander can cost between $1,000 to $2,500. The cost of a palate expander depends on several factors, including:
- Your location
- The dentist or orthodontist
- Your insurance coverage
- The treatment plan and time frame
You can use palate expanders independently or as part of a comprehensive orthodontic treatment plan with braces. Comprehensive orthodontic treatments including an expansion appliance can cost $3,000 or more.
The cost may vary based on treatment length, types of braces, and any other necessary orthodontic work.7
Does Insurance Cover Palate Expanders?
Yes, most insurance plans cover part of the cost of palatal expanders. Palate expanders are typically considered medically necessary.
However, always check with your insurance provider for specifics on your coverage.
Side Effects of Palatal Expanders
The most common side effect of using a palate expander is mild discomfort. You may feel pressure or soreness in your teeth and upper jaw for the first few days after adjustments.
Other typical side effects include:
- Toothache
- Mild gum irritation
- Difficulty speaking
- Bad taste in the mouth
- Dry mouth or lips
- Mild difficulty eating
- Headaches
These side effects are temporary and should improve as your body adjusts to the appliance. Other less common side effects may include:
- Relapse — relapse occurs when the palate shifts back to its previous position.
- Root resorption — the body may dissolve a tooth’s root due to pressure from the expander.
- Open bite — a gap develops between the top and bottom teeth when the mouth is closed.
- Palatal separation — the mid-palatal suture in the middle of the hard palate can sometimes separate.
Most side effects are minimal. Contact your orthodontist immediately if you experience severe pain or other problems.
Do Palate Expanders Hurt?
No, your palate expander shouldn’t hurt. It may cause discomfort or soreness for the first few days, but symptoms should subside as your mouth adjusts.
Contact your doctor right away if you feel pain from your palate expanders.
Minimizing Side Effects from Palate Expanders
Orthodontic appliances such as palatal expanders can be uncomfortable. However, there are things you can do to minimize discomfort and other side effects:
- Over-the-counter (OTC) pain relievers – ask your dentist which pain relievers they recommend for discomfort.
- Choose soft foods – opt for soft foods like mashed potatoes, ice cream, jello, yogurt, eggs, smoothies, protein shakes, and applesauce for the first few days.
- Avoid chewy foods – items like gum, hard or sticky candy, popcorn, ice, and nuts can get stuck or break the palate expander.
- Cut foods into pieces – you’ll have an easier time eating bite-size pieces of raw vegetables and fruit rather than biting directly into them.
- Use a soft-bristled toothbrush – soft bristles keep your teeth and the palate expander clean without damaging it.
- Floss daily – flossing is essential because food will likely get caught under the expander.
- Clean your expander – use a water jet or a syringe filled with water to flush out any food caught under the palatal expander.
Caring for Your Palate Expander
Like any orthodontic appliance, you must take care of your palate expander. You’ll need to:
- Brush after meals – it’s easy for food to get caught in your expander. Brush your teeth after you eat.
- Brush the expander – when brushing your teeth, brush your palate expander with a soft-bristled brush.
- Drink lots of water – drinking plenty of water throughout the day will wash away any debris caught in your palate expander.
- Turn screws as directed – your doctor will tell you how and when to turn your palate expander. Follow their directions for the best results.
How to Turn a Palate Expander
Turning your palate expander widens the device to apply further pressure on the palate bones. Your orthodontist will instruct you on how often and how much to do so.
Typically, you’ll need another person to turn the expansion screws. It’s easiest to lie on your back so the person helping can shine a light into your mouth.
There are holes in the middle section of the palate expander. Insert the expansion key into each hole and turn it in the direction the arrows point. Your doctor will tell you how many times to turn the key.
Once you’re finished with all the screws, remove the key.
Alternative Treatment Options
If an orthodontist doesn’t think a palate expander is the best choice for you, there are alternative options. Orthodontic treatments to address a narrow mouth or crowded teeth may include:
- Tooth extraction — your doctor may recommend removing one or more teeth to create more space for the remaining teeth to move into alignment.
- Traditional braces — braces don’t expand the palate, but their wires and brackets can move teeth into their proper positions.
- Oral surgery — in severe cases, your doctor may recommend a surgical procedure to realign the upper and lower jaw.
Summary
A palatal expander is an orthodontic appliance used to widen the upper jaw. It can correct crowded teeth and malocclusion. Your orthodontist may also recommend it before traditional braces.
You usually wear palatal expanders for around 6 to 12 months. They’re most effective when used pre-puberty before the palatal bones fuse.
Treatment costs can range from $1,000 to several thousands of dollars, depending on the dentist, location, and insurance coverage. Most insurance plans cover part of the cost, as expanders are usually considered medically necessary.
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