The palate is the technical term for the roof of the mouth, which is, in part, made up of the maxillae (upper jaw bones). It’s not something most people give a lot of thought to. But, when the palate doesn’t develop properly, whether due to genetics, chronic mouth breathing or oral habits like prolonged thumb sucking, it can have a big impact on a child’s bite, dentition, appearance and health.
Thankfully, a narrow palate and small upper jaw can be fixed. And though there are treatment options for adults and older teenagers, the problem is much more easily corrected while a patient is still growing.
One of the most common ways to do that is using a rapid palatal expander. In this post, I’ll be filling you in on everything you need to know about this orthodontic appliance.
What is a Rapid Palatal Expander?
A rapid palatal expander (RPE) is a type of orthodontic appliance used to widen the upper jaw, or palate. It attaches to your child’s upper back teeth and sits against the roof of their mouth. There’s a screw in the center of the expander that’s activated using a key.
By widening the palate, there will be enough room for the permanent teeth to erupt, and discrepancies between the upper and lower jaw will be fixed to create an ideal bite. Expansion can also open the airway and give your child a broader smile.
How Does Maxillary Expansion Work?
In children, the upper jaw, or maxilla, is made up of two halves that meet in the center of the palate, at what’s called the midline suture. The suture doesn’t fuse together until around puberty. Before this, it responds to pressure from a rapid palate expander.
Every time you or your child activate their expander, it creates tension at the suture that gently separates the maxillary bones, guiding their growth outwards. Eventually, new bone forms between the two halves, which stabilizes the results.
Depending on your child’s age and their specific orthodontic concerns, it could be possible to pair an expander with braces as part of comprehensive treatment. However, when it comes to certain issues, including airway problems, using an expander as a phase 1 appliance will achieve the best outcome.
When Does a Child Need a Rapid Palate Expander?
Any time a child has a narrow palate or the upper jaw is too-small relative to the lower jaw, a palatal expander could be helpful. While there are other instances where palatal expansion is indicated, the most common reasons I use the appliance are:
- Severe Crowding
Crowding occurs when the jaw is too small to fit all of the teeth. An orthodontist can spot emerging crowding and intercept the problem during childhood. This is one of the reasons the American Association of Orthodontists recommends children have their first orthodontic screening no later than age 7.
That’s not to say every child who will eventually have crowded teeth will need phase 1 orthodontic treatment. In fact, I have Oak Ridge and Wayne Invisalign and braces patients of all ages with crowding. But when it’s going to be severe, a palatal expander can guide jaw growth and minimize future issues. This will make later treatment faster and easier.
Early orthodontic treatment with palatal expansion is also beneficial when crowded teeth are blocking permanent teeth from coming in. When a tooth gets stuck under the bone or tissue (impacted), which is fairly common with the upper canines, expansion can make enough room for the teeth to erupt on their own. Waiting can mean needing extractions and more invasive, oral surgical procedures.
- Crossbite
A crossbite is when some of the bottom teeth sit outside of the top teeth. An anterior crossbite, or front crossbite, involves the teeth in the front of the mouth, while a posterior crossbite, or back crossbite, affects the teeth in the back of the mouth.
Not every type or degree of crossbite requires a palate expander. But, when a crossbite is skeletal (i.e, caused by the size or shape of the upper jaw) and will be moderate to severe, early intervention is ideal.
This is because, if not treated early, kids will often compensate by shifting their jaw to one side, which can cause permanent changes in their facial structure. Phase 1 treatment will also prevent the need for corrective jaw surgery in adulthood.
- Airway Issues
The palate is the base of the nose and sinuses. A narrow palate can obstruct the airway and make it difficult for kids to breathe properly through their nose, leading to chronic mouth breathing. When children mouth breathe, impurities aren’t filtered out of the air and it interferes with their growth and development.
Less oxygen is absorbed by the lungs with chronic mouth breathing as well, so the body has to compensate, which can lead to sleep-disordered breathing, including obstructive sleep apnea. Airway issues in children have been tied to problems with development, behavior, academic performance and more.
Maxillary expansion is a tried-and-true way to correct the problem. Widening the palate, widens the floor of the nose, creates room for the tongue and promotes proper tongue positioning, preventing it from obstructing the airway during sleep. All of these effects allow for nasal breathing and reduce or eliminate sleep-disordered breathing.
How Long Does a Palatal Expander Stay In?
Generally, a rapid palate expander stays in place for six to 12 months. The active phase of expansion where you or your child turn the expander usually lasts for less than six weeks. However, after the right amount of skeletal expansion is achieved, the appliance has to stay in place while new bone forms in the gap between the maxillary bones.
Does a Palatal Expander Hurt?
Expansion typically isn’t painful and your child should never experience severe discomfort. However, they may have some soreness and pressure after activating their expander. This will be more pronounced during the first few days of treatment. To manage this, have your child stick with a liquid diet for the first day and then soft foods for about a week. It’s also a good idea to turn the key at night, so most of the pressure is gone by the time your child wakes up.
How to Adjust an Expander
My team and I will show you and your child how to adjust an expander in our office so you feel comfortable doing it. These are the general steps:
- Have your child tilt their head back.
- Put the key we gave you into the hole of the appliance.
- Push the key toward the back of the mouth until it stops and you can see the next hole in the expander.
- Remove the key and that’s it. The hole for the next activation should be visible.
What if You Forget to Activate the Expander?
If you forget to activate the expander, do not double up and do two turns in one day. Instead, just keep going with one turn per day until expansion is complete.
Patients sometimes ask, “What happens if you turn your expander too much?” The answer is it can interfere with your treatment and increase discomfort. Turning the key more than prescribed won’t speed up the process.
What Can Kids Eat With an Expander?
As I said above, kids will want to opt for liquid food (soup, smoothies, etc.) for the first day and then soft foods (scrambled eggs, oatmeal, mashed potatoes, yogurt, etc.) for about a week.
Once they feel ready to go back to their normal diet, they can still eat most of the things they usually do. However, avoid really hard, chewy or sticky foods that could damage the appliance, including caramels, whole, raw apples, sticky candy, gum, hard bagels and jerky.
How to Care for an Orthodontic Expander
Practicing good oral hygiene with a rapid palatal expander is important. Kids should floss once daily and brush their teeth in the morning, after meals and snacks, and before bed. When they brush their teeth, they’ll need to brush all of the parts of their expander too.
Palate Expander Before and After: What to Expect?
If you look at palate expander before and after pictures, the first thing you’ll notice is that patients have a wider, more aesthetic smile. Expansion can also create a more balanced facial appearance.
Though the cosmetic enhancements are important and can go a long way in boosting kids’ self-esteem, there are also a number of key functional benefits. Expansion can:
- Ensure the upper and lower teeth come together correctly, creating a healthy, stable bite and harmony between the teeth, jaw, chewing muscles and temporomandibular joints (TMJ)
- Make room for the permanent teeth to come in properly
- Reduce the risk of tooth decay and gum disease by alleviating crowding
- Open the airway to encourage nasal breathing and prevent issues like obstructive sleep apnea and the related consequences
- Allow kids to avoid the need for tooth extractions, lengthy treatment and corrective jaw surgery
- Fix an emerging crossbite
Early Orthodontics in Wayne and Oak Ridge, NJ
At Smile Experience Orthodontics, we’re experts in dental and facial development. If your child is age 7 or older and hasn’t seen an orthodontist yet, bring them in for a complimentary evaluation.
Your child probably won’t need treatment right away and they’ll simply come in for periodic growth and development check-ups so I can pinpoint the best time for them to start treatment. If I do spot certain red flags, however, intervening early using a palatal expander or another phase 1 appliance can give them the best opportunity for a healthy smile and strong bite.
Schedule a complimentary consultation for your child today!
