Palatal Expanders: Everything You Need to Know - Smile Prep (2024)

Your mouth is unique, from the shape of your teeth to the ridges of your gum line. One feature that might make your smile stand out is the width of your upper jaw. Sometimes, it adds a little something to your smile, but in other cases, a narrow jaw can cause issues, including bite irregularities and cleft palates.

Palatal expanders widen the upper jaw, making room to move the teeth, open up the airway, or make other adjustments. What are these devices, and how do they work? We have the details you need in our guide to palatal expanders.

What Are Palatal Expanders?

Palatal expanders are orthodontic appliances that widen the upper jaw. Orthodontists always customize them based on a physical mold or a 3D scan of your upper arch. They send this impression to a lab that makes an expander the ideal size and shape for your mouth.

Also called palate expanders and orthodontic expanders, they have been around since the mid-1800s and use pressure to slowly but steadily enlarge the roof of the mouth. Doctors most often recommend these appliances for children and teens whose jaw growth is ongoing. However, they can also work for some adult patients.

How Do Palatal Expanders Work?

Let’s start with a quick anatomy lesson. The upper jaw is composed of two maxillary bones, which are connected by the intermaxillary suture. Together, these three parts are called the maxilla. These individual parts remain separate until roughly the middle teen years, when they fuse.

Palatal expanders work by applying pressure to the maxillary bones. The strength of this pressure varies based on what the patient needs, which mostly comes down to if the bones have already fused. It must be strong enough to separate the bones at the suture, widening the upper jaw and expanding the palate.

Expanders comprise two halves that attach to the upper molars on both sides of the jaw and are typically connected with a jackscrew. Patients turn this screw on a set schedule using a special key, and each turn widens the expander by about a quarter of a millimeter. This ensures constant pressure on the maxillary bones, causing them to move apart.

Signs You or Your Child Might Need a Palatal Expander

• Crowded teeth
• Overlapping teeth
• Crooked teeth
• Misaligned bites
• Impacted teeth
• Difficulty chewing
• Speech problems
• Breathing problems
• Poor sleep

Are Palatal Expanders Painful?

Like most orthodontic devices, palatal expanders usually cause discomfort at first. This initial discomfort often lasts several days, and after that, it usually only returns for an hour or so with each adjustment. Adjustments also cause a unique sensation of pressure and tingling in the roof of the mouth and teeth, usually lasting under ten minutes.

The pain from palatal expansion should never be severe. If your discomfort doesn’t subside with time or an over-the-counter pain reliever, speak to your dentist or orthodontist.

Pros and Cons of Palatal Expanders

Palatal expansion comes with some major benefits to your oral health, but like any orthodontic treatment, it’s not perfect. For all its enticing pros, you have some cons to consider too. Here are a few of the most prominent ones.

What Conditions Can They Correct?

Palate expanders can address any condition related to a narrow upper jaw. This umbrella condition is called narrow maxilla, and this is the irregularity palatal expanders are designed to treat. By treating this underlying condition, they also address all the related issues.

Crossbites

This condition refers to top and bottom teeth that don’t come together properly in a closed mouth. Palatal expanders can address a specific type of crossbite where a narrow upper jaw causes the upper teeth to sit inside the lower teeth.

Crowded Teeth

If the teeth do not have enough room in the jaw to erupt in a nice, tidy row, they will crowd together. This can negatively impact oral hygiene and aesthetics, sometimes making the teeth rotate in place, causing snaggletooth. Orthodontic expanders can help make room for all the teeth to sit properly in the jaw.

Impacted Teeth

Much like crowded teeth, impacted teeth can develop when the jaw is too narrow for proper eruption. In this case, they can grow under other teeth, or even sideways. Widening the jaw can give the impacted teeth the room they need to emerge correctly.

Cleft Palate

A palate expander on its own won’t correct a cleft palate, but it can be an integral part of multi-stage treatment, creating the space necessary for other therapies and surgeries to work properly.

Narrow Smile

While this is a cosmetic condition rather than a medical one, it’s something that people might want to correct. The width of our smiles is determined by the width of our jaws. Expanding the upper arch can create a larger and more balanced smile.

Speech Difficulties

Although palate expanders can cause speech problems, they also can treat them. If the upper arch is too narrow, it can impact tongue placement, which is important for clear speech.

Eating Difficulties

When the teeth don’t come together correctly, you cannot properly chew food. This is a struggle all on its own, but improperly chewed food also causes digestive distress, including gas, bloating, and pain.

Restricted Airway

While rare, sometimes a narrow jaw causes a narrow nasal airway. When sleeping, the airway can collapse — a condition called sleep apnea — or you might have to breathe through your mouth. It can also reduce airflow in general, causing fatigue and other general health issues.

Who Can Get a Palatal Expander?

Most people who can benefit from palatal expanders can use them, though age has a big impact on safety and efficacy. In most cases, they’re not good for children under seven, since they can cause problems with a young child’s nasal cavity. The ideal palate expander patient is between 7 and 14 years old, since at this age, there is less risk of nasal cavity damage but the upper jawbones haven’t fused yet.

After age 14, orthodontic expanders can still work. In the past, patients over age 14 had to have surgery and an expander, but advancements have offered alternatives, including using temporary anchorage devices with expanders. Still, surgically assisted and implant-assisted expansion might be necessary.

Not everyone can use orthodontic expanders, though. You need to have good overall and oral health, and you also need to have your molars (or implants that replace them), since this is where the expander directs its force. It’s also important that you have good bone density and an uninjured jaw.

Types of Palatal Expanders

There are several types of palate expanders, each with unique benefits and applications. When selecting an orthodontic expander, your doctor will determine which option best addresses your needs and matches your comfort level.

Removable Palate Expander

This type of orthodontic expander is best when your jaw only needs to widen slightly, or when you are focusing strictly on dental expansion. You’ll wear it at all times, removing it only when eating, playing sports, or cleaning the appliance and teeth. Usually, you only turn the screw 2–3 times each week rather than 1–2 times per day.

Hyrax Rapid Palatal Expander

Often called an RPE, this palate expander fits tightly around the back molars, with the bands glued into place. You turn the screw in the middle 1–2 times per day, depending on the instructions from your doctor. It usually expands the jaw by about 0.25 millimeters per day, though it can achieve up to a 0.5 millimeters per day, if necessary.

Quad Helix Appliance

This is another type of fixed expander, which doctors glue to the back molars. What makes this option unique is how it expands. Instead of the patient or their parents needing to turn the screw, the expander is already compressed when the orthodontist places it, so it can gently open on its own, slowly adjusting on its own.

Surgically Assisted Rapid Palate Expander (SARPE)

When the bones have already fused or the jaw is exceptionally narrow, you can turn to an oral surgeon for a surgically assisted rapid palate expander. They will insert it directly into the mid-palatal structure and attach it to the molars. You turn the screw 1–2 times a day to facilitate steady expansion.

Implant-Supported Palate Expander

Orthodontists typically only use this type of orthodontic expander for teens and adults. Rather than using the teeth to apply pressure to the jaw, it uses four mini implants as anchors. This requires working with both an orthodontist and an oral surgeon.

Cost of Palatal Expansion Treatment

There are many variables at play when it comes to the cost of palatal expansion, including the type of expander, the severity of the conditions being treated, the age of the patient, and whether you need other appliances and procedures for your treatment. Basic treatment in a child might range from $1,000–$2,500, while comprehensive treatment in an adult can cost upwards of $6,000.

Many dental insurance plans will cover palate expansion, at least for children. Adult treatment still might be covered, but it’s less likely. And even if you have coverage, most policies will only pay up to 50% of the cost. Still, this can have a major impact on your out-of-pocket costs.

Some dental and orthodontic practices will offer discounts or flexible financing options — some of which don’t charge interest or require a large down payment. So ask your dentist or orthodontist about their payment plans if you’re concerned about the cost of treatment.

Can Expanders Be Used With Braces?

Palatal expanders are orthodontic devices, and braces are perhaps the most well-known orthodontic device. But do they go together?

In many cases, yes, but you can get a palate expander without braces, and vice versa. If you’re getting palatal expansion treatment for crossbite, crooked teeth, and even impacted teeth, braces will often be part of the treatment. For other conditions, it’s less common — though not unheard of — to combine the two. And in limited cases, palatal expanders can impact both arch width (skeletal expansion) and tooth position (dental expansion).

Skeletal Expansion

Skeletal expansion is an orthopedic correction. The upper jawbones move further apart, making it seem like the teeth have moved as well. However, that’s because the teeth are anchored in the jawbones, which have shifted, so the changes are orthopedic, not dental.

This is the primary mechanism of action for palatal expanders in children and younger teens. Once the maxilla fuses, skeletal expansion is minimal, making this a secondary or non-existent function of palatal expanders.

Dental Expansion

Dental expansion is when the teeth move within the jawbones, but the bones themselves remain unchanged. In some cases, both occur — the arch expands and the teeth move within the bones. This is often the only function of palatal expanders for older teens and adults.

Unfortunately, there is a limit for healthy dental expansion, since there is a fine line between good expansion and pushing the teeth to an unhealthy position outside of the bone.

Best Alternatives to Palatal Expanders

Palatal expanders are often the solution to a narrow upper arch and the issues it causes. Still, they are not the only option. Before getting an expander for yourself or your child, talk to your orthodontist about all your options. Some choices to consider are:

• Braces: In some cases, braces alone can correct alignment issues enough that a narrow arch isn’t problematic. They can often work for crowded teeth and crossbites if the conditions aren’t too severe.
• Space Maintainers: This is an alternative that is only available to children. Baby molars are larger than permanent ones, and space maintainers hold this extra space once the primary teeth fall out.
• Teeth Removal: If widening the upper arch is risky or impossible, or if you have severely impacted teeth, removing them could be the best option. This can make room for other teeth to realign and eliminate impaction.
• Jaw Surgery: Teens and adults that require significant changes to the upper arch, or who need alterations to both arches, may benefit more from jaw surgery than palate expanders alone — though getting both is also an option.

Final Thoughts

Palatal expanders widen the upper jaw, helping correct a wide variety of issues, from tooth alignment to narrow nasal passages. These appliances work best before the two bones of the upper jaw fuse, but even adults can benefit from them. And when they aren’t an option, there are still numerous alternatives.

Get your dentist or orthodontist’s recommendations, and stick to their directions, and you’ll end up with the best option for your smile.