Appliances for Widening the Upper Jaw
When most people think of the orthodontist’s office, they usually think of braces and Invisalign. However, orthodontists use a variety of appliances to achieve different goals—such as preserving space in the mouth or widening the jaw. This article focuses on appliances used to widen a narrow jaw—banded and bonded expanders.
At Burke & Redford Orthodontists, we believe in educating our patients and their families so they feel comfortable with the different appliances that may be used during orthodontic treatment.
Problems Caused By Narrow Upper Jaws
An upper jaw that is too narrow can cause a variety of orthodontic issues, such as:
- A jaw that is too narrow is often too crowded to fit all teeth comfortably. Jaw expansion is a good option to relieve overcrowding and can help decrease the chances of needing to extract permanent teeth.
- Biting, Chewing, and Speech Difficulties. A narrow upper jaw may affect how the upper and lower teeth fit together. As a result, patients may have problems with biting, chewing and speaking.
- Excessive Wear On Teeth. When a jaw is too narrow, teeth fit together inappropriately and can rub excessively—causing wear or damage. Jaw expansion idealizes the width relationship of the upper and lower arches so they align correctly.
- Proportion Problems. A narrow upper jaw might be out of proportion with the lower jaw. If untreated, orthognathic (jaw) surgery may be needed as an adult. By guiding jaw growth when patients are younger, orthodontists can create proportional jaw relationships, which provides a balanced facial appearance and a more attractive smile.
Palatal expansion is best done when patients are young and the jaw hasn’t finished growing. This doesn’t mean adults can’t have their jaws widened, but the results will be more challenging to achieve and may require surgical assistance.
The bottom line is that jaw expansion is easier to achieve before the jaw stops growing. It also prevents patients from experiencing complicated dental problems later in life. After all, most patients would prefer to wear a palatal expander for several months when they are young rather than undergoing extensive jaw surgery as an adult.
What Is A Palatal Expander?
Orthodontic appliances that widen the roof of a patient’s mouth—thereby expanding the jaw—are called palatal expanders.
The two halves of the upper jaw are called the palate (roof of the mouth). These two halves are joined by a “suture” or growth plate that runs down the middle of the palate. The suture is similar to the soft spots in an infant’s head and can be stretched. After expansion, the suture fills in with bone.
By widening the suture, the upper jaw bone also expands. Because expansion results in a larger bone, the results are permanent. In other words, once extended, the jaw will stay that way and won’t revert to its original size. Expansion with an expander device is one of the most stable orthodontic movements.
All banded and bonded expanders are custom-made for the patient. There are two basic types—banded and bonded expanders. The model used will depend on the patient’s situation. However, both operate on the same basic principles.
- Banded Expanders are used on teens and adults who have their permanent teeth. The appliance consists of stainless-steel rings (bands) that go around the first molars. A metal expansion mechanism sits in the middle of the palate. The expansion mechanism is activated regularly during treatment—slowly widening the jaw in the process.
- Bonded Expanders are used on younger patients who have a mix of baby and adult teeth or sometimes on adolescents that have only permanent teeth. Instead of bands, acrylic bite blocks are molded to fit over several back teeth. These blocks are bonded (glued) to the teeth with orthodontic adhesive. The bite blocks cover the sides and biting surfaces of the back teeth. As with the banded expander, a metal expansion mechanism sits in the middle of the palate.
Activating the Palatal Expander
No matter which type of expander is used, the expansion mechanism will have a center screw that is turned with a “key.” To activate the expander, patients place the key into the hole in the
center screw and gently push the key toward the back of the throat one notch.
The activation schedule for each patient will depend on the amount of expansion needed. The orthodontist will give each patient detailed instructions on how often and for how long to activate the appliance. Usually, patients complete one turn every evening for one to six weeks. Once activation is complete, the appliance is left in place for two to three months so the expansion can “set.”
Patients will visit the orthodontist during the activation phase so progress can be monitored and adjusted as needed.
Younger patients will most likely need help activating their expander, usually from a parent. The orthodontist will review the activation procedure to ensure that there are no questions. Here are some basic guidelines for activating an expander.
- Lie on a flat surface (such as a bed). It helps to have enough light so that the inside of the mouth is easily visible.
- Carefully insert the key into the hole in the middle front of the expander.
- Push the key gently and steadily from the front toward the back of the mouth. Maintain steady movement and don’t back up. The key should be pushed back until the next hole appears in the screw.
- Activate the expander at the same time every day. The key shouldn’t be turned more than once in 24 hours. If a turn is missed, don’t double turn the following day. Continue with one turn per day until the total number of turns instructed by the orthodontist is accomplished.
Patients should also contact an orthodontist if the expander feels loose or any other problems arise.
Expectations and Adjustment Period
Patients are often surprised to learn there is less soreness associated with an expander device as compared to braces. As with all appliances, there will be an adjustment period that lasts a few days. Here are some things to expect and how to deal with them.
- During and immediately after activating the expander, patients may feel some discomfort or pressure that feels like “tingling” or “itching” under the expander. Pressure might be felt near the nose, cheeks, or between front teeth. This is completely normal.
- Any soreness can be relieved with ibuprofen (Advil, Motrin) or acetaminophen (Tylenol).
- Difficulties with speech, chewing, and eating are common during the first few days. To improve speech, patients may want to read aloud or talk out loud more often to help the tongue adjust. A diet of soft foods is also helpful during this time.
- Patients may generate more saliva at first, but this will clear up quickly.
- Food may accumulate between the roof of the mouth and the expander while eating. To help dislodge the food, patients should take regular sips of a beverage and swish it around in their mouth before swallowing.
- As with all orthodontic appliances, patients should avoid eating chewy or sticky foods and use caution when eating hard or crunchy foods.
After only a few days, space may begin to open up between the two upper front teeth. This is a sign that the expander is working and the jaw is widening. In fact, the larger the gap, the better the expansion. This gap will either fix itself once expansion is complete or will be treated with braces.
Cleaning and Maintenance
It is essential to clean the space between the expander and the roof of the mouth each day. If food isn’t removed, it can cause irritation or infection.
The expander should be brushed whenever the teeth are brushed, at least twice a day but more if possible. Your orthodontist will review how to clean and brush the expander effectively. A water flosser can be a helpful tool for keeping the expander clean.
If you have questions or concerns about palatal expanders (banded and bonded expanders) or any other orthodontic appliance, contact Burke & Redford Orthodontists at (951) 699-8011 or fill out the contact form on our website.