Expanders are needed when the dental arches are too narrow or too small. Palatal expanders create wider more attractive smiles and reduce the need for extractions. Lower expanders widen the lower arch by pushing the back teeth outward, thereby, providing more room for the teeth and the tongue. Upper expanders can actually enlarge or widen the upper jaw. In growing patients, the upper jaw has a growth plate down the center of the palate. The expander attaches to the back teeth and pushes the two halves of the upper jaw apart. Once the upper arch is widened, the expander is left in place for several months to stabilize the jaw while new bone fills in. The amount of upper jaw expansion is determined by the width of the lower jaw.

Many times the need for an expander is obvious. Narrow arches with crowded teeth, crossbites where the upper teeth bite inside the lower or upper front teeth that protrude excessively are all situations in which an expander is necessary. However, there are conditions where the need for an expander may not be as apparent. When crowded lower teeth are widened or tipped outwardly with braces to avoid extractions, the upper arch may be too narrow to fit properly with the lower. Another indication that an expander may be necessary is an excessive dark space between the corners of the mouth and the side teeth when smiling. Finally, almost all overbites need an expander to coordinate the width of the upper and lower jaws, when the bite is corrected.

There are basically two types of palatal expanders. A banded expander or a bonded expander. A banded expander consists of an expansion screw that fits in the palate and is secured to the teeth with metal orthodontic bands. To be most effective, the expansion screw should be held in place by four orthodontic bands (2 on each side). Unfortunately, this appliance takes several appointments to deliver and fitting the banded expander can be quite uncomfortable. For this reason, most orthodontists only use two bands for an expander, which results in more tipping of the teeth and less jaw expansion. Tipping teeth can actually make it more difficult to fit the upper and lower teeth together properly. Dr. White uses the bonded expander exclusively for his patients. With the bonded appliance, the expansion screw is secured to the teeth with custom-made acrylic caps which are bonded to the back teeth. Not only is the bonded expander much more comfortable to fit, the expansion is more effective and the appliance can be delivered after one visit. Dr. White has also been able to use a modified version of the bonded expander to correct bites in many instances where jaw surgery would have been needed.

ACTIVATING THE EXPANDER (TURNING THE KEY)

• The expander is activated or turned by placing a “key” into the hole in the center of the screw and gently pushing the key towards the back of the mouth. Continue to push the key back until the next hole is completely exposed.
• Remove the key by directing it further toward the throat. Do not pull the key forward while it is still engaged in the screw as this will “undo” the activation.
• If the expander is working properly, a space will develop between the front teeth. The space will begin to close naturally about 30 days after turning is stopped.
• Initially, speaking and chewing will be difficult and usually improves in 5-10 days.
• Food will get caught around the expander so patients are encouraged to use a water pick and to clean around the edges of the expander with a gum stimulator.
• A schedule for the number of turns necessary, as determined by Dr. White, will be given to each patient. If a turn is missed, add another day for turning to the schedule.

ADJUSTING TO THE EXPANDER

The greatest challenge with an expander is learning to speak, chew, and swallow with the new appliance. It usually takes 3-7 days to adapt comfortably to the expander. Here are a few tips to help.

• Read out loud to help improve your speech.
• Eat softer foods or soups for a few days and swish with a mouthful of water after meals to dislodge any food trapped between the expander and your palate.
• With the expander in place, you will probably not be able to bite with your front teeth. This is by design to make the expander more effective. Use a knife and fork or tear pieces of your food with your fingers before placing them in your mouth.
• You may notice more saliva in your mouth for a few days. This can lead to “slurping” when trying to swallow. Close your lips together before swallowing to help and brush your expander frequently or rinse with warm salt water to help decrease the amount of saliva.
• Hang in there. Everyone has some difficulty adapting to an expander. You will get used to it, we promise! It’s not uncommon for patients to comment on how “strange” it feels when we remove their expander months later.

TROUBLE SHOOTING

If you are unable to turn your expander, the expansion screw has probably not been fully turned and only a portion of the next hole is exposed. To complete the turn, the key must be inserted into the hole in the back of the screw. Position the key at a 45 ° to the handle and insert it into the back hole and push the key toward the throat until the next hole is completely exposed.

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