Expanders are orthodontic appliances that can reshape teeth and bone. They are commonly used to correct crossbites caused by narrow and constricted jaw forms. By widening the jaws, this creates more room for the permanent teeth which may be crowded. Expansion is most effective before puberty when the jaws are still moldable. While there are many variations in design, expanders all serve the same purpose. Dr. Mibab uses a fixed appliance for the most effective means of expansion, and parents prefer this type because they cannot be lost by the patient. Expansion is most commonly done in the upper jaw, hence the term palatal expansion. Palatal expansion works by applying gradual outward pressure on the bone and teeth, opening the sutures of the upper jaw. A gap is temporarily created (seen as a space between your front teeth) and allows new bone to grow. Do not be alarmed when the space opens. It is a good indication the appliance is working properly, and the space will close naturally.
As the upper jaw is expanded with an appliance, there is usually indirect expansion of the lower jaw caused by uprighting tipped lower teeth. As a parent, it will be your responsibility to activate or turn the appliance with a special key. Dr. Mibab recommends turning the appliance once a day for approximately 4-6 weeks. After the turns have been completed, the expander remains in place for six months to stabilize the new bone growth.
During the activation phase of the appliance, some pressure may be experienced at the bridge of the nose, around the ears, cheeks or between the teeth. Tylenol or Advil will effectively reduce any discomfort.
Please be careful about what you eat. As with spacers, please avoid hard, sticky of chewy candy, especially gum. Avoid popcorn. It will be difficult to talk and swallow at first. Food will get caught around the expander, especially for the first few days. A WaterPik or similar device will help. Be sure the appliance is cleaned well every time you brush. Vigorous rinsing is helpful, especially with a prescription fluoride rinse such as Phos-Flur or Gel-Kam.
To activate or turn the appliance:
- Have the child lay on a bed or couch with their mouth wide open.
- Firmly grip the key between the index finger and thumb.
- Insert the wire key into the foremost hole of the appliance as demonstrated by our staff and the online video.
- Gently but steadily push the key from the front toward the back of your child’s mouth. DO not back up. You know you have turned it enough when you are able to see the next screw hole.
- Remove the key from the hole by sliding the key down toward the back throat area of the mouth.
- If something does not function well, or your child has persistent pain, stop the activation. Do not continue to expand the appliance. Please contact our office as soon as possible.
- The most common problem occurs if you accidentally undo or reverse the turn as you go to remove the key. When this happens, you will not be able to get the key into the next hole for the future turn. You must reinsert the key in the last hole and redo the turn.