Everything you need to know about your child’s palatal expander!

One of the most common treatments in orthodontics is the use of a rapid palatal expander, often referred to as an “RPE”. An RPE is used to widen the upper jaw (maxilla), and is usually used to correct crossbites, and to create more space for crowded teeth. The following are the questions that we are asked most frequently by kids and their parents here at Meadows Orthodontics.

“Is the expander going to hurt?”

The most common description by kids is a “tight” or “pressure” feeling. Pain is relatively uncommon, and if sensitivity is reported, it usually only lasts several minutes, or even seconds. We generally have parents activate the expander once or twice a day, which is only 1/4mm to 1/2mm. The vast majority of kids feel very little discomfort and adapt very quickly!

“Am I going to sound different when I talk?”

I always inform my patients that “S” sounds will be a bit slurred at first due to the positioning of the tongue on the palate and the new obstacle for the air producing this sound. Most patients overcome this and adapt within a couple days, returning to normal enunciation. I tell kids to practice reading a book or magazine out loud after the expander is placed to help speech return to normal the fastest.

“My child has a hard time breathing through his/her nose, and snores. Will the expander help with this?”

Studies hace shown that there is a reduction in nasal resistance after expansion, and it has been shown to help with obstructive sleep apnea in some children. However, I do not use expansion for the sole purpose of treating these problems, as treatment for airway obstruction should be interdisciplinary (treated along with your physician, who may precribe medications, or recomend proceedures such as an adenotonsillectomy). Personally, my son had his tonsils and adenoids removed, which helped with his airway and snoring for several years before returning recently (he is 10). I started treatment for his crossbite and crowding with an RPE recently, and within 2 weeks his LOUD snoring (I think all of Castle Rock could hear him!) has disappeared. So, yes, it can help, but every patient is an individual and has different results with airway issues.

“My child has a gap forming between her front teeth!! Is this normal?”

Yes, this is to be expected! The gap is the result of widening of the mid palatal suture of the maxilla. Sutural expansion is usually the goal of expansion treatment, as opposed to mearly tipping the back teeth outward towards the cheeks (which usually occurs also, but we try to minimize this tipping). After active expansion has stopped, you may notice the gap narrowing  spontaneously. The suture not closing, rather the fibers in the gums have been “stretched”, and sometimes pull the teeth back together a bit after expansion. Again, this is usually a good thing.

“How long does the expander need to stay in?”

I usually keep the expander in place 6-9 months after the last turns were completed. Removing the expander too early without retention often results in the teeth relapsing back towards the original width. Have patience! Keeping the expander in while your upper jaw remodels will be worth it, so you wont have to wear one again in the future!

“I was told that I was to old for an expander to fix my crossbite. Is this true?”

The answer to this depends on the individual. As a person ages, the mid-palatal suture fuses into one, solid piece of bone. At this point the maxilla cannot be expanded without a surgical procedure. There is significant individual variation as to when this happens, but generally fusion can happen from 11-12 years old to mid teens for females, and mid-teens to late teens for males. On the other hand, I don’t like expanding children at too young of an age (eg: 6 or 7 years old) if there is no downside to waiting for one comprehensive phase of treatment when they are ready for their full braces. Again, there are individual exceptions for severe early problems.

“Does my diet need to change with the expander in?”

We will discuss avoiding very sticky foods and candy, but unless braces are on your teeth also, your meals do not need to change significantly!

 

I hope this helps! If you have further questions, I am always available to discuss them.

Dr. Dan Rejman

Castle Rock, Colorado