Dr. Greg Jorgensen
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What to Expect With Your Child’s Orthodontic Expander

Posted by Dr. Jorgensen on August 22nd, 2011

ExpanderOne of the most common orthodontic appliances used in young children is the palatal expander. These appliances look intimidating to patients and the thought of having to “do the turns” every day scares a lot of parents. What can you expect while your child has an expander in their mouth?

Arch expansion is one of the most common ways to eliminate crowding and crossbites in growing patients. Successful expansion requires that the growth plate in the room of the mouth (the midpalatal suture) is not fused. This fusion usually occurs between 14 and 16 years of age.

An expander is attached to the upper arch by bands placed around the teeth or plastic bonded over the teeth. Although there are removable expanders, fixed ones have an important advantage in that they cannot be lost or forgotten.

While there may be some initial discomfort when an expander is placed just because there has never been anything like that attached to the teeth before, for the most part upper arch expansion is relatively painless. Patients report that they feel pressure on the teeth, in the roof of the mouth, behind the nose, and even between the eyes as their expander is activated. This pressure fades within minutes.

Besides pressure, you can also expect your child to speak differently for the first few days. Additionally, you may hear them slurping as their mouth creates extra saliva after expander cementation. One of the most visible signs that the suture is opening (the desired effect) is the appearance of a space between the upper central incisors. The space is created as the expander pushes the two halves of the palate in opposite directions. Once you have stopped activating the expander, it is normal for the space to close spontaneously. This occurs as the elastic fibers in the surrounding gum tissues return to their original positions. The underlying bone, however, remains expanded. It is also normal for the front teeth to feel a little loose and get sore as they move back together.

To make the first couple of days more bearable for your child as they adapt to their new expander, you may want to find some fun foods for them to eat that don’t require a lot of chewing. Examples include yogurt, pudding, mashed potatoes, ice cream, etc. A day or two after their delivery appointment, the expander will feel natural in their mouth and normal eating will resume. While expanders are more forgiving of hard and sticky foods than are braces, it is recommended that patient avoid jelly like candies that would get stuck in the expansion screw.

Because there is always some relapse (movement back towards the original size), your orthodontist may choose to over-expand your child’s palate. He will decide how much expansion is necessary as part of the initial diagnosis and treatment plan. After your orthodontist indicates that you’ve reached your target, he will instruct you on how long the retainer should stay in place to stabilize the results. This may range from two months to the entire length of treatment.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

625 comments so far in response to “What to Expect With Your Child’s Orthodontic Expander”

  1. LilliAnn Lucas says:

    My daughter, who is 8, just got a palatal expander put in place for her crossbite. She’s handling it well and says it feels fine. My question is about the next step of treatment. The only orthodontist in town (we live overseas in Hanoi, Vietnam right now) said that since the expander will put pressure on both sides of her mouth, he might need to put in a palatal screw to keep it from pushing out the side that is normal right now. This seems invasive to me and I can’t find much information about palatal screws on the internet, which also concerns me. Is this a device you use? What do we need to know about it? Our orthodontist is Vietnamese and was trained in France. He is difficult to understand sometimes, so I am not sure we have the full picture of what a palatal screw is and how it would be put in place.

    • The palatal screw his is describing is called a TAD (see my article on TADS located on this blog). In my opinion, 8 years old is too young for this. Even if you over-expand on the side that is normal at the start, you can expect relapse that will bring it back to match the lower. I wouldn’t use a TAD in my own 8-year-old unless there was a severe problem.

  2. Chris says:

    Hello. My son was born with a midline cleft palate (mostly soft palate) that was repaired at age 9 months. He had an expander when he was 8. It made his upper arch more rounded rather than v-shaped. He is now 11, and at his craniofacial team appointment, the dentist said that there is not room for his adult upper canines, and that he needs another expander to create space– soon! They referred us to an orthodontist who is part of a craniofacial team and has lots of experience with clefts. This new orthodontist took X-rays, examined my son and agreed that he needs another expander so that these teeth can come down. And then he will need braces. We know many families who have used this doctor and he comes highly recommended. But I just want to make sure that it is ok to have two expander treatments. Is that ever done?

  3. Ashley says:

    My son is 4. His top palate is so high up and narrow he can’t form his words very well. He also has sucked his thumb for a very long time. His top teeth are pushed out and the bottom pushed in. His dentist suggested an expansion device with a thumb guard. He a picky eater to begin with and since having it put in Tuesday he has refused to eat anything! I called his Dr and dentist they both said he’ll eat when he’s ready. It’s been 5 days of nothing. He’s hungry. I’ve tried all kinds of different soft things. He cries and is terrified to eat. How normal is that? I’m going to call first thing Monday and have it removed. He has got to eat. I hate to waste the money but it’s caused so much worry and I’m afraid, trauma. I was hoping to save from braces later in life but at this point, he’s got to eat. Thank goodness for Pediasure till they open. I can’t wait for him to “eat when he’s ready”

    • I’ve never had a patient who didn’t start eating within days of the expander placement. I would keep up the nutrition shake and also introduce some fun foods like yogurt, pudding, and ice cream. Very soon your son will be eating normally as the newness wears off.

  4. Allison Harding says:

    I just got my expander in today and thought it’s not the worst thing in the world I am having a tough time eating. We don’t have soft foods that I can eat so I don’t have that option. My parents gave me some of their McDonalds to try and eat but I ended up getting food stuck in the top of my expander even after I drank some water to try and wash some of the food out from the space between the roof of my mouth and the expander. Do you have any recommendations as to what I could possibly to and eat that would not get stuck in the space between the roof of my mouth and my expander? Also, do you have any idea as to how long after getting the expander that my braces would be put on? My parents were given a 2 year treatment timeline but they worry that it won’t be done in time and they won’t have money to pay for it. Anyway, do you have any idea as to when I would be getting my braces put on?

    Thank you.

    • You will learn how to eat normal food with your expander, but in the meantime focus on easy to swallow foods like yogurt, pudding, ice cream, soup, etc. As for the timing of your braces, only your local orthodontist can answer that for you.

  5. Mindi says:

    Dr. Jorgensen,

    First of all, thanks for being available to those of us with concerns.

    I have twins sons. They just turned 10. First orthodontic treatment was mid-November. Orthodontist installed expanders in mouths of both boys. While installing an expander in one son’s mouth, the Dr. took a cellphone call – and then proceeded to work on my son WITH HER DIRTY CELLPHONE hands. Within 3 days, my son had contracted strep throat AND an upper respiratory virus. THANKS DOC! (then his bother contracted the strep from him, and I contracted it from….both of them, I guess…! It was epic!)

    We are no longer with that orthodontist. Our new orthodontist has to now work with what the other orthodontist started. He stated that, yes, one son did need the expander (significant cross bite), but the other son did not need an expander (no cross bite) but rather a bite plate (he has an over bite not a cross bite). We are now in a holding/healing position with this son. We are to remove his expander within three months, as the new Dr. wants the suture to have time to ‘fill-in’ before we do so.

    So confusing. Any thoughts on our particular case.

    Thank you, again, for taking time to respond to concerned parents.

    • I share your concerns about the lack of infection control in the first office you visited. It sounds like you are now in good hands. The only comment I would make about the first treatment plan is that we sometimes use expanders to reduce crowding even when there is no crossbite. The use of the expander in the child without a crossbite doesn’t alarm me.

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