Dr. Greg Jorgensen
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My Orthodontic Expander Made a Huge Gap Between My Teeth

Posted by Dr. Jorgensen on January 25th, 2013

Over the past couple of decades there has been a shift in orthodontics from extracting teeth to expanding the arches when there is crowding present. Expanders work great, but there are some side effects that catch parents by surprise. One of them is the appearance and disappearance of a gap between the front teeth.

The palate or roof of the mouth is made up of two bones joined together down the center by a junction called a suture. When a patient is young, this suture is made up of stretchable cartilage that is the area where growth takes place (a “growth plate”). After skeletal maturation somewhere between 14 and 17 years of age, this suture fuses and the palate becomes a single solid structure. Expanders take advantage of the presence of the growth plate if they are used before it is fused. One sign that the expander has actually moved the two halves of the palate apart is the appearance of a space between the front teeth. The central incisors are located on different sides of the growth plate and they spread apart as the palate is expanded. The result is a visible gap between the teeth. This gap is normal and desirable.

After the expander has provided the desired amount of expansion, the orthodontist will typically leave it in place for several months holding the two halves of the palate apart while new bone develops between them. Upon removal of the expander, there is always some relapse or loss of arch width. Most orthodontists over-correct by a few millimeters in anticipation of this change.

During this stabilization period, the gap created during expansion tends to close on its own. This happens slowly over time, but it shocks many parents the first time they notice it is smaller or gone altogether. Understandably, many parents call our office worried that the expander has slipped and that the benefits achieved during the activation phase have been lost.

During palatal expansion there are two forces on the teeth. The force created by the expander pushes the palate apart and a gap appears between the teeth. At the same time there is an opposite force acting on the teeth produced by the gum tissues. Just like other soft tissues in the body, the gums are elastic. As the expander pushes outward, the gum tissue starts pulling the teeth back together. You can tell this is happening by comparing the size of the gap between the teeth with the amount of expansion visible on the expander. Rarely will the size of the gap between the teeth ever get as large as the distance between the two sides of the expander because the teeth start moving back together even before expansion is complete. Another sign that the front teeth are being pulled back together is that they get sore and feel a little loose during expansion for no obvious reason (just like when braces are moving them). Now you know that they are being pulled back together by the elastic fibers in your gum tissue. In fact, it is not uncommon for the gap between the two front teeth to be completely closed by the time the expander is removed.

Knowing ahead of time that an expander will create a gap between the front teeth and that it will go away on its own is reassuring when it happens. Understanding what is normal will save you some worry and an unnecessary phone call to your orthodontist. If what you see in your mouth or in the mouth of your child does not seem to follow the pattern described however, give your orthodontic office a call and let them know. It is better to be safe than sorry!

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.

130 comments so far in response to “My Orthodontic Expander Made a Huge Gap Between My Teeth”

  1. Hannah says:

    I’m getting my palatal expander & braces on in less than a week. And I was curious if when I have the expander w/ the braces will it not be as a severe gap change as it would be without braces?

  2. Jackie says:

    My granddaughter had a palatal expander inserted and was only able to tolerate it for about five days. She experienced excessive saliva which terrified her into thinking she wasn’t able to swallow and would not eat or drink. Now after nearly five months without it (she only has upper braces now) she still wakes every morning with a build up of saliva, a feeling of choking, and a stomach ache. Could she be allergic to the metal in the braces, or could there have been some damage that might have occurred when she had the expander on? The expander was the new type that automatically expands itself. You do not manually turn it.

    • I have never heard of an expander causing any problems after it is removed. Neither have I heard of allergic reactions causing extra saliva. I don’t think that the symptoms you’re describing are related to her braces and I would have her seen by her regular physician to see if something else is going on.

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