Palate Expanders

The Complete Guide To Most Important Orthodontic Appliance, The Palate Expander

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Palate expanders are appliances that I recommend often for patients in my private practice. In my humble opinion, it is the most important orthodontic appliance that we use.

But this treatment recommendation can come as a surprise to many families. Because of this, palate expander treatment recommendations affect parents in many ways. Parents have feelings of anxiety from not understanding what a palate expander is used for, how much discomfort it will cause their child and how much it will cost.  

Understanding what an orthodontic expander is, who needs one and what it does will make accepting this time-tested treatment recommendation much easier. 

In this article, we will guide you through answering all of your questions about palate expanders, seeing before and afters, and understanding this most important orthodontic appliance.

What Is A Palate Expander

A palate expander is an orthodontic appliance that is used to correct a width problem or discrepancy between the upper and lower jaws. In the most simple terms, it is used to widen the upper jaw.

Palate expanders are used when your orthodontist detects a width issue with your upper jaw. This is typically discovered in the form of a posterior crossbite or severe crowding. Crossbites are a bad type of bite that orthodontist always correct as early as possible.

Crossbites are very common. A recent study featured in the Journal of Clinical Orthodontics states that posterior crossbites are found in 7.7% of patients with baby teeth or a mix of baby teeth and adult teeth. They also noted that crossbites are even more common in adulthood.

Palatal expanders are typically used in younger children who still have growth potential. However, they are occasionally used in adult patients in select cases.

Palate Expander: Before and After

Palate Expander 6 months into treatment

Here is a series of pictures of an actual patient from our office who I prescribed a palatal expander. Our patient was diagnosed with a bilateral crossbite and severe crowding of her upper arch. 

Now 6 months into treatment, her crossbite is corrected, her upper arch has a beautiful arch-form and her teeth are nicely aligned! This is a great result in her initial phase of orthodontic treatment and she is well on her way to a life-changing result!

Here is another excellent before and after video of an actual patient of ours whom I prescribed an expander for her treatment. Her name is Suzy! Check out the video to see how we made the space using an orthodontic palatal expander and then we allowed her body to use the precious space for a beautiful result. 

At 9 years old, Suzy presented with severe lower crowding and a constricted upper arch. The constriction of her upper arch prevented the upper incisors from coming in properly. From my experience, when the front incisors are crowded, the much larger canine teeth will not have enough room and can become impacted.

We decided on a proactive Phase I treatment approach for Suzy. We used a combination of palate expander appliance on the upper arch and limited braces on the lower arch for her treatment.

Not only did we improve her bite and create space but this young lady is now more comfortable at school and can be more social without fear of being bullied due to her teeth. 

Why Does My Child Need A Palatal Expander?

Orthodontists around the world recommend palate expanders for children for many different reasons or a combination of reasons. It is likely that during your child’s braces consult that your orthodontist observed one of the many situations that require upper jaw expansion to help fix the problem.

A list of these situations can include:

These are just a few of the reasons that your child needs a palatal expander. In many children that need an expander, orthodontists usually find more than one of these conditions, therefore making the need for an appliance even more important.

With that being said, the primary reason that orthodontic expanders are used is to correct crossbites. This is because a crossbite can lead to many significant problems later on in life such as pain, discomfort with the bite and permanent tooth damage.

Orthodontic expanders can also be used to assist in providing space for severely crowded teeth.  An expander may be the difference between extraction and non-extraction treatments, in some cases. 

In other cases, a palatal expander can widen the jaw and provide the aesthetic value of a nice wide smile. In situations where orthodontists find impacted teeth, blocked out teeth, or crowded lower incisors a palatal expander may help provide the crucial space needed to align the teeth and bite. 

How Much Does A Palatal Expander Cost?

The cost of palatal expander treatment is well worth it.  Palatal expander treatments can be the sole treatment in a Phase I interceptive treatment or it can be a feature of your comprehensive treatment plan with braces. There will be two significant differences in treatment costs.

Phase I interceptive treatment with a palatal expander can cost between $1000-$2500, depending on the type of expander and the number of expander appliance checks that your treatment requires. 

Comprehensive treatment that includes an expansion appliance can cost between $3500-6000, depending on the length of your treatment with braces, the type of braces you select and any additional upgrades that you select for your treatment. 

At the average orthodontic office, the impression/digital scan, fabrication, and insertion and appliance checks for your palatal expander are all included in the fee for the appliance.  Be sure to verify this with your orthodontist prior to starting any treatment. 

How Does A Palatal Expander Work?

A palatal expander works by applying a force to the maxillary bones strong enough to separate the bones at the suture, widen the entire upper jaw. and expand the palate.

The upper jaw is made up of two bones. These bones are called maxillary bones. These two bones are connected together in the middle at the intermaxillary suture. This connection at the suture forms one structure called the maxilla.

The fusion of these two bones occurs during the middle teen years. Palatal expansion works best in early adolescent years before the maturation of the mid-palatal suture. 

CT imaging used to track expansion image source

How Long Does A Palatal Expander Stay In?

A palatal expander will remain in the mouth for at least 6 months and as long as 1 full year. Early removal can cause an immediate relapse of the expansion.

Your orthodontist will leave a palatal expander in even after the expansion of the palate is complete. This is because immediately after expansion the body begins to fill in the missing bone at the suture. This bone replacement takes about a full year to complete. 

Most orthodontists will leave a palate expander in for at least 6 months. Some doctors will remove the expander at 6 months and replace it with a smaller appliance to hold the expansion such as trans-palatal arch or a removable acrylic retainer.

If the expander is broken, dislodged or removed too early, the upper jaw expansion will relapse and the jaw will return back to the original size. This is why it is very important to follow the instructions given by your orthodontist with regard to care for your orthodontic appliances. Failure to follow these instructions can lead to a loose or broken appliance and extended treatment times.  

Types Of Orthodontic Palate Expanders

There are multiple types of palatal expanders that orthodontists use for different situations. In addition to the base models, all palate expanders can be modified with auxiliary features. This allows palatal expanders to be multifunctional and assist in correcting thumb habits, tongue thrusts, open bites, anterior crossbite and more.

While there are multiple varieties of expanders here are the most commonly used palatal expanders

Bonded Expander

Hyrax Expander

Hass Expander

Quad Helix Expander

Does A Palate Expander Hurt?

A palatal expander isn’t the most comfortable orthodontic appliance, however, it isn’t very painful. 

The most uncomfortable part of the expander process is the orthodontic separators that are placed to make space in between your teeth. Orthodontic separators feel like a big chunk of meat stuck in between your teeth that you can’t get out. The good thing is that they only stay in for a week, at the longest.

After the separators, palate expanders are very straight forward. When you complete your initial turns you will feel a slight pressure as the expander transmits force through your molars and to your palatal suture.

Each turn of the screw is equal to less than a millimeter of expansion. This assures that the amount of expansion each day is tolerable. The first 3 days will be the most uncomfortable. During these days we recommend softer foods and smaller bites to our patients. You can check out our guide of 15 Best Soft Foods For Braces to get ideas of the types of foods that are safe for palate expanders and braces. 

When it is time for your expander to be removed don’t panic! Your orthodontic team will use a special removal instrument to remove the palatal expander easily and without any pain. For every patient that has been treated with an expander, this moment is the best moment!

How Will A Palate Expander Help My Child’s Bite

A palate expander is a tried and true method to correct an upper jaw width problem. Orthodontic expanders give orthodontists a great tool to apply an orthopedic level force to the upper jaw bone. When a child has a cross-bite that can lead to problems later in life, a palate expander should be the treatment option of choice for your child. 

Expanders help the bite fit together properly and can widen the smile to give your child the best smile esthetics. A proper bite for your child will prevent potential pain, jaw joint problems, fractured teeth and grinding. 

Is A Palatal Expander Really Necessary

When prescribed by your orthodontic professional, a palatal expander is really necessary to correct the bite.

For a posterior crossbite in a child, a palatal expander is the Gold Standard for true skeletal correction. Palatal expanders are necessary to correct skeletal jaw discrepancies. When the upper jaw is more narrow than the lower jaw, your child will have a bite problem. This includes a crossbite on one side or both sides in the most extreme cases.

There are legitimate reasons to start your child’s orthodontic treatment early. The advantage of utilizing a palatal expander at a younger age is that there is an upper age limit for non-surgical palatal expansion.

After the age of 14-16 and young boys and girls the maxillary suture fuses. When this happens,  the success rate of non-surgical palatal expansion decreases.  That makes using a palatal expander at the right time very important.

Early treatment with a palatal expander is the best option when it is prescribed by your orthodontic professional. 

How To Eat With A Palate Expander

You will eat without difficulty with a palatal expander.  The diet recommendations given to you by your orthodontist will still hold true for your palatal expander. You want to center your diet around healthy, low-sugar, high protein options to give you great flavor and balance in your daily diet.

However, you must still avoid all hard, crunchy, sticky chewy foods. These foods can dislodge bend or break your expander.

The first few days after your initial expander turns your teeth and gums will be sore. You will feel pressure on the roof of your mouth and possibly around your nose. This uncomfortable feeling won’t make it difficult to eat, but you may feel pretty crummy. 

For these difficult days check out our 14 Best Soft Foods For Braces post which is written for patients who are feeling sore during their first few days of braces. 

Overall, you will still be able to eat a healthy well-balanced diet with your palatal expander in place.  As your bite improves from the expansion, chewing will actually be easier, more efficient and more enjoyable!

How Do You Clean A Palate Expander

Keeping your braces free of plaque and food is an absolute must and the same goes for your palate expander. From the day your expander is delivered, you will need to take special care to clean around the bands of the appliance and also learn how to clean underneath the appliance.

There will be a space between the tissue surface of the appliance and the roof of your mouth. This space traps food when you eat. Using a water flosser will help to dislodge any food that may be caught above your expander. Once the food is loose, you can use your soft-bristle toothbrush to brush away the food debris and clean the palate expander. This will keep the expander clean and keep your breath nice and fresh. 

You can also try this cool trick to clean food from above your expander!

Clean your palate expander every day. During the first weeks of turning food can become stuck in the keyhole, preventing you from turning your expander. Food can make it difficult to see the keyhole to turn and if food is left long enough it can become hard and unremovable from the keyhole.

If this happens, a new palate expander will have to be made and the process started over. This mistake will cost you additional fees and delay your orthodontic treatment. 

What Happens If My Palate Expander Comes Loose

If your expander comes loose,  push it back into place and avoid eating any hard, sticky, crunchy or chewy foods. Make an emergency appointment with your orthodontist right away. 

Orthodontic expanders can come loose for a few reasons. The most common are:

Palate expanders generally come loose on just one side. When This happens your child will be able to move the expander up and down on the side that is loose. Push the expander back into place and contact your orthodontic office right away. Hold the expansion by keeping the expander in the mouth. 

If your palate expander becomes loose on both sides, it will come completely out of the mouth. When this happens there is a risk of the appliance falling off while eating and potentially going down the throat.

This is a major choking hazard for your child. Because of this risk, an expander that is loose on both sides should be removed completely by the parent.

Place your child’s appliance in a zip lock baggie and call your orthodontist immediately to schedule an appointment to have it glued back on. If the palate expander remains out of the mouth for too long, the upper jaw will shrink back to its original size and you will have to start the expansion treatment all over again. This will cause a significant delay in your overall treatment.

What Happens If My Palate Expander Breaks

Palate expanders can break, occasionally. When this happens it is essential to book an appointment with your orthodontist right away.   When they do break, palate expanders typically break in 2 common spots:

When a palate expander breaks the sharp edges that remain can cut the roof of the mouth, tongue,  cheeks or lips causing painful lacerations in the mouth.

Because of this, a broken palate expander is a true emergency and you should book an appointment immediately to have your appliance re-made.  Completely remove the appliance from the mouth. However, you lose some of the expansion that you have gained during treatment.

The best way to avoid breaking a palate expander is to follow the food guidelines given to you by your orthodontic team.  Hard, crunchy, sticky and gooey foods can break your palate expander. 

How To Turn A Palatal Expander

Turning a palatal expander is easier than it looks! Most parents cringe at the idea of having to stick a key into a small hole in their child’s mouth. However, after the first few turns, it get easier and easier to do. Here are the key things that you need to to do to make turning the appliance a success

Most expander keys have a small bend in the key wire to prevent parents from jabbing their child in the roof of the mouth. This creates a fail-safe and protects your child from injury. 

Find the keyhole in the expander screw and insert the key completely. You will feel the key fit into place. 

Give a firm controlled push straight back. Be sure to turn until the see the next hole. This is critical to make sure you complete the turn and have the next hole available to insert the key. 

You will feel resistance as the screw turns and the expander applies pressure to the teeth. Your child will feel a pressure at the roof of the mouth and their teeth. Complete the turn by removing the key in a down and backward motion.

Be careful not to reverse the expansion screw when removing the key. If this happens you will not be able to see the next hole and you won’t be able to complete the next turn. 

Repeat the process for all additional turns. 

Be sure to follow your orthodontist’s exact protocol for how many turns per day for your child. At our office, we recommend that parents complete both turns right before bedtime. This will keep your child from being miserable as a school if you turned it in the morning. 

Where Can I Buy A Palate Expander Key

Your orthodontic office is the best place to source an extra palatal expander key.

Some offices may give you an extra key at no charge. Other offices may charge for an additional key. Expect to pay up to $5 for a replacement key. The big takeaway here is to keep your key in a safe place and not to lose it. 

If your orthodontic office does not have additional keys for sale, you can purchase a palate expander key from Amazon.com.  This palate expander key has a large handle for increase manual dexterity and also features a counter to help you keep track of the number of turns that you have completed. 

Palatal Expander Myths 

Myth #1: Palatal expanders break your upper jaw

MYTH BUSTED! A palatal expander does not break your jaw. It separates the bones at the mid-palatal suture. Think of this suture as finger-like projections. Until a certain age in boys and girls, these projections can be readily separated. After puberty, the suture becomes more complex in nature and essentially fuses together. 

Myth #2: Expanders cannot be used in adults

MYTH BUSTED! This is not entirely true. We find the greatest predictability with palatal expander therapies in pre-puberty children and early puberty teens. This timing is well before the suture has started to mature. After the middle teens the suture begins to fuse making palatal expansion much more difficult and much less predictable. While there are adult cases that are successful with orthodontic palatal expansion, it is not the norm. Adults that need true skeletal expansion will see the best and most predictable results from surgically assisted rapid palatal expansion(SARPE). 

Myth #3: Expanders will make your nose wider

MYTH TRUE! There are scientific research journals that show that there is some variation in the base of nose width after palatal expansion. The maxillary bones are a part of the greater maxillo-facial complex, so this makes sense. However, this facial change appears to be temporary and not long term, as test subjects were followed up with later after the study. 

Conclusion: Palatal Expanders

As a versatile orthodontic tool, the palatal expander can improve your child’s bite and smile! But most importantly your child’s self-confidence and self-esteem will be more positive than ever, as they begin to see the positive changes from their treatment!

If you are in orthodontic treatment with braces or clear aligners in the West Valley of Phoenix and have any questions about your treatment, please contact us. Dr. Jesse McGuire is here to answer your questions and help you throughout the entire treatment process. At ProSmiles Orthodontics we pride ourselves on exceptional patient care and comfort with braces or clear aligners!

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