A common step in early orthodontic treatment is use of a palate expander. A palatal expander is an appliance used to correct a narrow roof of the upper jaw or for crossbite of the back teeth. The way that palatal expanders can guide development makes them an effective tool for children, whose mouths and jaws are still growing.
What Is a Crossbite?
Teeth should fit together with the top teeth on the outside of the bottom teeth. Crossbites can be on either side of the mouth and can involve a single tooth or multiple teeth. There can also be crossbites with front teeth. However, a palatal expander is typically used when a crossbite involves back teeth.
There are several factors that can cause a crossbite. A crossbite may be caused by the jawbones, by the teeth, or by a combination of the two. Commonly, pressure from the cheeks, lips, and tongue, or because of a long-term thumb or finger sucking habit, or long-term pacifier use can contribute to a crossbite. There also are conditions that people are born with that impact the bones of the face that can create a crossbite such as cleft lip and palate or craniosynostosis.
How Does a Palatal Expander Work?
The top jaw has a fibrous layer called a suture. The suture is found in the middle of the top jaw and connects the right and left half. During normal growth the top jaw gets wider. As children get older around their teens, the fibrous layer turns into bone.
It is easier to use an expander to widen the jaw or move the teeth to get rid of a crossbite before the suture is replaced by bone. The expander puts force on the teeth using a wire spring or a small screw that is attached to teeth with metal bands.
If the fibrous layer turns to bone expanders may not work as well and other options for expansion may need to be explored, including surgery. Other benefits to an expander include creating space for other teeth and correcting some crookedness. There are also expanders that can help with breaking thumb or finger sucking habits at the same time of expansion.
Are There Different Types of Expanders?
There are different types of expanders: removable, fixed and attached to bone.
Removable expanders are not very common, as they require a great deal of patient cooperation. Fixed expanders are held in the mouth with special glue and may have a wire spring or a key associated with it. Expanders with a wire spring are adjusted by the orthodontist or dentist, while expander with keys are adjusted by the parents. In older patients where the suture is mostly replaced by bone, there is an option for an expander that is placed into the bone.
Expanders are a custom appliance designed for the specific needs of each patient. Expanders come in various shapes and sizes. We only a discussed a few common designs here, but there are many more.
The American Academy of Orthodontics recommends an orthodontic evaluation by the age of 7, and crossbites are one of things your orthodontist will be looking for to determine appropriate age for treatment. If you have any additional questions, you should reach out to your local orthodontist or pediatric dentist.
Kaitrin Kramer DDS, MS, PhD is a craniofacial orthodontist at Nationwide Children’s Hospital’s Cleft Palate-Craniofacial Clinic. She received her doctorate in Dental Surgery from The University of Michigan, and then completed a research post-doctoral training and was an adjunct clinical assistant professor at the University of Michigan School of Dentistry before heading to The Ohio State University for her M.S. and Certificate in Orthodontics.
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