When Does Your Child Need a Palate Expander? Expert Advice

As an orthodontist, I get a lot of questions from parents about palatal expanders. What are they? When should a child get one? What do they do?

I’m here to answer all your questions and concerns on all things expanders and braces. Keep reading to find out more about the best age for a child to get a palatal expander and what exactly they do.

When should your child Get a Palatal Expander

The best age for a child to get a palatal expander is typically between 8 and 11 years old. Of course, many orthodontists may decide to start earlier or later than that, and it’s even possible to get a palatal expander as an adult.

One of the main reasons why this age range, 8-11 years old, is ideal, in my opinion, is because the child is typically mature enough to handle the dental procedures involved in fitting and activating a palatal expander. This includes taking dental impressions, cementing the device, and making regular visits to the orthodontist for activations.

Children who are younger may not be able to cooperate fully during these procedures (for example, keep their mouths open for a long time so that their back teeth stay dry), which can make the process more difficult and less effective.

Younger children are often less skilled when it comes to keeping their appliances clean and using all the different braces care accessories.

Another reason why this age range is ideal is that the child’s permanent first molars are usually fully erupted by this point. This is important because a banded palatal expander relies on the molars for anchorage, meaning that the device is attached to the molars to ensure that it stays in place during the expansion process.

Finally, the mid palatal suture, which is the seam between the two halves of the upper jaw, is still malleable enough to be separated and widened in children below puberty age. This is crucial because the expansion of the upper jaw requires the suture to be gradually opened up over a short period of time, which allows new bone to grow and the maxilla to widen.

If the suture has already fused or is more difficult to open, it may not be possible to achieve the desired expansion. Typically, the mid palatal suture is fully fused by age 11–13 years in girls and 14–16 years in boys, so it’s important to take advantage of this window of opportunity.

What Does a Palatal Expander Do

A palatal expander is a dental device that widens the upper jaw. The device works by applying gentle pressure to the mid palatal suture, which causes the suture to open up. As the suture opens, new bone grows in that middle space, which permanently widens the maxilla. The expansion is not just limited to the teeth, but also the surrounding bone, which creates more space for the teeth to come in straighter and less crowded.

It’s important to note that palatal expanders create a true expansion of the maxilla, not just the tipping of the teeth that we often see with braces. This is why expanders are so important for correcting certain orthodontic problems, like crossbites.

In terms of the actual device, there are two different types of palatal expanders: removable and fixed.

Removable expanders are typically used for mild crowding cases. They act mainly on teeth and since the screw is only turned once or twice per week they don’t cause an opening of the suture. Many orthodontists have moved away from using removable expanders since the same result can be accomplished with braces at a later stage, without the hassle of early treatment.

Fixed expanders, on the other hand, are bonded to the teeth and remain in place for several months. During this time, the expander will need to be activated to widen the maxilla and maintain the desired amount of pressure.

Fixed expanders are also called rapid palatal expanders (RPE) because the screw is turned daily. This causes massive pressure on the suture and opens it up quickly. You’ll see a gap forming in a matter of days.

We’ll only be talking about fixed expanders in this article since they’re the only type of device that causes true widening of the maxilla.

  • To learn more about how palate expanders work, check this article that explains the process in detail.

Reasons why your child may need a palatal expander

As an orthodontist, I understand that some parents might be hesitant about getting a palatal expander for their child. But let me assure you that there are several reasons why your child may need one.

Palatal expanders are an effective way to correct many orthodontic issues, especially those related to the width of the upper jaw.

Crossbite

One of the most common reasons for a child to need a palatal expander is crossbite. Crossbite occurs when the upper teeth fit inside the lower teeth, and it’s caused by a narrow maxilla. This can cause permanent asymmetries in the dentition and even affect the jaw bones and face shape if not corrected as early as possible.

If the crossbite is severe and the child is young, we can use a bonded expander (one that has acrylic blocks on multiple teeth instead of just bands) to glue it to the baby teeth and raise the bite.

Crossbite used to be the only indication for a palatal expander, but nowadays many orthodontists use expanders to treat moderate to severe crowding cases as well. There are several schools of thought in our field, so it depends on your orthodontist’s training.

Severe crowding

Another reason a child might need a palatal expander is severe crowding. Severe crowding can be seen early on a panoramic X-ray while the permanent teeth are still in the bone. Your doctor can easily evaluate and predict whether your child’s teeth will need more space.

For severe crowding, serial extractions are often indicated, and to avoid it, we can attempt to expand the maxilla with the help of a rapid palatal expander. The mandible often grows wider to catch up with the maxilla, but some orthodontists opt for bottom removable expanders or braces to expand the mandible as well.

No room for canines

Moderate crowding can also be a criterion for using a palatal expander. When the canines are about to come in at age 11-12, it’s a great time to widen the maxilla a little bit to make room for them.

Canines often end up crowded, overlapping over teeth, or getting stuck higher up because they’re generally the last teeth to erupt (aside from third molars). It’s easy to spot this issue before it happens by simply taking an X-ray right before it’s time for the canines to come in and assess how much room they have.

While you can also make room with braces, a palatal expander will create a wider smile without tipping teeth. The nice part about palatal expanders is that the expansion is highly customizable and we can set out to achieve less expansion if that’s what we need.

Class III malocclusion

An underbite, also known as a Class III malocclusion, is a dental condition in which the lower jaw protrudes forward, causing the lower front teeth to overlap the upper front teeth when the mouth is closed. This gives the appearance of an “underbite,” where the lower teeth appear to jut out in front of the upper teeth.

We can notice an underbite in children as young as 5-6 years old, and the earlier we catch it, the better. While there’s no guarantee that we can correct class III malocclusions since they’re genetic and we can’t predict how much the bottom jaw will keep growing, early intervention is key.

In underbites, we use a combination of a palatal expander plus a facemask that’s hooked onto the expander. This helps to widen the upper jaw and bring it forward, allowing for proper alignment of the teeth and a more balanced bite. In some cases, orthognathic surgery may be necessary to correct severe underbites.

What’s next after a palatal expander?

If your child is about to wear an expander, know that this is just phase 1 of treatment. All kids in expanders need an additional phase 2 in braces in a couple of years (or right away, if they’re older).

Phase 1 of orthodontic treatment typically involves using appliances like palatal expanders to correct underlying skeletal issues in younger children. These appliances widen the upper jaw, make more room for permanent teeth, and improve the bite.

However, even after the palatal expander has done its job, your child will still need phase 2 of orthodontic treatment to align teeth and achieve a beautiful, functional smile. Phase 2 typically involves braces, which use brackets and wires to move teeth into their correct positions, but you can opt for aligners too.

The good news is that because the palatal expander has already widened the upper jaw and created more space for teeth, phase 2 of treatment is often more straightforward and can often avoid the need for extractions. This can result in shorter treatment times and a more comfortable experience for your child.

It’s essential to remember that each child’s orthodontic needs are unique, and the length of phase 2 treatment can vary depending on the complexity of the case. Some children may need only twelve months of braces, while others may require up to two years. Your orthodontist will be able to give you a better estimate of the treatment time needed after evaluating your child’s individual needs.

Conclusion

In conclusion, as an orthodontist, I highly recommend fixed expanders for children who need them, and knowing when to get a palate expander for your child is crucial. Expanders can help avoid more extensive treatment later in life and improve oral health and overall well-being.

If you’re unsure whether your child needs a palatal expander, I encourage you to schedule a consultation with an orthodontist. They can evaluate your child’s specific situation and provide recommendations for the best treatment options.

Whether you’re new to braces or a braces veteran, taking care of your teeth and gums during orthodontic treatment is crucial. That’s why I’ve put together a list of orthodontist-recommended tools that will make caring for your braces a breeze:

  • An awesome mid-range electric toothbrush. Rotating electric brushes are much more effective, in my opinion, than sonic ones. You can keep your teeth white by using whitening replacement heads.
  • A countertop water flosser to blast out food debris between teeth. I know handheld models are tempting, but you’ll need a lot of water. You can almost replace flossing with this and your gums will be healthier.
  • Braces accessories to get into all the nooks and crannies: straight or angled interdental brushes, floss threaders, orthodontic wax or silicone. For pain management, have gel ice packs handy, Orajel, and Mouth Magic (a cool soothing solution for mouth sores).
  • For clear aligner patients, a tool like PUL helps both remove and seat your aligner or retainer. Don’t forget to use a cleaning product like crystals to keep your trays fresh and hygienic.

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