Does My Child REALLY Need a Palate Expander?

Jaw expansion, also known as maxilla or palatal expansion, is an orthodontic treatment that gradually widens your child’s upper jaw. The last five decades have seen a significant increase in its use, aligning with a broader trend in the US of avoiding tooth extraction.

Today, a palate expander is the most common fixed orthodontic appliance, and its use starts in children as young as 6 years old. Factors contributing to its popularity include the rise of Teen Invisalign, self-ligating braces, and concerns about obstructive sleep apnea, which have all contributed to more dental professionals turning to expanders as a quick fix.

What most parents struggle to decide is if the expander is truly necessary, and if so, at what age. Sometimes, yes, it’s necessary, but just as often, especially for kids under 9, it’s better to wait and see under the guidance of an orthodontist. With a treatment plan in the 6-month time frame and jaws that are continuing to grow and develop through pre-adolescence, parents have time to let their kids be kids.

What Is a Palate Expander?

A palate expander is a device used by dentists and orthodontists to widen the upper jaw. These expanders, usually made of metal, are put on the roof of the mouth and attached to the back teeth.

There’s a small key in the middle of the device that gets turned little by little to push the two halves of the palate apart. The upper jaw consists of two bones separated by a joint at the middle point, called the mid-palatal suture. As the jaw expands, new bone grows to keep the suture between the plates intact. This joint fuses at approximately 12 years of age making this a relatively painless procedure if done before then.

But what about my child’s lower jaw?

The lower jaw doesn’t work in the same way as the upper jaw because it only has one bone with no midline joint. So, attempts to expand the lower jaw consist of pushing the teeth outward. This may be necessary if the teeth are positioned too narrowly. However, it is important to minimize lower teeth expansion to prevent pushing the lower teeth out of the bone. A telling sign of too much lower teeth expansion is if you are seeing gum around these teeth receding.

Why Are Palate Expanders So Common?

In recent years, expanders have become the most common orthodontic appliance treatment for children during their developmental stages, before their adult teeth emerge. The primary objective with a palate expander is to create enough space for permanent teeth to emerge correctly aligned, reducing the need for extractions and potentially preventing issues with impacted teeth.

A narrow upper jaw can lead to overcrowding and overlapping of teeth, which can cause lisping speech patterns and improper chewing, as well as potential breathing problems like snoring and sleep apnea. Additionally, on the perceived facial beauty scale, a narrow jaw can lessen the appearance of a full upper lip as well as the prized square jaw line.

Thus, many dentists claim that using an expander can help children avoid treatments like braces, corrective surgery, and more. And, for many parents, these claims along with improving their child’s physical appearance before their teen years, are enough to convince them it’s the right thing to do.

Are Palatal Expanders Necessary for My Child?

The necessity of palatal expanders has been vastly exaggerated. While the possibility of needing one might come up during your child’s early orthodontic evaluation, it is best assessed once the upper permanent or adult first molars have emerged, typically after 6 years of age. The ideal time to expand the upper jaw is between 9 and 12 years old when the upper permanent incisors (front teeth) are growing in and before the upper jaw starts to fuse.

Jaw expansion after 12 years of age is still possible, but the older the patient, the more likely the teeth will be tipped outward and the less likely the expansion will be stable. Expanded teeth will always tip back inward to their original location. Expanded jaws tend to stay wide for a lifetime.

While a child is still growing, an orthodontist can best determine whether a palate expander is an appropriate solution for jaw-related problems tooth alignment problems such as:

Crowded or overlapped teeth

Expanding the upper jaw can often fix overcrowding without needing tooth extraction. But if pulling teeth is necessary due to severe overcrowding, it can lead to healthier teeth and gums in the long run. Plus, some kids who had to pull teeth might not need their wisdom teeth removed later in life because there’s enough space for them to grow in naturally.

Impacted or ectopically erupting teeth

These are teeth that haven’t come in yet, are not in the proper play, or are growing in the wrong direction. These are visible on a dental x-ray.

Crossbites

This is when the lower jaw shifts to the side when biting, or the upper teeth bite inside the lower teeth. The lower jaw can often look crooked when a crossbite is present. At other times, the crossbite is hidden but is still being negatively affected and the teeth are being worn down prematurely.

Breathing problems and snoring

Some say expanding the upper jaw can help with breathing and cure pediatric sleep apnea (where the child snores at night when sleeping and sometimes stops breathing due to the airway [nose and mouth] being too narrow or small.) Unfortunately, some dentists recommend palate expanders for children as young as 3 years old under the guise of being “airway-friendly.” However, scientific studies repeatedly show that jaw expansion doesn’t open the airway enough to help.

*Any child with suspected breathing problems should be seen by a Pediatric ENT (Ear/Nose/Throat) doctor to have their airway examined to see what treatment is indicated.

Dentists typically use expanders on children for 4-6 months, depending on the severity of their condition. Early intervention definitely makes it easier to reshape the upper jaw and prevent more significant orthodontic problems down the road.

While palate expanders can be useful in certain cases, they’re not as necessary as they’re sometimes made out to be. In approximately 80% of cases where adult canine teeth are surfacing incorrectly, these issues can self-correct if the upper jaw is expanded and the upper baby canines are removed at the appropriate time. This combination of treatment (expansion followed by removal of the baby canine) really helps the wayward canine find its way into its proper position.

Did You Know?

Impacted Canines are one of the most common problems orthodontists treat. The upper permanent canines (the fang tooth which is the third tooth from the center on each side) have a weird tendency to tip toward the midline and grow in the wrong direction. If left untreated, these canines can get stuck in the roof of the mouth or occasionally damage the roots of the adjacent teeth, causing them to become loose and eventually fall out. In extremely rare cases, upper canines can erupt through the palate and into the nose holes.

Top Consequences of Unnecessary Expanders

Dental expanders have become a one-size-fits-all solution over the years, with hundreds of thousands of children undergoing unnecessary upper jaw expansion.

Unfortunately, it can be hard for parents to tell if their child truly needs one, and sometimes, even after going through the process, the jaw can go back to how it was before. The practice has been paid and the parent is none the wiser.

Dental professionals who use palate expanders during a child’s development phase often promise prematurely that the child will be able to avoid tooth extractions later because enough space has been created for the teeth to grow in straight.

Inappropriate expansion and over-expansion can lead to

    1. excessive protrusion of the front teeth (teeth that look like they stick out too much) and
    2. lack of space for the last molars to grow in after 12 years of age. When these molars don’t have enough space to grow in, a flap of gum will remain over the tooth, creating an area that can easily become infected. This common infection (pericoronitis) can occur from 12 years of age well into adulthood.

Precautions for Dental Expanders

Although expanders can be helpful in certain cases, most kids don’t actually need them. It is essential for parents to be aware that some dental professionals may recommend an expander for financial gain, even when it is unnecessary.

Before agreeing to any unnecessary dental work, such as a palate expander to prevent tooth extraction or sleep apnea, it is recommended to seek a second opinion. As Dr. Neal D. Kravitz, DMD, MS, Harvard graduate, and Editor-in-Chief for the Journal of Clinical Orthodontics, pointed out, some dentists have regressed to “pseudoscience” and are “pushing non-extraction methods and practicing outside the boundaries of evidence-based treatment.” Only a certified orthodontist should prescribe palate expanders for your child.

In rare cases, when used properly, palate expanders might help prevent future dental issues and save money on orthodontic treatments down the line. But this isn’t very common.

At Walton and Maready, we prioritize transparency and will never recommend appliances or treatments unless they are essential for your child’s current and future oral health. If a dental professional has prescribed an expander for your child and you would like a second opinion, please contact us for a free consultation. Your child’s joy and well-being take top-priority at our practice.

, , , , , , ,

HOURS

Monday – Friday: 8:30am – 5:00pm


LOCATION

2305 Stafford Avenue, Raleigh, NC 27607


OUR ASSOCIATIONS