One question I get asked a lot on new patient consultations is “does my child need a palatal expander?” Majority of the time my answer is “no”. Most, if not all of the parents have no idea what a palatal expander does. In simplified terms, the rapid palatal expander widens a narrow upper arch.
This procedure is done most effectively with a fixed appliance and on average takes on 3-6 weeks for the expansion to be completed. After expansion is completed the patient receives a retainer to hold the expansion. In recent years, rapid palatal expansion has gained speed as a modality of phase I treatment in orthodontics, however, in the era of evidenced based and research based orthodontics its excessive use is unwarranted and not supported by scientific research.
Some common themes I hear for the use of a palatal expander are: to relieve crowding, prevent extractions, modify growth, to allow the lower jaw to reach growth potential, to shorten the time braces are worn. The aforementioned benefits of the expander sound nice, but, are purely anecdotal and are not research supported. The research presented in the major peer-reviewed orthodontic journals supports specific criteria for the use of a rapid palatal expander.
In our office we treat a lot of special needs, a crania-facial patients and cleft palate patients, who because of their skeletal anomalies often require palatal expansion. A second indicator, and the most popular use for rapid palatal expansion is when there is a cross bite present on the back teeth. This is often an indication of a narrow maxillary (upper jaw) that doesn’t coordinate with the lower, and thus needs expansion, which can be accomplished at a young age. Finally, new research, although in its infancy, is supporting the use of expansion is when the canines in the upper jaw are impacted and are prevented from erupting passively.
Remember, palatal expansion is extremely patient specific that should be completed quickly and should not be prolonged over an extended time period. Palatal expansion should only be incorporated in orthodontic treatment in isolated cases. When used improperly, it can lead to future complications and predispose the patient to: periodontal problems, pushing teeth out of supporting alveolar bone, and instability.
If a palatal expander is recommended for you or your child, be sure to ask specific questions about why it’s needed? Ask to see the research that supports its use in your situation. We will be glad to answer any questions you may have.