Does My Child Need A Palatal Expander?

Orthodontics- Can my child benefit from a palatal expander?


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.

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Laine August 04, 2012 at 12:09 AM
Her upper teeth are very crowded that her 4 permanent upper front teeth are pushed forward ( tongue trust or over bite). She said that she needs palatal expander with tongue crib.
Carrie September 18, 2012 at 07:27 PM
Hello. My daughter was a thumb sucker. She has an open bite and needs orthodontic treatment. I had a consultation with one doctor who insists on an expander. On a second opinion consultation, I was told that she has a normal palate. The width of her palate, the doctor explained, is 34 and will grow into the normal range of 35-38. He added that her front teeth are narrow and she only needs braces. I don't know what to think now. Are those measurements and his interpretation an accepted orthodontic practice? I have photos and xrays I could upload. dThank you for sharing your thoughts.
Helen December 07, 2012 at 06:55 PM
Hi Carrie, what did you decide? I have the same situation with my daughter..
Beverly December 08, 2012 at 02:16 PM
Hi, I was just told that my daughter, who just turned 12, will need braces after a palate expander because we waited too long to do a palate expander. It had been suggested for a few years at each visit because she had a mild upper left crossbite, but she (and I) were afraid of it, not ready. Now my child is ready, but we were told we waited too long,(only one baby tooth left), and were told the expander will cause the teeth to spread, and I probably won't like the spaces between the teeth it creates, and will now need braces to correct that, since the teeth won't self adjust because we waited until she was 12 (only one baby tooth left). Is that true? My child is fine with it, but did I make a horrible mistake waiting? The dentist said all her teeth are straight and fine, just a mild crossbite on one side that needs correcting before her palate fuses at puberty (around 14). Does this sound right, or overkill from a pediatric dentist who shares an office with a pediatric orthodontist?
Alexandre Petrakis June 25, 2013 at 09:06 PM
My 9 yr old son has a narrow mouth (from dad) compared to his relatively large teeth (from mom). His front two bottom teeth are emerging well behind his baby teeth (which are to be pulled along with two upper teeth to make way for descent of permanent canines). Our question is what to do after this step: expander or tooth extraction. His dad and his dad's mom both had permanent teeth pulled to make room; both are unhappy with their adult teeth - dad's have had a lot of movement with crossed teeth in the lower front and overly descended canines. We feel like both measures proposed (by different orthodontists mind you) seem rather extreme: permanent tooth extraction, and palate expander with a variety of orthodonture afterward. Would a palate expander for a short time be a consideration? Could it do harm in the event we do end up pulling teeth (i.e. too much room)? Thank you for your time.


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