What is an Expander? How Does it Work?

July 14th, 2016

The 2 most common names used to describe this orthodontic device are an expander or a jaw widener.  There are, in fact, many different types of expanders – an RPE (Rapid Palatal Expander), a Quad Helix, a Haas Expander, a Schwartz Appliance, and a W-arch to name just a few.   Each one has a slightly different indication, but the overall purpose of most expanders is to make the jaw wider.

How does an expander work?  Through adolescence the upper jaw is composed of 2 separate bones.  An expander pushes the two halves of the jaw apart, the cartilage between the bones is stretched, and new bone is formed.  Ultimately, the jaw ends up wider than it’s starting point, which ultimately makes more room for the teeth.

The lower jaw is a little different; although it started as two separate bones while developing in the womb, the two bones of the lower jaw fuse into one prior to birth. Thus, while lower expanders can make more room by pushing the teeth apart or by tipping them, they don’t actually make the jaw bone itself wider.

The 2 most common orthodontic problems addressed by expanders are Crossbites and Crowding:

1 – Crossbite:   When the upper jaw is too narrow, this can result in upper teeth that are inside lower teeth;  an expander widens the jaw to ensure the proper relationship of the upper jaw being wider than the lower jaw;
2 – Crowding:  If the jaw isn’t large enough to accommodate all the teeth, an expander can be used to make more room for permanent teeth.

Let’s use an analogy:  imagine you have a box of crayons and you accidentally place too many crayons into the box.  The result is crayons that are all jumbled up.  If straight crayons are your goal, you can either remove some crayons ~or~ make the box bigger.  Your jaw is like the box and your teeth are like the crayons:  if your teeth are all jumbled up because the jaw isn’t big enough, you can either remove some teeth ~or~ make the jaw bigger by using an expander.

In previous generations, extractions were often preferred to expansion.  However, extracting teeth unnecessarily can result in poor facial esthetics.  A Board Certified Orthodontist is the best practitioner to determine whether or not your child would benefit from expansion to help avoid extractions and to ascertain the ideal timing for its use.

What's the deal with Phase I?

February 18th, 2016

Phase I Questions:

Recently I surveyed a number of parents to find out their most burning
orthodontic questions.

Here’s what they asked…

Q. At what age should you start braces?  -Kelly M.

A. It depends.  The American Association of Orthodontists (www.braces.org) recommends an orthodontic evaluation at Age 7.

Isn’t that too early?  My child hasn’t lost all of her baby teeth yet.
A. While most children don’t lose their last baby tooth until age 12, many orthodontic issues are apparent by age 7.  Some of these require interceptive orthodontics to properly address.  Does that mean every 7 year old needs braces? Absolutely not.

Q.  Are two phases really necessary? – Kelly T.
A.  Sometimes
.  Certain orthodontic issues necessitate an early start:  crossbites, underbites, severe crowding, and early loss of baby teeth need to be addressed prior to losing all of the baby teeth.

Q. I still want to avoid 2 phases, can’t I just wait?  - Luciana L.
I completely understand, I have 4 kids of my own.  I often hear parents say, ‘But my kid’s teeth look fine.’ Many issues either aren’t visible to the naked eye or might not be easily spotted. Remember, a great smile is much more than just straight teeth.

Q. What is the long-term benefit to breaking orthodontics up into 2 phases?  - Amanda E.

A. Would you be interested to know that Phase I treatment can help avoid jaw surgery? What about avoiding the extraction of permanent teeth?  What about reducing the risk of TMJ?
- Underbites are best addressed before age 10 while jaw growth can still be modified.  By age 12 when all the baby teeth are gone, it’s too late and your child may require jaw surgery.
- Not correcting a crossbite early can lead to asymmetric jaw growth (chin deviates to the side) and a higher likelihood of TMJ (temporomandibular joint disorder or jaw joint pain).

In short: if waiting will adversely affect your child’s smile, Phase I is indicated;  if the orthodontic issues can be addressed with one round of braces, I recommend waiting until all the permanent teeth are in. The best way to know if your child needs Phase I: have a Board Certified Orthodontist perform an exam at age 7 -- you might be surprised what you learn.

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