Palatal expansion
Widening a narrow upper jaw in children with a special appliance during growth.
Does this sound familiar
Patients most often come for this with these words:
My child’s upper jaw is narrow
The back teeth bite the wrong way
The lower jaw shifts to one side when biting
There is not enough room for the permanent teeth
My child breathes through the mouth and has a high palate
In some children the upper jaw is narrow. This can lead to crowded teeth, back teeth that bite the wrong way and the lower jaw shifting to the side. During growth the upper jaw can be widened with a special appliance. A Cochrane review shows there is evidence for the effectiveness of some expansion appliances in posterior crossbite.
Why in childhood
In children the midline suture of the upper jaw has not yet closed, so expansion is easier and more effective. Expansion done in time creates space for the permanent teeth, eliminates the jaw shift and can prevent more complex treatment in the future. In adults the suture closes and expansion becomes more complex.
Causes
- Heredity
- Long-term thumb or dummy sucking. See: thumb sucking
- Mouth breathing and a low tongue position. See: mouth breathing
- Early loss of baby teeth
Appliances
| Appliance | How it works | Note |
|---|---|---|
| Fixed screw expander | A parent turns the screw at home as instructed | The result is predictable |
| Quad-helix | Wire springs push the side teeth outwards | Activated by the orthodontist |
| Removable plate | A plate with a screw, worn at home | Depends on the child’s cooperation |
How it goes
- Examination, photographs, models and the necessary X-rays
- The appliance is attached to the upper teeth and sits under the palate
- A parent activates the appliance at home as instructed
- Regular check-ups over a few weeks
- After expansion the appliance stays in place for a while so that the result consolidates
- We move on to braces afterwards if needed
One young patient
In one young patient we started braces right after widening the upper jaw: early loss and drifting of baby teeth could have led to more difficult problems later. More: early loss of baby teeth.
The first days
- A short feeling of pressure in the teeth and around the nose when the screw is turned
- Speech and swallowing may feel different for a few days
- Rinse after meals so that food does not stay under the appliance
- Avoid sticky and hard foods
What the science says
- Cochrane review (2021): in posterior crossbite some appliances such as the quad-helix may be effective, with low to moderate certainty of evidence.
- Meta-analysis (2021): mouth breathing in children is associated with changes in the development of the facial skeleton, including a narrow upper jaw.
Rules for parents
- Turn the screw only as instructed and as many times as instructed
- Keep a calendar to record the turns
- Check every time that the key moves in the right direction
- If the appliance loosens, your child complains of pain or the key falls out, message me
- Do not turn the screw after expansion has been stopped
We do the first turn together in the clinic so that the parent feels confident. Many parents are nervous at first, but after a day or two this routine feels simple.
After expansion
After the appliance is removed we follow how the bite develops. Some children need no further stage, while for others a short final phase is planned once the permanent teeth have come in. If the habits that caused the problem, such as thumb sucking or mouth breathing, have not been eliminated, the jaw may tend to narrow again.
Frequently asked questions
Is expansion painful?
There is a short feeling of pressure when the screw is turned. The discomfort is usually mild and passes quickly.
At what age is expansion best?
Often in the mixed dentition, roughly between ages 6 and 10. We determine the exact time after the examination.
How long does the appliance stay?
Active expansion takes a few weeks, then the appliance stays in place for consolidation for a few months.
Does expansion change the face?
It does not change the width of the face. The smile may look broader and fuller.
Is expansion possible in adults?
Classic expansion is limited. Mini-screw supported or surgical approaches may be discussed.
Is it hard to eat with the appliance?
In the first days the child needs to get used to it. Start with soft foods and avoid sticky and hard foods.
Read more
Scientific sources
The information in this article is based on the following peer-reviewed scientific articles and systematic reviews.
- Ugolini, A., Agostino, P., Silvestrini-Biavati, A., Harrison, J. E., & Batista, K. B. (2021). Orthodontic treatment for posterior crossbites. Cochrane Database of Systematic Reviews, 12(12), CD000979. [PMID: 34951927] | [DOI: 10.1002/14651858.CD000979.pub3]
- Zhao, Z., Zheng, L., Huang, X., Li, C., Liu, J., & Hu, Y. (2021). Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis. BMC Oral Health, 21(1), 108. [PMID: 33691678] | [DOI: 10.1186/s12903-021-01458-7]