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What is the “debate” on palate expanders?
“In a nutshell, the argument for doing a palette expansion (for good candidates) is that before the palette fuses (which happens around age 8-9, earlier in girls than boys), it can be widened (by being stretched or split along midline of palette) using orthodontics and that in the natural fusing process the gap will be filled in with bone. It is much easier (and less traumatic to the mouth) to do it at this young age than doing it later after the bone is already fused, in which case the bone must be broken to widen the palette.”
“When the first two opinions I got came in diametrically opposed, I sought a 3rd. Rather than clarifying my choice, it gave me a third quite different opinion. In the end I went with my gut and listened to the dentist who told me to wait 6 months and see how the next teeth came in. Sure enough, my son's missing teeth came in just fine. We avoided a palate expander and pulling of teeth (which one orthodontist recommended in conjunction with braces). I'm sure palette expanders are needed in some cases, but my experience leads me to think they are pushed too often and too young.”
“I had a palette expander when I was 12, and it wasn't bad at all. It looks like a scary torture device, I know, but the expansion is so gradual that it really isn't painful- you just feel a little pressure like when you get braces tightened. From what I understand the palette is not likely to expand/correct itself on its own- that being said, you could wait for a few years and reevaluate once all the permanent teeth have come in (like I did) since clearly it can still be done that late.”
“I just wanted to chime in as an adult that should have had the palate expander as a kid. Not because of too many teeth, but because of narrow upper jaw. My parents believed the dentist was just trying to make money off them, so I didn't have any of that type of dental work as a child. Fast forward to my
20's...Teeth alignment was wrong due to my jaw structure. Top teeth were wearing down bottom teeth due to direct contact with bite. Lower teeth started jutting forward to accommodate. NOT PRETTY! (I imagined witch look to my face would've happened eventually) To correct this and prevent further damage, I had to have surgery at 26 years of age and braces for 3 years. The surgery was BARBARIC!
Painful is an understatement. And add 6 weeks of jaw wired shut. I so wish I would've had orthodontic care/palate expander as a child as I'd rather unmedicated birth than that surgery again...Surgery definitely changed my appearance/face structure. My nose is now slightly off center. Some say not
noticeable, but I know they're just being nice. ;-)
Get as many opinions as possible, and make an informed decision.”
Yay (with a downside)
“We did palette expander for my daughter around that age. For her case, they didn't say it would avoid braces --in fact they were pretty sure she would still need them. The argument is by making room for the teeth to come in in the right place is better than having to move them around after they come in-more stable and less likely to move out of position after braces. Palatte expander was not as bad or long as we thought. Only downside is she had some form of orthodonture for over 5-6 years which got really old-for her and for me having to take her in once a month. She is 12 and they are coming off this month. Good luck.”
“When your teeth are crowded you can run into some major problems as an adult and even have to get teeth removed. Which always should be a last option. You also can create cavities from teeth that are too close.
. . . I also had an expander and a ton of other barbaric stuff in my mouth!! ... I am just saying the problems caused by an overcrowded mouth outweighed the negatives of getting the expander. If you do decide to get the expander always give some advil before the appointment. I don't have too many bad memories from my own ortho work but I do have great teeth now. Or so people say. And I think I worked in that field because of all the time spent there as a child.
“I had one of those. My upper palate wasn't wide enough so I had a perpetual underbite which made me look sad all the time! It did seem medieval but other than a bit of pressure when it was rotated (quarter turn nightly) it did not hurt. I was older, maybe 10, when I had it, and this was followed up w/braces. I don't think this could have corrected on its own as the palate wouldn't naturally expand on its own. My palate has not gone back to its original size, despite some sliding back of my teeth from the perfect bite achieved by the braces.”
“I can only speak as someone who had one of these devices. it was inserted when I was 5 years old (attached only to the few teeth that had come in) and my parents had to turn a key every night to widen it. It hurt a lot but I am glad I had it. If I hadn't had my palate expanded then by stretching (which is fairly gentle and non-invasive in the grand scheme of western medicine), I would have had to undergo jaw surgery as a teen involving breaking my jaw and resetting it. if the issue is narrowness of the palate, it will almost certainly not self-correct. Hope this helps and good luck. Your son will thank you later.”
I think it's worth considering a palette expander. Of course, you should only do what you feel comfortable with, but I wouldn't just dismiss it out of hand.
When I was a kid, I had WAY too many big teeth for the size of my mouth. I had to have MANY teeth pulled (including at least four permanent teeth) to make room for my teeth, in connection with wearing braces in middle school.
Unfortunately, my son takes after me, dentally speaking. (His fraternal twin has Daddy's nicely-spaced teeth.) So Stephen's front teeth started growing in all crowded and crooked at around age 7. Our dentist recommended consulting with an orthodontist to consider a palette expander but, at that young age, I
really felt that it would be too traumatic for Stephen. It's pretty awful.
BUT, about a year later, when the dentist mentioned it again, so we finally looked into it. We got second opinions (two dentists and two orthodontists), and they all universally said that my son should get the expander. By that time, I felt that Stephen was more "ready" psychologically. He could see how crooked his teeth were, and he had an older cousin with braces, so the "metal mouth" concept was becoming more familiar. We also realized that this would minimize the chances of having to get permanent teeth pulled later... So we decided to take the plunge.
To tell you the truth, it was pretty f'ing unpleasant during the first week, until he started getting used to it. With the metal contraption on top of your mouth, it is difficult to eat and talk. The first day was definitely tearful!
But eventually he did get used to it, and we all survived. And I'm actually glad we did it. His teeth desperately needed room to grow in straight, and he looks and feels much better now. Who knows? He may be able to avoid braces altogether.
So, in summary, the palate expander is not a "walk in the park." But I would not just dismiss it as a money-making scheme by orthodontists either. It can be really helpful for some kids.
Good luck with your decision, either way.”
[response from a dentist]
“I'd certainly ask lots of questions at each consult, so it is great to be prepared with them. I did notice one reply posted to the list earlier today that warned you to consider changes to your son's appearance from the treatment. I think that is a good point to be aware of and ask, e.g. how minimal or dramatic a change is expected and what if any impact that would have on his general facial appearance (if you do go ahead with treatment, initial records will include lots of photos, front and profile, with measurements and calculations made to plan for any palate/tooth movement). However, the story of that poster indicating that her original ortho treatment utilized flaring of the teeth in order to straighten them due to lack of space and then, because she was unhappy with the result, was followed by extractions and realignment, is one example of how IF your son is an appropriate candidate for expansion, both those undesirable outcomes could be avoided!
Anyway, I will stop now as I sound like an advocate for palatal expansion! I usually stay out of any such discussions (don't get me started about fluoride toothpaste and sealants..), but just didn't want you to get scared off by the possibility of treatment prematurely. Your son may actually think it's pretty interesting and "cool."”
Get a second opinion:
“My eldest daughter's ortho wanted her to have a palate expander, but that turned out to be exactly the wrong thing for her. That said, I am now a believer in early ortho intervention precisely because it is easier to move things around now than later. My middle daughter got braces at 8, and that was nearly too late.
I had my sister-in-law's employer, an oral surgeon in Chicago look at the x-rays and I got a second opinion and they explained why it was a poor choice in her case by showing us with the x-rays and various models that the size of her palate was not the problem. Thankfully, my daughter was spared the expander, which would have made her situation worse.
I can't think of any specific questions, but the key thing is to understand what's causing the misalignment. In my daughter's case, since the bite on her molars was reasonably well aligned, the expander would have made that worse by forcing the upper molars apart. What the ortho did instead was to pull the molars back which created more space for the permanent teeth in front to come in. By doing it this way, it avoided creating an overbite on the molars.
The Orthodontist walked us through the x-rays and also showed us other examples of her condition. He explained how the palate expander works and why it would have made her situation worse. He also showed us, using other models, how proper treatment would lean to the correct alignment when her permanent teeth came in. She just got her braces off and her teeth look terrific.”
“I don't have any personal experience with palatal expanders (although I've had braces twice!), but am familiar with them in theory as a general dentist. I encourage you to meet with an orthodontist to hear the pros/cons and what treatment will be like. These type of devices are used at a fairly slow rate, so they may not be as medievally painful as you imagine. I don't know the specifics of your son's case, but if he is a good candidate for palatal expansion it could also avoid extractions for the purpose of orthodontics later on, as there may simply not be room for all of his teeth to be arranged in a straight manner. No reputable orthodontist would in any way be pushing you towards this for financial self-interest.”