The answer to whether you can have braces and an expander simultaneously is yes. The combination is frequently recommended when a patient presents with both a narrow upper jaw and misaligned teeth. This dual treatment strategy is not simply a stacking of appliances, but a coordinated plan designed to address the foundational structure of the mouth before fine-tuning the dental alignment. The goal is to create a healthy, stable arch structure that allows the teeth to be moved into their correct positions for a lasting result.
Understanding the Distinct Function of Each Device
The two appliances are fundamentally different in the type of force they apply and the structures they are designed to move. Braces are considered an orthodontic device, primarily designed for dental movement. They consist of brackets, wires, and bands that apply consistent, gentle pressure to reposition individual teeth within the existing bone structure. Braces correct issues like rotations, gaps, and general tooth crookedness.
A palatal expander, most commonly a Rapid Palatal Expander (RPE), is an orthopedic device used for skeletal movement. Its function is to widen the upper jaw, or maxilla, by applying outward pressure to the two palatal bones. This force physically separates the midpalatal suture, which is the joint connecting the two halves of the upper jaw. This structural change creates a wider arch that forms the foundation for the teeth.
The distinction between these functions explains why both are sometimes required, as braces cannot independently widen the jawbone. If the jaw is too narrow, simply using braces to straighten crowded teeth would force them into an unstable position outside the bone. The expander performs a true skeletal change, creating a stable, broader base that reduces the likelihood of future relapse.
Strategic Reasons for Combining Treatment
The primary strategic reason for combining these appliances is to correct specific malocclusions involving a discrepancy between the size of the upper jaw and the lower jaw. This combination is highly effective in treating posterior crossbites, where the upper back teeth bite inside the lower back teeth. By widening the upper jaw with the expander, the orthodontist ensures the upper and lower teeth meet properly for a functional bite.
Simultaneous use is also the most effective way to manage severe dental crowding. Creating space through expansion often eliminates the need to extract permanent teeth, which would otherwise be necessary just to fit the teeth into a narrow arch. This concurrent approach streamlines the overall treatment time by tackling the skeletal issue and the dental alignment problem at once. For many younger patients, this combination is part of a two-phase treatment framework, allowing the orthodontist to guide jaw growth while the bones are still flexible and responsive to orthopedic forces.
Practical Considerations for Simultaneous Use
Wearing both a fixed expander and braces introduces unique challenges for the patient, primarily related to oral hygiene and comfort. The expander covers a significant portion of the palate, creating numerous nooks and crannies that easily trap food particles and plaque. Meticulous cleaning is required to prevent irritation, inflammation, and potential cavities around the brackets and under the expander.
Specialized tools become necessary to maintain proper hygiene with the combined hardware. A water flosser is strongly recommended, as the pressurized water stream can flush out debris from under the expander and around the brackets and wires. Interdental brushes are also essential for cleaning in between the wires and brackets and around the metal components of the expander. While braces require the use of floss threaders for traditional flossing, these tools are vital for cleaning under the expander.
Patients should anticipate an initial adjustment period regarding speech, which can include a temporary lisp, particularly with sounds that require the tongue to touch the roof of the mouth, such as “s” and “sh.” Speech usually returns to normal within a few weeks. The combination also doubles the dietary restrictions; patients must avoid the hard, crunchy foods that can damage brackets, as well as sticky, chewy foods like taffy or cheese that can become lodged within the expander.