The term “spacer” in orthodontics usually refers to a fixed appliance, such as a palatal expander, designed to gently widen the upper jaw. This device is cemented into place and contains a central screw mechanism. Periodic activation is required to achieve the desired skeletal change. The process involves using a small, specialized key, provided by the orthodontist, to manually turn this mechanism. Following the exact prescribed schedule is paramount to ensure the appliance functions correctly and achieves the planned movement.
Essential Preparation and Required Tools
Preparation requires a focused environment and excellent lighting, as the mechanism is small and often obscured. A focused flashlight or bright lamp positioned directly on the face improves visibility.
The primary tool required is the official adjustment key, which engages the turning mechanism. Ensure the key is clean and free of debris. The person performing the adjustment must thoroughly wash their hands to maintain hygienic conditions. Reviewing the prescribed number of turns is also necessary, as this number is unique to the treatment plan.
Step-by-Step Adjustment Procedure
The adjustment begins by locating the activation hole on the central screw mechanism. This hole faces the front of the mouth and is visible under proper lighting. Insert the key completely into the hole until the slight resistance of the turning mechanism is felt.
Once fully inserted, push the key firmly and gently toward the back of the throat, following the curvature of the roof of the mouth. This action rotates the screw mechanism one full increment, separating the two halves of the appliance. Continue the turning motion until the next activation hole rotates into view, confirming one complete turn.
The most delicate part is removing the key without accidentally reversing the turn. Guide the key down and backward out of the mouth, ensuring the next activation hole remains visible and centered. This visual confirmation confirms the turn is complete and locked into position. If multiple turns are required, repeat the process, carefully counting each turn to match the orthodontist’s instructions.
Immediate Post-Adjustment Care and Expectations
After the appliance has been adjusted, it is normal to feel pressure or tightness across the upper palate and surrounding teeth. This pressure is evidence that the expansion mechanism has activated and is applying the prescribed force. Mild soreness may occur and usually subsides within a few minutes or hours after the turn.
For managing any discomfort, over-the-counter pain relievers, such as ibuprofen or acetaminophen, can be used as directed by a healthcare professional. Immediately following an adjustment, it is recommended to stick to a soft diet for the rest of the day, avoiding hard, sticky, or chewy foods that could dislodge the appliance or aggravate the newly stressed teeth.
A common physical change resulting from the expansion is the formation of a gap, known as a diastema, between the two upper front teeth. This gap is a positive sign that the appliance is successfully widening the jaw. This temporary separation is a necessary part of the process and confirms that the mechanical expansion is working as intended.
Troubleshooting Common Issues
Key is Stuck
If the key becomes stuck within the mechanism, avoid forcing it, as this could damage the appliance or cause injury. Gently wiggling the key or attempting to complete the turn may free it. If the key is completely immobile, contact the orthodontist immediately.
Incomplete Turn
A common error is failing to complete the full turn, which leaves the key lodged because the mechanism is only halfway engaged. The turn is only considered complete when the next activation hole is fully visible, confirming that the screw has locked into the next position.
Lost Key
If a key is lost, the orthodontist’s office must be contacted immediately, as only the official replacement key should be used to continue treatment.
Appliance Damage or Severe Pain
If the appliance suddenly feels loose, or if a sharp wire or band is causing significant irritation, this suggests a breakage or detachment, and the orthodontist should be contacted immediately. Similarly, if the patient experiences severe, unrelenting pain, or difficulty with speaking or swallowing that persists beyond the initial discomfort, professional attention is required.