The specialized metal instrument provided by your orthodontist, often called an expander key, is not used to tighten traditional wire braces. This specific tool is designed for patient-administered adjustments of a fixed appliance, most commonly a Rapid Palatal Expander (RPE). The process involves manually turning a screw mechanism to gently widen the upper jaw. Understanding the function of this key and the appliance itself is the first step toward a successful home adjustment.
Understanding the Orthodontic Appliance and Key
The Rapid Palatal Expander is a custom-made appliance that fits over several upper back teeth and rests against the roof of the mouth. Its primary purpose is to widen the upper jaw, or maxilla, to correct structural issues like a crossbite or to create necessary space for crowded teeth to erupt correctly. The appliance consists of two metal or acrylic halves joined in the center by a threaded screw mechanism, which is the component the key engages.
The key itself is a small, L-shaped or swivel tool with a thin metal tip designed to fit precisely into the holes of the central screw. Each rotation of this screw produces a minute amount of separation, typically about 0.2 to 0.25 millimeters, which slowly applies pressure to the midpalatal suture. This gradual, controlled force guides the growth and expansion of the upper jawbone according to the prescribed schedule of turns.
Step-by-Step Guide to Home Adjustment
A successful adjustment begins with proper preparation to ensure a clear view and hygienic process. The patient should lie down comfortably with their head tilted back, and the person performing the turn should have clean hands and use a bright light, such as a flashlight, to clearly illuminate the palate and the expander. A quick rinse or brushing beforehand can help dislodge any food particles that might block the screw hole.
The next action is to gently insert the key into the hole that is currently visible and closest to the front of the mouth. The key must be pushed in completely until the bend in the metal is flush with the appliance. This ensures the key is fully seated in the screw’s mechanism to engage the screw and prevent slippage during the turning motion. Once securely seated, apply gentle, firm pressure to push the key toward the back of the mouth, or the throat.
The turn should continue until the screw has rotated a full quarter turn and the next empty hole becomes visible at the front of the appliance. You may feel a slight resistance or hear a soft click as the new hole aligns, signaling the completion of the turn. This full rotation is crucial, as it locks the expansion in place and prepares the appliance for the next adjustment. Stopping short will leave the screw in a half-turned position, making the next turn impossible.
The final step is the key’s removal, which must be performed carefully to avoid reversing the turn. While maintaining pressure toward the back of the mouth, gently pull the key straight downward or toward the tongue, being cautious not to pull it forward. Pulling the key straight out ensures the newly exposed hole stays correctly positioned for the next scheduled turn. Always visually check that the next empty hole is fully visible after removal.
Managing Discomfort and Troubleshooting
Following an adjustment, it is normal to experience a feeling of pressure or tightness across the roof of the mouth, behind the nose, or between the eyes. This sensation is a sign that the appliance is actively working to separate the two halves of the upper jaw. Temporary discomfort, including minor headaches, mild soreness of the teeth, and increased saliva production, typically subsides within a few days after each turn.
The appearance of a space, or diastema, between the two upper front teeth is a result of palatal expansion. This gap confirms that the palate is successfully widening at the midpalatal suture and is not a cause for concern. To manage soreness, over-the-counter pain relievers like acetaminophen or ibuprofen can be taken one hour before a scheduled turn, with your orthodontist’s approval. Sticking to a diet of soft foods for the first few days can also help minimize chewing pain.
Troubleshooting Specific Issues
If you encounter an issue during the process, like the key becoming stuck or the next hole not appearing, do not force the turn. A common problem is an incomplete turn from the previous day, which can be fixed by reinserting the key and completing the rotation until the new hole is visible.
When to Contact Your Orthodontist
If the appliance becomes loose, a band breaks, or you experience sharp, unrelenting pain that does not improve with medication, cease all adjustments immediately. If you are unable to complete a turn, contact your orthodontist right away for guidance and an immediate appointment.