A palatal expander is a common orthodontic appliance used to address a narrow upper jaw, or maxilla, by gradually widening it. This process creates necessary space for proper tooth alignment, corrects crossbites, and can help improve breathing by expanding the nasal passages. The treatment’s success relies on the consistent, correct activation of the device at home.
What is a Palatal Expander and Why is it Turned?
The palatal expander is often a fixed appliance cemented to the back upper teeth. It consists of two halves connected by a central screw mechanism, known as a jackscrew, which is the point of activation.
The physical reason for turning the screw lies in the anatomy of the upper jaw, which is composed of two bony plates. These plates meet at the center of the roof of the mouth along the midpalatal suture. In children and adolescents, this suture is not fully fused and remains responsive to orthopedic pressure.
Turning the screw applies a gentle, continuous outward force to the two halves of the maxilla, causing the suture to separate. This separation stimulates new bone growth to fill the resulting space, permanently widening the upper arch. Each turn typically expands the device by about 0.25 millimeters, ensuring the bone separation occurs slowly enough for the body to adapt.
Step-by-Step Guide for Expander Activation
The activation process is performed using a small, specialized metal rod called an expander key. Before starting, have the patient lie down or tilt their head back in a well-lit area to provide the best view of the device. This better visibility helps ensure the key is inserted correctly and the turn is completed fully.
Locate the hole currently visible at the front of the screw mechanism. Insert the curved end of the key firmly into this hole until it is securely seated. The key’s design, often with a bend, prevents it from being pushed in too far.
Push the key straight back toward the throat, following the direction of any arrows that may be present on the appliance. This rotation engages the screw mechanism. Continue pushing until the next hole becomes visible at the front, confirming a full turn has been made.
The final, crucial action is removing the key without reversing the turn. Gently pull the key straight out in a downward or slightly backward direction, ensuring the screw does not rotate forward. If the key is pulled forward, it can partially undo the progress just made.
If the key is accidentally dropped, have the patient tilt their head forward to allow it to fall out, or use a clean tool to retrieve it. If the next hole is difficult to see or the key seems stuck, do not force the turn. Cleaning the area with a soft toothbrush or water flosser may clear any debris, or you may need to contact your orthodontist for guidance.
Managing Discomfort and Physical Changes
It is normal for patients to feel some pressure or tightness immediately after the expander is turned. This pressure is commonly felt across the roof of the mouth, behind the nose, or between the eyes, and typically subsides within a few minutes or hours. Mild soreness or headaches can be managed with approved over-the-counter pain relievers, such as ibuprofen, which can be taken about an hour before the scheduled turn to minimize discomfort.
A visible sign that the expander is working correctly is the formation of a temporary gap, called a diastema, between the two upper front teeth. This gap appears because the teeth are anchored to the two halves of the maxilla being pushed apart. The presence of this space is a positive indicator of successful skeletal expansion, and it is not permanent, as it will close naturally or with subsequent orthodontic treatment.
Temporary changes in speech, such as a slight lisp, and increased saliva production are also common as the mouth adjusts to the bulky appliance. These issues usually resolve as the tongue and mouth muscles adapt, typically within a few days. Eating may be challenging initially, so sticking to soft foods helps manage soreness and prevents food from getting trapped.
Daily Maintenance and Hygiene
Excellent oral hygiene is necessary when wearing a palatal expander because the device’s many crevices can easily trap food particles and plaque. The appliance should be brushed thoroughly at least twice daily with a soft-bristled toothbrush and fluoride toothpaste. Special attention must be given to the areas around the bands and the threads of the screw mechanism where debris can accumulate.
A water flosser is an effective tool for cleaning the hard-to-reach areas around and under the expander. The high-pressure stream of water can dislodge food particles trapped in the central screw, which a toothbrush cannot reach. Rinsing with an antimicrobial or fluoride mouthwash at night can also help reduce the bacterial load and prevent plaque buildup.
To prevent damage or discomfort, avoid certain foods throughout the treatment period. Hard, crunchy, or sticky foods, such as caramel, taffy, hard candies, or nuts, can bend the wires, dislodge the bands, or break the expander. Avoiding these items ensures the expander remains intact and functions correctly for the full duration of the prescribed treatment.