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    Expander

    What is a rapid palatal expander?

    A rapid palatal expander (RPE) is a specially made appliance used to widen the two halves of the top jaw, also known as the palate or maxilla. The two halves are joined together by a “suture” in the center of the roof of the mouth. The RPE is attached to the upper back teeth and eases the suture apart, which makes the jaw wider. As the jaw expands, new bone fills in between the two halves of the palate.

    When is a palatal expander needed?

    An expander has many benefits. It can widen the upper arch so that the upper teeth fit better with the lower teeth, creating a better bite. Also widening the palate can make room for crowded teeth to align, which can often prevent the need for extraction of permanent teeth. A high palate and narrow arch may restrict breathing passages. Studies have shown that expanders can widen air passages and result in better breathing. Lastly, expanders contribute to a broader, more attractive smile. Expansion is easiest and results are most stable when performed on a growing child or teen.

    How do you turn or active an expander?

    Activation of an expander is usually done by a parent, guardian, or someone other than the patient. On the day the expander is placed, we give you a key that inserts into an opening in the activation portion of the RPE.

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    It is easiest to have the patient lie down on a bed or couch where there is good light. Then, the patient tilts their head back so that the RPE can be seen clearly with the arrows pointing in the direction of the turn.

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    The key is inserted into the top hole visible until it is firmly in place.

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    Note that when the key is fully inserted, the bend in center of the key is no longer visible.

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    Follow the arrows facing towards the back of the mouth to apply a small amount of pressure to swivel the key in their direction, completing a 90 degree turn on the key. As you turn, the fender rotates and a new hole becomes visible. The rotation stops when the key meets the back of the expander.

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    When the turn is complete, simply push down toward the tongue while you continue to lightly apply pressure toward the back of the mouth to remove the key. You should then see the next hole for insertion at the top. You will be given specific instructions as to how many turns to complete before the next appointment.

    How long is a rapid palatal expander used?

    The expansion of the palate is usually completed in 1-3 weeks. However, the appliance remains in the mouth for a longer period, generally 5-6 months to allow the new bone that has formed to mature. If an RPE is removed too early, some of the width gained could be lost. During expansion, a space may develop between the two front teeth. This is normal and when you stop turning the RPE, the teeth will start to come together again on their own.

    Does a palatal expander hurt?

    No, it doesn’t hurt. After the expander is turned you may feel pressure in the area of the teeth, and tingling around the bridge of the nose or under your eyes. The sensation generally lasts for about 5 minutes and then dissipates. That is why we often recommend a turn made in the morning and a turn in the evening to keep the patient comfortable.

    What problems can you have with an expander?

    The two most common problems that can arise when having an RPE is that food can become trapped between the expander and the roof of the mouth or difficulty making the activation turn. When the expander is placed, we show you how to clean around it. However, if food does get stuck, you can swish or gargle with water, or take a cotton swab and gently wipe the palate of the mouth.

    The other problem that can arise is not making a complete turn. Sometimes, you think you made the complete turn and then remove the key. It appears as if the turn was completed successfully, but when you go to make another turn the key will not go into the new hole. You will then have to return to the previous hole which is located towards the back of the mouth, insert key and complete the turn. See video below.

    If I miss a turn, what should I do?

    Don’t panic! Still keep your scheduled appointment to check the expansion. We can always make up a turn in office, or you can add it on another day. However, please call us at (914) 277-1111 if you cannot complete the prescribed number of turns because you are having trouble.

    Are there any precautions to take with an expander?

    There are certain foods that cannot be eaten while the expander is in place. These will include chewy, sticky sugary foods such as caramels, taffy, gummy bears, fruit roll-ups, Swedish fish, Starburst, Skittles, etc. Sugarless gum is also ok to chew while the expander is in place.

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