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Article: Palatal Expander essential for some children DR. JERRY GORDON
Although braces are usually performed on most children at ages 12 to 13 or older, the palatal expander is often used on children as young as eight, before the upper jaw rigidly attaches to the rest of the skull.

Children who have crowded teeth and narrow arches may need an orthodontic device called a palatal expander. The palatal expander is a device that is either permanently or temporarily placed into the upper arch and will gradually widen it enough to make room for the teeth. Although braces are usually performed on most children at ages 12 to 13 or older, the palatal expander is often used on children as young as eight, before the upper jaw rigidly attaches to the rest of the skull. By the time most children become teenagers, the palatal expander cannot be used as effectively.

A palatal expander is used for about four to six months on children whose upper arch is undesirably narrow, and does not allow enough room for their teeth to come in straight. After the device is inserted, either the parent or the orthodontist will expand the palate once or twice a day. To activate the expander, you will need to insert the metal, toothpick-shaped key into a keyhole located inside the expander. You then rotate the key towards the back of the child's throat.

Initially, the device will seem cumbersome and uncomfortable to the child. Chewing and swallowing food may be a task at first, and some discomfort should be expected. Children's strength Motrin or Tylenol should help relieve this discomfort. After a week or so, gaps between the front teeth should be visible, a good sign that the jaw is expanding. The orthodontist will periodically check on the progress of the palatal expander, and will stop the expansion when there is enough space for the teeth to come in. At this point, the palatal expander will stay passively in the mouth for a few months to allow the jaw to heal in the new position. It is also important to keep the device clean by brushing it along with your teeth at night and rinsing with water after drinking soda or juice.

There are several types of expanders, including the rapid fixed, slow fixed, and removable. In some cases, braces will need to be worn with the expander or at some time after the expander is used. Your orthodontist can tell you what type of treatment your child requires to get the best results.

According to Dr. Kellyn Hodges, and orthodontist practicing in Bensalem, "A Palatal Expander is a wonderful tool available to orthodontists that not only allows the teeth to be aligned straight, but also improves the overall shape of the smile. The smile that is considered most appealing tends to be broad and "U"-shaped. Palatal expanders broaden the upper arch and create a soft rounded "U" shape to the smile that is found to be very attractive. I love using them when needed because after treatment most patients comment on how straight their teeth have become and also how nice their face looks!"

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Dr. Gordon is the dental columnist for the Bucks County Courier Times. He has published more than 300 articles since 1998. Dr. Gordon was recently asked to provide commentary about mid-level providers for the influential dental journal Dental Abstracts.

Dr. Gordon responds to an article in Dental Abstracts challenging his views.

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