From the shape of your teeth to the ridges of your gums, your mouth is unique. And that includes the width of your upper jaw. However, when it’s too narrow, it can cause issues with bite, breathing, chewing, and more.
Palate expanders are the default treatment for narrow upper jaws, but they aren’t the only option. And in some cases, they aren’t the best approach. Below, we’ll look at five palate expander alternatives you and your orthodontist might want to consider.
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Palatal Expanders: An Overview
Palatal expanders are orthodontic appliances that increase upper jaw width. They are always custom-made based on a physical mold or 3D scan of the dental anatomy. Also called palate expanders and orthodontic expanders, these appliances have been in use since the mid-1800s.
How Do Palate Expanders Work?
To understand how orthodontic expanders work, you need to understand upper jaw anatomy. It’s composed of two maxillary bones and the intermaxillary suture. These three elements come together to form the maxilla. Each part is separate until about the middle teen years, when they fuse together.
Palate expanders apply pressure to the maxillary bones, separating them at the suture, expanding the palate and creating a wider upper jaw. The strength of this pressure varies based on how much additional width the patient needs and whether the bones have started to fuse.
While there are different types of palate expanders, most have two halves that are connected by a jackscrew and attached to the upper molars. You’ll turn the screw using a special key according to the schedule set by the orthodontist. Each turn expands the jaw by a quarter of a millimeter.
What Conditions Can They Treat?
Palatal expanders treat an umbrella condition called narrow maxilla — an upper jaw that isn’t wide enough. However, there are many related issues that fall under this umbrella. Treating the narrow jaw will either correct these conditions or better position the dental anatomy for other devices, like braces. Conditions orthodontic expanders can treat include:
- Crossbite: This is when the top and bottom teeth cross over each other instead of closing properly.
- Crowded Teeth: When teeth don’t have room to erupt in a nice, tidy row, they crowd together.
- Impacted Teeth: As with crowding, teeth can become impacted when there isn’t space for proper eruption.
- Cleft Palate: An expander won’t correct this condition on its own, but can be an important step in multi-stage treatment.
- Narrow Smile: Smile width is directly related to jaw width. A narrow smile is a completely cosmetic concern, but if you don’t like how it looks, an expander can correct it.
- Speech Difficulties: A narrow upper arch can restrict tongue movement, resulting in unclear or incorrect speech.
- Eating Difficulties: A misaligned bite makes chewing harder, and a narrow palate can cause issues with swallowing.
- Restricted Airway: A narrow jaw can also cause a narrow nasal airway, making the patient rely on mouth breathing.
Alternative #1: Braces
Once the maxilla has fused, skeletal expansion is difficult, though usually achievable with some level of surgical intervention. If you want to avoid surgery, your other option is dental expansion — moving the teeth rather than the bones in your palate. Orthodontic expanders can also achieve this, but if it’s your only goal, they might not be the best appliance.
Braces can also achieve dental expansion, and in a more comprehensive manner than expanders. This is because they direct pressure against all the teeth, not just the molars. They can also correct a wider variety of bite issues, which is great for complex cases.
However, they can’t actually widen the jaw. Instead, they can move the teeth more toward the outer edge of the gums, giving more space for the teeth and tongue. And since the teeth can only move so far toward the edge before they become unstable, the impact of dental expansion is fairly small.
Alternative #2: Clear Aligners
If you only need dental expansion, braces aren’t your only option. Clear aligners can correct all the same issues, with the added benefits of being removable and much less visible. These treatments use a series of plastic trays that incrementally shift your teeth into new positions.
Like braces, they can move your teeth to the outer edge of the gums and correct various bite issues. They won’t work for skeletal expansion, but if your case only requires dental shifts, or you need orthodontic treatment to prepare for an expander, they’re a great option.
In-office brands like Invisalign require you to visit the dentist or orthodontist every few weeks, but they can treat even severe misalignments. At-home clear aligners like Byte cut out these appointments to make their treatment less expensive and time-consuming, but they can only treat mild-to-moderate cases.
Alternative #3: Space Maintainers
This alternative works for children, but not adults. By age seven, your child’s orthodontist should be able to tell if their jaw is looking narrow. If it is, they can potentially use space maintainers instead of an expander.
It might come as a surprise, but baby molars are actually larger than permanent ones. Space maintainers hold this extra space when the primary teeth fall out, giving more room for the other adult teeth to emerge in proper alignment.
Space maintainers can be either fixed or removable, and they work by preventing other teeth from moving into the space they occupy. There are four types of space maintainers your orthodontist may use:
- Unilateral Space Maintainers: These wrap around an existing tooth and have a metal loop that fills the space left by a missing tooth.
- Crown and Loop Space Maintainers: These are similar to unilateral space maintainers, except they use a dental crown over the existing tooth to hold the loop in place.
- Lingual Space Maintainers: Doctors use these when multiple teeth are missing, but you need to maintain the space. They loop around molars and run along the tongue side of the teeth.
- Distal Shoe Space Maintainers: Doctors insert these space maintainers into the gums and only use them on the first permanent molar.
Alternative #4: Teeth Removal
When used as an alternative to orthodontic expanders, teeth removal is typically only for adults. While potentially effective for children, other options will likely yield better results without the pain and discomfort that comes with pulling teeth.
Teeth removal isn’t a comprehensive alternative to palate expansion; it won’t make the jaw wider. However, it might make room for the remaining teeth to move into better alignment, addressing things like bite issues even if it doesn’t make skeletal shifts.
Usually, extraction on its own is not a substitute for an expander. However, when combined with braces or aligners, it can be. Don’t let that deter you, though, since most adults who use expanders will also need alignment.
Alternative #5: Jaw Surgery
This is the most extreme alternative to expanders, but for adults who require skeletal expansion, it’s the only other choice. With this orthognathic procedure, the surgeon expands or preps the upper jaw so that an expander implanted into the palate can work.
Surgical upper jaw expansion uses cuts in the bone to create segments that can then be repositioned to help with everything from a narrow jaw to asymmetry. It comes with a lengthy recovery period and can be painful. Depending on your insurance coverage, it can also be quite expensive.
Something to consider is that jaw surgery is often part of a multiple-treatment solution, commonly used alongside expanders in adult patients. So discuss your expectations with your orthodontist if your goal is to avoid expansion.
What About Mewing?
Google palate expander alternatives and you’ll quickly come across something called mewing. Named for the orthodontist who came up with the technique, Dr. John Mew, the practice is meant to alter the skeletal and muscular anatomy by consistently changing tongue placement.
The idea is to maintain the same tongue position at all times — even when drinking. This tongue position is just resting flush with the roof of the mouth instead of the bottom. There are exercises specifically meant to train the tongue to rest properly. Below is an example:
- Close the mouth so that the teeth touch and the lips are sealed.
- Fully relax the tongue.
- Place the tongue on the roof of the mouth, with the tip near the back of the front teeth.
- Keep the tongue in this position for as long as possible and repeat when not eating or speaking.
Sounds simple, even if it requires some dedication. But the question is, does it work? Right now, there is no solid evidence one way or the other — no reliable studies on the method, just the testimonies of people who have tried it for themselves.
With that said, we know that tongue position and movement can impact tooth position, and even jaw shape when the bones are still developing. Tongue thrust, for example, is when the tongue pushes forward rather than relaxing on the palate and causes the teeth to protrude. But whether it can affect the bones in a fully grown adult is still up for debate.
Final Thoughts
Palate expanders are excellent devices for addressing a narrow upper arch and the complications associated with it. However, they aren’t the only option available. Just remember that the alternatives aren’t always as effective, and when they are, they’re often more invasive.
Frequently Asked Questions
I’m interested in braces as an expander alternative; what are my options?
In addition to traditional metal braces, you could choose:
- Ceramic braces
- Clear braces
- Lingual braces
- Self-ligating braces
You should also consider clear aligners. Options like Invisalign and Clarity might be able to make the corrections you need.
Are there age limits on jaw surgery?
To operate on the jaw, it needs to be fully developed. Skeletal growth usually ends between ages 14 and 16 for girls and 17 and 21 for boys.
What is tooth extraction like?
This depends on the condition and placement of the tooth. In most cases, the doctor will numb the area with topical anesthetic, then inject a local anesthetic. They’ll remove the tooth using dental pliers, then sanitize and stitch the gums for safe healing.
Are space maintainers implanted into the gums?
Some are but most are not. The average space maintainer attaches to existing teeth and has a loop to hold the required space.
Is mewing worth trying before getting an expander?
There is no clinical evidence showing that mewing is safe or effective. At the same time, there also isn’t any scientific evidence to the contrary. It’s up to you if you want to try it, but understand that if it isn’t effective, you’ve lost time you could have otherwise spent using proven treatments.
What happens after palate expansion treatment?
The expander needs to remain in place to hold the bones in the right position, preventing relapse. Once everything fuses, you can get it removed.
Will a narrow upper jaw always require expansion?
No. It depends on how the narrow upper jaw impacts the nasal passages and speech, as well as how it matches up with the lower jaw. Narrow upper jaws don’t always cause problems though.
What are some reasons to consider alternatives instead of getting a palate expander?
While they’re widely considered safe and effective, palate expanders can be uncomfortable and even cause choking. They also are not necessarily effective in adults, causing dental (rather than skeletal) expansion.
Does it take a long time to adjust to expanders?
Most people need 3–7 days to adjust their eating and speech. Excessive saliva production, however, often lasts 10–14 days for many people. Still, within two weeks, life should feel normal.
Does palatal expansion hurt?
Genuine pain is not normal (unless you needed surgery or extraction) and is a signal that something is wrong. Discomfort and soreness, though, are standard when the appliance is first placed and briefly after each adjustment.
Do I need to change my diet when using an expander?
Yes, for two reasons. One, certain foods are more likely to cause choking when you wear an expander. Two, some foods can dislodge or damage the expander. It’s important to know what and how to eat when wearing an orthodontic expander.
What are the typical side effects of palate expanders?
- Jaw soreness
- Tooth soreness
- Sinus pressure
- Headaches
- Speech changes
- Increased saliva production
- A gap between the two front teeth
What do I do if I lose the key to turn my expander?
Talk to your dentist or orthodontist. They can give you a new one. If you lose it over the weekend, you should be fine to skip a day or two.
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