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Palatal Expansion: Why This Technique Works and How to Implement It

Palatal expansion was first described in1860 but didn’t come into widespread use in orthodontics until nearly 100 years later.  Dr. Andrew Haas of Ohio was the most influential advocate of jaw expansion and used “rapid palatal expansion” in many of his treatments.   Known for his  non-extraction orthodontic approach in an era when extraction was coming to be done on many patients he influenced many orthodontists to use expanders and avoid extraction.  

Underdevelopment of both jaws has become widespread in all industrialized societies as people adopted a Western Diet which requires little chewing force.  Jaw expansion has become a response to this problem.   Jaw expansion is possible because of the presence of a suture allowing the two halves of the upper jaw to move laterally.   Expanders can be fixed (cemented on the teeth) or removable (attached to the teeth, but removable for activation and cleaning).   There are advantages and disadvantages for each type. 

Expanders were first used to correct posterior crossbites (narrowness of the upper jaw resulting in upper teeth being narrower than the lower teeth).  Because the lower jaw has no midline suture orthodontists were universally afraid to try to expand the lower jaw.  Most orthodontists confined use of orthodontic jaw expanders to the upper arch and achieved no more than 4-5 mm of expansion.  In the mid-1980’s  Dr. J. Michael Dierkes (then head of orthodontics at Emory University) presented a paper to a prestigious orthodontic group advocating simultaneous palatal expansion as well as expansion of the mandible (lower jaw).  

When I heard Dr. Dierkes speak nearly 40 years ago, I began expanding both jaws for my own two boys.    We call expansion of both jaws “Arch Development”.  This  became a crucial part of our practice in developing jaws to make more room for the teeth, the tongue, and improve the airway for our patients.   Expansion of 10 mm or more is easily possible.   My own grandson has had this very treatment just like we did for his father.  Sadly, there are still many orthodontists who still are afraid to change and adopt this easy and effective treatment.

If you are an orthodontist, pediatric dentist, or general dentist doing orthodontics and getting into airway treatment here are some things you need to know about palatal expansion:

  1. Palatal expansion can be done at any age (despite claims to the contrary)
  2. The amount of expansion achieved is small if it is only used to correct posterior crossbites
  3. Developing both arches (even though there is no suture in the mandible) dramatically increases the amount of expansion possible and thereby maximizes tongue space/airway improvement 
  4. Lateral Expansion alone may resolve airway issues, but it may not.  You often can’t expand your way out of an anteroposterior problem and OSA is an A-P problem.
  5. Lateral expansion is the first step in improving the airway but advancing teeth and/or jaws in the A-P plane of space dramatically improves outcomes.

FAQs about Palatal Expansion

What is a Palatal Expander and what is it used for?

A palatal expander is a removable or fixed appliance which applies a force to laterally widen the upper jaw.  It creates room for all the teeth to be aligned when they are crowded and can improve the airway.

Palatal expanders work by using the teeth as a handle to the upper jaw and causing the two halves of the upper jaw to move away from each other.   The midline suture which allows this to occur fills in with bone slowly following the expansion.
A palate expander can correct a posterior crossbite, create enough room for crowded teeth to be aligned and avoid extraction, improve the space for the tongue to be properly placed on the palate at rest, and improve the nasal airway.
Orthodontists are taught to worry about pushing the teeth laterally off the bone support which purportedly might cause tooth loss.   This is particularly something orthodontists are warned about in treating adults.   Many in the profession state that the adult maxilla cannot be expanded without surgery and warn that trying to do so might cause teeth to be lost.   Starting in the mid-1980’s I (and many others) began expanding the adult maxilla without surgery and have done so successfully.   I expanded my own maxilla 7 mm. over 30 years ago and have no damage.  In the hands of someone properly trained there are very few risks.
Palatal expansion ideally can be done on children in the primary dentition prior to age 6 to develop room for the teeth, improve the airway, and address breathing problems which might actually include OSA.   Palatal expansion can be done in the middle of a child’s dental development when they are exchanging primary teeth for permanent teeth.  It can be done for teenagers who have all their teeth in.  It can also be done for adults with permanent teeth as long as their teeth have healthy bone support without periodontal disease.   It can even be done for adults with no crowding, no crossbites, but just need more tongue space to improve rest oral posture.
There are many types of palatal expanders.   The two major types are fixed expanders and removable expanders.    Both have advantages and disadvantages.  The choice of which to use depends on many factors.

Used under the direction of a well-trained dentist, palatal expanders are very safe and quite effective in correcting problems they are designed to correct. Learn more at OrthO2Health’s website! 

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