Bracket Chatter: The Right Time For Orthodontic Evaluation


While some orthodontists and parents may have differing opinions as to the right time for orthodontic treatment, when it comes to adjusting imbalances in bone structure of the face and jaw, many agree early intervention is key. With dentofacial orthopedics, the signs of issues are often seen as early as seven years of age and can include misalignment of bite, cross bite, crowding of the teeth, nose and respiratory ailments, impacted canines and cleft lip or palate. That’s why studies suggest preliminary treatment to enlarge the dental arch and palate with rapid palatal expansion is beneficial for both anatomical and dental development. Here are five key reasons to help you better understand the benefits for application of early expansion.

  1. Anatomy studies are clear. The palatal area at the roof of the mouth is still adaptable with hardening into bone beginning for most in pre-adolescence through the teens. However, the roof palate of younger patients is much more responsive to the orthopedic treatment with an expander and less pressure is needed to achieve the desired result. When less pressure is used, we reduce the risk for negative consequences. As a patient grows there is greater risk of tipping the teeth out of alignment, creating a less stable orthodontic shift rather than orthopedic expansion.
  2. Use of an expander while a patient still has some baby, or primary teeth along with permanent teeth, allows the use of the baby teeth to serve as anchors for the expansion appliance. This is important in helping to eliminate the negative effects that can be caused by the necessary force being applied to permanent teeth, therefore protecting them. Expansion appliances use the strength of the roots and surrounding bone of the teeth to which they are attached. It is those teeth and supporting bone that carry the lateral pressure of the expansion as the palate opens. When primary teeth are used to support the expander, the newly-erupting adult teeth do not bear any of the expansion pressure and instead receive benefit from the additional space. Expander devices are specifically created to affix exclusively to each patient’s baby teeth, and have the added benefit of distributing the work over several teeth on each side. Studies report the use of a banded hyrax appliance attached to primary molars and canines or a Haas expansion appliance attached to the second primary molars and primary canines are both successful and stable.
  3. In most cases the reason for expansion is because of a crowded upper roof palate resulting in crooked or protruding teeth, jaw misalignment or crossbite. In treated patients, an expansion appliance is placed into the roof of the mouth as high as possible without negatively affecting palatal tissues. As a result, patients sometimes experience temporary difficulties with speech and swallowing, similar to that caused by a retainer. This inconvenience usually passes quickly as patients grow accustomed to the device.
  4. New and permanent teeth that come into mouth with adequate bone and soft tissue support benefit from the ideal scenario for long-term stability and more sound periodontal health. For patients with a crowded, developing mouth, the plan is to create space for the teeth to come in straight without the risk of future gum-related issues or tooth damage.
  5. The effects of a small upper palate goes well beyond adolescence. Growing evidence suggests that maxillary constriction left untreated can be a factor in airway restriction starting in children and continuing through adulthood. The effects of a rapid maxillary expander can help increase nasal airway and improve overall respiratory function. As further airway evaluation becomes part of early dental exams, the benefit of early expansion can include improved air intake and even better sleep.