At Droel Orthodontics, the answer is probably “No.”  This article will explain why.

The face and teeth exist in 3 dimensions:

• Side to Side (lateral)
• Front to Back (horizontal)
• Top to Bottom (vertical)

An orthodontic expander works in only one of these three dimensions:  Side to Side. Most orthodontic issues involve all three dimensions to some degree. Very often an expander actually worsens the problems in the other two dimensions.

If you are told that your child needs an expander at age 7-10, before all the permanent teeth have erupted, you will be told the expander is needed for two reasons:

1. To grow the upper arch wider before the palatal sutures fuse. What are palatal sutures? These are the spaces between the bones on the roof of the mouth which are somewhat open before the age of 11 to 12 years.
2. To see if the extra space created by the expander will make the upper arch “bigger” in hopes that teeth will not be crowded and possibly have to be removed.

I do not recommend Phase I orthodontic expanders because:

1. An expander only addresses the Side to Side dimension and ignores the Front to Back and Top to Bottom dimensions. The lateral expansion by an expander can make any problems in the other two dimensions worse, and more difficult to treat later.
2. Problems in the other two dimensions will have to be resolved later. This will require a Phase II treatment when all of the permanent teeth have erupted, at age approximately 12 years. Therefore, the child will have braces twice and the parents will have to pay twice.

In almost all cases, I recommend doing one treatment beginning at approximately 12 years and taking about 24 months or less.  The timing of upper arch expansion is not age critical. It can be accomplished perfectly well at age 12 or later.

Before

After

The photos above show a treatment that was begun when the child was 13 years old and completed when the child was 15 years old. Looking at the “Before” photo, it might seem that the teeth were very crowded and an expander might have been used.  But an expander was absolutely not necessary to achieve the attractive and functional smile in the “After” photo.

Looking at the “Before” photo above, some parents would say that they would like a more attractive smile for their child during the growth period before age 12 or so.  In that case, I can devise a short treatment plan for about 1/3 of the cost of the typical “Phase I Expander Treatment,” without the use of an expander.

Is an expander ever necessary?  Yes, I use one  in the case of a child with a cleft palate.

Since every patient is unique, I recommend that you bring your child in for a free orthodontic exam around age 7 or 8.  I will advise you on the optimal time to begin treatment for your child’s particular case.  Treatment can almost always be done just once, for one all-inclusive reasonable fee. In the meantime, your child will be scheduled for free periodic “wait and see” appointments so that we can monitor growth.