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Appliances and Procedures

Palatal Expander

A palatal expander, also known as a rapid palatal expander, rapid maxillary expansion appliance, or orthodontic expander is used to widen the upper jaw so that the bottom and upper teeth will fit together better. Although the use of an expander is most common in children it can be and has successfully been used in adults at times.  It is most often followed by braces to straighten out all the teeth now that room has been created.

Although it may vary from person to person, most usually feel slight pressure on their teeth. As the patient turns the expansion screw using the key, a space develops between the front two teeth. Some may notice a larger space while others do not notice a space at all. It usually takes several days to adjust to eating and speaking after first receiving the rapid palatal expander. Although rare, patients may experience pain and headaches while wearing palatal expanders and when the screw is turned. They may also feel a sore on their tongue from contact with the expander's metal bars.

Patients who have expanders may experience extra saliva and lisps (pronouncing the letter S as a T sound) or a slight 'hissing' S sound.

When the palatal expander is first removed, patients usually report that their mouth feels extremely big and spacious.



Orthodontic retainers are custom-made devices, made usually of wires or clear plastic, that hold teeth in position after aligning the teeth. Most patients are required to wear their retainer(s) all day and night except while eating and then, after a short time, every night at least initially. 

There are three types of retainers typically prescribed by orthodontists and dentists: Hawley, Essix, and Bonded (Fixed) retainers.

The best-known type is the Hawley retainer, which includes a metal wire that surrounds the teeth and keeps them in place. Named for its inventor, Dr. Charles Hawley, the labial wire, or Hawley bow, incorporates 2 omega loops for adjustment. It is anchored in an acrylic arch that sits in the palate (roof of the mouth). The advantage of this type of retainer is that the metal wires can be adjusted to finish treatment and continue moving teeth as needed.                                      


Another common type is the vacuum formed retainer (VFR). This is a polypropylene or polyvinylchloride (PVC) material, typically .020" or .030" thick. Essix is a brand name many dental offices are familiar with. This clear or transparent retainer fits over the entire arch of teeth and is produced from a mold. It is similar in appearance to Invisalign trays, though the latter are not considered "retainers". Essix, if worn 24 hours per day, do not allow the upper and lower teeth to touch because plastic covers the chewing surfaces of the teeth.  Some feel the Essix are less conspicuous and easier to wear than Hawley retainers.

For patients with disorders such as Bruxism, Essix retainers can assist in protecting the teeth from wear and cracking. 

Most removable retainers are supplied with a retainer case for protection. During the first few days of retainer use, many people experience extra saliva in their mouth. This is natural and is due to the presence of a new object inside the mouth and consequent stimulation of the salivary glands. It may be difficult to speak for a while after getting a retainer, but this speech difficulty should go away over time as one gets used to wearing it.
An entirely different category of orthodontic retainers are fixed retainers. A fixed retainer typically consists of a passive wire bonded to the tongue-side of the (usually, depending on the patient's bite, only lower) incisors. Unlike the previously-mentioned retainer types, fixed retainers cannot be removed by the patient. Some doctors prescribe fixed retainers regularly, especially where active orthodontic treatments have affected great changes in the bite and there is a high risk for reversal of these changes.  If not properly maintained, fixed retainers may lead to tartar build-up or gingivitis due to the difficulty of flossing while wearing these retainers. As with dental braces, patients often must use floss threaders to pass dental floss through the small space between the retainer and the teeth.
Depending on the patient's bite and habits, these fixed retainers can last anywhere from 6 months to many decades of life.
Whatever type of retainer becomes yours, they should be considered very important in maintaining your new smile for your lifetime.  Teeth will move on their own throughout your life and we don't want you to have to repeat orthodontic treatment in the future simply because you forgot to wear your retainer!
Wishing you a beautiful smile for a lifetime!


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