Want to see parents of school-aged kids freak out? Just mention the subject of orthodontics — crooked teeth, crossbites, braces, retainers and more. Whether they have children in the middle of expensive dental appointments or their monthly DDS payments are still on the horizon, the topic brings out a food of emotions: trepidation, nostalgia, wariness or just plain financial panic. Often a combination of all of the above. And if you really Want to get them going, ask them if they have any familiarity with the phrase “palate expander.”
“I had one as a child! You hurt like hell!” says one mom, in a recent Facebook post on the matter. “I feel like all my friends’ kids are getting it these days,” chimes in another. “All three of my kids had one! He hated it. I couldn’t bring myself to turn the key – my partner had to do it,” said a third parent. And “My husband is convinced it’s a medieval torture device used to get more money out of vulnerable parents and orthodontists underestimate the complications and responsibility of parents!”
Palate expandersfor those lucky enough not to know, they are small metal devices that have been in use since the late 19th century and look and act like they haven’t been updated since then. Temporarily anchored to the back upper teeth of a child’s upper jaw and intended to literally open said jaw a few extra millimeters before the palate fuses in late adolescence. Aside from the expense (orthodontics is only very rarely covered by insurance), expanders are a team effort. An adult must insert a tiny tool and literally turn the screw to open the device wider, millimeter by millimeter, day by day. Everyone is affected — and complicit.
And if you listen to the chatter of parents in the pick-up scrum, they seem increasingly commonplace. But are they necessary? According to some experts, these devices – while effective – are overused, especially on younger children. It sometimes settles in children as young as 3 or 4 years old. So much so that last year, Dr. Neal Kravitz, DMD, editor-in-chief Journal of Clinical Orthodontics and faculty member at Harvard Dental School, published a paper by Orthodontics Seminarswith a title “Everyone gets an Expander.” (Kravitz tells me the headline is meant to read in the style of Oprah’s “You get a car!”)
In the paper, Kravitz explains that there has been a move since the 1990s toward two-phase treatment: a first phase during preadolescence (around age 8) with expanders and then braces on only a handful of teeth in front of the mouth. followed by a second phase during puberty with full mouth braces. “But there’s no evidence that this approach is more effective or more efficient,” says Kravitz. “It is, however, much more expensive for the family. In the vast majority of cases, children can wait until middle school during the peak of adolescent growth and receive a single phase of comprehensive orthodontic treatment.”
Thus, it is done very early and very often, he notes. In fact, only about 10% of children will actually have the skeletal stenosis that requires a dilator, and using a palatal dilator without one has limited indications and questionable benefit. For many parents, the 10% figure is too low, simply based on what they hear and experience.
The hope behind all these expensive ministrations is the enlargement of the upper jaw. This is the main reason orthodontists should prescribe expanders, says Dr. Olivier Nicolay, DDS, clinical professor and chair of orthodontics at New York University School of Dentistry. The jaw size difference obviously leads to crowded teeth, but it can also lead to what’s known as a crossbite, malocclusion (that is, your teeth or bite not being aligned) and other potential problems in the long run. These include problems with chewing and eating, as well as uneven tooth and gum wear, says Dr. John Callahan, DDS, the president of American Association of Orthodontists and orthodontist in central New York.
Once the palate has been widened (called Phase 1 in some orthodontic practices), the teeth ideally have more room to move into a more comfortable and desirable alignment—which then becomes the nail’s job to make permanent. (What, you thought you were done?) Braces usually come right after the expander is removed. Welcome to Phase 2.
I had fun with my own Phase 1, so to speak. A few years ago, my daughter, now 15, had an expander in her mouth for what was described to me as a narrow upper jaw — and then crowding of her teeth, which were all overlapping, especially in the front. We managed not to lose the tiny, precious tool – called a wrench – but we did manage to find ourselves back at the office for a rerun when our (my) first attempts to insert and turn resulted in (her) gagging and crying (both of us ).
Only about 10% of children will actually have the skeletal stenosis that requires a dilator, and using a palatal dilator without one has limited indications and questionable benefit.
With braces and other orthodontics, the line between health and aesthetics has always been blurred. “It’s really hard to say what’s really necessary,” says Lyla, a mom of two in Upstate New York. “And you kind of have to take the doctor’s word for it. With my son, it was obvious that his teeth were crooked, but then they started suggesting all these other things, like extractions, and I wasn’t sure. It’s a mystery – and a fine line between vanity and necessity.” Additionally, doctors often talk about how a bad bite or crooked teeth can “cause problems later,” but these can feel vague and not as well-documented. These problems tend to be jaw-related or alignment-related, but doctors often don’t specify what these problems really are.
Perhaps that’s because we place so much social and emotional weight on smiles — for those who can afford to pay to improve them it’s a given. According to a study from the American Academy of Cosmetic Dentistry48% of people say that a smile is the most memorable feature people remember, regardless of age. In a research conducted by American Academy of Cosmetic Dentistry (AACD), 74% of people said they believe an unattractive smile can hurt a person’s career. According to a overview from the American Dental AssociationThe Health Policy Institute (ADA), 82% of respondents believe that “straight, bright teeth help you get ahead in life.” For parents trying to give their kids every chance in life, this could be one of those things you just can’t skimp on – even if it means charging for a few years of braces.
“We have a real problem with over-medicalization in pursuit of additional revenue. Regardless of the field of medicine or dentistry, when treating children, you can achieve more by doing less.”
Kathy, a mom of three in North Carolina, had many friends “who let their orthodontist tell them to get their kids braces twice. Once in third or fourth grade and then again later in high school or later. When I’ve asked why I’ve done it twice, they really haven’t said, just ‘we recommend it…’ I think they’re tormented by the fact that you don’t know anything and most people won’t know I’m repulsed.”
Some orthodontists also recommend dilators for children who have airway and breathing problems that affect their sleep – eg. obstructive sleep apnea (OSA). This should be done as part of a team effort with the child’s doctor and the ear, nose, and throat (ENT) doctor and come after other tests and treatment, says Dr. Shankar Rengasamy Venugopalan, DDS, associate professor at Tufts University of Dentistry. Unfortunately, some orthodontists and other dentists jump straight to the extension to help with breathing and sleep problems, and many do so based more on anecdote than good science, says Dr. Mitchell Levine, DMD, his spokesperson American Academy of Sleep Medicine and Associate Professor of Orthodontics at the University of St. The research on whether dilators can help is mixed,” says Levine. “There is no correlation between airway dimensions and OSA. Many patients submitted [expander] treatment didn’t have a real sleep study.”
There are actually some studies that have shown that stretching has worsened apnea, notes Venugopalan, who says the first and best treatment for children who have sleep apnea is usually to be checked by an ENT for enlarged tonsils and adenoids, which they may require surgery. movement.
Translation: If your orthodontist goes straight to an expander because your child snores, take a big step back. “We have a real problem with extra-medical pursuit of additional revenue,” says Kravitz. “Whether it’s medicine or dentistry, when you’re treating children, you can do more with less.”
And so must Do ambivalent parents do when faced with so much money and discomfort—not to mention the fate of their child’s smile—on the line? First, you should know that by and large, most orthodontists aren’t trying to pull a fast one, says Callahan. Yes, unfortunately there are a few more greedy for profit who kind of spoil it for everyone else. To find someone you can trust, make sure you’re seeing a board-certified orthodontist, and Callahan suggests finding someone who’s a member of the AAO.
Parents should listen carefully when the orthodontist recommends an expander and ask questions about it Why It is recommended, especially since technically “crowded teeth” is not a sufficient reason in itself. And definitely consider getting a second opinion if you’re not sure. In some cases, exports or even a “watch and wait” approach is better. It certainly costs less.
And finally, if after much searching you end up getting a dilator for your child, be sure to ask for a spare twist wrench.
Liz Krieger is a writer and editor whose work has appeared in Good cleanliness, health, trim, travel + recreation, and many more. She lives in Brooklyn with her husband, two daughters, two undiscovered cats and an extremely scruffy rescue dog. You can follow her Instagram and Twitter.
