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What it’s like to get an upper jaw expander

Joey needed an upper jaw expander to correct his crowding but he was afraid it would hurt and he wouldn’t be able to eat.

Becky, a team member at the office of Dr. Michael Sebastian could tell Joey was nervous so she made a point of explaining about the expander to help Joey understand what was going on, because you’re usually scared of the unknown.

The first step was to place separators between his back upper teeth (these are small round elastic pieces). She showed them to Joey and explained they would feel like having those teeth flossed when they are placed.

Separators

            The separators would stay in until the next week. Becky took Joey’s arm and pressed on it, she asked Joey, “Does this hurt, or does it feel like pressure?” Joey said “it feels like pressure.” Becky assured Joey that the separators would feel like that. She also gave Joey some grape Advil to reduce any possible soreness which might develop.

What a relief! It wasn’t hard at all. Joey could eat whatever he wanted except sticky candy. At Becky’s direction, Joey’s mom would give him some Advil 30 minutes before the next appointment.

Next week, Joey came in to fit for the expander. Becky again was there to make sure Joey had a great experience. As before, she explained what was going to happen that day. They would first remove the separators which had opened a small space for the bands to easily slip on the teeth.

Bands

            Like fitting a pair of new shoes, she would have to try on a couple of different bands to get the size perfect. Bands are rings which fit around the two upper six year molars and are attached to the expander. With a gentle touch and Joey’s help, they used a bite stick to push the bands into the correct position.

Bite Stick

With the right bands in position, a scan of Joey’s mouth was done. Becky showed Joey that the scanner is like a very small camera which takes thousands of pictures. You move it slowly around the mouth and on the video screen an exact copy of Joey’s teeth appeared. It only takes about 5 minutes. The orthodontic lab would use this scan and the bands to make Joey’s expander. This was so easy, Joey couldn’t believe how quick and painless it was.

Becky put new separators in so next week the expander could be placed on Thursday at 3:30 pm.

Joey left school for the big day. When he got to the office, Becky gave him Advil. Joey was nervous, it hadn’t hurt so far but he was sure it would today. Becky eased his fear by explaining that today would be just like the last appointment except the two bands they fit would be attached by the expander. They would go through the same process except a special glue would be used to hold the expander in place, nothing like any glue Joey had used before. It was a special glue made for using only in the mouth.

Dr. Sebastian, Becky and Joey worked together to put in the expander. It was just like fitting the bands at the last appointment except for the glue. Joey got to hold “Mr. Thirsty” to remove the flavor of the glue. It took 3 minutes for the glue to set then Becky removed the excess glue and Joey was done! Wow, all the worry and he was fine.

Mr. Thirsty

            Becky gave Joey and his mom instructions on care and cleaning of the appliance. She also recommended that Joey take Advil every 4 to 6 hours for the next 24 hours as research has shown that this reduces any discomfort by up to 90%. Becky suggested Joey stay on a soft diet for 5 days until his tongue got used to moving food around the appliance.

Joey and his mom followed these instructions and his first 5 days were nothing like he imagined. He was sore but was able to do all his school work and after school activities. At his next appointment, Dr. Sebastian showed Joey and his mom the change which had occurred over this first 6 weeks, they couldn’t believe it, Joey knew the right thing was being done.

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) may also be a sign of sleep apnea in children according to experts.

            An estimated one to four percent of children experience sleep apnea, according to the American Sleep Apnea Association. Many of the children who deal with this disorder are between the ages of two and eight.

            Sleep apnea occurs when a person stops breathing during sleep; it is usually caused by something blocking or clogging the upper airway.

            The Centers for Disease Control and Prevention states that around 9.4% of children between 2 and 17 have been diagnosed with ADHD.

            Studies show that around 25% of children diagnosed with ADHD may have obstructive sleep apnea (OSA), the American Sleep Apnea Association explained.

            Experts say that learning difficulties and behavior issues may be a side effect of "chronic, fragmented sleep."

            When sleep apnea occurs, breathing stops during sleep, oxygen levels drop in the body while carbon dioxide levels rise, Norton Children's Hospital explained. This triggers the brain to wake up in order to breathe.

Symptoms of OSA include:

• Snoring
• Loud or heavy breathing
• Mouth breathing
• Pauses in breathing
• Snorting, coughing or choking in sleep
• Sweating more in sleep
• Bed wetting
• Restless sleep
• Abnormal sleeping positions (commonly seen in children with Down syndrome)

Children who deal with OSA may display the following during the day:

• Behavioral issues
• Hyperactivity
• Lack of concentration at school
• Morning headache
• Poor school performance
• Poor weight gain

ADHD symptoms include the following:

• Trouble sustaining focus on activities he or she finds boring or unrewarding
• Trouble listening and following directions
• Trouble staying seated, fidgeting; may experience discomfort trying to sit still
• An excessive amount of energy
• Tendency to interrupt, blurt things out
• Difficulty organizing tasks and activities
• Difficulty waiting his or her turn
• Easily distractible, often distracted by external stimuli (sounds, smells, etc.)
• Forgetfulness, tendency to lose necessary things (schoolbooks, keys, wallets, purse)
• Impatience
• Interrupts or intrudes on others
• Often daydreams or seems like he or she isn’t listening when being spoken to directly
• Very talkative

If you think your child has sleep apnea or ADHD, it’s recommended that parents talk to their child’s pediatrician. At our office, we screen every child for upper airway obstruction which can be a contributing factor to sleep apnea. Ask how we can help!

Upper jaw expansion, if needed, is probably the single best treatment you can do for the developing child. The benefits are numerous:

1. Children with a narrow upper arch are more likely to have Sleep Disordered Breathing (SDB) which includes Sleep Apnea

(Narrow Upper Jaw)

2. Children with deficient hearing have an improvement after upper jaw expansion
3.  Improvement in Halitosis
4. Improvement in nasal breathing- upper jaw expansion has been shown to decrease nasal resistance

                                 (Before expansion)                            (After expansion, airway enlarged)

5. Increased size of upper airway
6. Decreased bed wetting

              (Before expansion tongue in low      (Normal tongue position after expansion,                            tongue thrust position)                    tongue in roof of mouth)

        (Before expansion and tongue thrust        (After expansion and resolution of                                          treatment)                                         tongue thrust)

7. Decreased tongue thrust- normalize tongue position which helps in speech
8. Improvements in cognitive functions by Sleep Disordered Breathing (SDB) patients after expansion because their sleep quality improves so can function better during day.

All this, and there is no mention yet of the skeletal and dental improvements which are achieved with upper jaw expansion.

(Before)                                                   (After)

9. Correcting a functional shift caused by constricted upper jaw with a posterior crossbite allows the mandible to close normally without shifting. This reduces the stress on the TM joints and the potential for asymmetric growth of the condyles.

(Before expansion)                                                 (After)

10. Developing enough space skeletally to resolve crowding and negate the possibility of extractions later.
11. Improve the path of eruption of maturing teeth. Allowing them to erupt into supporting gingivae and thus develop healthy gingiva.
12. Develop a full smile with upright posterior teeth which fill the buccal corridors for maximum esthetics.

Best Age?

We’ve covered all the benefits of upper jaw expansion. Now let’s understand when is the best age for expansion. Research has shown the best time is between the ages of 6 and 10 if you want to maximize the above benefits plus increase the stability. The upper jaw is very malleable during this stage of development so if expanded properly the upper jaw responds well and the results are stable, long term.

This type of expansion is skeletal, the other type of expansion is dental, this is when the teeth are tipped out which is not stable. Prior to age 10 expansion is about 85% skeletal 15% dental, as the child ages the numbers reverse. By 17 y.o. the ability to get skeletal almost zero.

Type of Expander?

The last area of concern is the type of expander used. Again we rely on good research to experience to choose the expander. The fixed quad helix is the top expander for results achieved. We have been using a specifically designed fixed quad-helix for 20 plus years. We custom design the appliance for not only posterior expansion but also anterior expansion, tongue restraining in tongue thrusting patients and crib for finger sucking. By doing this we don’t have to use different appliances and can treat multiple areas with one appliance. The expansion requires 6-8 months with 6 months retention for long term stability.

Don’t hesitate to contact us if we can be of any help!

What does Chlorine do to your Teeth?

Often times we have patients with discolored enamel around their brackets.  One of the first things to take in consideration, especially in teens, is every day activities, like swimming.

Chlorine is one of the leading causes of teeth discoloration and many people aren’t aware of the problem because you can’t see the pH balance of a pool. This is also known as “Swimmer’s calculus.”  Pools have a high pH level that stains teeth brown and prevents saliva from doing its job in cleansing the mouth. Poor pH balance in a pool can also cause the enamel of teeth to soften, making teeth more susceptible to damage and decay, as well as more sensitive in general.

As the enamel of your teeth wears down from exposure to chlorine, it becomes discolored.  Poor enamel health is common in competitive swimmers because of prolonged exposure to chlorine which could also cause sensitivity.

How can you protect your teeth from Chlorine?

The best recommendation to prevent chlorine from staining  your teeth, would be to try and keep your mouth shut while you’re in the pool. This is nearly  impossible to prevent, but the less amount of pool water you get in your mouth, the better.

Another important thing to do, is to brush and floss your teeth as soon as you get out of the pool. You don’t want the chlorine to sit on your teeth any longer than necessary.  We suggest  always bringing  your toothbrush when you go to the pool to swim.

If you love to swim, make sure you have toothpaste with MI Paste or baking soda. Both of these can help fight the acid caused by pools and lessening the chances of chlorine discoloration of your teeth.