Questioning the expander.

[Ting Tang]

I have read these orthodontic expanders are overprescribed and may even result in bone loss. My son has a cross bite, and my next in line is supposed to undergo the same process. We had a heck of a time turning the key today. It wasn’t fully aligned; yesterday I never even saw the orthodontist, just the assistant. The office is so busy, and I’ve been skeptical. But it’s the only office, and I ruled out going elsewhere in case emergencies arise. I’m sure he will get used to it, but I’m not sure it was the right decision. I wish he could’ve gone right into braces instead. Sigh. He’s not been eating much. Yogurts and broth. 

[KSera]

I don’t know if they’re overprescribed, but have an anecdote. One of my kids has had an expander. I was reluctant, but they had a very crowded mouth and I decided it was the right choice for this kid and ortho was respectful of fact I wanted to do the minimum amount and not over expand (I had noticed so many kids with expanders ending up with these very flat arches in front, rather than a more a natural curve). We did expander and then braces and it worked well for that child.

Fast forward a couple kids to another with a very crowded mouth. Plan was to expand and then braces. Then Covid hit and we did nothing. That DC has since finished losing teeth and had their big growth spurt and all teeth are fitting fine without crowding. Braces are still needed, but I don’t see any need for an expander anymore. 

[Sneezyone]

I had an expander. I needed it. Small mouth, small ear canals, too many teeth (and I didn’t even get wisdoms, without em I had plenty). I hated it with a fiery passion and now as an adult who doesn’t wear a retainer, have some crowding on the bottom (no expander) but not the top. I cannot imagine how much worse if I hadn’t done the expander. Depends on the kid and your genes.

[prairiewindmomma]

We are glad we did it. It fixed crossbite and tooth impaction issues for our kids that needed it. Those issues were obvious in the imagery. I had adult teeth pulled as a teen because an expander wasn’t an option for me; I am glad my kids get to keep more teeth.

The learning curve the first few days was awkward and then it felt like old hat. Just don’t pull out the key too early—it needs to be moved all of the way to the back until it doesn’t move anymore. The next key hole should be fully visible before you remove the key.

[East Coast Sue]

One of my kids had a very pronounced crossbite and underbite. We did a round of expanders then braces. Early treatment definitely helped, but it wasn’t nearly sufficient to fix the problem. She had surgery on her upper and lower jaw. I can’t imagine not trying an expander b/c it helped bridge the time until she was ready for the surgery (growth complete). I’d consult with an oral surgeon who does jaw surgery for a second opinion. In my dd’s case, her surgeon was involved in every step of the treatment planning process so we had a great relationship way before surgery. He is a truly phenomenal doctor. Our orthodontist was okay but didn’t seem as if he had the expertise of the surgeon.

[wendyroo]

My youngest (7) has an expander right now. Our ortho said we could wait and do an expander and braces when DD is older, but her underbite is so severe that she was biting into the roof of her mouth causing pain and scarring. Plus, we think it is really impacting her speech, and making it hard for her to communicate. 

She has had the expander for six weeks, and we expect her to keep it for 10 months. (Then a retainer at night for a couple years, then braces when she is ten or eleven.) It is annoying on many levels, but we have settled into a routine. And after a first bout of cranking it every night, now we don’t have to do that for the time being. 

I remind DD about my aunt who had a mouth shape just like DD’s. My aunt grew up before expanders, so they waited until she was 19 and then broke her jaw to realign it. That was incredibly painful, and she had to have her mouth wired shut for a prolonged period. An expander is definitely the way to go - despite all its inconvenience. 

[TheReader]

So, I don't know the specifics, but my son was originally told he'd need an expander, etc. 

But in the meantime, he was working with a speech therapist who also did myofacial stuff (I forget the exact term here....) and she worked with him on some stuff (tongue placement; he wasn't letting his tongue rest in the correct spot or something when not talking), and it dramatically changed and reshaped his pallate so he didn't need the expander after all.

NO IDEA if that's what's going on w/your kiddo, or could work, but might be worth a shot. 

[Ting Tang]

Thank you all for sharing your experiences!  I am feeling better.  He definitely has a crossbite, so I am not surprised orthodontia work was recommended.  I started to read on various site about these expanders being overprescribed, which made me feel uneasy because this office is like an assembly line.  My orthodontist's office was cozy and private.  It all feels so strange.

We also waited two years because of Covid. Originally, this was all to be done in two phases.  I was quoted $8000.  Well, now is it around $6k+ because it is one phase.  My next in line was recommended to go through two phases, but we are going to wait until he is in the 6th grade.  He also had a tooth removed.  

Hopefully this is the right thing to do for him! 

[Ting Tang]

Just now, TheReader said:

So, I don't know the specifics, but my son was originally told he'd need an expander, etc. 

But in the meantime, he was working with a speech therapist who also did myofacial stuff (I forget the exact term here....) and she worked with him on some stuff (tongue placement; he wasn't letting his tongue rest in the correct spot or something when not talking), and it dramatically changed and reshaped his pallate so he didn't need the expander after all.

NO IDEA if that's what's going on w/your kiddo, or could work, but might be worth a shot. 

No, but that is very interesting!  I am glad you get to avoid this process. It looks crazier than anything I ever had cemented into my mouth, and that was pretty crazy in itself, lol.

[cintinative]

My son did the two phase--the first with expander and then braces.

Unfortunately he inherited his mom's (and uncle's, and grandmother's) overcrowded mouth.  I had to have something like 8-10 teeth pulled before I could get braces, and then had to get my wisdom teeth extracted because they were impacted.

I never heard anything about bone loss.  Too late now, but that's interesting.

We went to three different orthodontists for an opinion and proposed treatment plan and they all recommended the expander. The expander type was different depending on the orthodontist.  

 

[wendyroo]

26 minutes ago, Ting Tang said:

My next in line was recommended to go through two phases

OTOH, our orthodontics office is not big on splitting work into two phases unless teeth are clearly causing a current problem. Even with my daughter whose bottom teeth are biting into and scarring her palate, they still said it was entirely up to us if we wanted to do the expander now or wait and do everything together when she is older. We decided to go with the two phase because she is in pain and having severe speech delays, but they said from an orthodontic perspective, we could have waited a few years, done all the work in one phase, and gotten the same final results as the two phase process.

[Ting Tang]

8 minutes ago, wendyroo said:

OTOH, our orthodontics office is not big on splitting work into two phases unless teeth are clearly causing a current problem. Even with my daughter whose bottom teeth are biting into and scarring her palate, they still said it was entirely up to us if we wanted to do the expander now or wait and do everything together when she is older. We decided to go with the two phase because she is in pain and having severe speech delays, but they said from an orthodontic perspective, we could have waited a few years, done all the work in one phase, and gotten the same final results as the two phase process.

Thank you for sharing this.  Very interesting.  This is why I am skeptical about our orthodontist.  I was told two phases was easier on the child, but I think we're just going to get it all done in one full swoop.  Nobody appears to be in pain.

[kirstenhill]

Out of my four kids, three need/needed braces badly (the other could maybe have used them for minor cosmetic reasons, but with three other kids needing them we didn't want to invest just for small changes for him).    I feel like two phase treatment is really becoming what most orthos recommend these days. By waiting, we avoided the two phases with the older two, but on the other hand both the older two had to get 2 permanent teeth removed to make space in their small mouths to deal with their overjet - the very same thing I had to have done when I was their age.  With the youngest, we did agree to an expander - but he has both the overjet and the crossbite (I could clearly see it on the xrays and model) and the ortho hopes that by starting with the expander we should be able to avoid pulling the permanent teeth like we did for the other two .  His could have been a two phase but technically is a one phase as he should be just ready to go into regular braces when he is done expanding. 

One thing I have learned is that different Orthos definitely have different treatment ideas, so I highly recommend people get more than one opinion/treatment plan/quote before starting.  Then especially if different treatment plans are suggested, ask pointed questions about why one plan would be preferred over another.  We did that especially with kid #2 with two orthos that had very different ideas on what to do.  I chose the one I felt more confident in his reasoning and I felt was more upfront with me (it also happened to be cheaper and closer, which was a bonus).  We didn't get two quotes with #3 since I really trusted the ortho we picked for #2 (kid #1 with braces started when we lived in a different city so we had different options) and #2 and #3 are overlapping, so it was in our best interest to stick with the same office since they can try and time the two boys appointments together.

Edited September 30, 2023 by kirstenhill

[KSera]

1 hour ago, wendyroo said:

OTOH, our orthodontics office is not big on splitting work into two phases unless teeth are clearly causing a current problem. Even with my daughter whose bottom teeth are biting into and scarring her palate, they still said it was entirely up to us if we wanted to do the expander now or wait and do everything together when she is older. We decided to go with the two phase because she is in pain and having severe speech delays, but they said from an orthodontic perspective, we could have waited a few years, done all the work in one phase, and gotten the same final results as the two phase process.

We got multiple opinions for our first couple kids and the one we went with was the one who preferred to wait and do it all in one phase to have the kid have less time overall with stuff on their teeth (which is frequently a hygiene complication). This approach also meant it cost less than the two phase. Considering the one phase outcome was great, it’s hard not to feel that wanting to do two rounds is primarily for money making in many cases. 

[Ting Tang]

56 minutes ago, KSera said:

We got multiple opinions for our first couple kids and the one we went with was the one who preferred to wait and do it all in one phase to have the kid have less time overall with stuff on their teeth (which is frequently a hygiene complication). This approach also meant it cost less than the two phase. Considering the one phase outcome was great, it’s hard not to feel that wanting to do two rounds is primarily for money making in many cases. 

This is why I am so skeptical about this office.  The lady who is in charge of finances has the personality of Mrs. Duggar.  There is no depth.  I don't know if it is a defense mechanism against all the questioning parents, lol.

[Tenaj]

I thought the general trend in recent years was a one- phase treatment.  My oldest two boys 31 and 26 now went through a two phase, expander then braces treatment but for my younger four it has been a one- phase treatment (three of them with expanders then braces).  

Regarding your "assembly line" comments, I can sympathise.  We go to a busy practice and the practice has gone through 4 or 5 different orthodontists over the years. I finally realized it's really the assistants who know what is going on -lol!

As far as the expander, all five of my kids adjusted relatively quickly.  Have him lay down when you turn the key - I've found it's easier to get the right angle.  After the first few times it gets easier.  

Our most recent experience is my youngest and she had the expander and now a Herbst appliance.  I wasn't sure she was going to adjust to that one - it is so much metal that you can actually see it poking her skin when her mouth is closed.  She had a rough few days but two weeks later she's fine.  

[BusyMom5]

I've had 2 that needed expanders right before braces, so not 2-phase.  Their mouths are still pretty crowded and I've never questioned whether they were unnecessary.  They've been in braces for 3 years!  Still working on getting them straight- their teeth were so crowded, we had to put spacers in to make room for teeth to come down, teeth coming out the roof of the mouth (and we were glad, because we had oral surgery booked to get them exposed).  My DH did not get an expander and ended up having to pull several adult teeth and his are all very crowded.  I really trust my orthodontist,  though.   I've been going to him for 12+ years.  My oldest had an issue that required consultation with an Ortho as soon as her adult teeth came in. He was always prescribing minimal treatment.