Sometimes we see a patient whose upper jaw, or arch, is more narrow than his lower one. This condition causes the upper molars and premolars to fit slightly inside the lower ones. Over time, the teeth can wear into an uncomfortable bite. You're probably wondering just how that can be corrected. Well let me tell you all about it.
When the upper arch is too narrow there is a way to widen it. We use an appliance called a rapid palatal expander, or RPE for short. Our skulls are made of all sorts of 'plates' that join together like a jigsaw puzzle. These joints are called sutures. When we are young, the sutures are held together with cartilage allowing them to expand as we grow. We have one of those sutures in the palate of our mouths. If you rub your tongue on the roof of your mouth you can feel the slight ridge of it. (Go on, you know you want to!)
When we need to help the upper arch to widen a bit quicker to keep up with the lower arch we use the RPE. This device is made up of two metal bands, which have been fitted to the upper molar teeth, and are attached to a screw. The appliance is glued to the teeth and the screw is turned about a quarter millimeter once or twice a day. This opening of the screw puts pressure on the suture to stretch the cartilage open. When the upper arch is expanded a little past the optimal bite relationship we hold everything steady for about six months to allow the cartilage to fill in. Our patients are a little surprised by the rather large gap they get between their front teeth. Fortunately, teeth like to touch each other so they drift back together a little which makes the gap far less noticeable.
Widening with a palatal expander has to be done while the cartilage is still soft and pliable. It works best on children aged five to fifteen. By around age sixteen the head is finishing its growth stage and the cartilage starts to harden into bone.
You may think this sounds pretty painful but it really isn't. Most of our patients tell us they feel a little pressure and tingling in their noses and cheeks for a few minutes after the screw has been turned. This happens mostly in the first week. Once the cartilage relaxes it opens more easily. We've found that turning the screw right after dinner works well. I, personally, like to add in a cold treat like ice cream or a popsicle for extra comfort.
Now, about turning that screw... who does that? The idea of coming into the office everyday probably isn't workable. The easiest solution is for us to show you how to do it yourself. We promise to walk you through the procedure until you're comfortable. Your first turn alone might be a little scary but you'll be a pro in no time!
The other day one of our parents asked me why we don't use headgear anymore. We got into a fun conversation about how many of our junior high school friends had metal sticking out of their mouths and straps wrapped around their necks. We call that 'The Dark Ages of Orthodontics.' Braces have come a long way since then and one of our favorite innovations is the Carriere Distalizer.
In the good old days, when a patient had a large overbite, the Orthodontist would prescribe a metal bow with an adjustable neck strap which the patient would wear to move his upper molars toward the back of his mouth. This contraption, although effective, was bulky and embarrassing to be seen in! Who wanted to go to a sleep over and take their head gear with them? Imagine having to wear it to school!
Fortunately for this young generation, a brilliant Orthodontist by the name of Luis Carriere developed a system using a small bar, bonded to the upper molar and canine and powered by elastic wear, to move those molars back. Voila! The external headgear has been replaced with an internal one!
We have had great success with this new method mainly due to patient compliance. It's so much easier to put an elastic band on than to strap yourself into an uncomfortable headgear. The best part of all is how quickly it works when the patient is really conscientious about elastic wear.
Headgear isn't totally obsolete just yet. We do have a type of headgear that we use for a less common problem. Some patients have an under bite, which is a condition where the lower jaw has grown faster than the upper one. This leaves the lower teeth on the outside of the upper teeth- not a good situation! When we need to treat this condition in a younger child, Dr Eric prescribes a headgear that fits the front of the face and uses elastic bands to bring the upper jaw forward. It's not fun to wear, but it sure does a good job correcting that type of bite.
One of the questions we're most frequently asked is "Will I have to wear a retainer when my braces are off?"
Okay, it actually sounds more like this: "Wait, what? I just got my braces off and now I have to wear something else? Why do I have to wear a retainer? What if I don't wear it, then what happens?"
The short answers to those questions are:
"Because the doctor said so."
And, "You'll probably have to wear braces again and your parents will be mad."
None of those answers satisfy the average teenager so we asked Dr Eric to explain it for us. Without all the really technical stuff, this is the reason why he prescribes a retainer after your braces treatment: When we move the teeth to a more optimal position we are also moving the roots of your teeth through the bone. The bone dissolves and then reforms around the roots but this takes time. The teeth need to be supported in their new position while this is happening.
Ideally, we'd like to leave your braces on passively holding your teeth steady for about a year or so. Not many of our patients would find that option acceptable so a retainer is the next best thing.
Generally speaking, we have you wear the retainer for one to four weeks full time taking it out only to eat and brush. After that you'll wear it while you're sleeping. Many long term studies have shown that wearing the retainer for about three years gives the best results.
Towards the end of that three year period we have you start phasing your retainer out by skipping a night and seeing if the retainer is tight when you put it in the next night. If it's not, then you go two nights off, etc. Some people find that wearing the retainer a few nights a week indefinitely works well for them.
What we don't like to see happen is for someone to stop wearing their retainer early and have to come back for re-treatment. We really like catching up with all of our past patients, but we'd much rather you just stop by to say hello!