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.
So you're at the movies with your best friend and he's eating a big bucket of popcorn by himself. The temptation is too much, so you grab a handful. Next thing you know, you've got a wire twisted out and poking your cheek. Or maybe you're at your softball game and you're chugging down a cold drink. You accidentally bite down on a piece of ice and feel a pop. Your molar brace is loose and flopping around back there scratching your cheek.
DON'T PANIC! The first thing you need to do is look for your wax packet so you can roll a ball of wax over the wire or bracket to save your cheek. Okay, so you didn't bring the wax with you but no worries. Dig through your mom's purse until you find a piece of sugarless gum. (Or maybe you could ask the nice lady sitting next to you at the movies.) Chew up the gum and pinch a little piece off to use just like you would a piece of wax. Now mind you, the operative word here is SUGARLESS! We don't want you putting a bunch of sugary gum on your tooth and leaving it there all day. That would not be good for your teeth.
When you get home you can ask mom or dad to clip your wire off. If you need to remove the loose bracket, have them clip the wire behind the next bracket over. The easiest way to do this is to have them get a q-tip and a small wire cutter. They can use a nail clipper in place of the wire cutter just make sure you wash either one thoroughly before use. They'll use the q-tip to hold the cheek out and clip the wire, then they can use the q-tip to sweep the piece of wire out of your mouth. Comfortable now? Great! Your next step is to call the office and leave a message with your name and phone number. We'll call you back and schedule an appointment to have your brace put back on. You're in the clear.
We don't have many true emergencies in Orthodontics. Mom or dad can usually fix you up at home. If they have trouble, or are not sure what to do, they can call the office and a message will direct them to our emergency line. We have a technician on call who can usually walk them through a fix right over the phone. There are times that you may need to be seen outside of office hours. For instance, you try to get food out of your expander and pull it loose or maybe you get hit in the face while you're playing and you need some help. The technician on call will be glad to meet you at the office to take care of you. On the rare occasion that the on call tech can't handle the situation alone, she'll call Dr Eric or Dr Larry who will be happy to come to the rescue. We've got your back!