PATIENT EDUCATION
This special appliance is designed to widen the roof of your mouth by gently separating the suture in the center of your palate. The suture is similar to the soft spots in a baby's head and will eventually fill in with bone as well. This expansion is easier and more effective at earlier ages because the "soft spot" is bigger. It's typically used when the upper jaw is too narrow for the lower jaw or when the upper teeth are crowded or blocked out of the dental arch.
There are two types of expanders.
The first type of expander is a BANDED expander. In adolescent patients or adults whose permanent teeth have erupted, the appliance is fixed to the first molars and often the first premolars by the use of orthodontic bands.
The second is a BONDED expander. This appliance is bonded (or glued) to the posterior teeth. This bonded expander not only covers the outside and inside edges of the posterior teeth, but also covers the biting surfaces of the back teeth. Thus, it is normal for the front teeth not to hit as they did before the appliance was placed. Both of these appliances transmit the force of the jackscrew through the teeth to the underlying bony support.
How often should you activate the expander?
The activation schedule is dependent on each individual case so please activate as directed. Usually, the RPE screw is turned 1 time per day, typically at bedtime, for 4 to 6 weeks. You will visit our office regularly while activating your appliance so we can monitor your progress. If the next appointment is missed, do not continue turning the appliance until your progress is evaluated. In that case, please call the office promptly to reschedule.
How do you activate the appliance?
The patient should lie on a flat surface, such as a bed. It is helpful if there is a source of light, such as a reading light, available so that the inside of the mouth can be illuminated.- Firmly grip the RPE key. The metal tip key will rotate about the end of the plastic handle. This provides the needed mobility for activation.
- Insert the key carefully into the hole in the middle front part of your appliance.
Push the key gently and steadily from the front toward the back of your mouth. Do not back up. Remove the key towards your throat. Pushing the key back as far as possible brings forward a new keyhole position. Make certain that you have finished the turn, or you will not be able to find the next hole at the time of your next turn. You're now ready for the next activation.
What will it feel like once its activated?
During and immediately following the activation of the appliance, you may sense some initial discomfort and pressure causing a tingling or "itch" under your RPE. The pressure experienced will be by the bridge of the nose, in the region of the cheeks, or between the front teeth.
Will it hurt?
The first day or two is the breaking-in period and will be the most challenging. Initially, the patient may feel frus trated. We have found that with patience, encouragement, and a positive attitude the patient will quickly adapt.
The following are some helpful ideas that will ease this adjustment period.
- Some tooth tenderness is normal and can be relieved by taking ibuprofen (Advil, Motrin) or Tylenol.
- Speech and eating difficulties usually are resolved within 24 - 72 hours. A helpful tip is to read aloud for a few days until speech improves. It is helpful to eat softer foods for the first meal or two until the patient has grown accustomed to this new feeling. Initially, cold treats such as ice cream or Popsicles may relieve some uncomfortable symptoms and help the patient become accustomed to eating with the appliance in place. This should not become a habit, however, due to the high sugar content. We recommend eating nutritious dishes like pasta (macaroni and cheese, casseroles), soup, cereal, applesauce and yogurt. Within a few days, the patient should be able to eat almost anything allowed on the "Orthodontic Diet List".
- During meals, food may accumulate between the roof of the mouth and the appliance. It is best to finish the meal or snack first, then dislodge the food by swishing around a mouthful of your drink. It is important to use the "swish and swallow" method. Trying to suck the material from the appliance may cause food particles to become lodged in the lungs, and could lead to a serious lung infection.
What will happen over time?
After about one week of activation, a space usually opens between the two upper front teeth. The appearance of the space is an excellent indication that treatment is progressing as expected. The space will continue to increase with subsequent activations. Occasionally, these front teeth will become slightly mobile and sensitive. This will subside within a short period of time. Discomfort can be relieved by taking ibuprofen (Advil, Motrin) or Tylenol. If the appliance becomes loose or if there is pain or extreme breath odor, call the office immediately. If the patient thinks that the appliance feels loose, even though not visibly, the patient should be seen within a few days.
What happens once activation of the RPE is done?
After activation of the appliance has been discontinued, there will be a gradual closure of the midline space spon taneously. The upper front teeth will tend to drift and tip together. This closure of the space is to be expected, and is not a sign that the treatment is becoming unsuccessful.
How should I clean the RPE?
It is very important that the space between the appliance and the roof of the mouth be cleansed thoroughly each day. Some people have found a WATER PIK to be useful, if additional help is needed. lffood particles remain under the appliance, they may become a source of irritation to the roof of the mouth that will become uncom fortable for the patient. In extreme circumstances, infections may result.
We have reviewed tooth-brushing instructions. Please pay particular attention to the margin where the appliance meets the gums on the cheek side and tongue side.