Explained by Orthodontic Specialist Dr. Begüm Ulaşan and Milim Dental Bursa

Do your child's upper teeth not fully align over their bottom teeth?

Does their smile look "narrow, like a triangle"?

Did the dentist say, "The upper jaw is narrow; braces may be needed later, let's consider a palatal expander appliance"?

At this point, the same questions begin to circle in the minds of parents:

1. What is palatal expansion, and what kind of treatment is it?
2. Will my child be in a lot of pain?
3. How long does it last, and is it permanent?
4. Who should perform this procedure in Bursa—an orthodontic specialist?
5. What is the approach of Dr. Begüm Ulaşan and Milim Dental on this topic?

In this comprehensive article, based on the clinical approach of orthodontic specialist Dr. Begüm Ulaşan at Milim Dental Bursa, we will explain the treatment for upper jaw narrowness and palatal expansion step by step.

1. What is Upper Jaw Narrowness (Palatal Constriction)?

Normally:

1. The upper jaw slightly envelops the lower jaw externally.
2. The upper teeth protrude slightly outside the lower teeth.
3. Teeth close in a balanced manner during chewing.

When upper jaw narrowness occurs:

1. The upper jaw remains narrower than the lower jaw.
2. The upper teeth cannot fit completely outside the lower teeth.
3. In some areas, the lower teeth may protrude outside the upper teeth (crossbite).
4. Crowding increases as the teeth cannot find enough space in the palate.

In this situation:

1. The child's smile may appear narrow and triangular.
2. The area between the nasal floor and the palate may be "high and arched."
3. Chewing may become difficult, and a habit of chewing on one side may develop.

In many children who visit Milim Dental Bursa, orthodontic specialist Dr. Begüm Ulaşan always evaluates the upper jaw narrowness and the bite relationship during the initial examination.

This is because palatal narrowness is often a significant risk factor for future development of:

1. Crowding
2. Mouth breathing
3. Jaw joint problems
4. Aesthetic issues

2. Why Does the Upper Jaw Become Narrow?

Upper jaw narrowness can have several causes:

2.1. Genetic Structure

Some children may inherit traits from their parents, such as:

1. Narrow jaw
2. Crowded teeth
3. Upper jaw narrowness

If there is a family history of "all our teeth being crowded," a narrow palate and upper jaw narrowness in the child are not surprising.

2.2. Thumb Sucking, Pacifier, Prolonged Bottle Use

Habits extending beyond 3–4 years of age, such as:

1. Thumb sucking
2. Pacifier dependency
3. Frequent bottle use

can push the upper front teeth forward, alter the form of the palate, and negatively affect the development of the upper jaw laterally.

2.3. Mouth Breathing

In children who breathe through their mouth due to causes like nasal congestion, adenoids, or allergies:

1. The tongue does not rest against the palate as it should.
2. The upper jaw loses internal support from the tongue.
3. Over time, a narrow and high palate can develop.

For this reason, Dr. Begüm Ulaşan and Milim Dental Bursa emphasize the importance of assessing the airway and nasal breathing—not just the teeth—in children with palatal narrowness. A referral for an ENT (Ear, Nose, and Throat) consultation is recommended if necessary.

3. What is a Palatal Expander Appliance and How Does It Work?

A palatal expander appliance (upper jaw expansion appliance) is:

1. A specialized orthodontic device that is fixed to the child's upper molar teeth.
2. It has a small screw mechanism in the center.
3. It is positioned close to the center of the palate.

The principle is very simple:

1. In childhood, the upper jaw bones are in two halves with a growth line (suture) in the middle.
2. The screw mechanism is turned at regular intervals, advancing it by very small amounts.
3. With each turn, the two halves of the upper jaw move apart at a micron level.
4. Over time, these small movements accumulate, and the upper jaw widens.

This procedure is called rapid maxillary expansion (RME) in medicine.

When planning palatal expansion treatment at Milim Dental Bursa, orthodontic specialist Dr. Begüm Ulaşan evaluates all of the following factors together:

1. The child's age.
2. The degree of upper jaw narrowness.
3. Whether a crossbite exists.
4. The status of mouth breathing and ENT health.

4. What is the Most Suitable Age for Palatal Expansion?

The success of this treatment is closely related to age. As a child grows:

1. The suture in the middle of the upper jaw is softer.
2. The bones are more flexible.
3. Expansion is easier and more permanent.

Generally:

1. Ages 7–12 are considered the most ideal period for palatal expansion.
2. In girls, the suture may tend to close slightly earlier.
3. Expansion can still be done after 13–14 years, but individual differences are significant.

In Adults (after 18 years of age):

1. The suture in the middle of the upper jaw is usually fused.
2. Expansion with the appliance alone is often insufficient.
3. Surgically assisted rapid maxillary expansion (SARME) may be necessary.

Therefore, Dr. Begüm Ulaşan at Milim Dental Bursa advocates for intervention at the right age and time in children diagnosed with palatal narrowness, rather than adopting a "let's wait until they grow" approach.

Palatal expansion performed in the early phase:

1. Facilitates later orthodontic treatment.
2. Reduces the severity of crowding.
3. In some cases, may increase the chance of treatment without tooth extractions.

5. How is Palatal Expansion Treatment Applied?

The treatment can be summarized in several stages:

5.1. Diagnosis and Planning

1. Clinical examination: Jaw narrowness, bite, and facial form are evaluated.
2. Necessary X-rays are taken (panoramic, cephalometric, and 3D imaging if needed).
3. The degree of upper jaw narrowness, the need to create space for teeth, and the mouth breathing status are analyzed.

5.2. Appliance Preparation and Placement

1. An impression of the child's upper jaw is taken (classic impression or with a digital scanner).
2. A personalized palatal expander appliance is prepared in the laboratory.
3. The appliance is usually permanently cemented onto the upper back teeth (molars).
4. The child does not remove and insert it; it stays continuously in the mouth.

5.3. Screw Turning (Activation) Period

1. The doctor thoroughly shows the family and child how to turn the screw.
2. The screw is usually turned a very small amount once a day or once every two days (as planned by Dr. Begüm Ulaşan).
3. This process typically lasts around 2–4 weeks (varies according to the case's needs).

As the screw is turned:

1. The upper jaw halves gently move apart.
2. A very slight gap may appear in the middle of the palate (temporary).
3. A space may be visible between the front teeth.

This is not concerning; it is an expected part of the treatment.

5.4. Retention Period

Once the expansion is complete:

1. The appliance is not removed immediately.
2. It is typically kept in the mouth for several more months to allow the upper jaw's new width to become stable.

During this period:

1. Bone tissue matures in the new position.
2. The achieved width becomes permanent.

Afterward:

1. The appliance is removed.
2. If necessary, detailed alignment and bite correction are performed using classic braces or clear aligners.

6. What Does the Child Feel During This Process? Is It Painful?

Palatal expansion treatment:

1. Is not a surgical procedure (for classic RME in children).
2. Can be applied in a clinic setting without the need for local anesthesia.

Children's experience is usually as follows:

When the appliance is first placed:

1. Sensation of a "foreign object" in the mouth.
2. Speech being slightly affected for a short time.
3. The tongue's adjustment period to the new appliance.

On screw activation days:

1. Feeling of slight pressure / fullness in the upper jaw.
2. Mild throbbing in some children.
3. Need for soft foods in the first few days.

These sensations are often not at the level of unbearable pain; they are more often described as "the pressure felt when braces are placed."

Dr. Begüm Ulaşan at Milim Dental Bursa ensures that before starting treatment:

1. Both the child and the family are informed in detail about what to expect on which day.
2. This makes the process more predictable and less frightening.

7. Daily Life with a Palatal Expander Appliance: Diet, Speech, Cleaning

7.1. Diet

In the first few days:

1. It is necessary to avoid very hard or sticky foods.
2. Soft foods (soup, pasta, puree, yogurt) are more comfortable.

In the long run:

1. As the child adjusts to the appliance, they can consume most foods close to normal.
2. Very hard crusts, chewing gum, or Turkish delight are generally not recommended throughout orthodontic treatment anyway.

7.2. Speech

Speech may be slightly altered for the first 3–7 days; minor lisping may occur, especially with "s, z, sh" sounds.

The tongue adapts quickly to the appliance, and most children return to their normal speech flow within a week.

7.3. Cleaning

Since the palatal expander appliance is fixed:

1. Both the teeth and the appliance must be meticulously brushed with a toothbrush.
2. Water flossers or interdental brushes can be helpful.

The Milim Dental team facilitates this process for families in Bursa by providing step-by-step brushing instruction.

8. What Happens if Palatal Expansion Treatment is Not Done?

If palatal expansion is not performed in a child with upper jaw narrowness:

1. Teeth may become severely crowded, increasing the severity of malocclusion.
2. Lower teeth may pass outside the upper teeth in some areas (crossbite).
3. Jaw joint loading may increase.
4. Longer, more difficult, and sometimes extraction-based orthodontics may be necessary later.

Thus, palatal expansion is:

1. Not just for "aesthetics."
2. A critical investment for the long-term protection of jaw and dental health.

9. Palatal Expansion in Bursa: The Approach of Milim Dental and Dr. Begüm Ulaşan

When making the decision for palatal expansion at Milim Dental Bursa, orthodontic specialist Dr. Begüm Ulaşan:

1. Never relies solely on X-rays.
2. Evaluates factors such as the child's facial development, breathing pattern, speech, habits (thumb sucking, mouth breathing), and family history together.

The goal is:

1. Not just to "widen the narrow palate."
2. To reduce the child's future need for orthodontics.
3. To address the jaw-teeth-breathing triad together.

If your child exhibits symptoms such as:

1. A narrow smile.
2. Crossbite.
3. Crowding.
4. Mouth breathing.

You can schedule an orthodontic examination appointment with Dr. Begüm Ulaşan in Bursa to find out if palatal expansion is necessary, and if so, what the most appropriate timing would be.