Short answer. To turn a palate expander, lay your child back, place the key in the hole at the front of the center screw, and push the key toward the back of the mouth in one steady motion until it stops and a new hole appears at the front. Then take the key out by pulling it backward and down, so the turn is not undone. Turn only as often as your orthodontist prescribed. Each turn opens the screw about a quarter of a millimeter.
By Rodrigo F. Viecilli, DDS, PhD, board-certified orthodontist at Limestone Hills Orthodontics in Austin, TX, where expanders are used in children and bone-anchored expanders in teens and adults.
Before you start
- The key. It comes with a handle or a safety cord. Hold the handle or loop the cord around a finger so the key cannot be dropped into the throat.
- Light. A phone flashlight or a headlamp works best.
- Position. Have your child lie on a bed or sofa with the head tilted back and the mouth wide open.
- The schedule. Know how many turns a day were prescribed and for how many days. Keep the turn chart next to the toothbrush.
How to turn the expander: seven steps
- Find the hole. Look at the screw in the middle of the expander. A small hole faces the front of the mouth.
- Seat the key. Push the tip of the key into the hole until it is fully in. A key that is only halfway in can slip.
- Push toward the throat. Move the key from the front of the mouth toward the back in one slow, steady sweep. The screw rotates as you push.
- Go all the way. Keep pushing until the key stops against the back of the expander. A turn that stops short hides the next hole.
- Check for the new hole. With the key still in, you should see the next hole appear at the front.
- Remove the key backward. Pull the key down and toward the throat to slide it out. Pulling it forward can rotate the screw back and undo the turn.
- Mark the chart. Record the turn so nobody repeats or skips one.
The whole thing takes about ten seconds once you have done it twice.
How often and for how long
Follow the schedule your orthodontist gave you, because schedules differ. Some call for one turn a day and some for two. At Limestone Hills the usual protocol for children is two turns a day, morning and evening, for 10 to 14 days. Each turn opens the screw 0.25 millimeters, so the active phase adds up to several millimeters of width.
After the last turn the expander is not removed. It stays in place for 3 to 6 months without any more turning while new bone fills in the widened seam in the roof of the mouth. Taking it out early lets the width close back.
What your child will feel
- Pressure, not sharp pain, across the roof of the mouth, the cheeks or the bridge of the nose. It usually fades within minutes.
- A gap between the two upper front teeth. This is the sign that the expander is working. It closes again by itself or with braces.
- Extra saliva and a lisp for the first few days.
- Food catching under the expander. A water flosser or a vigorous rinse clears it.
Turning at bedtime, after brushing, lets the pressure pass during sleep. An over-the-counter pain reliever such as acetaminophen, given as the label directs, is enough on the rare day it is needed.
Troubleshooting
| Problem | What to do |
|---|---|
| You cannot see a hole | The last turn was not completed. Look from below with a light, find the hole partway back, seat the key and finish the turn |
| The key will not go in | Food is usually blocking the hole. Brush and rinse, then try again |
| You missed a turn | Do not double up. Do the next turn at its normal time and tell the office how many were missed |
| You turned an extra time | Do not turn it back. Do no more turns that day and call the office |
| The key came out before the turn was complete | Put it back in the same hole and finish the push |
| The expander feels loose or rocks | Stop turning and call the office |
| Pain that does not fade, or a sore on the roof of the mouth | Stop turning and call the office |
When to stop turning
Stop when you reach the number of turns you were given, or when your orthodontist tells you to at a check visit. Do not add turns because the gap looks small or the bite looks unfinished. The amount of expansion was calculated from measurements, and overexpansion is harder to fix than underexpansion.
Keeping an expander clean
Brush the expander itself along with the teeth, aim a water flosser under it once a day, and avoid sticky and chewy foods, which wrap around the screw. The chart in foods to avoid with braces applies to expanders too.
Teens and adults: bone-anchored expanders
In older teens and adults the seam in the palate is harder to open, so the expander is anchored to the bone with small screws. These appliances, called MARPE or MSE, are also turned at home, with a different key and on a schedule set for each patient. See MARPE at Limestone Hills. For whether a child needs an expander at all, see does my child need a palatal expander and the palatal expander page.
Common questions about turning an expander
How many times do you turn a palate expander?
As many as your orthodontist prescribed. Common schedules are one or two turns a day for two to four weeks. At Limestone Hills children usually turn twice a day for 10 to 14 days.
Does turning an expander hurt?
Most children feel pressure for a few minutes, not pain. The first few turns are the most noticeable. Turning at bedtime helps.
What happens if you miss a turn on your expander?
Nothing harmful. Continue with the next scheduled turn and do not double up to catch up. Let the office know, because missed turns lengthen the active phase by the same number of days.
Is a gap between the front teeth normal with an expander?
Yes. A gap between the two upper front teeth shows that the two halves of the upper jaw are separating as planned. It usually closes on its own within a few months or is closed with braces.
How long does an expander stay in after the last turn?
Usually 3 to 6 months. The expander holds the new width while bone fills in. It is not turned during that time.
Limestone Hills Orthodontics is on RM 2222 in Northwest Austin. Patients with an expander question between visits can call (512) 720-6399. New patients can book a free orthodontic consultation.
Sources. American Association of Orthodontists, patient information on palatal expanders (aaoinfo.org). Activation protocol and retention period from Limestone Hills Orthodontics, Austin, TX.
