Your Child's Palatal Expander
A fixed expander gently widens the upper jaw while your child is still growing. You turn it once a night at home. Everything you need is on this page — start with the video.
Watch a turn being done end to end. It is the fastest way to feel confident before the first one at home.
The printed guide
The same two-page handout we give you at the chair — the full schedule, what is normal, and a box to tick off each night's turn.
How to turn it
One turn every night, at the same time — bedtime is best, because the pressure fades while your child sleeps. The screw has four holes; each turn brings a fresh one round to the front.
Key into the front hole
Have your child lie back with their head in your lap under a good light — a phone flashlight helps. Put the key straight into the hole you can see at the front, all the way until it stops.
Push toward the throat
Push until it will not go further and a new hole appears at the front. That is one turn. If no new hole shows, it did not finish — put the key back in and finish it.
Slide it out the front
Straight down and out toward the lips. Do not drag it back the way you pushed it — that can roll the screw backwards and undo the turn you just made.
Three rules that matter more than the rest
- Missed a night? Turn it the next night and carry on.
- Never double up to catch up. Expanding too fast is painful and can damage tissue.
- Stop at the number we gave you. It is set for your child's jaw, not from a chart. Do not keep going, and do not stop early.
What is normal, and what needs a phone call
- Pressure or a dull ache for an hour after a turn
- A gap opening between the two front teeth
- A lisp, extra saliva, and food collecting underneath
- A sore spot on the tongue in the first week
- Feeling the pressure up near the nose or eyes
- The screw will not turn, or spins with no resistance
- It feels loose, rocks or clicks, or a band came off
- Something is poking, or a sore is not healing
- Severe pain — not the familiar post-turn ache
The whole schedule
Only one stage is your job. Retention is by far the longest part, and it is the part that makes the width permanent.
- 1 Spacers About a week before, to open a hair of space for the bands.
- 2 Scan and fit Spacers out, impression or scan taken, appliance made to fit.
- 3 Delivery day Cemented in. We turn the screw three times before you leave.
- 4 48 hours No turning at all. Your child needs those two days to settle.
- 5 Your first turn A short visit — you do it here, with us watching.
- 6 Nightly turns One a night at home, for the number we write on your handout.
- 7 The hold 8 to 12 weeks with nothing to do, while new bone fills the seam.
- 8 TPA retention About 4 years. Nothing to turn, nothing for you to do.
Questions we get most
Does a palatal expander hurt?
Not the way a toothache does. Most children feel pressure behind the nose or between the eyes for about an hour after each turn, and it fades. The first night is the worst night. If your child is sensitive, ibuprofen an hour before the turn works better than anything given afterward.
Why has a gap opened between my child’s two front teeth?
That gap is the proof it is working. It means the expander is moving bone rather than just tipping teeth sideways. Do not stop turning. Over the following weeks the fibres between those teeth pull them back together and the gap closes on its own.
We missed a turn. What now?
Turn it the next night and carry on. Never double up to catch up — expanding too fast is painful and can damage tissue.
How long does the expander stay in?
The turning takes roughly two to three weeks. After the last turn the expander stays cemented in for another 8 to 12 weeks while the seam you opened fills in with real bone. That waiting phase feels like nothing is happening, and it is the most important part.
What is a TPA, and why does it stay in about four years?
A TPA, or transpalatal arch, is a thin wire across the palate between the upper molars that we place once the expander comes out. There is nothing to turn and nothing for you to do. An expanded jaw wants to relapse and that pull lasts years, not months — losing the TPA early is the main way this treatment fails.
When in doubt, call. We would rather hear from you.
This page supports, and does not replace, the instructions we give you at the chair. Where the two differ, follow what we told you in person.
Call (870) 741-4746