Palatal Expansion: Benefits and Treatment Options for Adults and Children
Palatal expansion is a treatment used to widen the upper jaw (maxilla) by gradually separating the mid-palatal suture. This allows for better alignment of the teeth, improved breathing through the nose, and better tongue posture. While it's commonly used in children, new technology and protocols have made adult palatal expansion possible—with life-changing results.
Why Widen the Palate?
A narrow palate doesn't just cause dental crowding—it often contributes to a cascade of health issues:
- Mouth breathing and nasal obstruction
- Poor sleep quality and snoring
- Sleep apnea and UARS
- Facial imbalance and asymmetry
- Crowded teeth requiring extractions
- Poor tongue posture affecting swallowing and speech
Widening the palate addresses the root cause of these problems rather than just treating symptoms.
Benefits of Palatal Expansion
Improved Nasal Breathing
Expanding the upper jaw also expands the nasal floor, increasing airflow and reducing nasal resistance. Many patients report being able to breathe through their nose easily for the first time.
Better Sleep and Airway Function
By creating more room for the tongue and improving airflow, palatal expansion can help reduce symptoms of UARS and mild to moderate obstructive sleep apnea.
Facial Development and Aesthetics
In children, palatal expansion can improve midface growth and prevent narrow, elongated facial features. In adults, it can improve cheek support, facial symmetry, and smile width.
Dental and Orthodontic Benefits
Expansion creates space in the dental arch, often reducing or eliminating the need for tooth extractions. It also helps align the bite properly and creates room for crowded teeth.
Tongue Posture and Oral Function
A wider palate supports better tongue posture, which in turn supports healthy swallowing, speech, and facial muscle tone. Proper tongue position also helps maintain the expansion results.
Jaw Pain Relief
Proper palatal expansion can help reduce TMJ symptoms by improving jaw alignment and reducing stress on the jaw joints.
Palatal Expansion: Children vs. Adults
| Aspect | Children | Adults |
|---|---|---|
| Suture Status | Open and flexible | Fused (interdigitated) |
| Device Used | RPE, Hyrax, ALF | MSE, MARPE, FME, SARPE |
| Anchoring | Teeth only | Bone-anchored (TADs) |
| Timeline | 3-6 months total | 6-12+ months total |
| Primary Goals | Guide growth | Correct structural issues |
| Surgery Required? | No | Sometimes (SARPE/DOME) |
| Discomfort Level | Minimal | Moderate |
Is Adult Palatal Expansion Really Possible?
Yes! With the advent of bone-anchored devices, adults can now achieve true skeletal expansion that was previously only possible in children.
How It Works in Adults
In adults, the mid-palatal suture is fused. Bone-anchored expanders use TADs (Temporary Anchorage Devices) screwed directly into the palatal bone to apply enough force to split this suture and widen the maxilla.
Device Options for Adults
- MSE (Maxillary Skeletal Expander): 4 TADs with molar attachments, most widely used
- MARPE (Miniscrew-Assisted RPE): Hybrid approach with TADs and tooth support
- FME (Facegenics Midface Expander): 6-10 TADs, purely bone-borne, newer design
- SARPE/DOME/EASE: Surgically-assisted expansion for difficult cases
Critical Success Factors
- Work with a trained airway orthodontist experienced in adult expansion
- Proper case selection and imaging
- Correct device placement and activation protocol
- Post-expansion retention and stability measures
- Myofunctional therapy support
Expansion Devices Explained
For Children: Traditional RPE
The Rapid Palatal Expander attaches to molars with bands. Parents turn a small screw daily to gradually widen the palate. Because children's sutures are still flexible, this tooth-borne approach works well.
For Adults: Bone-Anchored Expanders
MSE (Maxillary Skeletal Expander)
- 4 TADs placed in the palate
- Connected to a jackscrew mechanism
- Also attaches to molars for additional support
- Most research and track record available
- Expansion of 4-8mm possible
FME (Facegenics Midface Expander)
- 6-10 TADs for maximum bone anchorage
- Purely bone-borne (no tooth attachment)
- Custom-designed for each patient
- Newer technology with promising early results
- May allow for greater expansion in some cases
SARPE (Surgically-Assisted Rapid Palatal Expansion)
- Surgical cuts made to release the maxillary sutures
- Followed by traditional RPE activation
- For patients with completely fused sutures
- More invasive but highly predictable
- Sometimes combined with other procedures
Conditions That May Improve with Palatal Expansion
- Chronic mouth breathing
- Nasal congestion and obstruction
- Snoring and mild-moderate sleep apnea
- High-arched, narrow palate
- Dental crowding
- Recessed midface
- Narrow smile
- Facial asymmetry
- Poor tongue posture
- Swallowing dysfunction
- Speech issues related to palate shape
- TMJ pain and tension
- Chronic headaches related to jaw position
Treatment Timeline
Children
| Phase | Duration |
|---|---|
| Active expansion | 2-4 weeks |
| Retention in device | 3-6 months |
| Follow-up retention | 6-12 months |
| Total | 9-18 months |
Adults
| Phase | Duration |
|---|---|
| Pre-treatment planning | 1-2 months |
| Active expansion | 1-3 months |
| Retention in device | 6-12 months |
| Post-expansion orthodontics | 6-18 months |
| Total | 14-36 months |
What to Expect During Treatment
Initial Placement
- Local anesthesia for TAD placement (adults)
- Some pressure but minimal pain
- Device fitted and activated
- Instructions for home care and activation
During Active Expansion
- Daily or twice-daily turns of the expansion screw
- Pressure sensation in palate, nose, and sometimes between eyes
- Gap between front teeth (diastema) is normal and expected
- Improved nasal breathing often noticed quickly
- Regular check-up appointments
Retention Phase
- No more active turning
- Device remains in place while bone fills in
- Gap between front teeth closes naturally or with orthodontics
- Monitoring for stability
Frequently Asked Questions
Does palatal expansion hurt?
Most people report pressure but not sharp pain. Children typically adjust within days. Adults may experience discomfort for a few days after each activation, especially in the first few weeks.
Is surgery required for adults?
Not always. Devices like MSE and FME can provide non-surgical expansion in many adult cases. In more complex cases with completely fused sutures, SARPE may be recommended.
Can expansion change my face?
Yes. In both adults and children, expansion can enhance facial symmetry, widen the smile, support the cheeks, and improve overall facial balance. Changes are typically subtle but noticeable.
Will I have a gap in my front teeth?
Yes, temporarily. A gap (diastema) between the front teeth is actually a sign that true skeletal expansion is occurring. This gap closes naturally over time or with orthodontic treatment.
Is it permanent?
With proper retention and follow-up care, results can be long-lasting. Myofunctional therapy and good oral posture habits help maintain the expansion.
How much does palatal expansion cost?
- Children (RPE): $1,500 - $3,500
- Adults (MSE/MARPE): $4,000 - $8,000
- Adults (FME): $5,000 - $10,000
- SARPE: $8,000 - $15,000
Costs vary by location, provider, and case complexity.
Finding the Right Provider
Not all orthodontists are trained in adult expansion or airway-focused treatment. Look for:
- Specific experience with MSE, FME, or MARPE in adults
- Understanding of airway and breathing issues
- Before/after cases with documented results
- Comprehensive evaluation including 3D imaging
- Willingness to coordinate with other specialists
Conclusion
Palatal expansion isn't just for crowded teeth—it's a foundational treatment that can impact breathing, posture, sleep, and appearance. Whether you're a parent considering early intervention for your child or an adult seeking answers for symptoms that have plagued you for years, expansion might be the missing piece.
The key is finding an experienced provider who understands not just the mechanics of expansion, but its broader impact on airway health, facial development, and quality of life. With the right approach, palatal expansion can be truly life-changing at any age.
