High palate and spacing problems

My two-year-old son has a high palate. I've been told that my son may need spacers put in at a later time to make room for his permanent teeth. We have not yet gone to the dentist, and I know we should soon. However, I just wanted to know what your experiences are with a high palate in a toddler. Are spacers very painful? How long would he need them for? At what age should we begin to worry about this?

Question:

Palatal development in the fetus begins at about six weeks in utero. The shelves of the palate are derived from outgrowths of the maxilla (upper "jaw" bone forming the midfacial region). These outgrowths proceed toward the midline of the future palatal area at about 8 weeks. When the shelves first start to develop, they are in a vertical position with the tongue underneath them. Once the tongue shifts downward as a result of mandibular (lower jaw bone) growth, the palatal shelves move horizontally and eventually fuse together. Some people have high palates as a result of interference from the position of the tongue during development.

Spacing problems with your son's teeth due to the high palate may appear as a unilateral or bilateral crossbite. In other words, your son's lower teeth would overlap the upper teeth on one or both sides of his mouth. The "normal" jaw and tooth position occurs when the upper teeth slightly overlap the lower teeth. In addition, crowding of the upper teeth may be noted. If a bilateral crossbite is present, palatal expansion would be needed. This involves placement of either a fixed or removable appliance which contains a jackscrew. The jackscrew is not as tortuous as the name suggests! The screw can be turned one quarter turn twice daily to open the palatal suture (where the right and left palatal plates join). This should be continued until the crossbite is resolved, usually in about one to three weeks. After the expansion phase, a period of retention is necessary to allow bone growth to occur. The initial retention phase should last at least 3 months. Once the initial retention phase is complete, a retainer should be worn for one to two years to counteract additional relapse forces. Patients have indicated that palatal expansion is an easy and fairly comfortable process.

Various studies and texts are not completely clear as to when palatal expansion should be done. Most experts agree that for the most stable results, it should be done before or during puberty. Because other orthodontic treatments may be needed to finalize tooth positions after the palatal expansion, it is suggested that the palatal expansion phase take place about nine to eleven years old. This is known as the late mixed dentition stage, when the child still has some primary teeth (molars and cuspids) which will be lost soon. The exception to this suggestion is if the bilateral crossbite is associated with a shift in the lower jaw caused by an interference between the upper and lower teeth. In this case, earlier treatment is recommended.

I suggest that you take your son to the dentist for an exam soon. At this point, his development should be monitored for possible future orthodontics. He may need no orthodontic treatment, early intervention at about six or seven years old, or treatment closer to ten to eleven years old. Careful advanced planning will ensure the correct treatment for your son.

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