About Steven Litwin DDS Expertise I can answer all questions pertaining to dental health for all ages. Topics can include but not be limited to: TMD/migraines; Orthodontics, Implants, cosmetic procedures, crowns, veneers, periodontics (gum treatment), oral surgery, and other areas of interest/concern in the dental field.
Experience I am a practicing dentist in the Baltimore area and have been for over twenty years. I have treated thousands of patients over the years and continue to provide dental health care for them in all aspects of dentistry. I also include non invasive treatment for patients having been diagnosed with TMD and/or chronic headaches/migraines and have had great success without the use of medications.
Organizations Member of The Greater Baltimore Implant Study Club
Education/Credentials I graduated from Georgetown University Dental School in 1987 with a D.D.S. degree. I have completed countless continuing education programs throughout the years in all areas of dentistry.
Past/Present Clients I have patients that travel from out of state to have me provide for their care. Patients come from Pennsylvania, Florida, Delaware, and other areas in addition to the state of Maryland.
Question My family and I recently and somewhat unexpectedly moved to a
different state. We had begun treatment on our daughter with
an orthodontist who gave her a palate expander and braces. We
have consulted two orthodontists in our new town who both
recommend removing the expander and the old braces and extract
4 teeth then put on new braces. This all sounds unnecessary so
I have come up with a different idea. The old orthodontist
told us to turn the expander every night for the next 2 months
then we will leave it alone for 6 months like he said then get
our dentist to remove it. Does this sound like a good plan?
Answer Hi Edward,
The reason the palatal expander is used is because there is a narrow palate and a cross bite between the upper and lower back teeth. The primary reason to use a rapid palatal expander is to increase the width of the maxilla (meaning that if the roof of the mouth is very narrow and high then a cross bite is usually present as well). When the arch is expanded there is also some residual movement of the premaxilla (the area where the upper front teeth are) forward but not a huge amount. If there are teeth that are blocked out and not erupting i.e. bicuspids or cannines then the value of using of a rapid palatal expander to gain the necessary space is limited in that the space gained is in arch width and not length. Now this assumes that an accurate analysis has been completed with regard to the amount of crowding present. If there there is only slight crowding then some space will be gained by the expander use and extractions would not be indicated. If, however, there is a large amount of crowding where teeth are blocked out as I mentioned above then extractions can be indicated to gain the necessary space. The orthodontist should have done this evaluation/analysis to determine the amount of crowding. As a general rule of thumb if there is greater than 7mm of crowding then extractions are recommended. Edward, intuitively you would think why cant you just keep expanding the upper jaw wider and wider to make the room needed. Think about this, there is a biological limit to the amount of modification you can achieve. If the top jaw is overexpanded then the possibilities of other issues developing are high such as reverse crossbite (where the top back teeth actually are positioned wider than the bottom teeth and do not even meet, possible fracture of the maxilla, possible sinus involvement and other concerns. The bottom line is that what needs to happen is to first determine the amount of crowding present then base the best treatment options on this answer. My recommendation is not to keep turning the rapid palatal expander for such a long period of time (normal amount of active treatment with this appliance is about 2-3 weeks then its worn as a retainer for several months). I hope this helps and think if both of the orthodontists agree that extractions are indicated then I would feel comfortable with their recommendation based on what information you have provided to me.
