Trying to figure out all the orthodontic routes you can take with your child can be overwhelming. However, if you start educating yourself early on, you can be better prepared to make informed choices. One aspect of interceptive orthodontics is using a palatal expander — an appliance that widens the lower jaw. Here are just a few questions you might have about this device.

When would your child need an expanding appliance?

Only your orthodontist can tell you if your child needs an expander, but there are two typical candidates:

• Those with narrow mandibles (upper jaws) from behavioral problems, like thumb sucking, mouth breathing, or tongue thrusting
• Those with lingual crossbites, a malocclusion where the upper teeth are either to close to the tongue

If a child's issue isn't severe, would they still need a palatal expander?

Again, your orthodontist can consult with you on this question. However, it's best to weigh the pros and cons if your child could go either way. For instance, palatal expanders can be a good route if your child has allergies or sleep apnea. By expanding the palate, your child's nasal breathing will improve.

Palatal expanders can be fantastic for young children who are still growing; they could possibly avoid extensive orthodontics, tooth extractions, or even surgery later on.

However, expanders are a commitment — not just for the child but the parent as well. For instance, expanders have a mechanism where you will be required to use a swivel key to expand the jaw. It can be difficult for children to do this themselves, so you or another parent must stay on top of this procedure or the appliance won't work.

Like any orthodontic appliance, it can be difficult to clean and make your child sore as structural changes happen. If there are easier methods of fixing your child's issues, your dentist may recommend another treatment route.

If you choose a palatal expander for your child, which type do you need?

The type of device is largely dependent on what the orthodontist is familiar with and what he or she has had the most success with. There are many palatal expanders to choose from, but they all fall into roughly two categories: tooth- and tissue-anchored expanders.

Tooth-Anchored Expanders

These appliances are placed on the first molars and are mainly made of stainless steel. The great benefit of these devices is that they are smaller, so your child won't feel like there is much of an obstruction on their palate. The downside is that these expanders can sometimes cause crown tipping, where the top of a tooth moves, but the root doesn't. To avoid this problem, the dentist can also band the expander to more than just the first molars.

Tissue-Anchored Expanders

This expander is great since there is pure skeletal expansion without the risk of crown tipping. These expanders are often made of a mix of acrylic and metal; they tend to look more like retainers. The downside of tissue-anchored expanders is that they can cause irritation to the upper palate and be difficult to clean. If your child has a bad gag reflex, then tooth-anchored ones may be better.

Contact a local orthodontist, such as Dr. Peggy Alvarez-Penabad, for more information on expanders and other treatments.