Appliances

Information About Upper Expanders

An expander is used to widen the top jaw creating a larger bone to accommodate all the permanent teeth when they erupt and to minimize future crowding. This type of change is an orthopedic boney change, and will remain permanently once we achieve the necessary amount of expansion.

There are several designs for these expanders, but all have a center screw that must be turned with a key. The screw is usually turned for 7-20 days.

The expander is “activated” by placing the key into the key hole in the center screw and then gently pushing the key toward the back of the mouth, towards the throat one notch. Sometimes activating the expander causes some slight discomfort. If needed, taking Advil or Motrin assists with any discomfort. There should not be any pain or bleeding. If this does occur, please contact our office immediately.

After the turning has begun, the front teeth will begin to separate. This is a good sign the appliance is working properly. After we have achieved the required expansion, the patient will continue to wear the appliance. This allows the newly created bone time to fill in and insures there will not be any relapse.

THE HERBST FACT SHEET

The Herbst consists of four stainless steel molar bands that fit like rings around your back molar teeth-one in each corner of your mouth. Attached to the upper molar bands are two metal cylinders or sleeves. Attached to the lower molar bands are two metal bars running parallel to your lower back teeth, and two metal rods or arms that slide into the sleeves hanging down from the upper molar bands. Your appliance may also have an upper expander with a screw located in the middle of your palate.

HOW DOES IT WORK?

The appliance works by using the metal sleeves and rods to hold your lower jaw forward to correct your overbite. In the next few months, your lower jaw will grow into this new correct position, and your overbite will disappear! It takes about 9 to12 months for this magic to occur. The expansion screws are used to make room for crowded teeth by making the dental arch wider and will help with the bite correction we are doing for you.

THINGS THAT RUB?

The lower bar will sometimes irritate the cheek or lip in the lower front corner of your mouth. Place wax there to cushion the area for the first 1 to 2 days. The metal attachments on the outside of the upper stainless steel molar bands can sometimes rub the cheek in the back of your mouth. Try to keep some wax on these areas, especially the first 1-3 nights. The expansion screw may irritate your tongue at first. Be careful not to rub your tongue against it constantly-this will only keep your tongue upset.

SAY WHAT?

You may talk funny with the herbst at first. Reading aloud or spending a lot of time on the phone will solve this problem. You will soon get used to it and your normal speech will soon return.

DROOLING AND OTHER MINOR DISCOMFORTS

Swallowing may seem difficult at first, but it gets better. Do keep swallowing-it is the best cure for the initial drooling response, which will decrease after about 24hrs. Your gum tissue around the molar bands may be sensitive during the first day. Warm salt water (8oz water +1/2 tsp. Salt) rinses help this tremendously. Your teeth or jaws may become sore when you turn your expansion screw. For this soreness, or just general discomfort when getting adjusted to your new Herbst, take the appropriate dosage of Advil, Tylenol, etc.

AS THE SCREW TURNS

Not everyone needs expansion with the Herbst; please follow the specific instructions we give you for the expander.

TROUBLE SHOOTING

Occasionally the Herbst will come apart when the lower rod comes out of the upper sleeve-especially when you yawn too wide or when you are trying to show your friends how wide you can open your mouth! Avoid these two activities. Usually, you can reassemble the two pieces following the instructions given to you by Dr. Ibrahim.

A LAST WORD FOR PARENTS

The Herbst appliance has worked miracles for hundreds of children in our office. Keep this fact sheet in mind during the first week of treatment! Your child will eventually accept this mechanical distraction, and things will return to normal again. Call us anytime if you have a question, problem or concern. Your partnership is invaluable to us and your child. If you have any questions regarding your appliance or treatment, do not hesitate to ask.

Face Mask Therapy with Upper Exapnder

• Mark all turns on your calendar so you can report to us how many turns were made and when thery were made.
• Remember to turn the key all the way until it stops.
• Please wear the mask 12-14 hours per day.

• Turn the expander ___ days, then stop.
• 1) Turn the expander once (standard turn)
  2) Skip one day
  3) Reverse Turn (turn from the back towards the front upper teeth)
  4) Repeat steps 1-3 until next visit
• 1st month Elastic size ___ oz (lion)
• 2nd month Elastic size ___ oz (whale)

Information about Face Mask Therapy

Today you are getting your face mask. This appliance is designed to help develop the upper jaw bone and correct a midface deficiency (underdeveloped upper jaw as compared with the lower jaw).

The face mask will be used in conjunction with your upper expander. Hooks are placed on the upper expander and rubber bands are placed on the upper expander hooks and attached to the face mask. The effect of the traction from the rubber bands will stimulate (encourage) forward and downward growth of the upper jaw.

****You will be given different sizes of rubber bands to wear during the progress of treatment. It is important to wear the correct rubber bands for the prescribed period of time

If worn properly. face mask therapy can be extremely effective. It must be worn for at least 12-14 hours a day. Wearing a face mask may not be fun, but it may minimize the need for future jaw surgery. Parents and patients must understand that this may be the last viable option before surgery. I strongly encourage you to cooperate and wear your mask as directed.