Orthodontic problems in children are not limited to crooked teeth. Crowding, crossbites, a high or narrow palate, inadequate tongue space, and abnormal oral habits can be signs that the jaws and dental arches are not developing ideally.

At Amore Dentistry, pediatric orthodontic evaluations focus on craniofacial growth and development, not simply tooth alignment.The upper jaw, or maxilla, is particularly important because it forms the upper dental arch, supports the midface, and contributes anatomically to the floor and lateral walls of the nasal cavity. A narrow maxilla can therefore affect more than the position of the teeth.

Our approach to pediatric expansion has been heavily influenced by the work and teachings of Dr. Ben Miraglia and Dr. Kevin Boyd, particularly their emphasis on early recognition of maxillary underdevelopment, craniofacial growth, oral function, and breathing.

What Is Pediatric Expansion?

Maxillary expansion is an orthodontic/orthopedic treatment used to increase the transverse width of the upper arch when a child has maxillary constriction or another clinical indication for expansion.

During childhood, the craniofacial skeleton is still growing and the midpalatal suture has not reached the degree of maturation seen in adults. This allows us to take advantage of growth when orthopedic correction is indicated. Depending on the child's age, anatomy, dentition, and treatment objectives, expansion can be performed with different fixed or removable appliances.

Expansion may be considered in children with:

• Posterior crossbite

• Narrow maxillary arch

• High or vaulted palate

• Significant dental crowding

• Inadequate space for erupting permanent teeth

• Constricted smile or arch form

• Functional shifts of the jaw

• Limited tongue space

• Chronic mouth-breathing patterns

• Abnormal oral habits

• Relapse or developing malocclusion

 

Not every child with one of these findings requires expansion. Treatment is based on the complete clinical picture.

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Why Treat Before All of the Permanent Teeth Erupt?

This is the principle behind interceptive orthodontics.Instead of waiting for the permanent teeth to erupt into an already constricted arch and then attempting to straighten them, interceptive treatment addresses certain developing skeletal, dental, and functional problems while the child is actively growing.The goal is to improve the environment into which the permanent teeth will erupt.

 

Early treatment can be particularly important when we identify:

• Transverse maxillary deficiency

• Crossbite

• Significant loss of arch space

• Abnormal eruption patterns

• Functional jaw shifts

• Oral habits affecting development

• Significant discrepancies between the upper and lower arches

 

Expansion does not guarantee that a child will never require braces or clear aligners. Some children will still require a second orthodontic phase once the permanent teeth erupt. The difference is that the later orthodontic phase may be addressing tooth position within an arch that has already been appropriately developed. Jaw Development, the Tongue, and Oral Function. The tongue should normally have adequate space within the dental arches and rest against the palate during appropriate oral rest posture. A narrow or high palate can reduce the amount of available tongue space. For this reason, our examination does not stop at measuring the teeth.

 

We evaluate:

• Palatal width and shape

• Dental arch form

• Tongue posture

• Swallowing pattern

• Lip competence

• Nasal versus oral breathing

• Oral habits

• Frenum restrictions when relevant

• Occlusion

• Facial growth pattern

 

Expansion can create additional transverse space, but the function of the tongue, lips, and facial muscles also matters for long-term development and stability.Some children therefore benefit from co-management with a myofunctional therapist, ENT, pediatrician, allergist, sleep physician, or other healthcare provider.Expansion and Nasal BreathingThe relationship between maxillary development and the nasal cavity is anatomical.Because the palate forms the floor of the nasal cavity, researchers have studied whether maxillary expansion affects nasal dimensions and respiratory function.Systematic reviews of rapid maxillary expansion in children have reported increases in nasal and maxillary dimensions and short-term improvements in measures associated with mouth breathing. Other research has evaluated changes in airway dimensions and sleep-disordered breathing following expansion.These findings are important, but they need to be interpreted appropriately.Expansion is not a universal treatment for mouth breathing, snoring, or pediatric obstructive sleep apnea.A child can mouth breathe because of enlarged tonsils or adenoids, allergies, nasal obstruction, habit, abnormal oral function, craniofacial anatomy, or a combination of factors.Our responsibility as an airway-centered dental practice is to recognize these findings and determine when other specialists need to be involved.

Signs We Look For During a Pediatric Airway & Growth EvaluationParents may notice:

• Mouth breathing during the day or night

• Snoring

• Restless sleep

• Teeth grinding

• Sleeping with the mouth open

• Chronic nasal congestion

• Crowded teeth

• Crossbite

• A visibly narrow or high palate

• Forward-head posture

• Difficulty keeping the lips comfortably together

• Tongue thrust

• Speech concerns

• Dark circles under the eyes

• Behavioral or attention concerns associated with poor sleep

 

These findings do not independently diagnose an airway or sleep disorder, but they may indicate the need for further evaluation.

 

Our Diagnostic Process

 

A pediatric orthodontic evaluation may include:

• Dental and medical history

• Clinical examination

• Digital photographs

• Digital intraoral scan

• Evaluation of the bite

• Arch-width assessment

• Palatal evaluation

• Facial growth assessment

• Tongue and oral-function screening

• Breathing and sleep questionnaire

• Appropriate dental imaging

• CBCT imaging only when clinically indicated

 

We then determine whether treatment should begin now, whether another specialist should evaluate the child, or whether growth should simply be monitored.

 

Our Treatment Philosophy

Our goal is not to expand every child. Our goal is to identify children whose developing anatomy, occlusion, or oral function indicates that intervention during growth may be beneficial.When expansion is indicated, we use the child's remaining growth to address the underlying transverse problem rather than waiting until adulthood, when treatment options and skeletal response can be very different.

 

Research & Clinical Influences

Our pediatric airway and expansion philosophy incorporates the teachings of Dr. Ben Miraglia and Dr. Kevin Boyd as well as the growing body of orthodontic, pediatric dental, ENT, and sleep literature examining maxillary development, nasal breathing, and pediatric sleep-disordered breathing.

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Schedule a Pediatric Airway & Orthodontic Evaluation with Dr. Carlie Amore in St. Petersburg, Florida.