hey it's dr amanda with straight smash solutions straightsmastersolutions.com and today we're
going to talk a little bit more about turn frequency in expanders be it a fixed rpe
a hyrax schwartz whatever type of palatal expander you want to use and uh maxillary mandibular
whatever mandibular of course is not a palatal expander it's just a expansion device because
there's no suture but we're not going to get into the weeds too much with all that if you want to
go back to the very very basics on how it works whether you need a top a bottom a top and a bottom
et cetera et cetera et cetera design you should definitely check out my entire playlist on phase
one interceptive appliances i have over a hundred and something videos everything you need to know
is in there to find that just go to your youtube channel put in the search bar at the top straight
smile solutions from there it's going to take you to my youtube channel which has a green banner
from there you scroll down until you find the playlist it's i don't know where it is right
now it's somewhere scroll down on the front page and you will see one that says like phase one
interceptive airway it's all the little kids stuff omt habits click on that playlist and just scroll
through the ones that sound interesting to you or you can search within the playlist for rpe anyways
today we're going to specifically talk about rapid versus slow and the benefits risks things
like that so way back when when i was practicing full-time in ortho i always did a rapid but i
stopped doing rapid sometime in there because i saw a lot of weird things happen and i felt like
the how do i say this without offending people the demographics that i was working with
often english wasn't the first language and even though we get things translated weird things would
you know understanding maybe wasn't happening fully um as well as sometimes weird things
would happen like a parent would punish the kid by overturning so it made me really really nervous so
i started doing slower expansion plus it allowed me to keep the same instructions for a removable
versus a fixed because i don't do rapid expansion in a shorts i only do wrap it in a fixed
banded appliance so that way my assistants had a consistent instructions consistent handout front
desk had consistent instructions we always do it this way this is the way we do it
less side effects fewer side effects also the other benefit was
um you wouldn't get that giant gap between the front teeth which patients hate and often when
you're doing phase one or interceptive expansion not comprehensive with braces
you may not even be putting on braces you might not be doing phase one aligners you might just be
widening the arch and if you go nice and slow and the frequency i'm not going to get into because i
have other videos on that you know when to do what which direction to do it um then you wouldn't get
that giant gap which is so not aesthetic you know it just was really gradual and slowly the teeth
would just start to align on their own because they had more space and more freedom to move and
it's just real gentle not as much discomfort and i think for me also the second thing that
happened when my daughter was about eight we did expansion on her schwartz is like this um
i started on rapid and the amount of discomfort she had was really high it was after doing it for
so many years as an orthodontist and not realizing what it was like as a parent i really changed the
ways i changed the ways i did things and yes it maybe takes three months instead of two weeks
but less discomfort less side effects doesn't look as ugly and less risk because what are
the risks well sometimes first of all if the patient is wearing inconsistently
you're not going to get splitting of the suture so i'd rather find that out you know before we
tip the teeth and blow them through the bone which is what can basically happen i can tell
you know when the patient comes in if they weren't wearing it consistently and i don't want to get to
the point where i've no return where i've damaged the roots and teeth so at least they come back in
four weeks i know you know secondly we don't have the ugly gap third we don't have all the pain and
the drama at home it's just for me it works better so that's the way i do things um like i said the
frequency is going to change it might change every month so we have a we start off with either two
turns at the top one turn on the bottom two turns on the top two turns on the bottom or one and one
depending on the age the pubertal growth spurt and i have tons of videos on how to choose that
and then when the patient comes in we reassess we might change it up you know so patient has to come
in the other suggestion i have for you whenever you're doing expanders you know is to make sure
your office knows that if it first of all no expander patients walk out without an
appointment everyone has an appointment in three to four weeks everyone does okay not an option and
if they cancel an expander appointment oh you're following up you're following up
you cannot ghost your patient you cannot lose your patient because weird weird scary things
can happen if you lose that patient and they keep turning okay so you need to train your staff and
also perhaps have a list run a report i don't care how you want to do it in the back office
but if someone doesn't come back in like even i've even had up like a notebook in the back
office with you know names or initials in the date we put the expander and if they don't follow up
that's a problem we need to go knock on their door send them letters 55 phone calls 55 emails 55
texts you need to come in you need to come in you need to come in because we're literally breaking
your jaw we have to see you i can't tell you how much scary stuff i've seen happen with expanders
and i don't want to freak you out because most of this happened either because the frequency
was wrong they overcranked it they didn't wear it consistently and tried to shove it in or they kept
turning when they weren't supposed to and didn't come in for follow-ups and these were not my
not my patients not my patients there were other doctors patients and i either subbed
in their office or i filled in or they were train wrecks and like uh you know they got sent to me
because i knew how to handle it you know how to fix it i was a fixer but i've seen scary stuff
happen so you as the doctor and as the staff need to be responsible to make sure your expander
patient does not ghost you okay when you deliver the expander it's kind of like placing a bonded
retainer you're married to that patient now i don't care if it's fixed or removable you need
to make sure they come in in a month i don't care if your power went out if there's covid you can do
a virtual appointment you are responsible make sure they come in and i can't say that enough
so anyways yes i might do things differently than other orthodontists but there's a reason for it
also because i work primarily with general and pediatric dentists i'm orthos for sure
um who are new at this and let's do it a little bit more gradually so there's less
drama in your office and less emergencies that's the ultimate you know thing so
anyways hopefully that was helpful give you some tips and tricks expanders should not be scary
but you know you should definitely be doing them for sure alright thanks so much