Other Appliances

RPE (Rapid Palatal Expander)

The Rapid Palatal Expander is an all metal appliance used to widen the upper jaw so that the bottom and upper teeth will fit together better. It is also used to help expand the upper arch to allow enough space for overcrowded permanent teeth to erupt. As the patient turns the expansion screw using the key, a space sometimes develops between the two front teeth . Some may notice a larger space while others do not notice a space at all. It usually takes several days to adjust to eating and speaking after receiving the rapid palatal expander. The RPE is most often followed by braces to straighten out all the teeth and to close the space that has been created (when the patient is developmental ready to start treatment.)



Headgear is often used to correct an excessive overbite. This is done by placing pressure against the upper teeth and jaw, which would hold the teeth in position or help move them into better positions. The severity of the problem determines the length of time headgear needs to be worn. Headgear typically needs to be worn approximately 12 to 22 hours to be truly effective in correcting the overbite, and usually anywhere from 6 to 18 months depending on the severity of the overbite and how much a patient is growing. The key to success with your headgear appliance is consistency. Headgear must be worn a certain number of hours per day, and if not, it must be made up the following day.

Headgear should never be worn while playing sports and should also be removed while eating or brushing your teeth.


Thumb Sucking / Tongue Thrust Appliance

Tongue thrust is one of several terms describing a swallowing pattern in which the individual pushes the tongue against or between the teeth. It also refers to inappropriate forward tongue placement at rest and/or during speech. Other names for the speech disorder include myofunctional disorder and orofacial-myology disorder.

This frontal positioning of the tongue may be seen at rest and/or during talking or swallowing. In other cases, the tongue may not be seen; however, the effects of the tongue pushing against the teeth may cause dental problems or jaw malformations.

In a person without a tongue thrust, typically the tongue tip rests lightly against the roof of the mouth, with the sides of the tongue touching the molars. When a swallow occurs, the tongue pushes up and back to clear the saliva. Any deviation from this pattern may indicate a tongue thrust.

In some cases, a tongue thrust may coincide with an open bite (a space between the top and bottom front teeth.) Some parents will identify this as a “binky hole” in toddlers or preschoolers. If this pattern is still present after a child stops using a pacifier or sucking the thumb, tongue thrust therapy is warranted, and a consultation with an orthodontist is recommended.

In other cases, a child may also have an articulation disorder. These children will often have difficulty producing certain sounds such as S, Z, SH, CH, and sometimes the F and V. Sometimes the child also produces L, D, T, and N using the tongue tip and teeth, rather than the tongue tip and the roof of the mouth.

Lastly, some children may not demonstrate any articulation or dental problems but the presence of a tongue thrust is noticeable, particularly during eating and drinking, and the child may feel self-conscious. Parents often describe the child as a “messy” or “sloppy” eater because food and drink leak through the lips during mealtimes.


  • Some experts point to thumb sucking or pacifier use if it continues after the age of two years.
  • Others note allergies and enlarged tonsils/adenoids as a cause. In this type of case, children (and adults) often keep their tongue forward in order to maintain a clear airway for breathing, and will breathe through the mouth when not speaking rather than through the nose. A child who does this will usually sleep with the mouth open and may snore while sleeping.
  • Still others point to poor oral muscle control. When this is the case, it appears that the tongue is too large to fit in the space inside of the teeth. Improving muscle tone through oral-motor exercises in a tongue thrust therapy program can help the tongue to fit in the mouth better. This is seen in some children who are otherwise typically developing, and in children with other disabilities in which low muscle tone is present.



A set of three clear retainers that allows Dr. Firth to minutely move teeth that have a slight misalignment. Also known as ABC Aligners. Each tray is worn for three weeks with an office visit in between to monitor re-alignment.


CS-2000 Forced Springs

Your child just will not wear his/her rubber bands for their bite correction and their treatment time length is way past its time! With Dr. Firth’s diagnosis and recommendation one of our trained orthodontic assistants and Dr. Firth will place permanent coil springs onto the braces that currently exist. They are like permanent rubber bands. We use the newest addition to the Series 2000® appliances, which is the CS 2000®, for superior fixed Class II and III correction.

(Shown as CLII)

(Shown as CLIII)


Separators (Spacers)

When you get braces, the first thing we do is place orthodontic separators. In order to put on orthodontic bands you have to slip them over the teeth like putting a ring on your finger. Teeth are usually tight (it's pretty hard to floss back there isn't it)? So, separators are these little things that are placed between the back teeth to gently move them apart just a little so the bands will fit on easily at your next appointment. In the old days these were metal and used on every tooth because they had to band every tooth. Mostly, however, we use "spacers" that are like little rubber bands. The teeth will move apart slowly just a little. It feels like a little piece of food between the teeth. Some patient's teeth get a little sore, but it's not bad. Sometimes after the teeth move, the spacers fall out. Call our office to see if you need them replaced prior to your next appointment.