About the TPA Appliance

by ArchWired.com Readers Macy in New Hampshire and Stacy in Ohio




The TPA (Trans-Palatal Arch) is a thin wire that goes across the roof of the mouth from first molar to first molar. Most people get a TPA to maintain arch width and aid in molar movement that wires alone can't achieve. In my case, the orthodontist was using the TPA to maintain the width between my first molars and use the immobilized first molars to pull my displaced bicuspid back into line (think of a lever).

The day I got my braces on, the assistant took an impression of my upper arch before the wires were put on. I noticed I had lingual tubes on my first molar bands that would eventually be used to seat the TPA. There are some who have the arch bonded directly to the bands.







At my first adjustment, the TPA was sitting in a ceramic mold of my teeth. It looked like someone got bored and started bending one of those heavy gauge paper clips. The orthodontist came over and snapped the ends of the device through the lingual tubes and the assistant used metal ties to secure the arch into place. I was given a slip of paper that instructed me to rinse with salt water if I was in pain and warned me not to play with it because it would only make the soreness wore. I was also told to make sure I chopped long stringy foods (even pasta) into bite sized pieces because trying to unwind something that is wrapped in the roof of your mouth is not attractive or easy. The orthodontist also told me to make sure I brushed my tongue regularly as that is what would help keep my arch clean and odor free.

At first, trying to talk was difficult because this thing was stopping my tongue from hitting the roof of my mouth. The worst for me was probably the "K" sound. However, talking was the least of my problems because the wire presses on your tongue and eventually makes a running U impression (always a hit to show off at family gatherings). The constant pressure caused my tongue to be very sore and swollen. The feeling is like a bad burn. Too bad most numbing gels aren't very tasty because that seemed to be the only thing that gave me some relief while my tongue adjusted to this torture the orthodontist's office put me through.

After a couple weeks the pain went away and I found that no one but me noticed the slight slur of certain sounds. Then, two weeks before my next adjustment, the soreness came back again and I noticed the arch had changed positions just enough to make an impression in a slightly different spot. After that bout of pain went away, it was smooth sailing from there.

Eventually, I did play with it a little just because it was there. I would push on the U portion of the arch with my tongue just to feel the slight pressure on my molars. When I was in the musical mood, I would run my tongue across it just to hear the dull twang.

Sometimes food would get stuck between the arch and the roof of my mouth, especially the sides (thank heaven for proxy brushes). If I wasn't careful, food would also get caught up under the arch and just hang down the back of my throat that lead me to feel like I could choke at any minute.

After four months, the orthodontist hinted that my arch might come out at the next visit if everything looked good. At my next visit, she changed her mind and nothing was mentioned about removing it until I had been wearing the TPA for eight months. I went in for an adjustment the Tuesday before Thanksgiving and the orthodontist looked at my bite up, down, and all around and asked if I would like an early Christmas present. She clipped the wire ties and with a yank on both sides, removed the arch and put it in an envelope for me to keep as a memento of my ordeal.

This is probably one of the few cases where the orthodontist did understand about what I was going through because she had a TPA as an adult as well.

Thank you, Macy, for this excellent essay!


Stacy adds...

I am 33 yrs old, married 13 years. My son, Matthew,12 years old, encouraged me to get braces with him. My other son will also be getting them soon. I work at a bank, so I deal with public with this expander.  I am coping well. Nobody can see the expander in my mouth, but they can see the bands around two of my teeth. 

Getting the TPA in does not hurt. I expanded for 2 weeks everyday. The first few times (3) it was very tight and a bit uncomfortable after about an hour. After taking Tylenol I was fine.

My tongue was very sore for a few weeks. Food gets caught between the expander and the roof of my mouth. So I would take my tongue to try and get it out. Just having the expander in the roof of your mouth is not easy because that is where your tongue belongs when you speak.

My speech --  well it's been 10 weeks and it still sounds slurred and I can't get my "S" out very well. I can barely say my first name. I have to speak slowly and softly.

And my mouth is very juicy. Its hard to dry your mouth out. The expander keeps everything all wet. I drool so bad at night I have to keep a towel on my pillow. It's gross.

Eating is difficult because of the food catching up inside the expander. I have to rinse a lot while eating. I cover my mouth to chew because it's very difficult and uncomfortable to chew and swallow. I eat very small bites of anything.

The worst part of the expander is my speech! I can handle not eating my favorite foods. I just want my speech back although it is much better than the beginning.

On a good note, I did not get a huge gap between my two front teeth. It was a small slit and I was very happy about that.

I hope this helps others who have a TPA.

Thank you for sharing your experiences, Stacy!

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