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Facial Growth and Orthodontic Concerns

Could tongue-tie be contributing to your child's orthodontic problems?

The American Association of Orthodontists recognises that tongue-tie release may have an important role in managing orthodontic problems.

How could tongue-ties contribute to crooked teeth?

Orthodontic problems are usually a symptom of underdeveloped jaws and faces.

We know the development of the bone structures that form the lower two-thirds of the face and jaws are largely influenced by the function of the muscles that surround them.

It is possible to see how faces are affected by weak muscles in neuromuscular conditions like cerebral palsy, muscular dystrophy and Down’s Syndrome.   There is also research to support how poor jaw development occurs in premature babies who have more subtle forms of low muscle tone.

In particular, we know the tongue is a key organ or muscle that influences the growth of the midface and upper jaw.   It is the biggest muscle in the body for the space it occupies and the pressure it exerts helps to mold these bones, particularly in the earliest years of life.  Numerous studies have demonstrated how low resting tongue posture in mouth breathing children affects jaw development.

Most recently, there have been a couple of studies from Stanford Sleep Research Centre that demonstrates an association between the low resting tongue posture from restricted tongue-ties and underdeveloped upper jaws.

Since the palate forms the floor of the nose, narrow palates are associated with smaller nasal and sinus passages.  Studies have shown increased resistance to nasal airflow when the palate is underdeveloped.

This increases the risk of developing mouth breathing and obstructive sleep apnoea.

When is the best time for tongue-tie release for orthodontic purposes?

Even when palates are widened with orthodontic appliances, the teeth are not in balance with their functional environment and results can be unstable.

In his 2009 overview of tongue-tie release and orthodontics published in the Journal of Clinical Orthodontics, orthodontist Dr. Northcutt suggests that tongue-tie release should be done at the start of orthodontic treatment.   This gives more time for the long-established patterns of tongue function to be corrected to avoid negative outcomes.

What about anterior open bites?

One of the most challenging problems for an orthodontist to manage well is an anterior open bite.

This occurs when there is a tongue thrust or low resting posture of the tongue.  Instead of sitting up in the roof of the palate, it postures between the teeth during rest, swallowing and speech.

This habit is hard to break and often requires myofunctional therapy exercises to repattern more normal rest posture and function.   If this is not corrected, the new teeth positions will be very unstable.  Patients with this type of resting posture and swallow will tend to have a fast relapse once the braces are removed, and retainers are not worn every night.

When tongue-ties pose an anatomical restraint to retraining proper function, tongue-tie release and therapy to retrain the tongue should be considered. This will aid long-term stability of results.

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Contact Dr Lim to organise an initial consultation for a tongue-tie or lip-tie diagnosis and assessment

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