STARTINGearly Tongue-Tie
A “tongue-tie” or “tethered oral tissue” or “ankyloglossia” occurs when a band of tissue tethers the tongue to the floor of the mouth. This situation can result in problems breast feeding, swallowing, and speaking. Very simply put, the tongue is a very good (actually the most ideal!) orthodontic expansion device. An ideal tongue posture occurs when the mouth is closed and the tongue is between the arches sitting fully on the palate. An ideal swallow occurs when the tongue pushes food to the roof of the mouth after chewing and peristaltically moves the food down the throat. The action of chewing and a tongue-to-roof-of-mouth swallow helps to develop the maxilla and mandible in three dimensions. A tongue-tie restricts the ability of the tongue to support the maxillary arch. This often results in an underdeveloped maxilla and can affect the ability of the mandible to develop normally. The solution for a patient with a tongue-tie is a lingual frenectomy. However, this needs to be performed in conjunction with myofunctional therapy in order to re-train the tongue to function ideally. If this sounds like hard work, it is! However, it is necessary to restore function in most cases. Just because the tongue now has the ability to function ideally, does not mean it will forget the old swallow patterns. A myofunctional therapist is a hygienist or speech therapist with additional training in the function of the tongue. Finding and partnering with a trained therapist greatly enhances any effort to shape ideal growth.
Mouth Breathing
Mouth breathing is incredibly common in children. Allergies, low muscle tone, tonsil and adenoid hypertrophy, and even tonguetie can cause mouth breathing. When a child breathes through his or her mouth, the tongue cannot sit between and develop the arches. The result is retrusion and collapse of the maxilla and often the mandible. Screening for mouth breathing is as easy as observing the child at rest. Also, crowded teeth or lack of space in the primary dentition are big red flags. Often kids that mouth breathe have heavy plaque levels, gingivitis (especially in the anterior teeth), and may have high caries rates due to xerostomia. Treatment involves referring for a sleep study
if risk factors for sleep apnea are present or to an ENT to assess the reason for nasal congestion. The local myofunctional therapist can also be of assistance by teaching the patient exercises to change the resting posture of the tongue and aid in nasal breathing.
Adenotonsillar Hypertrophy
Hypertrophic adenotonsillar tissue has a direct correlation with sleep apnea in children. The benefits of removing the tonsils and/or adenoids can be seen dramatically and immediately. Improvement in school performance has been shown, as well as improvement in sleep disordered breathing.3 However, it is extremely important to realize sleep-related breathing disorder symptoms can recur in some patients and tonsillectomy may not be the first line therapy for all patients. Myofunctional therapy can improve outcomes after surgery and reduce the risk of relapse later in life.4 In addition, orthodontic expansion has been shown to be helpful in necessary cases. Reasons for adenotonsillar hypertrophy are complex and having a team treatment approach is necessary for persistent results.
Case Study
The following photos are of a six-yearold female patient who presents with mouth
Dr. Dan Bruce has a passion for treating patients with sleep-related breathing disorders and an even greater passion for helping children develop beautiful and functional airways. He enjoys creating interdisciplinary relationships with the health care community in order to provide the best outcomes for patients. Dr. Bruce practices in Boise, Idaho and is a Diplomate with the American Board of Dental Sleep Medicine. He has lectured on the topic of dental sleep medicine. Outside the office, Dr. Bruce spends his time exploring the Idaho outdoors with his wife and 3 children. Bethany A. Bewley, RDH, BA, MS, is a full time mom and part time Director of Marketing for a private general dental practice in Boise, Idaho. While working as a clinical dental hygienist, she received her Master of Science in Dental Hygiene degree from Idaho State University. Her thesis research on incorporating sleep apnea screenings into dental hygiene appointments won an award as part of the DENTSPLY/ADHA Graduate Student Clinicians Program.
DentalSleepPractice.com
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