Normal Functioning of the Tongue Ensures the Formation of the Face and Jaw Bones
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| In the image above, the mouth and tongue of a child with type 2 anterior tongue tie, a forked tongue at the tip, a yellow and cool upper jaw structure are seen. The dimple in the middle of the tongue and the "v-shaped tongue" are due to the long-term effects of tongue tie. During the child's infancy, negative health effects caused by tongue tie have also emerged, such as difficulty breastfeeding, inadequate weight gain, damage to the mother's nipple, early weaning from the breast, and early bottle feeding. Unfortunately, the "free tongue area" between the tip of the tongue and the starting point of the tongue tie is seen as insufficient, and the patient also has "articulation problems" when speaking hard consonants. Dentistry consultation and the use of a "palatal expander" were recommended for the effects on the jaw structure. As seen in the patient here, there are quite a few health problems that can be caused by tongue tie, which can be treated with a simple procedure. The patient may experience long-term bite problems and "neck, temporomandibular joint and upper back pain" due to the use of additional muscles while speaking. |
In babies, the tongue works as an muscle organ that "shapes the jaw and facial bones". It is not only responsible for swallowing, cleaning teeth, and moving food and milk. It works almost like a muscle organ. Tongue tie is a structure that emerges in the womb from the first month before your baby is born. In other words, your baby has already been exposed to the effects related to this for almost 8 months when he/she is born. A normal tongue sits on the upper palate during sleep, forcing it to grow by expanding forward and to both sides, and at the same time, allowing the lower jaw to grow forward together. If the tongue sits on the upper palate in the mouth, the oral airway is completely closed, meaning your baby has to breathe through the nose. In other words, in order for the tongue to work normally as a shaping muscle organ, there should be no permanent blockage in your baby's nose and no "tongue tie" that restricts the movements of the tongue or a neurological disease that prevents muscle work. Especially in babies born with tongue-tie, if there is a short and tight tongue-tie structure, your baby's tongue will remain attached to the mouth, and the tongue will not be able to "shape the face and jaw bones". When it works properly, your baby's tongue shapes the palate, which allows the palate to expand and create a space of its own. If the tongue cannot fit on the upper palate, a high and narrow palate may occur due to long-term nasal congestion, in addition to sleeping with the mouth open. However, permanent changes may also occur in the structure of the tongue itself in babies with tongue-tie. In addition to the short and wide tongue structure, the "retrolingual air space" decreases in long edema. Apart from the emergence of only an aesthetic or functional problem, a permanent "predisposition to sleep apnea" may occur (source link >> Is ankyloglossia associated with obstructive sleep apnea?).
Tongue tie is a common cause of a high arched palate in infants and children. If the tongue tie is short or tight, it can restrict tongue movement, changing the shape of the baby's mouth and leading to a narrow, high palate.
Untreated tongue tie may cause a narrow and high palate, small lower jaw and - misalignment of your upper and lower teeth (malocclusion)!
The image above belongs to a 23-year-old woman who grew up with a tongue tie and did not receive any treatment. It was reported that the patient had continuous dental problems since childhood and was treated by different dentists. The patient has a Type 3 anterior tongue tie, although it is not very tight and short. It can be seen that the patient's lower jaw is small and set back, there is a tooth closure disorder (misalignment) between the upper and lower jaws, the upper palate is narrow and high, and the structure of the palate is closer to a "narrow V-shaped palate" than a "wide U-shaped palat". It was understood that the patient's nasal base is also narrow and that she has a complaint of nasal congestion. When the hard palate and the base of the nasal cavity are the same bone, a narrow nasal base and a slightly depressed maxillary sinus anterior wall can be noticed when viewed from the front in patients with a narrow and high palate. If this patient's tongue tie had been shorter and tighter, these symptoms would have occurred to a much greater extent. Conversely, if the tongue tie operation had been performed immediately after birth, these symptoms would have occurred to a limited extent. It is appropriate to check the tongue tie in every newborn baby and consult a physician to determine whether surgery is necessary. Especially in babies with structural effects such as forked tongue, v-shaped tongue, callus-shaped tongue or cup-shaped tongue, early surgical intervention can prevent the emergence of these dentofacial deformities and prevent unnecessary further treatments.
In the image above, the sublingual view of an adult patient with a type III anterior tongue tie that is not very severe is in the photo on the left, and the narrow palate structure, which is not very obvious, is in the photo on the right. The more the tongue tie restricts tongue movements, the more noticeable the effect on the jaw and teeth structure is. It was also learned that the patient had complaints of sleeping with his mouth open as a child. There is a palate image that is less "narrow" than the other narrow palate images on this page.
U-Shaped and V-Shaped Palate
In the first of the 3 photos above, the "U-shaped palate" photo shows a normal structure, that is, a U-shaped or wide U-shaped palate, wide and shallow palate structure. In infancy and childhood, when there is no factor causing nasal congestion and no problem such as tongue tie that restricts the movement of the tongue, this jaw structure emerges. In this way, the patients' nasal airways and throat airways remain wide, reducing the possibility of collapse.
The middle photo is a palate structure between a narrow palate (the maxillary transverse deficiency) and a normal palate.
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| In the image above, the V-shaped narrow and deep palate structure is seen in the photo on the left, and the overlapping teeth of the same patient are seen in the photo on the right. These photographs, which belong to an adult patient who has not been treated and has enlarged adenoid hypertrophy, have caused a much more complicated and serious health problem, a narrow jaw structure and permanent airway obstruction, which can only be treated with a simple operation, adenoidectomy. |
In the "V-shaped palate" photo on the far right, it can be seen that the palate structure is "V-shaped" and narrow, the front teeth are displaced more forward than the lower teeth level, and the palate is deep and high (high arched palate). This palate structure occurs in patients with problems such as adenoid hypertrophy and septum deviation that cause nasal congestion in childhood, and when there are problems such as tongue tie that prevent the tongue from performing its "bone-forming organ" function. When these patients are viewed from the front, it can be seen that the base of the nose is narrow, the maxillary sinus is collapsed inward on the front and adjacent edges of the nose, and the teeth overlap. It is usually accompanied by a lower jaw that is smaller than normal, as in the photo below 👇.
Other causes of high palate in infants include:
- Nasal congestion and prolonged open-mouthed sleep (infants are dependent on nasal breathing; when nasal congestion is permanent, the tongue cannot be placed on the upper palate and, as with tongue tie, the tongue is prevented from performing its shaping function)
- Congenital disorders
- Genetic causes (presence of high narrow palate in both parents)
- Poor tongue function unrelated to tongue tie (neurological and other causes that may cause restriction of tongue movement)
- Premature fusion of skull bones
- Prolonged pacifier use
- Prolonged endotracheal intubation
- Ethnic characteristics
- Thumb sucking
Overbite (vertical misalignment of teeth)
%20deficiency%20%20-%20lower%20jaw%20retrusion%20-%20vertical%20misalignment%20of%20teeth.jpg "- recessive lower jaw - vertical misalignment of teeth - mandibular (lower jaw) deficiency - lower jaw retrusion - vertical misalignment of teeth")
In the photo above, you can see an example of malocclusion where there is a serious gap between the upper and lower teeth, and the upper teeth are in front of the lower teeth (red arrow). This is an image of a patient with a narrow palate who had to breathe through the mouth for a long time due to nasal congestion in childhood.
Similar expressions related to this problem
- recessive lower jaw
- mandibular (lower jaw) deficiency
- lower jaw retrusion
- vertical misalignment of teeth
Causes of overbite
The causes of overbite can be briefly listed as follows.
- Genetic causes
- Tongue tie
- Teeth grinding (bruxism) or clenching (this problem is more pronounced in those with strong biting muscles)
- Continuous nail biting or nail picking with the mouth
- Finger sucking or pacifier use after the age of 3
- Continuous pushing of the upper teeth forward with the tongue
- Lip sucking by squeezing the lower lip under the upper teeth
- Long-term mouth breathing in childhood
Overbite treatment
Since the development of the jaw and teeth continues in children, various non-invasive treatment methods can also be used in the treatment of overbite. First of all, you should find a pediatric orthodontist and have your child examined by him. Orthodontic treatments are usually sufficient for children. The following methods can be used for the treatment of overbite in children:
- palatal expander (may be suitable for up to the age of 16),
- dental braces
- the orthodontist may plan to remove the baby teeth (this can be done to make room for adult teeth)
- jaw position correcting headgear and brace holders, bite plates or elastic bands
- nasal congestion and tongue tie treatments
- orthodontic treatments that gradually change the position of the jaws
Although orthodontic applications are useful in the treatment of overbite in adults; more invasive procedures may be required compared to children. The following procedures can be performed for overbite treatment in adult patients:
- braces, clear aligners can also be used
- tooth extraction if necessary
- jaw corrective surgical procedures (orthognathic operations), after these operations, which are also attended by jaw surgeons, various jaw holders that restrict the movement of the teeth can also be used. These operations can be planned for patients with severe malocclusion or when other treatments are ineffective. The aim of these operations is to reposition the jaws to ensure correct closure and to correct the underlying structural imbalances.
In order to plan these treatments, it is useful to meet with an orthodontist and a jaw surgeon.
Importance of "Baby's Tongue Resting on Their Palate"
Babies placing their tongues on the upper palate during sleep causes bone formation, which can seriously affect both the oral cavity and the nasal cavity. The video below shows the position of the tongue of a baby with a tongue tie and lip tie before and after the operation.
Video Showing the Change in Position of the Tongue During Sleep in a Baby with Type 4 Upper Lip Tie and Type 4 Tongue Tie (Submucosal or Posterior Tongue Tie) After the Lip Tie and Tongue Tie Operation
Reflux and Nasal Regurgitation May Be More Common in Babies with High Palate!
It takes a certain amount of time for the tongue muscles in babies to strengthen and for tongue control to be achieved. However, babies with a tongue tie or high palate may have difficulty lifting their tongue enough to form a tight seal around the breast or bottle teat during feeding. The clicking sound that occurs in this case is a common symptom of both tongue tie and high palate. In babies with a tongue tie or high palate, this clicking sound is caused by inadequate suction. The tongue's inability to wrap around the breast or bottle like a seal during feeding can cause the baby to swallow more air, which can worsen reflux. Reflux can often continue even if a tongue tie operation is performed, as the high palate cannot be easily treated and the tongue muscles cannot develop immediately. However, reflux usually decreases as the tongue's mobility improves and the palate gradually expands.
Nasal regurgitation, like reflux, can continue in babies with tongue ties, even if a tongue tie operation is performed, until the palate expands. High palates can change the coordination between the nerves and muscles in the soft palate, which can cause milk to enter the nasal cavity. Although it may seem like a simple condition, it may be surprising that a high palate can cause such negative effects on your baby.
Tongue Tie and High Palate May Cause an Increased Gag Reflex in Babies!
Babies with high palates often have an oversensitive, forward-positioned gag reflex. Normally, the tongue touching the hard palate helps desensitize the gag reflex and shifts it further back to where the hard and soft palates meet. Babies need to place their tongues on their upper palate and hold them in this position for long periods during sleep. However, when babies cannot keep their tongues in contact with their hard palate, they can easily gag at the breast or bottle, and this increased gag reflex can prevent them from achieving a deep latch.
Babies With a High Palate Often Experience Ongoing Nasal Congestion
A high palate does not only affect oral volume; it also narrows the space inside the nasal cavity, which can make it difficult for babies to breathe through their nose in general. In these babies, when there is an upper respiratory tract infection or a sinus infection, it makes it almost impossible to breathe through the nose. In other words, the normal formation of the jaw and face can negatively affect oral and nasal functions in babies in different ways. Since nasal congestion itself can also cause a high palate, it is very important for this vicious cycle to be broken as soon as possible in babies. Babies with high palates often breathe through their mouths and sleep in an open-mouth position.
High Palate, Lip Tie and Tongue Tie Can Cause Painful Nipples!
During breastfeeding, babies need to insert their mothers' breasts into their mouths up to the brown areola area (proper latching). If they do not lift their milk lips outward and upward enough due to the lip tie, they position themselves superficially on the breast and can grasp the nipples between the upper lip-palate and lower gum (improper latching). In this case, a "lipstick-like squeezed appearance" or "nipple damage" may occur on the nipples of mothers. Again, mothers who breastfeed babies with high palates may often experience pain in the nipples and breast tissue due to breastfeeding.
High palates in babies cause a very shallow grasping movement that causes the nipple to be pressed against the hard palate. Due to the "angle" the nipple makes to "fold" to reach the baby's mouth, pain can be quite pronounced in high-arched palates. Again, in babies with tongue tie, due to the impaired or underdeveloped first phase of swallowing, disruption in the movement of milk in the mouth may cause a pinching movement at the nipple and insufficient vacuum.
Treatment of Narrow and Deep Palate
Performing Frenotomy / Frenectomy as Soon as Possible if Babies Have a Short and Tight Tongue Tie
In babies, surgical treatment of a tongue tie that restricts the functions of the tongue (tongue tie release surgery) as soon as possible can eliminate palate and jaw problems much earlier or prevent these problems from occurring.
Palate Expanders
A type of orthodontic device called a palate expander, which allows the jaw and palate to expand, may be sufficient for babies and young children. Adults usually need surgery to shape the jaw and palate.
Palatal expanders are suitable for use between the ages of 5-16. In this age group, most adult teeth are present; since jaw development is not complete, the use of palatal expanders is effective.
In addition to expanding the jaw and palate, these products can also be used to correct misalignment of your teeth. Some types of palatal expanders are inserted into the patient's mouth; while they can be inserted and removed daily.
Jaw Expansion Surgery
When the jaw bone development is complete, correcting a narrow palate becomes more complicated. Jaw widening surgery is usually the best treatment option for teenagers and adults over the age of 16.
The surgery involves making an incision in your upper jaw bone and repositioning it with an expansion device. The bone will fuse after weeks or months of healing. There will be a gap in the front of your teeth that can be corrected with orthodontics.
Distraction Osteogenesis For Maxillary Expansion (DOME)
DOME, is a unique jaw-widening procedure developed at Stanford University to help alleviate obstructive sleep apnea symptoms associated with a high, narrow palate. A small study from 2017 noted that earlier surgical methods aimed at correcting a narrow palate were mainly focused on addressing dental issues (source >> Distraction Osteogenesis Maxillary Expansion (DOME) for Adult Obstructive Sleep Apnea Patients with High Arched Palate - PubMed). Another small study in 2019 found that, with this procedure since both the upper palate and the nasal floor expand at the same time, relief of the nasal and oral airways and a decrease in sleep apnea symptoms can be detected. (source >> Distraction Osteogenesis Maxillary Expansion (DOME) for adult obstructive sleep apnea patients with narrow maxilla and nasal floor - PubMed).
Be Careful About Holding Your Baby's or Child's Nose in a Way That Allows Them to Breathe Easily!
If your baby has nasal congestion, irrigate the nose with natural ocean water or isotonic. In older children, it would be beneficial to have an ENT specialist examine the underlying allergic rhinitis, adenoid hypertrophy and urethra. When a simple nasal trauma develops in children, a deviated septum or deformities that affect the airway in the nose, due to chronic mouth breathing and constantly keeping the mouth open, the development of a narrow and domed palate may become inevitable as a result of the activity of the muscles in the front of the face and the tongue not being able to settle on the upper palate. Surgical interventions for a deviated septum and rhinoplasty may require waiting until the nose is complete, that is, until the age of 18. If adenoid hypertrophy is present, similarly, chronic mouth breathing may affect the palate and jaw structure. In this case, an adenoidectomy operation may be planned for children. Similar article >> Dentofacial Abnormalities May Arise From Adenoid Hypertrophy
Things to Consider to Prevent Your Baby from Having Narrow - Arched Palate and Related Permanent Dentofacial Problems in the Later Period
You can prevent your baby from having jaw and facial development problems in the later period by paying attention to the following
While your baby or child is sleeping ...
It is very important for your baby to be observed by your doctor during sleep. It will be good news if your baby's mouth is closed during sleep. In this case, there is most likely no problem that can cause serious nasal congestion and your baby's tongue will function more easily.
While your child is sleeping deeply, gently press the lower jaw with your thumb and pay attention to whether the tongue is on the upper palate or down. As in the image above and the video showing the tongue tie surgery, if the tongue is on the upper palate during sleep, this will again be good news
When your baby or child is crying ...
When your baby is crying, look inside the mouth carefully. Can the tongue lift up easily? Is there a bifurcation at the tip of the tongue, heart-shaped tongue, or a v-shaped tongue? Are the tongue edges distinct and is the middle of the tongue sunken like a bowl? If these findings are present, there is a high probability of a tongue tie. Again, if you look at the middle of the upper lip below, you can pay attention to whether there is a lip tie in this area and whether there is a callus protrusion in the middle of the upper lip.
You can perform a simple examination with your hand ...
After washing your hands or wearing powder-free gloves, you can examine your baby or child's tongue and lip by lifting them up with both index fingers and searching for a lip tie and tongue tie. Remember that submucosal, or posterior tongue ties, can only be noticed under the mucosa during manual examination. Again, by pressing from the middle of the tongue down to the floor of the mouth with your index finger, you can check for a tight midline structure (tongue tie) between the tongue and the floor of the mouth. You can lift the upper lip and check for a lip tie extending between the lip and the gum.
When your baby is breastfeeding ...
It will be good news if your baby can insert the breast into the mouth up to the brown areola on the breast while breastfeeding. If your baby is superficially attached to the nipple, if there is a lipstick-like appearance due to compression and pressure on the nipple, if there is breast pain, if the baby has reflux, gas swallowing and colic pain, if the breast is pulled while breastfeeding and if it is separated quickly from breastfeeding, it is highly likely that your baby has a lip tie and tongue tie. It would be beneficial for a lactation specialist or a physician who is interested in the subject to examine your baby.
Other similar links >> / Health Problems Related to Enlargement of Tonsils and Adenoids in Children / Enlarged Adenoids - Symptoms, Causes, Diagnosis and Treatment
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon
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