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home : orthodontics : myofunctionalThere are two lasting gifts we can give our children:The first is roots The other is wings WARNING: read this BEFORE your child starts orthodontic treatment!! Children will outgrow a lot of things – nappies, crying, clothing, and toys for example. But there are some things they don’t outgrow. One of them is the physical problem known as the deviate swallow [also known as the tongue-thrust swallow]. To understand this problem we need to know something about the forces that cause it. The most important of these forces is, guess what, the tongue! Although it is soft and supple, the tongue can damage teeth that are strong and hard. This damage occurs through the tongue’s most frequent task – swallowing. We swallow about 600 times a day; 400 times through the day plus 150 times while eating and 50 times overnight. During a normal swallow, the tongue should lift to the roof of the mouth, when food will tip off the back of the tongue and head off down the throat. During this action, the tongue should not – or only gently - touch the front teeth However, with a deviate swallow, the tongue thrusts forward. It crashes into the front teeth and sometimes pushes beyond them – a bit like a large wave over Tamaki Drive during a big storm! At the same time the muscles around the mouth and chin contract into ripples of spasm across the lower lip. During this action, the tongue pushes into the front teeth with a 1 to 3 kilo force. Although this pressure lasts only a fraction of a second, 600 repetitions add up to about 2 tonnes of pressure a day. Is it any wonder that children with a tongue-thrust have teeth that are splayed out all over their faces!  This swallowing action is called a deviate swallow. And the people who treat this problem are called myofunctional therapists. Alana and Marnie have completed intensive training courses in the United States in myofunctional therapy and they treat our patients who have deviate swallows. We do not think there are other trained myofunctional therapists in Auckland, and we believe we are the only dental office in the country with staff members trained and working in these techniques.Don’t be too alarmed if your child has a myofunctional problem – its common! As many as 70% of people have some kind of deviate swallow. Why is this problem so widespread? There are a number of theories.  The most commonly accepted theory explains the deviate swallow as a result of too little exercise of the tongue and facial muscles during infancy. Instead of working for their food as nature intended with breastfeeding, many babies are almost force fed by baby bottles with fast flowing nipples. What probably happens is this – the milk flows too fast for the infant to swallow comfortably; but by thrusting his tongue forward, he can control the amount of liquid entering his mouth. When this happens two things go wrong. The most obvious is that the tongue is trained to thrust forward whenever the child swallows. He won’t swallow one way when eating and drinking and another way for the rest of the day. He will swallow the same way – the wrong way – 24 hours a day! The other problem is that the lips don’t get enough exercise. Since the child’s lips are pressed against the top of the bottle, they don’t develop enough strength to exert significant inward pressure. So, when the teeth start to erupt, the outward pressure of the tongue is not balanced by the inward pressure from the lips. So proper tooth alignment is almost impossible. The teeth sit in the 'neutral zone'in the muscle wars - between the tongue pushing out and the lips pushing in. With the muscular imbalance of the tongue-thrust, the teeth are pushed out of line and an orthodontic problem and an ugly smile is the result And to top it all off – a bottle teat is not the same shape as a real nipple. Surprise surprise! The bulk of the teat of the bottle or pacifier [also known as a ‘dummy’ – that should tell you something!] sits across the roof of the mouth and absolutely prevents the tongue from swallowing correctly. And don’t look at the ‘orthodontic’ or ‘dentists recommend…’ labels on pacifiers and bottle teats – THEY ARE ALL DUMMYS AND THEY ARE ALL BAD! Thumbs of course have the same effect on the swallowing pattern. The thumb is on the roof of the mouth, so the tongue has to thrust forward to complete a swallow. Bingo – we have a deviate swallow. All mothers know the problems of thumb or finger sucking and cheer when the habit finally stops – little realising that the damage has been done and the tongue thrust that accompanies the thumb habit will just carry on.  And then, the other reason for tongue thrusting - the tongue tie. Some children are born with a short and / or thick connection to the floor of the mouth [known as a 'lingual fraenum']. This shortened fibre can prevent the tongue from lifting in the correct swallowing movement. Instead, the tongue thrusts against the front teeth, pushing the teeth forward and, because the tongue is not lifting into the roof of the mouth, the palate and the entire upper jaw tends not to develop into its correct size and shape. This tongue tie was not a problem in the 'olden days' - a Plunket Nurse would examine the new born baby. If she detected a short lingual fraenum, out came the scissors - snip - and it was over! Nowdays this doesnt happen. The Nurses dont snip fraena, School Dental Therapists don't understand this stuff. And neither do dentists or doctors. So many children are going through life with the oral equivalent of having their shoe laces tied together. It effects speech and it effects swallowing. But most of all, it effects the optimal development of the shape and size of the jaws - something that is critical to achieving a satisfactory and long lasting orthodontic result. You can test for a tongue tie by having your child stick out his tongue. If he can't do so, or if when he does so the the tip is held back - looking like a sort of W shape at the tip rather than a V shape - then he probably is tongue tied. We fix this problem regularly. It just takes a couple of small injections under the tongue and we remove the fraenum with a little electrified loop [called electrocautery] - no scalpel and no bleeding and usually no suture. Mothers – here is another very simple test. Watch your child swallowing during a meal. The normal swallow has the lips closing for a moment with the mouth muscles quite relaxed . But if an earthquake runs across the lower lip and chin at each swallow – then there is a problem. And the older the child, the harder it is to correct this habit. So don't waste time - you certainly shouldn't wait around until all the permanent teeth have erupted. Treatment can still be done then - but it is harder than with a four year old! And if you do see such a problem, you may want to visit us. We help a lot of children who have a deviate swallow by using orthodontic and myofunctional techniques. Come in and talk. But probably more important - if your child is having orthodontic treatment and the myofunctional habit has not been recognised [most likely] and not corrected [usually], then there is one thing for sure - that beautiful result with the dazzling smile will be a merely temporary phase. No ifs or buts - THE TEETH WILL RELAPSE. So all that money and all that time and all that stress will be for nothing! Where we see myofunctional problems at an orthodontic consultation or diagnostic workup [the first visits of the patient to the office], then we work at correcting this either before we start ortho treatment, or, perhaps with an older patient where we don't have as much time up our sleeve, we work at correcting the deviate swallow or tongue-thrust along with the first phase of orthodontic treatment This myofunctional therapy is going to be an additional fee to the orthodontic treatment. Expect from $400 to $800 over a 12 months treatment period. But it will be worth it. Remember that if the problem is not addressed, then any orthodontic treatment will be a waste of your time and your money And if you express these concerns to your dentist or orthodontist and he replies that myofunctional therapy doesn't matter, is unnecessary, or doesn't work anyway, then he is simply telling you that he is ignorant of this very important phase of dental treatment. I suggest you go find yourself a more aware dental advisor |
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