Our Blog

Tongue Thrust

June 10th, 2020

Tongue Thrust

What is a tongue thrust?

A tongue thrust occurs during swallowing. The tongue should normally move forward and upward compressing against the roof of the mouth to create a seal so swallowing can occur. Instead, it moves forward between the upper and lower front teeth. The pressure every time a swallow occurs exacerbates a front teeth open bite and will often deform the shape of the upper jaw from U-shaped to more V-shaped.

(Pretreatment with front teeth open bite)

                               (U Shape)                                                    (V Shape)

So, a tongue thrust is functional in that the patient can swallow fine but, it is detrimental to the shape of the upper jaw, the bite and tooth alignment.

Why does a tongue thrust develop?

In many instances, tongue thrusting is the response to a front teeth open bite which was there to begin with. In other words, the patient develops the tongue thrust to compensate for the front teeth open bite. So it is very important in these patients to correct the open bite so the tongue can develop a normal swallowing pattern.

A limited number of people have a tongue thrust without a front teeth open bite. If so, unless there is an associated speech issue then there is no reason to treat. The speech issues are with the “th” and “s” sounds. Have the patient say “there, that, sixty six and sixty seven.” The words will sound slightly slurred, if so, refer to a Speech Therapist.

There are many causative factors for tongue thrusting such as:

  • Hereditary
  • Thumb or finger sucking
  • Enlarged tonsils or adenoids
  • Allergies/nasal congestion
  • Tongue tied
  • Macroglossia (large tongue)

-Heredity and thumb or finger sucking are similar since both result in “V” shaped upper arch which makes it impossible for the tongue to fit in the correct position. A specifically designed upper expander with thumb/finger guard works great.

-Enlarged tonsils or adenoids cause the tongue to position forward. This occurs because the upper airway in constricted due to the size of the tonsils so the tongue will have to move forward to open the airway for breathing. Large adenoids make it harder to breathe through the nose so the patient will position the tongue low and forward for airway. The same is true for allergies/nasal congestion. A upper expander with tongue trainer along with removal of the tonsils/adenoids or allergy treatment is the treatment of choice.

-With a tongue tied patient, the lack of tongue mobility makes it impossible for the tongue to move to the correct position. A upper expander with a removal of the frenum is the correct treatment.

-With marcoglossia the size of the tongue prohibits correct positioning. You can’t reduce the size of tongue very often so have to expand the upper jaw as much as possible to accommodate the tongue.

(After treatment with our specially designed upper expander with tongue guard of patient in initial photos)

Now you understand tongue thrust. Let us know if we can be of help!

What it's like to get an upper jaw expander

March 5th, 2020

What it’s like to get an upper jaw expander

 

Joey needed an upper jaw expander to correct his crowding but he was afraid it would hurt and he wouldn’t be able to eat.

Becky, a team member at the office of Dr. Michael Sebastian could tell Joey was nervous so she made a point of explaining about the expander to help Joey understand what was going on, because you’re usually scared of the unknown.

The first step was to place separators between his back upper teeth (these are small round elastic pieces). She showed them to Joey and explained they would feel like having those teeth flossed when they are placed.

Separators

            The separators would stay in until the next week. Becky took Joey’s arm and pressed on it, she asked Joey, “Does this hurt, or does it feel like pressure?” Joey said “it feels like pressure.” Becky assured Joey that the separators would feel like that. She also gave Joey some grape Advil to reduce any possible soreness which might develop.

What a relief! It wasn’t hard at all. Joey could eat whatever he wanted except sticky candy. At Becky’s direction, Joey’s mom would give him some Advil 30 minutes before the next appointment.

Next week, Joey came in to fit for the expander. Becky again was there to make sure Joey had a great experience. As before, she explained what was going to happen that day. They would first remove the separators which had opened a small space for the bands to easily slip on the teeth.

Bands

            Like fitting a pair of new shoes, she would have to try on a couple of different bands to get the size perfect. Bands are rings which fit around the two upper six year molars and are attached to the expander. With a gentle touch and Joey’s help, they used a bite stick to push the bands into the correct position.

Bite Stick

With the right bands in position, a scan of Joey’s mouth was done. Becky showed Joey that the scanner is like a very small camera which takes thousands of pictures. You move it slowly around the mouth and on the video screen an exact copy of Joey’s teeth appeared. It only takes about 5 minutes. The orthodontic lab would use this scan and the bands to make Joey’s expander. This was so easy, Joey couldn’t believe how quick and painless it was.

Becky put new separators in so next week the expander could be placed on Thursday at 3:30 pm.

Joey left school for the big day. When he got to the office, Becky gave him Advil. Joey was nervous, it hadn’t hurt so far but he was sure it would today. Becky eased his fear by explaining that today would be just like the last appointment except the two bands they fit would be attached by the expander. They would go through the same process except a special glue would be used to hold the expander in place, nothing like any glue Joey had used before. It was a special glue made for using only in the mouth.

Dr. Sebastian, Becky and Joey worked together to put in the expander. It was just like fitting the bands at the last appointment except for the glue. Joey got to hold “Mr. Thirsty” to remove the flavor of the glue. It took 3 minutes for the glue to set then Becky removed the excess glue and Joey was done! Wow, all the worry and he was fine.

Mr. Thirsty

            Becky gave Joey and his mom instructions on care and cleaning of the appliance. She also recommended that Joey take Advil every 4 to 6 hours for the next 24 hours as research has shown that this reduces any discomfort by up to 90%. Becky suggested Joey stay on a soft diet for 5 days until his tongue got used to moving food around the appliance.

Joey and his mom followed these instructions and his first 5 days were nothing like he imagined. He was sore but was able to do all his school work and after school activities. At his next appointment, Dr. Sebastian showed Joey and his mom the change which had occurred over this first 6 weeks, they couldn’t believe it, Joey knew the right thing was being done.

Symptoms of Attention Deficit Hyperactivity Disorder

February 25th, 2020

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) may also be a sign of sleep apnea in children according to experts.

            An estimated one to four percent of children experience sleep apnea, according to the American Sleep Apnea Association. Many of the children who deal with this disorder are between the ages of two and eight.

            Sleep apnea occurs when a person stops breathing during sleep; it is usually caused by something blocking or clogging the upper airway.

            The Centers for Disease Control and Prevention states that around 9.4% of children between 2 and 17 have been diagnosed with ADHD.

            Studies show that around 25% of children diagnosed with ADHD may have obstructive sleep apnea (OSA), the American Sleep Apnea Association explained.

            Experts say that learning difficulties and behavior issues may be a side effect of "chronic, fragmented sleep."

            When sleep apnea occurs, breathing stops during sleep, oxygen levels drop in the body while carbon dioxide levels rise, Norton Children's Hospital explained. This triggers the brain to wake up in order to breathe.

Symptoms of OSA include:

  • Snoring
  • Loud or heavy breathing
  • Mouth breathing
  • Pauses in breathing
  • Snorting, coughing or choking in sleep
  • Sweating more in sleep
  • Bed wetting
  • Restless sleep
  • Abnormal sleeping positions (commonly seen in children with Down syndrome)

Children who deal with OSA may display the following during the day:

  • Behavioral issues
  • Hyperactivity
  • Lack of concentration at school
  • Morning headache
  • Poor school performance
  • Poor weight gain

ADHD symptoms include the following:

  • Trouble sustaining focus on activities he or she finds boring or unrewarding
  • Trouble listening and following directions
  • Trouble staying seated, fidgeting; may experience discomfort trying to sit still
  • An excessive amount of energy
  • Tendency to interrupt, blurt things out
  • Difficulty organizing tasks and activities
  • Difficulty waiting his or her turn
  • Easily distractible, often distracted by external stimuli (sounds, smells, etc.)
  • Forgetfulness, tendency to lose necessary things (schoolbooks, keys, wallets, purse)
  • Impatience
  • Interrupts or intrudes on others
  • Often daydreams or seems like he or she isn’t listening when being spoken to directly
  • Very talkative

If you think your child has sleep apnea or ADHD, it’s recommended that parents talk to their child’s pediatrician. At our office, we screen every child for upper airway obstruction which can be a contributing factor to sleep apnea. Ask how we can help!

Why do upper jaw expansion?

February 13th, 2020

Upper jaw expansion, if needed, is probably the single best treatment you can do for the developing child. The benefits are numerous:

  1. Children with a narrow upper arch are more likely to have Sleep Disordered Breathing (SDB) which includes Sleep Apnea

(Narrow Upper Jaw)

  1. Children with deficient hearing have an improvement after upper jaw expansion
  2.  Improvement in Halitosis
  3. Improvement in nasal breathing- upper jaw expansion has been shown to decrease nasal resistance

                                 (Before expansion)                            (After expansion, airway enlarged)

  1. Increased size of upper airway
  2. Decreased bed wetting

              (Before expansion tongue in low      (Normal tongue position after expansion,                            tongue thrust position)                    tongue in roof of mouth)

        (Before expansion and tongue thrust        (After expansion and resolution of                                          treatment)                                         tongue thrust)

  1. Decreased tongue thrust- normalize tongue position which helps in speech
  2. Improvements in cognitive functions by Sleep Disordered Breathing (SDB) patients after expansion because their sleep quality improves so can function better during day.

All this, and there is no mention yet of the skeletal and dental improvements which are achieved with upper jaw expansion.

(Before)                                                   (After)

  1. Correcting a functional shift caused by constricted upper jaw with a posterior crossbite allows the mandible to close normally without shifting. This reduces the stress on the TM joints and the potential for asymmetric growth of the condyles.

(Before expansion)                                                 (After)

  1. Developing enough space skeletally to resolve crowding and negate the possibility of extractions later.
  2. Improve the path of eruption of maturing teeth. Allowing them to erupt into supporting gingivae and thus develop healthy gingiva.
  3. Develop a full smile with upright posterior teeth which fill the buccal corridors for maximum esthetics.

Best Age?

We’ve covered all the benefits of upper jaw expansion. Now let’s understand when is the best age for expansion. Research has shown the best time is between the ages of 6 and 10 if you want to maximize the above benefits plus increase the stability. The upper jaw is very malleable during this stage of development so if expanded properly the upper jaw responds well and the results are stable, long term.

This type of expansion is skeletal, the other type of expansion is dental, this is when the teeth are tipped out which is not stable. Prior to age 10 expansion is about 85% skeletal 15% dental, as the child ages the numbers reverse. By 17 y.o. the ability to get skeletal almost zero.

Type of Expander?

The last area of concern is the type of expander used. Again we rely on good research to experience to choose the expander. The fixed quad helix is the top expander for results achieved. We have been using a specifically designed fixed quad-helix for 20 plus years. We custom design the appliance for not only posterior expansion but also anterior expansion, tongue restraining in tongue thrusting patients and crib for finger sucking. By doing this we don’t have to use different appliances and can treat multiple areas with one appliance. The expansion requires 6-8 months with 6 months retention for long term stability.

Don’t hesitate to contact us if we can be of any help!