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Tongue thrusting, also known as orofacial muscular imbalance, is a condition in which the tongue protrudes from the mouth during swallowing and speaking. In some cases, the tongue will also protrude from the mouth when at rest. Tongue thrusting is common in children under age four, but can become a concern after that age. Tongue thrusting may affect speech and teeth alignment if not addressed.
Causes of Tongue Thrusting
Children may be more prone to tongue thrusting due to hereditary factors. Certain types of artificial nipples and prolonged thumb sucking behaviors may also contribute to tongue thrusting. Allergies, nasal congestion, and other conditions affecting breathing may also increase the occurrence of tongue thrusting behaviors as individuals compensate for the obstruction by holding the tongue lower in the mouth.
Tongue Thrust Complications
Tongue thrust has been associated with movement of the teeth, and has been linked to the development of anterior open bites and other types of malocclusion. While tongue thrust during swallowing has shown to exert pressure on the teeth, tongue thrust while resting has been noted as an even larger contributor to orthodontic conditions. The misalignment caused by tongue thrusting can affect the way words are pronounced, causing a speech impediment. Malocclusions can also cause jaw pain, headaches, and ear pain. In addition to these complications, the misalignment and speech problems caused by tongue thrust can also affect an individual’s self esteem and relationships with others.
Tongue Thrust Treatment
Correcting bite patterns will sometimes correct the positioning of the tongue. This can be done using braces in some cases. Cases in which open bite patterns are more extreme may require the use of temporary anchorage devices, surgery, or tooth extractions. If jaw and tooth alignment is found to be correct, nighttime mouth guards and visits with an oral physiotherapist may be sufficient to correct tongue thrusting behaviors.
If tongue thrusting behaviors are not addressed after bite patterns have been corrected, teeth will usually shift back to the original position. Follow up treatment for tongue thrusting may include visits with an oral physiotherapist and use of specific types of retainers. A wrap around retainer with a hole in the top often provides two types of support. The retainer serves to prevent teeth from shifting back to the original position, and the hole presents a diversion from the tongue which can prevent the tongue from falling between the teeth while at rest.
X-rays, also known as orthodontic radiographs, are an important tool for assessing a patient’s jaw, mouth, and bone health. There are several different types of X-rays used in dentistry and orthodontics. It may be necessary for orthodontists to use a few different types of X-rays in order to get a full picture of the patient’s mouth and facial structure before recommending treatment.
How Do X-Rays Work?
When an X-Ray is being taken, a beam of radiation passes through the body and hits either a sensor or a piece of film. Dense tissue such as bone and teeth will not allow the radiation to pass through, so it shows as a white or light image on the film. Softer tissues and areas of lower density allow the radiation to pass through, so it shows as a darker image on the film. Analyzing the darker and lighter spots on an X-Ray gives orthodontists an idea of the tooth and bone health of a patient.
Types of X-Rays
There are two main types of X-rays used in general dentistry and orthodontics. Intraoral X-rays are taken of the inside of the mouth. Extraoral X-rays are taken outside of the mouth. There are several different types of X-rays that fall into these two categories that are used for different purposes in orthodontics and dentistry.
Common types of intraoral X-rays which are used by orthodontists and dentists include:
Bite-wing X-rays show the upper and lower teeth from crown to bone in areas of the mouth
Occlusal X-rays show placement and development of full teeth and arch
Periapical X-rays show full teeth from crown to the end of the root inside of the jaw
Common types of extraoral X-rays that orthodontists or dentists may order include:
Panoramic X-rays show the entire mouth in one X-ray
Cephalometric projections show one side of the head
Tomograms show one layer of the mouth while blocking other areas to provide a clear view
CT Scans show a three dimensional image of the head. These must be performed at a hospital
Sialography show the salivary glands through the use of a contrast medium
Use of X-Rays in Orthodontics
The primary use of X-rays in orthodontic applications is to help orthodontists diagnose problems like impactions, misalignments of the teeth, and asymmetries of the jaws. Comparing and analyzing different types of X-rays such as panoramic X-rays and periapical X-rays helps orthodontists get a well-rounded picture of the tooth and jaw structure so that proper treatment can be administered. X-rays can also be used throughout orthodontic treatment to evaluate progress and make corrections as needed. Although not a primary application, X-rays taken by orthodontists may also reveal health conditions such as abscesses and tumors in the head that can save patient’s lives.
Baby teeth, also called primary or milk teeth, serve an important function in the development of permanent tooth placement. If baby teeth are pulled too soon or stay in place for too long, it can adversely affect the eruption pattern and alignment of the permanent teeth. It is important to speak to an orthodontist before making any decisions about baby tooth extractions.
Primary Tooth Loss Schedule
Baby teeth are typically lost at certain ages. These ages may vary slightly from child to child, but should follow a certain pattern that corresponds to the pattern of permanent tooth eruption. If a child begins to lose teeth in a pattern that is outside of the normal eruption schedule, it may cause crowding in the mouth or misalignments. If a child goes several years over the normal tooth loss schedule, it may delay permanent tooth eruption or cause existing permanent teeth to shift into unnatural placements.
Baby teeth are generally lost around the following ages:
Between ages six and eight the lower and upper central primary incisors are lost
After central primary incisors, the lower and upper lateral incisors are lost
Between ages eight and ten there is a one to two year pause
Between ages ten and thirteen the lower canines and first molars are lost
Following the first molar loss, the upper canines are lost, then upper and lower molars
If a baby tooth is damaged or begins to decay, it may be necessary to extract the tooth in order to save gum health and eliminate pain. However, extracting a baby tooth before it is time for the permanent tooth to erupt can allow surrounding teeth to shift to fill the gap. If the tooth can be saved, orthodontists often recommend using other methods so that the gap is naturally filled until the permanent tooth comes in. If it becomes necessary to extract a primary tooth, the orthodontist may recommend filling the space with a prosthetic tooth until the permanent tooth comes in. It may also be necessary to fill a space with a prosthetic tooth if more than three months pass between the loss of a baby tooth and the eruption of a permanent tooth.
Primary Tooth Extraction Benefits
If primary teeth are pulled at an appropriate time, it can sometimes prevent later complications. Pulling primary teeth will not permanently solve crowding issues, but it can help orthodontists guide permanent tooth development patterns so that straightening procedures and surgeries that would have been necessary later can be avoided. However, every child develops differently. Parents and orthodontists should discuss all possible remedies for childhood tooth complications before making the decision to extract baby teeth.Many jaw and tooth problems can be corrected with braces or other orthodontic tools and procedures. However, more severe complications may require orthodontic surgery to correct. Also called orthognathic surgery or corrective jaw surgery, orthodontic surgery can be useful in correcting conditions that are caused by congenital deformities, injuries, and developmental issues.
Orthodontic Surgery Indications
Jaw, ear, and head pain can all be indicators of abnormalities in the jaw structure that may require surgery to correct. If regular jaw functions such as eating, breathing, or speaking cause pain or are difficult, these factors may also indicate the need for orthodontic surgery. These issues should be discussed with an orthodontist in order to determine the need for surgery and pinpoint the exact cause. Orthodontists may not perform the diagnostic tests necessary to catch certain conditions if not alerted to these pain sensations.
In some cases, there may be visible indications that surgery is necessary. A receding chin or dominant overbite may indicate skeletal malformations that require surgery to correct. Correcting these conditions can help to boost confidence and can have emotional benefits as well as medical and cosmetic benefits.
Diagnosing Conditions Requiring Surgery
Assessing the need for orthodontic surgery is not always simple or straight forward. Collaboration between an orthodontist, dentist, and an oral surgeon is often the best approach, as braces may be required to successfully complete the correction, and other factors such as tooth health may come into play. Diagnostic tests such as x-rays may be used to determine the extent of the problem and identify the most effective surgical and procedural options.
Orthodontic Surgery Considerations
Depending on the condition that will be corrected using surgery, patients and orthodontists may have to take certain factors into consideration prior to surgery. These factors include subsequent or preliminary surgeries and procedures that may be necessary and patient appearance following surgery. There is software available that can allow patients to view projected results of orthodontic surgery, and this may help to determine whether braces or cosmetic surgery will be needed following surgery. Patients may also need to consider overall cost factors and plan accordingly for all eventualities. If orthodontic surgery is undergone and follow-up procedures are avoided, the desired results may not be achieved.
Conditions Corrected Using Orthodontic Surgery
There are many different conditions that can be corrected using orthodontic surgery, including but not limited to:
Tooth decay and abscess
Certain types of oral cancer
Braces can help to correct alignment and bite issues. This can effectively improve appearance and eliminate certain painful or inhibiting conditions, as well as improving dental and overall health. However, if braces are not properly cared for, it can result in tooth decay and staining. This can be frustrating for those that have spent time and money trying to attain a beautiful smile.
Braces Daily Care
Daily care such as brushing teeth and flossing become especially important when braces are involved. Braces can trap food and sugars against the teeth, which can speed the rate of plague build-up and foster decay. Those wearing braces should brush and floss after eating any food or drinking any beverage other than water in order to keep teeth clean and free of build up. This will help prevent braces problems and further complications with orthodontic treatment.
Special Equipment for Braces Care
A specialized toothbrush called an interdental toothbrush can be purchased to effectively clean behind braces. The head of the toothbrush contains a small, flexible metal rod surrounded by short bristles that is capable of moving between teeth and braces as well as the gaps between teeth. This brush can remove particles which are stuck on teeth better than flossing or brushing alone. A water pic may also help to remove plague and food particles from teeth, keeping teeth healthier while braces are worn.
Eating for Success
When braces are first installed, it is important to eat soft foods in order to reduce mouth soreness and adjust to the feel of the braces. After adjusting to the braces, it is possible to eat foods that are harder or crunchy, but it is recommended that these foods be broken up or cut into pieces. Eating corn on the cob, meat off the bone, or a whole apple may pull and damage braces, which may cause pain.
Avoid Sticky Foods and Sweets
Sticky or chewy foods such as taffy and hard candy may pull on braces and cause mouth pain. These foods may also become stuck to the teeth, and can be very difficult to remove. Both sticky foods and sweets should be avoided to prevent tooth decay and difficulties with braces care. Sucking on highly acidic foods such as lemons should also be avoided, as these may cause lasting damage to enamel.
Regularly Visit Professionals
Attending regular check-ups for dental care and orthodontic adjustments will help to ensure clean healthy teeth that are being corrected at a proper pace with braces. Dental cleanings will remove stains and plague before damage is permanently set, and dentists will often provide helpful tips to make braces care easier or more effective. Orthodontists will check braces for any loosening or damage, correct any issues, and tighten or adjust braces in order to progress correction of conditions.