What causes open bite? not genetic but wrong tongue posture, consequently proper tongue posture can also expand the palate. Does ALF appliance actually expand at the sutures?
When looking at various types of malocclusion, class I, II, III, and how they all correlate with how the patient is posturing their tongue in the mouth… you begin to see just how much the tongue is the causal point of how our oral dentition is formed and maxilla shape & position which in effect makes up large portion of the facial appearance.
There is a reason for everything (all types of malocclusion)
Cause of Open Bite – why do some people have open bites? it is because these individual’s accidentally learned to posture the tip of their tongue in between their front teeth, thus separating only the front teeth over time.
Unilateral Open Bite – one side of the bite doesn’t close, which is caused by the tongue being held in between teeth only on one side.
Bilateral posterior open bite (deep bites) – front closes / touches before the back teeth meet, caused by back tongue being held between the back teeth so the back teeth are very low in height and unable to meet as they were prevented from erupting by the tongue.
Bimaxillary protrusion (protruding front teeth) – tongue is postured at teeth level just like the open bite, but the patient has good muscle tone so keeps the front teeth together instead of letting the tongue go through them. So the teeth stay together but the tongue pushes the whole dentition forwards because it is postured right behind the teeth instead of on the roof of the mouth.
It is questionable to go into traditional braces to force these bites to close without addressing the dysfunctional posturing of the tongue.
This is why palate expansion is important for most cases because a bigger palate makes it easier for the patient to begin posturing the tongue on the roof.
Because we all tend to posture in a position that feels most comfortable. A big palate is more comfortable to place the tongue than a smaller one obviously.
Why the abnormal tongue postures?
Various factors contribute to smaller palate: weak muscle tone, incorrect swallowing pattern, & low tongue posture.
They are all intimately connected to each other. For example, if the child learns to suckle their food down from infant on wards because they were fed mushed foods, then this will cause their palate to become underdeveloped, which may cause tongue between teeth posture because the palate is now too narrow for the tongue to comfortably rest on it.
What type of malocclusion forms will vary depending on each individual response to reduced tongue space and their unique way of altering tongue posture.
I have had several readers write to me about their airway problems because of underdeveloped maxilla which causes them to posture their tongue between teeth to keep the tongue from falling into their airway, so they are attempting to hold their tongue with their teeth.
I presume this is a big reason why the tongue gets postured lower, and held between teeth as people are desperately trying to keep the tongue out of the airway but with smaller palate the tongue is running out of space inside the mouth.
Consequently this altered tongue posture will only make the situation worse, and cause uneven bites like the open bites mentioned above. Because it is the tongue’s job to rest on the roof of the mouth to maintain the size of the palate.
Of course weak muscle tone can cause all of these to take place as well, as I have noticed that the more I strengthened my jaw muscles the more my jaws started to remain closed at rest which prevent tongue between teeth posture and since I expanded my palate with biobloc, the tongue is then able to rest comfortably on the upper palate.
To get changes, it is the combination or the balance of the muscle tone and tongue posture, both are quite important.
Notice how impactful the tongue is to the surrounding bone tissue, With X-ray you can see that it even caused changes to the mandible. Now imagine what proper tongue posture can do overtime…
Use of appliances to expand the palate
Mike Mew says having inter-molar width of 35 mm is enough to begin posturing your tongue on the roof.
When you have smaller palate than this, using an appliance like biobloc or ALF might give you the best chance for change although it may be possible to try to expand with your tongue alone if you give enough effort.
I started at 32 mm inter-molar width and back then I didn’t know about tongue posture thus I never tried posturing the tongue on the roof so I can’t say how difficult it will be to change tongue posture with smaller than 35 mm width upper palate. I do know that I had tongue between teeth posture, with jaws that were several mm apart at rest.
Alf appliance (above) – I’ve never worn this appliance so I can’t speak from experience but I do like design of it because it doesn’t take up the tongue space on the upper palate. I believe one can be successful at true palate expansion with this appliance given that the individual is really committed to changing their resting tongue posture as the appliance is worn, strengthen muscle tone (teeth in light contact at rest), and learn proper swallowing pattern (swallow food/water using the tongue on the upper palate, without activating any facial muscles).
orthotropics biobloc – this might be the best option for younger kids, ages 8-12 because stage 1 which expands at semi-rapid expansion rate of 1 mm per week, and advance the front teeth forwards to reduce the indicator line and then putting the kids into stage 3 that has flanges to force their jaws to stay closed 24/7 causing strengthening of muscle tone and this altered posture of keeping their jaw closed at the new more forward position of the advanced front teeth, overtime causes the whole maxilla to remodel forwards in the face.
It is the best method I have seen that actually causes the maxilla to go forwards via appliance, strengthens muscle tone, and changes oral posture all at the same time.
It is a brilliant method for kids because it forces these muscle tone and postural changes which are only possible by adults that really want to change and put in effort to do so.
I guess it is the closest thing one can get to a “magic pill” where you are given outside intervention and it fixes problems for you.
But even orthotropics biobloc is not perfect, it is only the best attempt at causing these changes to take root, and results do vary depending on individual because there are factors that even biobloc cannot control, the main one being how hard the patient begins practicing posterior tongue posture.
And forcing the jaw to remain closed begins to increase muscle tone, but could patients get even more muscle tone if they incorporate 1-2 hour tough gum chewing per day?
Of course now you are getting into territory that becomes much harder to control by the clinician.
Best to seek biobloc for young children…
I do recommend the biobloc for young kids because they are much less likely to have any desire on their own to change muscle tone / posture. The best results occur on young patients ages around 8 with slight crowding that get big improvements in the appearance of their face, unfortunately most parents do not seek professional help for young children with only slight crowding because they do not feel condition is bad enough to warrant intervention. But the hope is in the future parents have better understanding of facial development, and they will seek intervention not for mild crowding reasons but for facial appearance, and set a course correction for good growth direction for rest of their childhood, which effectively can “save the face” from the modern trend of lengthening & flattening faces. The difference of plain face to a beautiful face.
Best means to change for adults?
if you are an adult with enough determination to change, you most likely can change the muscle tone by increased chewing each day of tough gum like I have, without the use of stage 3 biobloc.
I did use biobloc stage 1 to get my expansion from 32 mm to 40 mm inter-molar width.
One drawback of the biobloc is that the acrylic still does take up posterior roof of the mouth which will make tongue posture difficult during the time you are expanding with it. Although compared to DNA Appliance and homeobloc the acrylic takes up less space in the mouth.
But I do believe with biobloc you can achieve more dramatic changes much faster than ALF appliance, and for cases where the front teeth need to advance forwards quite the distance if re-opening extraction spaces… I’m not sure such changes is possible with ALF or with tongue alone.
Biobloc for adults is an approach of “get in there and get out quick”, get as much change as possible in little time as possible. And then appliance comes out and patient can begin tongue posture training.
(although I will add that because acrylic is right up on the palate with biobloc, youcould push the posterior tongue up right on the acrylic and put upwards force on the maxilla right through the appliance with effort)
ALF you can sort of try getting tongue posture changes at the same time. Which is better for adults is difficult to say. At the end of the day, they can both lead to good changes depending on patient’s own effort to change. Some clinicians are bit dubious of ALF appliance and whether it is actually getting expansion at the suture, but I believe if the patient is working the tongue with the ALF appliance, they will get just as good palate expansion as any other method.
Because of ALF’s advantage of not taking up tongue space, it may be the better option for patients that do not require dramatic changes like reversing extraction orthodontics, and already have pretty good inter molar width but want to expand a bit more… But when you already have 35 mm perhaps you can expand further just by training tongue posture.
Look at the this above boy, that expanded their palate by training the tongue posture alone.
Also in my past article: How Orofacial Myofunctional Therapy can change faces, there’s pictures of adults that got wider smile by training the tongue posture, without use of any appliance.
It is difficult to say if this type of natural palate expansion via tongue is possible for patients that have very small palates like 28 mm, because bone will change to long term forces, meaning the tongue has to learn to remain up on the palate consistently almost habitually & unconsciously because the concern is that we do live busy lives and can’t just sit there playing with our tongue all day long, and with small palate it becomes increasingly harder to get the tongue to learn the new posture simply because its not comfortable…
but if facing a situation where you can’t get into either ALF or biobloc or other form of expansion treatments than a lot of effort with your tongue will go a long way. I have never tried it with small palate so I can’t say how hard it will be, but the tongue certainly has the power to change your oral structure just like improper posturing of tongue can cause big changes to the dentition such as bimaxillary protrusion or open bites.
Do not forget about the muscle tone either because when the jaw begins to close at rest with increased jaw muscle, then that automatically helps raise the tongue posture because it is connected to your lower jaw.
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