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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So, just to clarify, you ideally want your intermolar width to be equal to or a bit greater than your tongue width? My intermolar width is 39mm with a tongue width of 53mm, so I should be hoping to eventually achieve that amount of growth?
53 mm is ancestor levels and it hardly exists in today’s world.
Just because tongue is that width doesn’t mean the palate will be.
Some of the largest palate in modern time would be around 42 mm.
These things are beyond my current understanding / experience. I’m currently 39 mm with the help of palate expander and I’m trying to see if I can expand further with the tongue alone.
when you say inter molar width is that the distance between the first molars or the pre molars?
first molars, the shortest distance between them.
No it’s the middle of the first molars.
Hi , i would like to know if there is a way to reverse wisdom teeth extraction ( like wisdom teeth implant) , because i think i had bone loss due to my wisdom teeth extraction and i want to reverse this.
Another question ; how much does a membership cost? Cause i have a lot of question concerning my extraction problem.
( sorry for my english i’m from france )
membership costs $10 a month, regarding wisdom teeth implants, look at the reply I left for the comment above. in short, I don’t think wisdom teeth implants are top necessity, what is more important is to remodel our maxilla and that requires jaw muscle and tongue posture, not wisdom teeth implants.
I have decently wide dental arches (good enough to comfortably fit my tongue), but I would definitely prefer wider. Is there any point in trying to increase width using something like Homeoblock? Or is such expansion pointless as the arches would tend to return to the original width supported by my tongue posture?
The other thing I’m not sure about is whether I need to reverse wisdom teeth extractions to achieve sufficient width (I had them removed at age 19 as they were “impacted”). Since then I actually haven’t noticed a decrease in width; if anything my arches are somewhat wider now at age 25.
How important is reversing wisdom teeth extractions to achieving ideal width of the upper palate? Anecdotally I’ve heard of many cases of the palate collapsing after wisdom extractions, yet this is not what I’ve experienced. That said, my palate probably wasn’t wide enough to begin with if extractions were required. I get the sense that bicuspid extractions are far more problematic than wisdom tooth extractions due to their location in the mouth. What do you think.
yea although wisdom teeth extraction can lead to collapse of the maxilla, I believe your tongue posture can overcome that. bicuspid I believe is far more problematic like you say. you can use appliances to expand but if you don’t improve tongue posture and swallowing patterns, your arches will relapse again. I also have had wisdom teeth extractions but getting wisdom teeth implants is not priority and I’m not sure if it is necessary at this point either. What is more important than wisdom teeth implant is to get our maxilla to swing up and forwards in the face with good oral posture, and make the jaws more square and wider with more chewing.
Thanks for your answer ,
if i am looking for wisdom teeth implant its because since i had my 4 wisdom teeth extracted and a bad adjusted splint ( which created me a maloclusion , my teeth don’t fit well together like they used to) my face have worsen a lot , my left cheek have totally sunken in and my right cheek is collapsing too.
i don’t know if those facial damage are due to the wisdom teeth removal or to the ” bad splint” . you seem to know a lot and that’s why im posting here to try to find some answer in order to fin solution to reverse this.
Do you think that wisdom teeth extraction can lead to a sunken/collapsing cheeks? or is it unlikely to be the case?
Before the extraction and the splint ( when i was 16 , im now 21 ) i used to be
a pretty good looking guy and my oral fonction and occlusion were perfect .
But now i realised that my tongue is not a the proper place , i also swallow the wrong way , my lower and upper jaw don’t fit together , my face is broken and i got TMJ .
SO what do you advise me to do? I was thinking about doing a skype consultation with dr mike mew or even fly to london to see what they could do for me.
I’m trying to correct swallowing and tongue posture by myself but its hard because in France we dont have orofacial trainer and this kind of people , then i need to find someone we will correct my occlusion ( is mike mew able to do this?) , i saw some appliance like the DNA appliance which claim to ” reset” things like they were suppose to be , Should i use this? , then palate expansion and face pulling to correct the damage and maybe wisdom teeth implant.
Thx for taking time to rea my long post , my main problem now is to find the cause of my sunken and collapsed cheeks and cure this .
not wisdom teeth extraction alone but poor oral posture. if Mike Mew is willing to treat you, imo he would be one of the best options out there.
I feel DNA appliance is hyped up a bit, I wrote about it here: http://claimingpower.com/homeoblock-dna-appliance-review/
what do I recommend? a lot of consistent effort to increase your jaw muscles and improve tongue posture and lip seal. I’m doing it without a oral myology trainer and it will be of most help to you imo.
I agree that the DNA appliance is an inferior product. I used it to expand to 38mm and now feel it is more of a hinderance than anything, especially how it keeps the front teeth and lips apart. My orthodontist cut the front bar off at my request, which was dumbfounding how much it impeded proper lip seal. I would rather not be reliant on a technological crutch, anyways. I may keep face pulling, however, but am curious as to the evolving consensus on that…
With proper musculature, I believe bone remodeling rates can be increased through periods of fasting and more specifically: urine therapy.
Thanks for the inspiration.
Can chewing gum for an extended period of time have harmful effects?
Also, if I’m understanding correctly, the benefit of chewing hard gum for an extended period of time, is that it’ll help develop muscle tone which will help the mouth to rest in close position and the tongue rest on the roof of the mouth. Any other benefits from chewing gum? Long-term benefits?
Thanks for your time– appreciate it!
I do not notice any harmful effects from extended chewing, our ancestors chewed way more.
besides change in posture, stronger jaws lead to slow remodeling of the bone.. widening of the jaw and face as a whole.
Hi Im a member and i must say this very interesting Reading. I wonder how much you paid for your threatment? I live in sweden so dr mew is the closest choice for me i think. Im going to reverse teeth extraction to.
Best regards
around $8,000 USD total but my doctor is semi-retired and doing it a lot cheaper than most places
THX you so much for you answer it means a lot.
i’m trying to correct my oral posture alone but its hard , for lip sealing i’m going to buy the “patakara lip trainer” but the hardest thing for me is to learn how to swallow the right way , i found this appliance do you think it could help in order to learn proper swallowing ? its called ” face-former”.
– concerning my sunken cheeks i did a lot of research and it could be because of muscle tightness related to my tmj disorder , knowing that my tmj is because of my maloclussion i would like to know which appliance could i use to cure this malocclusion while enhancing my facial feature , could biobloc solve maloclussion and tmj or am i looking in the wrong direction?
how much does membership cost? i really need your help
membership is $10 a month.
lip trainer is not the best way for lip seal, correct tongue posture is all you need.
never heard of face-former, re-learning swallowing pattern takes time and effort.
expanding your palate helps with this relearning process. ALF or Biobloc is pretty good imo for this.
hey i have a question. i wanna buy membership for only 1 or two months, as i dont have the money right now for the 4 months. so how can i buy membership for only 1 month???
Hi CP,
Maybe you’ve done this already, but could you show us exactly how to measure your inter-molar width, such as with a diagram?
I do not measure myself. My ortho does, with that being said you can purchase a caliper and run it across your first molar and try to get the shortest distance you get, and this will be your inter-molar width.
Does anyone know where I can find before and after pics or testimonials for ALF? I would like to hear more first hand experiences.
I was wondering: how is the alf going to increase the width between the last molars in the mouth? It seems only to be clasped to the molar right in front of the last molar in all the pictures I can find.. Is there some additional appliance to work that out or whats the deal with that?
I guess this summed it up pretty good, the alf can be used for many things.. molar distalization being one..
Does distalization mean forward/backward movement trajectory?
http://www.bronsonfamilydentistry.com/upload/DelzALFArticle.pdf
@ Facingtime
That’s an interesting link. In the second case study, the guy’s face actually lengthened and narrowed significantly after using DNA; I sure hope that’s not from using the device…
@ Facingtime
Sorry, meant to say ALF device, not DNA.
If you look at the whole picture you will see the aspect ratio is out of proportion.
The guys arms also lengthen, his waist lengthens…
The ALF Appliance is great.
Hi i have a question?? I have perfectly straight teeth and they’re supposedly aligned well when it comes to my bite (My dentist says I have nothing to worry about), however despite this I have a fairly narrow upper jaw. When I smile, you can’t actually see all my front teeth, at the far right and left sides of my smile. It’s almost like I have gaps where my teeth should be, except they are there; they’re just not very visible as they’re further back in my mouth.
Is there anyway to bring my teeth further forward so I have a fuller looking smile? and could this be achieved by using a palatal expander or should I just stick to proper tongue posture? As I said my teeth are perfectly straight and there’s no crowding whatsoever, I’m just worried about how narrow my jaws are. I’m really confused because usually people with narrow jaws have bad teeth? I don’t :/
work on proper tongue posture… if you can afford it something like ALF could help you.