When the tongue can’t function properly (especially the middle portion), a cascade of events can happen. This is a very important point because many assess proper tongue function by mobility alone, but this does not uncover a posterior tongue restriction.

Assessing a tongue by how far a child or adult can move it is simply not enough. The middle portion of the tongue must be addressed because it is the biggest driver in normal development.

Tongue Restriction or Dysfunction

Following the Functional Matrix theory, if there is a tongue restriction or dysfunction while in utero and the tongue cannot reach the palate, the facial muscles will be the biggest factor shaping the palate. This  results in a high, vaulted palate at birth.

In infancy, a lack of function may lead to an inability to nurse properly or create a proper seal. This can be worsened by a high vaulted palate. If the palate is not stimulated, oxytocin release is limited and the facial muscles continue to be the largest influence on the shape of the palate. Symptoms of this problem can show up in both mom and baby immediately or a few days after birth. They can include: 

• Swallowing too much air resulting in: gassiness, reflux, spitting up, colic, getting “full” on air, or not draining breast, which leads to frequent feedings.
• Increased effort needed to eat, so falling asleep when nursing, short nursing sessions, and poor sleeping/frequent waking.  
• Excessive non-nutritive sucking/thumb sucking to stimulate palate and release oxytocin.
• Incorrect latch, which can be painful and lead to cracking/bleeding nipples or not fully draining breast, which leads to mastitis, etc.  

So many times, a “simple” answer to these problems would be switching to bottles or special formula and/or reflux medications instead of addressing the real issue. This is all too often missed by the medical field. When the underlying dysfunction goes untreated because the symptoms have been pacified by those treatments, the dysfunction continues and more symptoms develop.

The function or dysfunction of a tongue can lead to more health issues than many realize. Recent research has linked tongue dysfunction to a myriad of issues such as skeletal and bite changes. These issues can also lead to sleep apnea and TMD among other things. 

The evolution of recent thought is that sleep apnea and TMD are chronic “end stage” diseases whose roots develop early in life. Interventions as early as birth may help prevent or at least curb the severity of these diseases.

Exploring Tongue Function

The tongue is used not only for speaking, swallowing, and tasting, but also for other less obvious functions. The most important may be the tongue’s function of protecting the airway. When touching the palate, the tongue releases oxytocin, which has a calming effect.

The tongue is a large factor in normal growth and development of the face including the nasal and oral spaces. The Moss functional Matrix theory in essence states that the soft tissues will dictate how the hard tissues form. Or, in other words, form follows function.

According to this theory, the tongue will influence development of the palate, nasal cavity, and overall facial form. It then stands to reason that normal function is important for normal facial growth and development.

Development of Swallowing Patterns

The normal function of a tongue begins at the 18th week in utero when the fetus begins swallowing. Infants are born with a congenital suckling/swallowing reflex. At birth, the infantile swallowing pattern (called a “Tooth apart” pattern) is characterized by positioning of the tongue between the gum pads and the jaw slightly apart.

Stabilization of the mandible is from facial muscles and the interposed tongue. The middle portion of the tongue must lift and touch the roof of the mouth to create a seal when nursing and also release oxytocin.

Then, as teeth erupt, children change to a transitional swallow pattern. They will fluctuate between the infantile tooth apart pattern to an adult tooth together pattern. In the tooth together pattern, the teeth are together and the tongue is to the roof of the mouth.

This transition may be altered if the tongue cannot learn the proper position. An altered swallow pattern such as a tongue thrust may occur. Issues that can alter swallower pattern can be a tongue tie, poor or hyperactive muscle tone, a high vaulted palate, delayed non-nutritive sucking habits, or essentially anything that will not allow the tongue to reach the proper spot.

To be continued …

Dentists make thousands of choices during their careers. From practice style to how to shape retirement plans, we get to decide how to do things. No matter what style of practice the dentist chooses, the mix of services the involved dentist gets to pick from is ever expanding. Dental sleep medicine is one of the newest services we have added to the list and many dentists are curious about adding it into what they already do.

Practicing Dental Sleep Medicine

Dental sleep medicine may be the closest thing to practicing medicine any non-oral surgeon dentist will get. Managing a chronic disease – sleep disordered breathing – is much like managing another one, periodontal disease. More and more dentists every day are taking up the challenge of helping their patients breathe better during sleep.

Membership in Dental Sleep Medicine organizations, like American Sleep and Breathing Academy, has grown by double digits each year. The calendar is crowded with courses on how to make oral appliances. Dentists are finding the rewards that come with this area of practice energizing and fun. Whole office teams are being reshaped to learn new skills.

Dentists are taught some medical basics during professional school, but years of concentrating on what we do for oral health can dilute the attention paid to patient health history, pharmacology, and medical comorbidities.  

Since every sleep disorder is a medical diagnosis, collaboration with medical professionals requires the dentist to revisit whole body health and recover the ability to communicate with physicians with appropriate detail. Patients certainly expect their dentist to understand their diagnosis and treatment strategies.

Once the person is diagnosed with sleep disordered breathing, treatment choices include positive air pressure masks, surgery, and oral appliances (mostly mandibular advancement devices). Dentists must have a working knowledge of each of these strategies, especially as we are relied upon for expert application of the third choice. Advancing the mandible to open the airway is the description of what we do, but the implications of that choice involve every bit of scientific based health knowledge dentists know. Incorporating sleep dentistry into your practice can bring new learning and new energy to your practice at the same time that you significantly improve the health and quality of life of your patients.

For more information join Steve at the Dental Sleep course.

It is estimated that 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed. Integrating dental sleep medicine into your practice can be a great way to engage your self and your team and serve your patients in a powerful way that will improve their overall health.

Dental Sleep Medicine Involves the Whole Team

Adding dental sleep medicine to your mix of services requires the entire team to gain new knowledge of the role of sleep and the diagnosis of a sleep breathing disorder, as well as how we can utilize dental devices as an adjunctive therapy. This has to be combined with ‘dental’  concerns such as muscle pain, temporomandibular joint disorders, missing or loose teeth to finalize a treatment recommendation. Working through complex multi-factorial diagnostic and treatment planning decisions is part of practicing dentistry, and we simply apply these skills to the additional medical information that is pertinent for patients with a sleep breathing disorder.

When any new service or technique is added to our daily repertoire in a busy dental practice it can cause disruptions, stress, and challenges that some dental teams won’t be able to see past to get the rewards that come from all the hard work. In addition to acquiring the technical expertise make sure you have prepared your team, and you may benefit from expert advice and finding meaningful mentors that can assist you.

A complicating factor for many offices is the choice to submit sleep therapy to medical insurance. Most dental offices are not equipped for medical billing and many financial administrators, perfectly comfortable with dental claim forms, find themselves mystified at the nuances of submitting to a host of unfamiliar payers. Fortunately, professional medical billers have stepped up to help, but even making this agreement requires dentists to stretch their knowledge and get expert advice in new areas of healthcare.   

Choosing Dental Sleep Medicine

Why do this? While dentists often improve people’s lives in fantastic ways with pain relief, reducing infection and inflammation, and beautifying smiles, rarely do we have the opportunity to give them a chance to live longer. Obstructive sleep apnea left untreated is proven to shorten life expectancy.

Treating the disease will enable people with persistent hypertension to reduce their blood pressure. Bed partners of snorers whose airways are opened improve their quality of life. Often married partners who had chosen to sleep separately reconcile into one bedroom. When someone sits with our team and tells us how much better they enjoy dreaming again after years of missing it, our days are brighter!

Are you trying to decide if treating sleep-disordered breathing is right for you? Dental continuing education provides plenty of introductory courses. I’m honored to be the editor of Dental Sleep Practice Magazine, dedicated to practical education.

There are academies and associations dedicated to supporting every member of the dental team as we expand our medical involvement to provide a service that only dentists are capable of performing. Mini-residencies are forming at leading educational institutions to provide in-depth, multi-disciplinary learning.

Is it worth the effort?

The first time your team celebrates together after a happy patient gives everyone a hug because of how much better they feel now that they’ve used your oral appliance, I think you’ll know the answer.