This very sweet 12 year old girl came into my office for an Invisalign consult. She has already been through the first round of orthodontics with traditional braces. She only bites on her 1st molars. No other teeth touch. Her tongue is constantly resting between her upper and lower teeth and she has been in speech therapy for many years to correct her tongue thrusting habit. She has a crossbite in the molar area, too.
So why is the orthodontics not working? Why is the speech therapy not working? Take a look at her tonsils, particularly her right side. They are huge! Every time she swallows, thousands of times every day, her tongue comes forward to allow the swallowing. The tongue may also come forward to assist her breathing as she has allergies that require medication. This is a situation that puts a patient at risk for Obstructive Sleep Apnea (OSA).So what's going on here? As the tongue comes forward, it opens up the bite between the upper and lower teeth. At the same time the tongue comes forward, the cheeks collapse inward putting pressure on the upper molars, which causes the crossbite and a high palate. This patient needs to have a thorough evaluation and treatment by an Ear, Nose and Throat specialist before proceeding further with orthodontics. And she most likely needs her tonsils removed.
As dentists, we need to look beyond the teeth, gums and bones to see what is really going on. The success of our dentistry depends on this, but so does the life and health of our patients.
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