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How Does the Tongue Fit in?

When the dental problem is crowded teeth, this can cause poor dental hygiene and therefore needs to be corrected. Lately, some dentists and orthodontists have been re-thinking the traditional practice of pulling teeth to make more space for the remaining teeth. Some are now recommending palate expansion to give the tongue more room, as well as the teeth. Dr. Bernstein can give you more information about this, so call or contact his Piedmont office for a neuromuscular dentistry consultation.
When the teeth are crowded

The accepted practice has been to extract pre-molars (bicuspids) to create space. You, or someone you know, may well have been treated in this way, and as a result may now have a nice set of straight teeth. Straight teeth are certainly a good goal and create a pleasing smile, but perhaps there’s an alternative. Is there a downside to having those extractions?
The position of the tongue

Our tongues are strong, being made of muscle. They come in a certain size and must fit in the space given to them, within the arch of the teeth.

  • If the tongue sits too far back in the mouth, it blocks the flow of air, often causing sleep apnea (periodic cessation of breathing)
  • If it sits too far forward, it can create a space between the lower and upper teeth, causing chronic malposition of the lower jaw and eventually leading to TMD/TMJ.

We could think of the tongue as a male lion and the teeth as timid deer. The lion is dominant and can push the border outwards, enlarging its territory and causing the deer to retreat to the edges.

If the mouth area is too small for the tongue, it goes to work making more space for itself. It uses its strength to push outwards against the teeth, simulating an orthodontic appliance. The tongue’s owner may not be aware of this maneuver. Over time, continued pushing moves the teeth, creates more tongue space, but often also causes gaps between the teeth.


An overbite is a common scenario, where the upper teeth hide, or partially hide, the lower teeth in coming together. This robs the tongue of some of its territory, as the lower teeth are now occupying some of it. People with overbites tend to have a collapsed look in the lower third of their face.
Bicuspid extractions

At first glance it would seem that removing some teeth to give the remaining teeth more room would also make more room for the tongue. But typically, after the extraction, the remaining teeth are fitted with traditional braces, or perhaps treated with Invisalign aligners, and moved to make even spacing, with no gaps or crowding. This constricts the dental arch, crowding the tongue. And a constricted arch often causes the teeth to slant inwards, meeting incorrectly in the person’s bite, rubbing on each other, accelerating wear and tear. Bite problems can result, leading to TMD and its painful symptoms, not to mention an unappealing smile.

Expanding the dental arch

Rather than removing any pre-molars, the dental arch (palate) could be expanded, which would both offer more tooth space and enlarge the tongue’s territory.

How would arch expansion be done?

  • The first step would be to ascertain the proper positions of the jaws regardless of any tooth crowding or gaps, as if the patient had no teeth. A TMJ / TMD neuromuscular dentist will use a TENS unit for this (Transcutaneous Electrical Nerve Stimulation). A TENS unit is a small, battery-operated box with several wires and electrodes. Electrodes are strategically placed on the face, neck and shoulders and for about a half-hour, while you doze off or read a good book, mild electrical current is delivered to your aching muscles. This interferes with the electrical currents in the nerves, and blocks that pain message from reaching the brain; this in turn causes the muscles to calm down.
  • Your lower jaw is now in a relaxed position, different from its usual tense one. This position is measured and recorded, and from this information a customized orthotic is made for you.
  • When you wear this orthotic, it gradually pushes the teeth into a position that will correspond with your jaw’s relaxed position. In some cases, some minor surgery might also be needed to separate the palate.
  • A TMJ dentist could also recontour some of the teeth, using porcelain veneers, laser recontouring, or dental bonding, so that they meet in a smooth, easy way.

Now any overbite is corrected, the tongue has more territory, and even the whole face will look more balanced. This person has had a kind of dental facelift.
Choose the best alternative

In some cases it could be that bicuspid extraction is the best way to go. But having alternatives and knowing what they are gives more room for decision-making. Consult Dr. Bernstein today if you’d like to discuss TMJ or TMD or for the options in your own case.