Hi Everyone and welcome back to my YouTube channel. My name is Priya Mistry and I'm a
General Dentist with a practice dedicated to taking care of patients with TMJ disorders.
Today's video is about tongue tie and how it's related to TMJ problems.
This video is for my fellow dental practitioners, it's for patients who are struggling with TMJ
problems, and for people who might just be looking for some more information.
This topic is so important to me in my private practice because tongue tie is directly related
to why a lot of my adult patients struggle with TMJ disorders. Fellow dentists -we can be of
great service to our patients if we are looking at more than just teeth! So with that being,
said let's get started. What is a tongue tie? Underneath our tongues is a band of tissue called
the frenum or the frenulum. All of us have this band of tissue, but not all of us are tongue-tied.
The frenum tethers the tongue to the floor of the mouth and if the frenum is too tight or
restrictive, then that is a tongue tie. The tongue needs a certain amount of mobility for nursing,
for chewing, for speaking, for swallowing, for proper tongue posture and without that mobility,
all of those things that I just listed off are negatively affected. So what is proper
tongue posture? Proper tongue posture is when the entire tongue is up against the roof of the mouth
with a light suction. The tip of the tongue should be resting against the little pad of tissue behind
our front two teeth and the middle and back of the tongue should also be elevated as well,
up against the roof of the mouth with a light suction. So take a moment to evaluate yourself.
You're watching this video, hopefully not talking, so if you're just watching it, then your lips are
closed, your teeth are apart, and your tongue should be up against the roof of the mouth.
When i ask people to evaluate their tongue position, probably about 40-50 percent of
people actually say that their tongue is down at the floor of their mouth. And that is not proper
tongue position! Proper tongue position - up, against the roof of the mouth - is so
important for so many things. It's important for development of the roof of the mouth,
it's important for stimulation of cranial nerves, and release of growth hormones and endorphins.
In this video, we'll be focusing about how it helps develop the roof of the mouth. When the
tongue is in its proper position from infancy onwards, it is extending forces onto the roof
of the mouth - or the palate - allowing it to grow and expand to its full genetic potential.
When the palate grows and expands to its full genetic potential, it can accommodate
all the upper teeth within the arch. When all the upper teeth can be accommodated in the arch,
there's not typically crowding and so these individuals do not need orthodontia or braces.
Another thing that helps form the dental arches is a diet that lacks processed foods. So when
we're eating unprocessed foods that are harder to chew, we're really working out our chewing
muscles and our facial muscles. And when these muscles are getting a good workout,
they get nice and strong and they exert forces inward onto the dental arches,
while the tongue exerts outward forces onto the roof of the mouth. And this is what allows the
arches to expand to their full genetic potential, and this is what allows for all the teeth to then
fit into the arches. If you look at the skulls of our ancestors before the industrial revolution,
if you look at the skulls of Cro-Magnon, if you look at the skulls of Neanderthals - none
of them needed braces! They could accommodate all of their teeth - including their wisdom teeth - in
all of their arches! Why is this? Proper tongue position and diet! Small or narrow arches with
very crowded teeth make it so that the upper teeth and the lower teeth contact each other in
a way that is far less than ideal. The upper teeth should fit against the lower teeth like a hat box
with the upper arch being wider than the lower arch. With a narrow upper arch due to improper
tongue position, which is typically caused by a tongue tie, deep bites and crossbites occur.
Crossbites and deep bites are far from ideal and what they end up doing is putting excess force on
the TMJs - the joints themselves - and the muscles that guide and support the jaw a crossbite is an
actual lateral misalignment of the jaw. And so what it does is when the teeth come together
in a crossbite, it puts a lateral force on this joint right here these TMJs, the Temporomandibular
Joints, are built for a lot of up and down, and forward and backward movement, but they
are not built for a lot of lateral movement! And so these lateral shifts that a crossbite causes
every time the teeth come into contact, then puts strain on the ligaments within the joints.
When these ligaments are strained, they get looser and what happens then is that the little disc of
tissue within the joint called the articular disc starts coming in and out of alignment. And
when it comes in and out of alignment it causes popping and clicking - and that can or cannot be
accompanied by pain - but it is far from ideal. We don't want those noises within the joint.
A deep bite is when the upper front teeth overlap the lower front teeth excessively, as this diagram
shows. What a deep bite does is it actually pushes or holds the mandible back, and doesn't allow it
to grow down and forward to its full genetic potential. When the mandible is held or pushed
too far back what happens is that that little disc of tissue -the articular disc - dislocates
more easily. So with the condyle - the little bony knob our mandible ends on - being too far back,
the disc dislocates forward and inwards much more easily. When it's out of alignment, that disc will
click and pop and snick, and when it's completely out of alignment, those sounds go away and the
jaw is locked closed. So for more information on that condition go ahead and check out my videos
"Jaw Locked Closed" part one and part two. The jaw locking closed is a condition that's very
difficult to identify and even more difficult to treat, so if we can avoid getting there in
the first place that's always the way to go. If we have very narrow arches with crowded teeth,
a typical solution kind of back in the day and I think it's sometimes still being done, would be
to extract the first premolars. So if you pull out four permanent teeth, how do you close the spaces?
Typically everything's pulled backwards to close those gaps up. So if everything is
pulled backwards, the volume of space that holds the tongue is basically made a lot
smaller and so where does the tongue go? It goes into the airway leading to sleep apnea.
When people have sleep apnea, they typically clench and grind their teeth a lot.
Clenching and grinding is sort of our body's response to stress, so if our body knows we're
not getting enough oxygen, it'll lead us to clench and grind our teeth. Grinding the mandible forward
like this also opens up the airway, so it's our body intuitively trying to get more oxygen. The
forces of clenching and grinding can be enormous - 80 to 100 times more than regular chewing
forces, or even more than that! Some people can generate enormous forces. The muscles of our head,
neck, jaw, our joints they're not built to take on that kind of force, so when that happens
it leads to headaches, it leads to jaw pain, ear pain; it leads to clicking,
popping, it leads to the disc being dislocated within the joint. So it's all really related
and this is the pathway of kind of how it gets there, and I hope that's what this
video is clarifying for you guys. Let's take a moment to look at a few images
on the left is an image of someone with proper tongue posture and a wide open airway.
On the right is an image of someone with low tongue posture and a constricted airway.
The image on the right is a patient of mine who's in her 40s with an anterior tongue tie that
was never diagnosed. She had her first premolars extracted during orthodontia, and now has a narrow
airway and has been diagnosed with sleep apnea. She also has low and posterior tongue posture.
It doesn't take a large stretch of the imagination to see that if she could elevate her tongue
and hold it forward and against the roof of her mouth, her airway would be larger.
Will that solve her sleep apnea? It certainly will help, but only a sleep test will tell if she's
getting adequate oxygen. Now let's explore the connection between tongue tie and TMJ disorders.
Tongue tie leads to low tongue posture, low tongue posture makes it so that the roof of the mouth or
the palate does not expand to its full genetic potential. This leads to narrow palates that are
vaulted, as well. Narrow, vaulted palates make it so that teeth are crowded; they have nowhere
to go if the palate is not wide enough. Crowded teeth lead to deep bites and crossbites, which put
excess strain on the muscles of the head, neck, and jaw as well as these joints right here.
Crowded teeth can also lead to the first [pre]molars being extracted and everything being
pulled back, leading to narrower airways, leading to sleep apnea, which then leads to clenching
and grinding, which then puts excess force on the joints and the muscles once again.
Typical symptoms that we see in our office, once again, are: headaches, jaw pain, ear pain, stuffy
ears, clicking or popping within the joint, or the jaw being actually locked closed - which is again,
difficult to treat. Again, because I have a practice where I exclusively treat patients
with TMJ disorders, the connection between tongue tie and TMJ problems is incredibly clear to me.
But since we weren't taught this in dental school, since there's no clear research due
to the lack of TMJ specialists, a lot of people don't know this information or it's hard to make
that connection. So I just want to make sure I'm doing what I can to get the information
out there. For more information, please read this book called "Tongue Tied" by Richard Baxter.
This book really helped me connect so many dots and it changed the way I practice both
general dentistry and the way I look at things and view things and practice in my TMJ practice,
as well. So this is such a wonderful tool and if any of you happen to be nursing mothers,
new mothers that are watching out there - this book is incredibly useful too! I will be releasing
videos soon specifically on tongue tie and nursing, tongue tie and breathing, myofunctional
therapy - what it is why it's so effective and amazing - and there's just so much more to come!
I'm excited to share it with you guys! If you liked what you heard or learned something,
please click "Like" below and SUBSCRIBE to my channel. There's so much more to come! Thank you!