Oral Facial Cranial Development in Children

These are questions that a Dentist named Weston A. Price asked himself, back in the 1930’s. He was interested in why people in the primitive cultures had beautiful wide jaws, and strong teeth. He found with his research that it had alot to do with the food that was available, unrefined and not at all processed - it required a lot of effort to chew the food. This meant that the bones and muscles of the jaw were getting good exercise every time they were eating. All these people had Class 1 Occlusions - which is the ideal position for the jaws to be in for skeletal strength and stability. What he found when these people from these cultures came into Western society, and started eating our processed and refined food, that their jaw bones and muscles became weak due to lack of use. They started to develop malocclusions (distorted bites), and there was a lot of crowding and teeth, not fitting into jaw bones properly any more. These factors continue the influence oral facial development of our children today.  As chiropractors it is important that we take the time to look at the jaw, and its relationship to the cranial bones and skeletal function. Children under the age of 3 years will not have even seen a dentist yet, and even when they do, the dentist will only really be looking at the teeth, not the bite. We have an opportunity to start to educate patents on the oral health of their child beyond cleaning their teeth. It is very evident early on which children are going to need orthodontic work. We can do a lot of positive work by balancing the posture and helping to get the jaw into a good structural alignment. Educating patients about the importance of whole foods that require effort to chew, so that they work the bones and muscles.
When we start to look at and in children’s mouths we will see that there are a lot of children with poor oral function. We are looking to see a Class 1 normal Occlusion.
 
Normal Class 1 Occlusion

 
Identifying a Common Malocclusion - Open Bite:
When you see a child who has a class 1 occlusion at the back, but the teeth do not connect in the front, then we have what is called an OPEN BITE. This is the bite that we see with children who have sucked a dummy, and will often be associated with a tongue thrusting habit. Tongue thrust (also called reverse swallow or immature swallow) is the common name of orofacial muscular imbalance, a human behavioural pattern in which the tongue protrudes through the anterior incisors during: swallowing, speech and while the tongue is at rest. Some young children will exhibit a swallowing pattern involving tongue protrusion, and it will resolve naturally into a more mature swallow response. But, for some this tongue thrust will be with them for life, people who tongue thrust do it naturally and are usually unaware of the behaviour.
 
To understand how swallowing occurs, make the sound of the letter “N”, you will notice the placement of the tongue behind the upper central teeth. That placement of the tongue is the first step in swallowing naturally in adults. The tongue should then flatten up onto the roof of the mouth during the process of swallowing. This is how the arch of the maxilla is expanded naturally over time - with the tongue pressing up to stimulate growth of the cruciate suture. When a child has an aberrant swallow pattern they are not getting this pressure of the tongue onto the roof of the mouth, so the maxilla is underdeveloped- hence the problem with teeth not fitting in the mouth.
 
The tongue posturing is a big part of the problem for these children. We are probably not aware of what a strong muscle the tongue is and how it can move the teeth and even the bones of the jaw around. If we have aberrant tongue posturing it will undo any of the work that even plates and braces can achieve. We need the tongue to be working with us not against us.

Aetiology 
While identifying the causes of tongue thrust, it is important to remember that the resting posture of the tongue, jaw, and lips are crucial to normal development of the mouth and its structures. If the tongue rests against the upper front teeth and against or between the anterior teeth during swallowing, or lies down low in the mouth, it can affect the normal dental development.

  • Dummy use
  • Low-lying resting posture of the tongue. E.g.: with tongue tie
  • Thumb and finger sucking
  • Some artificial nipples used for feeding infants
  • Mouth breathing
  • Nasal congestion
  •  Allergies
  • Difficulty swallowing: adenoids, tonsils, enlarged tongue

Tongue thrust, Open bites and Ear Infections
Many young children will exhibit a swallowing pattern involving tongue protrusion. This may well be one of the factors in why there are so many children with ear-infections! If they have been using a dummy frequently they will often have developed an open bite and a tongue thrusting pattern. These children are not using the posterior throat muscles to pull the tongue back during the action of swallowing (as they have the reverse swallow pattern where the tongue protrudes forward).  This means that the muscles which pull on the eustachian tubes and help with drainage of the ears are weak and underdeveloped, and not working effectively. Therefore, these children are much more prone to developing ear infections.
 
These children are also more likely to have poor lip competence (ability to keep lips together at rest) and are thus prone to mouth breathing and all the long term health compromise that this causes, from forward head posture to asthma.
 
What can we as chiropractors do to help improve oral function?
Firstly: Look at what is the underlying cause of the problem. 

  • Is the child sucking on a dummy, thumb or finger, or using a bottle for a prolonged period?
  • Does the child have a tongue-tie or a lip-tie?
  • Are there enlarged tonsils or adenoids? Is this due to allergic response?

We will need to address these causative factors as well as providing restorative chiropractic care.
 
Something else that we as Chiropractors to help restore optimal function to this area, is recommend a Myo Munchee.
 
The Myo Munchee (MYO) was developed by Dr Kevin Bourke (Dentist) in the 1960’s and 70’s- with the research of Dr Weston Price in mind. Chewing the MYO is all about exercising the muscles and bones of the jaw, while putting the jaw into a Class 1 Occlusal position. This exercise helps to re-establish the balance and function of the stomagnathic system.
 
The MYO provides non-traumatic exercise for the peri-cranial, facial and jaw musculature and bones. This improves the quality and quantity of the alveolar bone and the attached gingivae. Chewing this will also promote nose breathing and activation of the posterior throat muscles which are required to swallow the saliva produced when chewing. The child cannot use the reverse swallow pattern and tongue-thrusting when they have the MYO in their mouth. Chewing the MYO for 10 minutes a day will have profound effects on the long term oral health and function of these children. It establishes more competence in the orbicularis oris muscle (lip competence), and assists in the retraining of the reverse swallow tongue thrusting patterns.

In this article I have only talked about 1 type of Malocclusion that we commonly see in practice: The Class 1 Open bite. There are many others that we will see once we start to look: cross-bites, under-bites and over-bites. All will respond well to use of the MYO. If you would like more information please refer to the website: www.myoaustralia.com.
  
References:

  1. Weston A. Price:  Nutrition and Physical Degeneration - A Comparison of Primitive and Modern Diets and Their Effects
  2. MyoAustralia Website www.myoaustralia.com
  3. Early treatment of Malocclusion- Dr Kevin J. Bourke www.teethperfect.com
  4. The Importance of Correct breathing for raising healthy children- Rosalba Courtney
  5. ND DO Journal of the Australian traditional Medicine Society