The Role of Tongue Tie & Myofunctional Therapy in Orthodontics
The Role of Tongue Tie & Myofunctional Therapy in Orthodontics
This page is for education. Evaluation and treatment should be coordinated with your pediatrician/ENT/sleep physician, a tongue-tie specialist, and your orthodontic team.
How the Mouth Develops (and Why Soft Tissues Matter)
During infancy and through childhood, the tongue acts like a “natural expander” and guide for jaw growth. This pressure from inside the mouth opposes the constrictive forces of the cheeks and chewing muscles. When the tongue naturally rests on the palate (roof of the mouth) with lips gently closed and nasal breathing predominant, the upper jaw widens and the face develops in balance. This functional pattern supports an open airway, efficient chewing, clearer speech, and stable teeth alignment over time. When the tongue is incorrectly resting in the mouth and nasal breathing stops, the pressures from the cheeks and chewing muscles have too much influence on jaw growth. This leads to poor development and airway changes. (Educational overview; AAO airway resources and context)
What “Ideal” Looks Like
Tongue posture: Broad, relaxed contact against the palate at rest
Breathing: Primarily through the nose, lips together at rest
Swallow: Coordinated, tongue up and back (not thrusting forward)
Growth: Upper jaw wide enough to accommodate teeth; lower jaw follows; balanced facial profile
How the Mouth Develops
The MARPE expander (short for Mini-implant Assisted Rapid Palatal Expander) is a powerful tool used to widen the upper jaw by gently applying force through mini-screws anchored in the palate. At Phillips Family Orthodontics, we use a custom 3D-printed metal MARPE appliance with a Tiger Power Screw to ensure accuracy, efficiency, and comfort during treatment.
Palatal expansion through the MARPE can:
Improve how your upper and lower teeth fit together
Create space for crowded teeth
Reduce dark corners of the smile (buccal corridors)
Enhance your airway and potentially improve breathing
Support long-term bite stability and facial balance
What Are Oral Ties?
“Oral ties” are tight or restrictive bands of tissue (frenula) under the tongue, lips, or cheeks that can limit movement. A tight lingual frenulum (tongue tie/ankyloglossia) may restrict tongue elevation and forward movement; lip and buccal (cheek) ties can also influence latch, oral seal, and functional patterns. The American Academy of Pediatric Dentistry (AAPD) recognizes that restrictive frenula can affect health—especially breastfeeding and speech—and emphasizes careful diagnosis and timing.
How Oral Ties Can Disrupt Development
Rest posture: If the tongue can’t reach the palate, it tends to sit low or forward
Breathing: Low tongue posture may promote mouth breathing, which can narrow arches over time
Swallow & speech: Compensations (tongue thrust, floor-of-mouth bracing) may develop
Growth effects: Narrow palate, crowding, crossbites, and longer, narrower facial patterns may emerge
Evidence note: Professional organizations acknowledge ties can impair function, but also caution against reflexive surgery without comprehensive evaluation and appropriate therapy before/after. Collaboration is key.
Infants: Nursing, Weight Gain, and Behavior
In babies, oral ties can interfere with latch, milk transfer, and maternal comfort—sometimes contributing to poor weight gain or long, inefficient feeds. Parents may also notice gassiness, clicking, or frustration at the breast/bottle. A thorough assessment by a pediatric clinician, lactation specialist, and an experienced tie provider helps determine whether release is indicated and how to time it relative to therapy. (Guidance consistent with pediatric policy discussions and clinical literature.)
Local preferred expert: For comprehensive evaluation and release when indicated, we work with Dr. Brian Hatch at the Oral Tie Center of San Diego. Dr. Hatch’s team focuses on functional outcomes across ages and collaborates with therapy and dental/orthodontic providers.
What Are Oral Ties?
“Oral ties” are tight or restrictive bands of tissue (frenula) under the tongue, lips, or cheeks that can limit movement. A tight lingual frenulum (tongue tie/ankyloglossia) may restrict tongue elevation and forward movement; lip and buccal (cheek) ties can also influence latch, oral seal, and functional patterns. The American Academy of Pediatric Dentistry (AAPD) recognizes that restrictive frenula can affect health—especially breastfeeding and speech—and emphasizes careful diagnosis and timing.
How Oral Ties Can Disrupt Development
Rest posture: If the tongue can’t reach the palate, it tends to sit low or forward
Breathing: Low tongue posture may promote mouth breathing, which can narrow arches over time
Swallow & speech: Compensations (tongue thrust, floor-of-mouth bracing) may develop
Growth effects: Narrow palate, crowding, crossbites, and longer, narrower facial patterns may emerge
Evidence note: Professional organizations acknowledge ties can impair function, but also caution against reflexive surgery without comprehensive evaluation and appropriate therapy before/after. Collaboration is key.
Infants: Nursing, Weight Gain, and Behavior
In babies, oral ties can interfere with latch, milk transfer, and maternal comfort—sometimes contributing to poor weight gain or long, inefficient feeds. Parents may also notice gassiness, clicking, or frustration at the breast/bottle. A thorough assessment by a pediatric clinician, lactation specialist, and an experienced tie provider helps determine whether release is indicated and how to time it relative to therapy. (Guidance consistent with pediatric policy discussions and clinical literature.)
Local preferred expert: For comprehensive evaluation and release when indicated, we work with Dr. Brian Hatch at the Oral Tie Center of San Diego. Dr. Hatch’s team focuses on functional outcomes across ages and collaborates with therapy and dental/orthodontic providers.
What Is Myofunctional Therapy?
Orofacial myofunctional therapy (OMT) is a structured program to retrain oral and facial muscles—rest posture, nasal breathing support, tongue elevation, proper swallow, and lip seal. Therapy is typically delivered by trained speech-language pathologists or certified myofunctional therapists as part of a team. Evidence is growing and supports individualized, function-first programs, especially when therapy is coordinated with other care (e.g., release, orthodontics, airway management).
How Therapy Helps
Before a release: Prepares muscles and patterns so the new range of motion is useful
After a release: Reinforces tongue-to-palate posture, efficient swallow, and nasal breathing
Long-term stability: Good function helps maintain dental/orthodontic results
Where Orthodontics & Expansion Fit
If growth was suboptimal or constricted due to chronic mouth breathing, low tongue posture, or ties, orthodontics can help reshape form to support function. Palatal expansion (in growing children) or skeletal expansion approaches (in mature patients) increase maxillary width, create tongue space, improve dental alignment, and support nasal airflow. Your orthodontist coordinates with medical providers for airway screening and with therapy to reinforce healthy habits.
Airway & Facial Aesthetics
Airway support: Widening a constricted palate can enlarge the nasal cavity and reduce airflow resistance; however, orthodontic treatment alone is not a medical treatment for obstructive sleep apnea (OSA) and should be coordinated with a physician.
Facial balance: Proper transverse width and tongue space often produce fuller smiles and more harmonious midface development.
AAO/peer literature emphasizes that orthodontists can screen for airway risk and collaborate with physicians; expansion may aid airway in select cases but OSA diagnosis/treatment remains medical.
What Is Myofunctional Therapy?
Orofacial myofunctional therapy (OMT) is a structured program to retrain oral and facial muscles—rest posture, nasal breathing support, tongue elevation, proper swallow, and lip seal. Therapy is typically delivered by trained speech-language pathologists or certified myofunctional therapists as part of a team. Evidence is growing and supports individualized, function-first programs, especially when therapy is coordinated with other care (e.g., release, orthodontics, airway management).
How Therapy Helps
Before a release: Prepares muscles and patterns so the new range of motion is useful
After a release: Reinforces tongue-to-palate posture, efficient swallow, and nasal breathing
Long-term stability: Good function helps maintain dental/orthodontic results
Where Orthodontics & Expansion Fit
If growth was suboptimal or constricted due to chronic mouth breathing, low tongue posture, or ties, orthodontics can help reshape form to support function. Palatal expansion (in growing children) or skeletal expansion approaches (in mature patients) increase maxillary width, create tongue space, improve dental alignment, and support nasal airflow. Your orthodontist coordinates with medical providers for airway screening and with therapy to reinforce healthy habits.
Airway & Facial Aesthetics
Airway support: Widening a constricted palate can enlarge the nasal cavity and reduce airflow resistance; however, orthodontic treatment alone is not a medical treatment for obstructive sleep apnea (OSA) and should be coordinated with a physician.
Facial balance: Proper transverse width and tongue space often produce fuller smiles and more harmonious midface development.
AAO/peer literature emphasizes that orthodontists can screen for airway risk and collaborate with physicians; expansion may aid airway in select cases but OSA diagnosis/treatment remains medical.
Risks & Limitations
- Tongue/lip/cheek tie release: As with any procedure, there are risks (pain, bleeding, scarring, re-attachment). Outcomes depend on appropriate diagnosis, timing, and adherence to pre-/post-therapy. Evidence for indications and timing is evolving; decisions are individualized.
Myofunctional therapy: Requires motivation and consistency; benefit varies with diagnosis, age, and team coordination. Evidence base is growing but heterogeneous; programs should be tailored.
Expansion/orthodontics: Soreness, transient bite changes, and, rarely, gum/bone side effects if poorly planned. Expansion is not a stand-alone cure for medical airway disorders; physician involvement is essential for OSA.
Who’s a Good Candidate?
You (or your child) might benefit from a team evaluation if you notice:
Infants: Painful latch, prolonged feeds, poor weight gain, clicking, early fatigue, or reflux-like symptoms (coordinate with lactation and pediatrician)
Children/teens: Chronic mouth breathing, snoring, narrow palate/crowding, speech distortions, low tongue posture, open-mouth rest, picky eating or fatigue with chewing, bedwetting, or attention concerns (screening + medical collaboration)
Adults: Daytime fatigue, snoring, clenching/grinding, narrow smile/arch, difficulty maintaining nasal breathing, or relapse after orthodontics (screen → medical evaluation as indicated)
For suspected oral ties, Dr. Brian Hatch — Oral Tie Center of San Diego for evaluation and treatment when indicated.
Our Team Approach to Coordinated Care
Comprehensive exam & airway screening (orthodontic) with photos, 3D imaging as needed, and functional assessment
Collaboration with your pediatrician/ENT/sleep physician for medical conditions (e.g., OSA) and referral to Dr. Brian Hatch for oral tie evaluation when appropriate
Therapy alignment: We coordinate myofunctional therapy (pre/post-release and alongside orthodontics) with qualified providers per ASHA scope guidance
Orthodontic plan: Expansion or other tooth/jaw guidance to restore space and support healthy function
Retention & habit support: Maintain results with continued nasal breathing, proper tongue posture, and periodic checks
Risks and Limitations
- Tongue/lip/cheek tie release: As with any procedure, there are risks (pain, bleeding, scarring, re-attachment). Outcomes depend on appropriate diagnosis, timing, and adherence to pre-/post-therapy. Evidence for indications and timing is evolving; decisions are individualized.
Myofunctional therapy: Requires motivation and consistency; benefit varies with diagnosis, age, and team coordination. Evidence base is growing but heterogeneous; programs should be tailored.
Expansion/orthodontics: Soreness, transient bite changes, and, rarely, gum/bone side effects if poorly planned. Expansion is not a stand-alone cure for medical airway disorders; physician involvement is essential for OSA.
Who’s a Good Candidate?
You (or your child) might benefit from a team evaluation if you notice:
Infants: Painful latch, prolonged feeds, poor weight gain, clicking, early fatigue, or reflux-like symptoms (coordinate with lactation and pediatrician)
Children/teens: Chronic mouth breathing, snoring, narrow palate/crowding, speech distortions, low tongue posture, open-mouth rest, picky eating or fatigue with chewing, bedwetting, or attention concerns (screening + medical collaboration)
Adults: Daytime fatigue, snoring, clenching/grinding, narrow smile/arch, difficulty maintaining nasal breathing, or relapse after orthodontics (screen → medical evaluation as indicated)
For suspected oral ties, Dr. Brian Hatch — Oral Tie Center of San Diego for evaluation and treatment when indicated.
Our Team Approach to Coordinated Care
Comprehensive exam & airway screening (orthodontic) with photos, 3D imaging as needed, and functional assessment
Collaboration with your pediatrician/ENT/sleep physician for medical conditions (e.g., OSA) and referral to Dr. Brian Hatch for oral tie evaluation when appropriate
Therapy alignment: We coordinate myofunctional therapy (pre/post-release and alongside orthodontics) with qualified providers per ASHA scope guidance
Orthodontic plan: Expansion or other tooth/jaw guidance to restore space and support healthy function
Retention & habit support: Maintain results with continued nasal breathing, proper tongue posture, and periodic checks
Frequently Asked Questions
Do all tongue or lip ties need to be released?
No. We look at function first: feeding, speech, rest posture, swallow, and breathing. Some patients do well with therapy alone; others benefit from release plus therapy. Timing and necessity are individualized per pediatric and dental guidelines.
Is myofunctional therapy just “exercises”?
It’s more than generic exercises. OMT is a custom program to establish tongue-to-palate rest, nasal breathing support, a coordinated swallow, and lip seal—delivered by trained clinicians and coordinated with your dental/medical team.
Will expansion cure sleep apnea?
Expansion can improve nasal airflow and create tongue space, but OSA is a medical diagnosis. Orthodontists can screen and collaborate; your physician (and often ENT/sleep medicine) leads diagnosis and treatment.
What age is best for addressing oral ties?
There isn’t a single “best” age. In infants with feeding issues, earlier evaluation may be important. In older children and adults, decisions consider symptoms, function, growth, and readiness for therapy. Policies stress thoughtful assessment and avoiding unnecessary or mistimed procedures.
Do we still need therapy after a release?
Yes—release changes anatomy; therapy changes habits and muscle patterns so the new range of motion leads to lasting functional gains.
Frequently Asked Questions
Do all tongue or lip ties need to be released?
No. We look at function first: feeding, speech, rest posture, swallow, and breathing. Some patients do well with therapy alone; others benefit from release plus therapy. Timing and necessity are individualized per pediatric and dental guidelines.
Is myofunctional therapy just “exercises”?
It’s more than generic exercises. OMT is a custom program to establish tongue-to-palate rest, nasal breathing support, a coordinated swallow, and lip seal—delivered by trained clinicians and coordinated with your dental/medical team.
Will expansion cure sleep apnea?
Expansion can improve nasal airflow and create tongue space, but OSA is a medical diagnosis. Orthodontists can screen and collaborate; your physician (and often ENT/sleep medicine) leads diagnosis and treatment.
What age is best for addressing oral ties?
There isn’t a single “best” age. In infants with feeding issues, earlier evaluation may be important. In older children and adults, decisions consider symptoms, function, growth, and readiness for therapy. Policies stress thoughtful assessment and avoiding unnecessary or mistimed procedures.
Do we still need therapy after a release?
Yes—release changes anatomy; therapy changes habits and muscle patterns so the new range of motion leads to lasting functional gains.
Key Takeaway
Healthy growth is a team sport: tongue posture, nasal breathing, and muscular patterns shape the jaws and airway. When ties or habits disrupt development, therapy + (when appropriate) release + orthodontics can realign form and function—safely, conservatively, and with the whole person in mind.
Key Takeaway
Healthy growth is a team sport: tongue posture, nasal breathing, and muscular patterns shape the jaws and airway. When ties or habits disrupt development, therapy + (when appropriate) release + orthodontics can realign form and function—safely, conservatively, and with the whole person in mind.
Get started today with a complimentary consultation
ENCINITAS
PHONE
(760) 943-7770
ENCINITAS OFFICE
761 Garden View Court #101
Encinitas, CA 92024
OFFICE HOURS
Monday 8:30 am – 5:30 pm
Tuesday 8:30 am – 5:30 pm
Wednesday 8:30 am – 5:30 pm
Thursday 8:30 am – 5:30 pm
Friday – By Appointment
MIRA MESA
PHONE
(858) 578-1822
MIRA MESA OFFICE
10737 Camino Ruiz #210
San Diego, CA 92126
OFFICE HOURS
Monday 8:30 am – 5:30 pm
Tuesday 8:30 am – 5:30 pm
Wednesday 8:30 am – 5:30 pm
Thursday 8:30 am – 5:30 pm
Friday – By Appointment
ENCINITAS
PHONE
(760) 943-7770
ENCINITAS OFFICE
761 Garden View Court #101
Encinitas, CA 92024
OFFICE HOURS
Monday 8:30 am – 5:30 pm
Tuesday 8:30 am – 5:30 pm
Wednesday 8:30 am – 5:30 pm
Thursday 8:30 am – 5:30 pm
Friday – By Appointment
MIRA MESA
PHONE
(858) 578-1822
MIRA MESA OFFICE
10737 Camino Ruiz #210
San Diego, CA 92126
OFFICE HOURS
Monday 8:30 am – 5:30 pm
Tuesday 8:30 am – 5:30 pm
Wednesday 8:30 am – 5:30 pm
Thursday 8:30 am – 5:30 pm
Friday – By Appointment