Four articles in the October issue of the AJO-DO attracted my attention. All were related to the tongue. Lowe and Jacobson and Schendel discussed the competing advantages of appliances and surgery when correcting sleep apnea, while Ioi and colleagues assessed the ideal width of a smile. El-Dawlatly and co-workers discussed the dental and skeletal components of deep bites, and Cassis et al described the results of bonded spurs coupled with high pull chin cap therapy. However only the last article mentioned the word ‘tongue’.
When I trained, the word tongue did not appear in my orthodontic text book. Even now, few clinicians rate the tongue as very important, although most might accept that wide palates tend to be associated with tongue-to-palate postures and many would link a low tongue posture to class III malocclusion; however, scientists would consider such thoughts no more than anecdotal.
In truth, few scientists are interested, because we cannot accurately assess long-term tongue posture, but that should not mean that we can dismiss these concepts entirely. When evidence is lacking or contradictory, it is sometimes better to rely on logic. With sleep apnea, the tongue often rests close to the pharyngeal wall, associated with a retruded maxilla. The evidence suggests that the longer sleep apnea appliances are worn the more retruded the maxilla becomes, while surgical correction tends to relapse in the long-term. Might changing tongue posture be more effective than both?
What supports the maxilla and why do the buccal corridors have such influence on the appearance? It is important to assess the nature of deep-bites, but surely more so to assess their cause. Mostafa and his team did not mention the tongue, but I have never seen a deep-bite where the tongue does not overlap the lingual cusps of the lower teeth. Is this important?
Attractive faces have wide arches and pronounced malar processes, but despite the broad width these are usually associated with hollow cheeks. Perhaps the tongue is positioned in the palate with flat buccinator muscles. Perhaps we should pay more attention to tongue posture.