The Merriam Webster dictionary defines the tongue as “the soft, movable part in the mouth that is used for tasting and eating food and in human beings for speaking”. While this is true, what the definition leaves out is the fact that the tongue is made up mostly of muscle. This explains why it is so effective in moving food through the oral cavity, and why when one receives lidocaine (‘novocaine’) during a dental procedure, your tongue feels like it’s paralyzed.
One of the clearest examples of the power of the tongue is in individuals who have enlarged tongues, hyper-active tongues or a condition known as tongue thrust. Over time, as the tongue pushes on the teeth (mostly the front teeth), the teeth are displaced, and are gradually moved forward and tipped out, resulting in a malocculsion known as an ‘open bite’. If the tongue thrust habit persists, the open bite can become quite significant, making it a challenge to correct even with braces.
When we identify a patient with a tongue thrust, we typically recommend placement of a habit appliance. This appliance, called a crib appliance, affectionately described as a ‘hockey mask’ by our patients, is cemented onto a patient’s back molars. The ‘crib’ portion of the appliance is made up of a smooth cage like attachment which prevents the tongue from pushing directly against the palate and the backsides of the upper front teeth,thereby eliminating the undesired pressure contributing to the open bite. And since the lips are a muscle in and of themselves, over time, lip and cheek pressure can reduce the open bite, and improve a patient’s bite.
The crib appliance is typically kept in the mouth for a year to break the tongue thrust habit. After an initial short period of adjustment to the appliance, most patients adapt easily, and have no problems whatsoever with eating and speech. And despite it’s cage-like appearance, most patients are not put off by it’s look.
In some cases where patients are also sucking their thumb, spurs are added to the appliance which act as a deterrent for thumb placement.
While the crib appliance is effective in stopping the tongue thrust habit, oftentimes one will need full braces to close the bite and improve one’s smile completely. However, if left untreated for too long, even braces may not correct one’s bite completely. Hence, early intervention is recommended.
One of the more important parts about the profession of pediatric dentistry is the need to stay current, educated and well informed. Dentistry is in a constant state of flux, with new products, technology and techniques being introduced on a daily basis.
The access we have to continuing education is enormous and varied – there are the ‘old-fashioned’ paper scientific journals, online courses in the form of webinars, newsletters, courses at our local dental schools, evening talks sponsored by our local dental societies, blogs, study groups, seminars with the thought leaders in our profession, and even daily emails with ‘pearls of the day’. Phew…that’s a lot of learning!
Sometimes just getting away from it all is what’s needed to be able to thoughtfully absorb all of the information which is out there. That is one of the purposes of the annual American Academy of Pediatric Dentistry Conference which is held every year during the Memorial Day Weekend. During the conference (of which there are usually over 4000 pediatric dentists, assistants, hygienists, business staff and academics in attendance), one has the luxury of being able to choose from dozens of continuing education courses. With topics ranging from those heavy on the science (“TMJ and related conditions in children and adolescents”) to practice management topics (” Caries is Not Binary: How and What Professionals and Consumers Are Learning Will Change the Way We Practice”) to the mundane (” ICD-10 Is Coming! Be Prepared!), there is literally something for everybody. There are also exhibits with vendors displaying the latest technology such as lasers, low radiation digital x-rays and scanners and practice management software.
This year’s conference was held in Seattle. Our very own Dr.’s Schneider and Griffith represented our practice and brought home lots of information for use in our practice.
Here are a few pictures from their trip:
Dr. Griffith and Dr. Schneider touring the exhibit halls
There was a fascinating article that appeared last year in the Sunday New York Times discussing the impact of HIPAA on the ubiquitous happy baby pictures one oftentimes sees in Pediatrician and Obstetrician offices. We ourselves used to have a “No Cavity” wall which was replaced a number of years ago with electronic pictures that are erased on a daily basis.
HIPAA, which stands for “The Health Insurance Portability and Accountability Act” is a now, old law which governs patient privacy and ensures that one’s health information is protected. You, as the patient, probably know of it by the mountains of papers which you have to sign even before you are seen by your Doctor. I
The New York Times article discussed how the age old tradition of posting pictures of babies on a bulletin board are falling victim to offices bending over back to adhere to their interpretation of what the rules of HIPAA mandate. While there is no explicit line in HIPAA stating that ‘baby pictures sent in by parents may not be posted’, pictures are considered a protected entity, in the same way radiographs and medical charts are protected. One would think that if a parent were to post a picture of their baby on the practice’s Facebook page, or send in a picture of their baby, that there is implied consent to post the pictures in the office. It turns out that ‘implied consent’ is not adequate, and that ‘explicit consent’ needs to be obtained. Yet another form needs to be signed.
Our practice is quite mindful of the privacy rights of our patients, and prior to posting any pictures online or in the office, we have parents sign a consent form. While this may have done away with some of the spontaneous pictures we used to take, we are mindful that in this day and age of privacy concerns, that it is wise to err on the side of caution. The times are a changing!