06/03/2026
Tongue ties are not the only restriction we look at in our assessment of jaw development.
Underbites, underdeveloped upper jaws, and the contribution of upper lip and cheek ties.
Here’s one of two 8.5-year-old twins I’ve been treating who both presented with Class III relationships (underbites) and underdevelopment of the upper jaw.
Both children were treated with palatal expansion using Biobloc, which corrected the underbite and allowed the adult teeth to erupt into a more favourable relationship.
For as long as I’ve treated underbites, I’ve recognised the connection with low tongue posture. In my observation this is associated with tongue-tie and sometimes enlarged tonsils.
However, in recent times, as I’ve started paying closer attention to other oral ties, I’ve increasingly recognised the role that facial tension from upper lip ties and buccal (cheek) ties may play in restricting normal upper jaw development.
The top photos are from the initial consultation in November 2024.
The lower two photos of upper lip tie, and upper cheek ties, were taken last week, just before we performed five oral releases including upper lip, two upper cheek, lower lip, and tongue-tie releases.
When I reviewed the twins today, both reported that the most noticeable change overall was that their cheeks felt “loose.”
Their mum reported this twin's upper lip appeared less tight, and that her speech sounded clearer, with better engagement of the upper lip and tongue.
Class III malocclusions are traditionally considered one of the most unstable orthodontic problems to treat, and many families are told early on to save up for jaw surgery.
But when we start to recognise how soft tissue restrictions, lip tension, cheek attachments, and low tongue posture may influence facial development, it opens another avenue.
If these functional contributors are addressed early, it may be possible to redirect a more normal pattern of facial growth and reduce the need for more complex treatment later.
This pattern has become very clear and difficult to ignore once seen.
Disclaimers:
Any orthodontic procedure carries risk, and individual results may vary. Before proceeding with treatment, you should seek a second opinion with a specialist orthodontist.
Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.