The tongue is the most influential muscle in the mouth, and most of its influence happens when nothing is happening at all — at rest. Where the tongue sits for the twenty-odd hours a day a child is not eating or speaking shapes the palate, the arches, and the ability to keep the lips closed.
At Savannah Dental in Savannah, GA, we assess oral function alongside structure, because in a growing child the two continually shape one another.
Tongue Posture And Facial Development
In a healthy resting pattern, the lips are gently closed, the teeth are slightly apart, breathing happens through the nose, and the tongue rests broadly against the roof of the mouth.
That last detail carries structural weight. A tongue resting against the palate provides light, constant outward pressure, which helps encourage the upper arch to develop to its full width. The palate is also the floor of the nasal cavity, so a broader palate typically means more room above it.
When the tongue rests low — sitting on the floor of the mouth rather than against the roof — that stimulus is reduced. Over years of growth, the pattern that often follows includes:
- A narrower upper arch with less room for teeth
- A higher, more vaulted palate
- Crowding or rotation as permanent teeth erupt
- Weak lip seal, making an open-mouth posture feel more natural
- Changes in facial proportion over the growing years
Low tongue posture is rarely a choice. It is usually a consequence — of nasal obstruction, restricted tongue movement, or habit that outlasted its original cause.
Tongue Ties And Breathing
A tongue tie (ankyloglossia) is a restriction of the lingual frenulum, the band of tissue connecting the underside of the tongue to the floor of the mouth. When the restriction limits movement, the tongue may be unable to reach and rest against the palate.
That is the connection to breathing: if the tongue physically cannot get to the roof of the mouth, it defaults to a low resting position, which in turn tends to accompany an open-mouth posture and mouth breathing.
What we assess is function, not just appearance:
- Can the tongue elevate to the palate with the mouth open?
- Can it move laterally and extend past the lower lip?
- Where does it rest when the child is not thinking about it?
- Is there difficulty with feeding, speech clarity, or clearing food from the teeth?
An important caveat, and we would rather say it plainly: not every tongue tie requires release. Tongue tie has become a heavily discussed topic, and there is legitimate professional concern about over-diagnosis. Many children have some degree of frenulum attachment with no functional consequence whatsoever. We recommend a release procedure when function is genuinely restricted and that restriction is affecting development — not because a frenulum is visible.
Lip Ties Vs. Tongue Ties
The two are frequently mentioned together and are not the same thing.
- A tongue tie involves the frenulum under the tongue and may restrict elevation, extension, and lateral movement. Its main relevance is to tongue posture, feeding, and speech.
- A lip tie involves the frenulum connecting the upper lip to the gum above the front teeth. A restrictive attachment may limit lip mobility, affect infant latch, contribute to a gap between the front teeth, or make thorough cleaning of that area harder.
Of the two, tongue restriction is generally more relevant to airway and facial development, because it is tongue posture that shapes the palate. Lip ties are more often a feeding, hygiene, or spacing consideration.
The same caution applies to both. A visible frenulum is normal anatomy. The question is always whether it restricts function.
Myofunctional Therapy For Children
Myofunctional therapy is a program of targeted exercises that retrain the muscles of the tongue, lips, and face toward healthier resting and functional patterns. Think of it as physical therapy for the mouth.
Goals typically include:
- Establishing correct tongue rest posture against the palate
- Strengthening lip seal so a closed-mouth posture becomes comfortable
- Encouraging nasal breathing as the default pattern
- Improving swallowing patterns, where the tongue thrusts forward against the teeth
- Supporting chewing and speech function
Timing matters in both directions. If a tongue tie is genuinely restricting movement, exercises alone may not achieve much until the restriction is addressed — and conversely, a release without follow-up retraining often does not change a habit that has been in place for years. The two work together.
Myofunctional principles also underlie appliance-based approaches such as Myobrace®, which combine habit correction with guided development. Which route suits a particular child depends on age, findings, and how much the family can commit to daily exercises — this is one area where consistency at home genuinely determines the result.
Thumb Sucking, Pacifiers, And Oral Development
Sucking is a normal, self-soothing infant reflex, and early use of a thumb or pacifier is not a concern. What matters is duration and intensity.
Prolonged habits — generally past ages 3 to 4, and particularly once permanent teeth begin arriving — can influence development because the mouth adapts to sustained pressure:
- Narrowing of the upper arch, as cheek pressure works inward without the tongue counterbalancing it
- An open bite, where the front teeth no longer meet when the back teeth close
- Flaring of the upper front teeth and changes in bite relationship
- A reinforced low tongue position, since the thumb or pacifier occupies the space the tongue should hold
- Tongue thrust swallowing patterns that persist after the habit ends
A few practical notes. Pacifiers are generally easier to phase out than thumbs, since they can be removed. Orthodontic-shaped pacifiers may reduce impact but do not eliminate it. And pressure or shaming tends to backfire — these are comfort habits, and children usually respond better to gradual, positive approaches. If your child is still sucking well past age three, mention it at a routine visit and we can discuss what is happening and whether anything is needed.
Open-Mouth Posture In Children
Open-mouth posture — resting with the lips apart even when not speaking or eating — is one of the most visible signs of altered oral function, and one of the easiest to overlook because it becomes familiar.
You may notice it while your child watches television, concentrates on homework, or sleeps. Chapped lips, a dry mouth, or drooling on the pillow past the toddler years often accompany it.
Open-mouth posture is a signal rather than a condition. It commonly reflects nasal obstruction, restricted tongue movement, weak lip muscle tone, or a habit that persisted after its original cause resolved.
The reason we take it seriously is that it is self-reinforcing. Lips apart means the tongue drops low, which reduces the stimulus for the arch to widen, which narrows the space above — which makes nasal breathing harder still. Interrupting that loop while a child is growing is more effective than addressing its results later.
What An Evaluation Involves
We assess tongue mobility and resting position, lip seal and muscle tone, swallowing pattern, palate shape and arch width, bite relationship, and breathing pattern. We also ask about feeding history, speech, and any habits still in place.
From there the recommendation might be monitoring, myofunctional therapy, a release procedure where function is genuinely restricted, guided arch development, or referral to an ENT, speech-language pathologist, or pediatrician. Often it is a combination, sequenced in a particular order for a reason we will explain.
Why Families Choose Savannah Dental
- Function assessed, not just anatomy: We evaluate what the tongue and lips actually do, not only how they look.
- Conservative about procedures: We recommend release when function is restricted — not because a frenulum is visible.
- Advanced training in airway dentistry: Our doctors have pursued additional education in functional and airway-focused care.
- Collaborative: We work with speech-language pathologists, ENTs, and pediatricians when that serves your child better.
Frequently Asked Questions
How do I know if my child has a tongue tie?
Appearance alone will not tell you, and it will not tell us either. What matters is whether the tongue can elevate to the palate and move freely. That takes a functional assessment.
Does every tongue tie need to be released?
No. Many cause no functional problem at all. We recommend release when restriction is genuinely affecting posture, feeding, speech, or development.
How old should a child be for myofunctional therapy?
Programs generally suit children old enough to follow and repeat exercises consistently, often from around ages 5 to 6. Younger children may be better served by appliance-guided approaches.
My child still uses a pacifier at four. Is that a problem?
It is worth discussing. Effects depend on how often and how intensely, and stopping now may allow some changes to improve on their own as growth continues.
Can exercises alone fix mouth breathing?
Sometimes, when the cause is habit or muscle pattern. If nasal obstruction is the underlying reason, that needs addressing first — and that may involve a physician.
Schedule An Evaluation
If your child rests with their mouth open, has difficulty lifting the tongue, or still has a sucking habit past the early years, an evaluation will clarify what is driving it and whether anything needs to change.
