Post frenectomy

Hi Sandra How are you? Just a few questions for when you have a chance. 10 year old girl who had a frenectomy last year. I saw her a few months post but did more traditional artic therapy (sh,ch, s, ) with some of your program. She has no lip rounding for SH and kept for mouth open for sh, ch, and s. Jaw tends to push out forward with speech. Her carryover homework was fair. Attendence was ok but always late. She is an overbooked kid with soccer after school almost every day. Overall improvement was inconsistent. Anyway shes back . I spoke to Mom about importance of homework and that shes approved till Nov. If no changes I will discharge her. OK I am thinking about using your program with her consistently. I do not believe she was a tongue thruster from testing her previously but she has incoordination and strength issues with her tongue: Lingual palatal seal is done with jaw jutting forward and she says it hurts her frenum a bit. Tongue elevation is relying on bottom lip. ‘ My question is Do you think its a good idea to do your program with her even if she is not a tongue thruster? How do I incorporate speech and at what point ? Any other thoughts………….. She needs help but I am feeling lost. D.

Hi D, Good to hear from you.  I was thinking about you earlier today. For post frenectomies, I always do profic exam #1 rather strictly.  Secondly, it is not unusual for a former tongue-tie client to be a “functional” class III occlusion.  In other words, they had to carry their mandible forward when they were tongue tied.  It may become a fucntional habit thereafter.  That could explain the jaw being pushed forward during some speech sounds and the difficulty with lip rounding.  Try pushing/holding your mandible far forward and you’ll see that successful lip rounding is compromised quite a bit. So, what to do? 1.  Prof exam #1 as thoroughly as possible 2.  Be sure that she learns and uses correct posture: back teeth almost closed, tongue tip to spot (definitely the back part of the spot), and lips closed. 3.  How strong are her lips?  Sometimes overly strong lips are an indicator of Class III 4.  Do the suctioning exercises until she is really good at them.  That way she’ll learn to suction up and back with her back teeth closed (diagonal straw, for example). 5.  Keep in touch and let me know if I’m on the right track or something else is in order…. my best, Sandra