Saturday, 30 October 2010 / Published in Dental Hygienist, Dentists, Orofacial Myologist, Orthodontist, SLP-A, speech languge pathologist, Therapists, Uncategorized
QTT measurement indicates restricted frenum…HELP, I need you!
Sandra, I have a question for you or should I say a situation that I need your advice on. I have been seeing a little guy since January who is 5 1/2 yrs. old. He has a significant tongue thrust with interdental placement errors on t, s, z, l and d. When I evaluated him I couldn’t even get a measurement for his frenum since he couldn’t get his tongue to spot. Now that I have been working with him, I am comfortable that the measurements I get with him are reliable. So his open mouth posture measurement is 44mm and with his tongue to spot ( he can’t get a suction yet) his best measurement was 18mm. So according to the guidelines, it would be safe to recommend a clipping. He can get his tongue to lateralize on this teeth, but certainly not to his gum ridge. He is stalled at production of single “da” and “ta” at most 5 reps then it disintegrates. But he is very good now with single “la” and “na”. He has the mouth prop turned on its side (10mm) to do these, he can’t do it with the wider opening. So after a month of practice, with little gain, I suggested to the parents it is now time to investigate a clipping. His regular dentist does not do these but when he examined him he said his mouth is a “mess” but the frenum doesn’t seem to be the issue. He has Medicaid so they saw his regular pediatrician (hoping to get a referral to someone who can do it) who said he has no problem and doesn’t agree with my findings (which I faxed to him). Am I wrong, I don’t feel like I am, but now what do I do with this little guy ??????HELP, I need you!!!!!! My best When you say “lateralize” on teeth, do you mean he can move the tip of his tongue to the lateral dentition on both sides of his mouth (hopefully, without mandibular assistance)?? And do you mean that he can’t get his tongue tip to his gum ridge on the outside of his incisors? If so, that is pretty severe. My guess from what you’ve said, is that he isn’t really using the tip of the tongue for T, and D, but rather a location behind the tip…is that correct? Can you see the tip of the tongue UP during the N production? Have him prolong the NNNN to check it out. The measurements for the ROM quick assessment indicate a problem. Now, you have to have him open his mouth fully and lift his tongue so you can see where the frenum is attached to the tongue itself (more than half way towards the tip? or very short and maybe thick/fibrous? embedded into the tissue of the tongue even above the obvious attachment area? where is the other end of the frenum….attached far back on the floor of the mouth? just behind the lower alveolar ridge? actually ON the lower alveolar ridge?) These are all considerations. Get a really good look at all of those things and if it indicates what I think it will indicate, then you have to do what you have to do…the mom has to know that years and years of therapy are not going to be able to help when there is a significant restriction standing in the way of progress. If you can get any good photos or videos, I’ll take a look. Or maybe on Skype with the mother’s permission? Check the blog for other related questions and answers. I hope this helps. Stay warm and keep smiling!