Ages 3 - 7

Airway and tongue position

Preventative orthodontics

Myofunctional therapy

MyoBrace for normalizing facial growth

Why consider an early evaluation?

The very first consideration for this age group is to determine whether the child is “mouth breathing” particularly at night, and if the child is developing a malocclusion or bad bite characterized by crowding, a deep vertical overbite, openbite, and narrow jaw development. Is the upper jaw narrow or constricted? What about tongue position? Is there a tongue-tie relationship?

  • It is estimated that eighty percent of children will need orthodontics at some point, so there may be only a small chance of avoiding this need.
  • Our philosophy is to start the treatment as soon as the child is old enough to cooperate, which can be as early as age four or five.
  • In many cases, malocclusions (crooked teeth and narrow jaw structures) are the result of poor oral myofunctional habits in the developing child—the way the child uses the muscles in the mouth.


  • At age three, half of facial growth is complete! At age seven, 70 percent of facial growth is complete. At age twelve, when traditional orthodontic treatment often begins, 90 percent of facial growth is complete.
    A major orthodontic myth: wait until all permanent teeth come in before considering orthodontic treatment.
  • A thought to consider: Instead of waiting until facial growth is almost complete to begin treatment, we could have a positive influence on facial growth by starting to correct poor oral habits much earlier. The orthodontist and family can work together to help the patient outgrow the orthodontic problems while there is time to have influence on facial development.
  • In addition to using myofunctional therapy training, growth guidance appliances can be used at night while sleeping (when most growth occurs). This combination makes treatment very effective to improve facial growth and correct facial imbalances.
  • That is, at a young age, determine the causes of mouth breathing and abnormal tongue position that are hinderances to normal dental and facial skeletal development


The primary reason for malocclusions occurring in the first place is poor development of the upper jaw. This is the culprit in almost all malocclusions, causing crowded teeth, overbites, and underbites. How does this happen?

1. Tongue posture. The normal resting position of the tongue is in the roof of the mouth. In growing children, this tongue position stimulates the roof of the mouth to grow in width and to grow anteriorly. The primary cause of an underdeveloped or narrow upper jaw is a low tongue posture. This most often is due to “mouth breathing” or the presence of a tongue-tie. LINK: Is Your Tongue-tie Causing Your Health Problems?

2. Mouth breathing. When a patient breathes primarily through the mouth instead of the nose, his or her tongue must drop down for the air to pass over it during breathing. When this happens, the tongue is no longer fitting in the roof of the mouth to stimulate normal development of the upper jaw. The outside pressures from the cheeks then overrides the tongue as the tongue is no longer stimulating normal upper jaw development resulting in narrowing of the upper jaw over time.

3. Short frenulum. The tongue is tethered or anchored in the mouth by the lingual frenulum, a thin strip of tissue. If the frenulum is too short or broad, the patient may have what is called a relative “tongue tie.” This condition will not allow the tongue to rest in its normal position in the roof of the mouth, which is critical to normal development. If the upper jaw does not develop normal, expect a malocclusion to develop.

4. Habits. Other poor myofunctional habits, such as thumb or finger sucking and lip biting, can also cause a development distortion of the upper jaw over time.


The entire body can benefit from early orthodontic/orthopedic treatment. The benefits of early treatment go well beyond the teeth and jaw structures. From an holistic viewing point, it makes good sense to identify any obstacle that may hinder normal dental and skeletal development. This now leads us to the importance of oxygenation:

  • Sleep disordered breathing: This category includes every adverse sleep condition from labored breathing to mild snoring to obstructive sleep apnea. These can be serious problems that can lead to other troublesome issues if left unresolved.
  • Mouth breathing: This habit leads to a reduction of oxygen delivered to the body. Research has shown that mouth breathers experience as much as a 40 percent reduction in oxygen being exchanged for carbon dioxide in the lungs. Breathing is more than inhalation of oxygen-rich air. Exhalation is critical to get rid of the carbon dioxide accumulation and toxic substances. The nose filters and moistens the air. If this does not occur though an unobstructed nasal passage, a child’s normal growth and development, including the brain, cannot occur. Unfiltered air can lead to enlargement of the tonsils and adenoids, which in turn can contribute to abnormal tongue position with or without a tongue-tie. To assure that each child reaches the full mental and physical potential, proper nasal breathing and tongue position must be established.
  • Infections of the upper airway, tonsils, and ears. If a child breathes mostly through the mouth, the nose cannot filter inhaled air properly. This will lead to increased upper-airway infections that will cause swelling of the tonsils and adenoids, compounding the blockage of the airway. Restoration of nasal breathing can help reduce the size of swollen tonsils and adenoids, causing their shrinkage over time.
  • Tongue-tie and ear infections: It all starts at birth. A tongue-tie or frenum is essentially a short, tight membrane underneath the tongue. It attaches the tongue to the floor of the mouth. The tongue frenum is exceedingly strong and can restrict movement and normal peristaltic action (wave like) while breast feeding, swallowing, or eating in general. This restriction can lead to Eustachian Tube Dysfunction resulting in ear and sinus infections as well. Ear tubes seldom address the cause of the problem. Quite often the child is given the diagnosis of failure to thrive, which can prevent normal development.

A Holistic Approach to Orthodontics

Call us at (678)352-0919

Dr. J. Michael Dierkes, DDS, MS, NMD is a nationally recognized orthodontic specialist who has been creating beautiful smiles for over 30 years. His services have improved the lives of people from Roswell and the surrounding areas, including residents of Sandy Springs, Alpharetta, Marietta, and Atlanta. Whether you are an adult, a child, or a teenager, our knowledgeable staff is committed to helping you achieve the radiant, beautiful smile you deserve. Please call us today to schedule your initial consultation!