What 25 Years in Pediatric Dentistry Taught Me About the Tongue
When I began my journey in pediatric dentistry twenty-five years ago, my attention was firmly fixed on teeth. Like many clinicians of my generation, I was trained to diagnose disease, restore form, manage behaviour, and deliver treatment efficiently and safely. Pediatric dentistry meant mastering restorations, pulp therapies, crowns, extractions, space maintainers, and caring for children who could not always cooperate—sometimes under general anesthesia, when that was considered the most humane and practical choice.
For many years, I took pride in doing exactly that. Children were treated, parents were relieved, and outcomes were predictable. I believed I was practicing good dentistry.
As my clinical experience grew, so did my exposure to newer modalities. Conscious sedation, including nitrous oxide–oxygen sedation, became part of my practice. It marked an early shift in my thinking—not merely completing procedures, but respecting the child’s physiology and emotional experience. Soon after, hard and soft tissue lasers entered my clinical world. They offered refinement, gentler healing, and a different way of interacting with tissue. I embraced them, believing technology represented progress.
At the time, I thought I had reached the cutting edge. Yet, with time, I came to understand something humbling. Acquiring advanced tools and technology did not automatically mean I had mastered the deeper biological principles they were meant to serve. Buying a sophisticated device is not the same as understanding physiology—much like owning a car does not mean one knows how to drive it. The tools were valuable, but they were only instruments. Real maturation in my practice did not come from mastering the tool, but from learning to see the biological forces—growth, function, adaptation—that were shaping the child long before I ever picked up an instrument.
Only later did I understand that each of these advancements was pointing me toward something deeper—an aspect of growth I had long overlooked.
The tongue had always been there. It moved aside for mirrors, resisted impressions, and occasionally complicated procedures. Like most dentists, I associated it primarily with speech or feeding, often considering it peripheral to core dentistry. Tongue ties, when encountered, were managed as isolated anatomical findings.
That perception began to change as I started managing tongue-tie cases more frequently. The procedures became refined and predictable, especially with laser technology. Parents reported immediate improvements, particularly in feeding. Yet over time, I noticed that not all children experienced lasting functional change. Some continued to mouth breathe. Some struggled with speech clarity, oral posture, or orthodontic stability. The restriction had been released, but something remained unresolved.
That discomfort forced a deeper question.
I began exploring concepts not emphasized in my formal training—oral posture, neuromuscular coordination, breathing patterns, and the relationship between the tongue, jaws, and airway. What became increasingly clear was this:
Function precedes form
The tongue is not passive tissue. It is a powerful, adaptive muscle central to breathing, swallowing, speech, and craniofacial development.
Releasing a restriction, I came to understand, is not the same as restoring function.
In many ways, the tongue changed how I understand growth.
This realisation naturally led me to myofunctional therapy. Initially, I approached it cautiously. Like many clinicians, I questioned its scope and consistency. But as I observed outcomes over time, one truth became difficult to ignore: without addressing muscle memory and functional patterns, long-term stability was often compromised. Relapse was not always a mechanical failure; it was frequently a reflection of persistent physiology.
Dentistry taught me how to change structure. Myofunctional therapy taught me that structure cannot remain stable unless function supports it—without correcting function, the body will always try to return to its old patterns.
As my understanding deepened, patterns emerged. Children with narrow arches, altered facial growth, chronic mouth breathing, disturbed sleep, and behavioural concerns were not presenting with unrelated issues. They were adapting—often silently—to compromised airway function. Mouth breathing was not a habit chosen casually; it was often a response to an airway that was not functioning optimally.
Over the past two decades, international research has increasingly linked breathing patterns to craniofacial development and pediatric sleep-disordered breathing.¹,² Studies in orthodontic and sleep medicine literature have reinforced the relationship between airway dynamics, facial growth, and functional adaptation.²
In India, emerging data reflects similar concerns. Epidemiological research from tertiary centres, including work conducted in Delhi, has reported significant prevalence of sleep-related breathing disturbances among school-aged children.³ In my own clinical experience across years of practice, nearly half of the children I evaluate demonstrate habitual mouth breathing patterns to varying degrees. While prevalence figures vary across populations, the frequency with which this presents in daily pediatric practice makes it difficult to ignore.
Over time, this began to feel less like isolated observation and more like a public health reality—with implications for growth, sleep quality, learning, and long-term well-being.
It was at this stage that another understanding crystallised:
Airway awareness may well represent the next evolution of pediatric dentistry
Teeth were no longer the starting point. They became indicators—visible markers of deeper functional influences. The mouth could no longer be viewed in isolation from breathing, sleep, posture, and growth.
Simultaneously, I witnessed a broader societal change. Twenty-five years ago, early intervention was rarely a conversation parents initiated. Today, families are far more aware and proactive. Parents ask about sleep quality, feeding challenges, breathing patterns, and behaviour. This growing awareness presents a meaningful opportunity for pediatric dentists.
Yet it also reveals a gap.
Access to trained myofunctional therapists in India remains limited. Awareness among healthcare providers continues to evolve. Even when a clinician identifies functional concerns and initiates appropriate care, sustaining therapy between appointments—ensuring compliance and continuity—can be challenging in a country as vast and diverse as ours.
This reality deepened my curiosity. I sought knowledge through global courses, interdisciplinary dialogue, and conversations with clinicians who had long practiced airway-centered care. What emerged was not a single protocol, but a more integrative way of observing children.
Chairside, I began paying closer attention to how a child breathed at rest, where the tongue positioned itself naturally, whether the lips were habitually parted, and what parents shared about sleep. Simple screening conversations—asking about snoring, restlessness, or frequent waking—often revealed more than radiographs. Validated tools such as the Pediatric Sleep Questionnaire have demonstrated reliability in identifying sleep-disordered breathing symptoms in children.
None of this evolution happened in isolation. Mentors and global thought leaders challenged assumptions and expanded my lens. From them, I learned that clinical growth arises not from certainty, but from sustained curiosity.
Looking back, my journey has not been about mastering techniques alone. It has been about widening perspective. From restorative dentistry to sedation, from lasers to tongue ties, and eventually to airway and myofunctional considerations, each phase added depth to my understanding of the child as a whole.
The development of digital tools such as MyoCircle was not a reactive step, but a continuation of this journey—a response to the need for standardisation, guidance, and continuity in functional care when human resources are limited. It grew from the same hunger that had guided my learning all along: to understand more deeply, and to support children better.
I do not believe pediatric dentistry is abandoning its foundations. Rather, it is expanding them. As clinicians working during critical years of growth, we are uniquely positioned to observe early patterns, intervene thoughtfully, and collaborate across disciplines. Awareness of function and airway health does not replace traditional pediatric dentistry—it completes it.
After twenty-five years in practice, this is what the tongue has taught me: dentistry is not only about what we restore, but about what we are willing to notice. The future of pediatric dentistry may lie not in doing more procedures, but in understanding more deeply the systems that shape a child’s growth, sleep, and long-term well-being.
What can a pediatric dentist do?
- 1. Guilleminault C, Li K, Khramtsov A, Pelayo R, Martinez S. Sleep disordered breathing: surgical outcomes in prepubertal children. Laryngoscope. 2004;114(1):132–7.
- 2. Katyal V, Pamula Y, Martin AJ, Daynes CN, Kennedy JD, Sampson WJ. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: Systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2013;143(1):20–30.e3.
- 3. Suri JC, Sen MK, Adhikari T. Epidemiology of sleep disorders in school children of Delhi: A questionnaire-based study. Indian J Sleep Med. 2008;3(2):42–50.
- 4. Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric Sleep Questionnaire (PSQ): Validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000;1(1):21–32.