Straight Talking Orthodontics – don’t neglect the lips and tongue!

It’s not all about the teeth…this month Shivani Patel explains why the lips and tongue are equally important during orthodontic assessments, and why they shouldn’t be overlooked.

There is much more to having an aesthetic smile than just great looking teeth.

The lips, tongue and soft tissues surrounding and supporting the teeth are equally important.

It’s the dentist job to ensure that, when examining patients, these things are not overlooked. The lips, tongue and soft tissues are important for eating, speaking and smiling.


This is a large muscle and is always in contact with the lips and teeth.

The tongue’s main role is taste, part of our five senses. The tongue has the ability to differentiate between sweetness, saltiness, sourness and bitterness.

The taste buds/papillae are located on different parts of the tongue. We have on average of 10,000 which get replaced every two weeks.

The tongue is mainly the cause of bad breath due to substances called mercaptans. These are founds in foods such as garlic, onions and beer.

In addition, the tongue often has a white furry layer on it that contributes to bad breath.

All patient should be encouraged to use metal tongue cleaners daily and focus cleaning towards the back of the tongue to aid in better breath. These can then be placed in the dishwashers to be cleaned on occasion.

Piercing risks

Tongue piercings were a fad…I haven’t seen as many lately.

However, patients must be warned of these foreign objects in the mouth.

Firstly, if not done correctly, sometimes tongue piercings in the first stages can get infected. This can be very dangerous as swollen tongues can lead to blocked airways resulting in a serious medical emergency.

Piercings also hold onto debris and can lead to general infections and bad breath.

During orthodontic treatment, patients with piercings can easily dislodge lingual and buccal brackets. This increases treatment time and the number of orthodontic emergencies.

We have also seen patients with tongue piercings who have a habit to grind them on the top of the incisor teeth. As a result, this causes distinctive wear patterns on the incisor edges.

Other dangers

As well as this, some patients have forward adaptive tongue positions, sometimes referred to as tongue thrusts.

These can sometimes contribute to malocclusions such as anterior open bites.

In addition, patients who drink, smoke and chew tobacco products have an increased risk to mouth cancer.

These often can be seen as a white patch or non-healing ulcer on the tongue, lips and buccal sulcus. This is why all dentists are now trained routinely to screen all patients for mouth cancer.


The observation of the lips at rest and when smiling are a crucial part of the new patient examination.

It is important to measure lip length and observe the fullness and drape over the teeth.


Measure and record the amount of incisor show at rest and on smiling – note how the lip rises as the patient smiles.

If the patient use regular lips fillers, this should be noted. This is because it affects tooth show.

As a result, this will have an impact on planning for restorative and orthodontic cases where the upper incisor position/shape/size has to be changed.

Photography also plays an important part in recording the lips at rest and in function.

As well as this, discussing soft tissue drape forms an important part of the treatment plan and consent.

Preventing discomfort

During treatment it’s important to ensure the patients lips are well moisturised – provide them with lip balm before you retract them for photography or isolation.

This can cause the patient discomfort as well as lip chapping and bleeding.

In addition, orthognathic surgery to the mandible can lead to temporary paraesthesia of the lips.

This initial swelling and numbness should improve over time. The maximum healing should be expected to take up to 12 months following the procedure.

Any extended lip numbness that remains has no effect on function.

To sum up, the lips and tongue need TLC and should always form part of the extra oral assessments on new patients.

Catch up on previous Straight Talking Orthodontics columns:

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