Ask A Therapist: Optimal Bite & Structural Cross Bite

Hello Sara,

I took your course in NYC Sept 2013. I have a question, if you don’t mind answering, I have a student with down’s syndrome who is 12 years old and up until now has not been motivated to work many aspects of speech and language.  This year she is more motivated and feel that I can take a more aggressive approach with TalkTools. She has also been diagnosed with a cross bite by her orthodontist. He states that it is both structural and positional. He does not feel hopeful that she will be a candidate for orthodontia for many reasons. How then can I work on jaw strengthening when she has a structural cross bite and poor prognosis for orthodontic intervention?

Thank you for you time.



Hi D,

In the class you learned about how to establish the most optimal bite using two #2 Bite Blocks.  Look back into your notes to see how they are placed.  As long as you can get the back molars to make contact with the Bite Blocks you can rotate them to the front, remove one and still do the Jaw Grading Bite Block exercise.  Sometimes, when you rotate to the front you lose the optimal bite position.  If that happens then keep both Bite Blocks in his mouth when you rotate to the front, keep both in his mouth as you introduce “Exercise A: Bite Block” but only pull on one side at a time.  The two in her mouth will maintain the optimal bite as the pull will be working on strength at only one side at a time.

Once you can see the optimal bite you can use that same positioning to work on the Bite Tube Hierarchy.  I hope this answers your question.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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