Specialist article palate
High palateHow tongue and breathing shape its form
Your palate is high and narrow, and the findings say pointed palate or gothic palate? Here you will learn how the tongue and nasal breathing contribute to the shape of the palate, what studies show about mouth breathing, how palatal expansion and surgery can be put into context and how to record your progress with photos.
Does this sound familiar?
The palate is high and narrow, and nobody asks why?
What applies to you?
Tap whatever applies to you.
If several points apply, it is worth looking beyond the shape. In our view, how a high palate develops is, as a rule, closely linked to where the tongue lies and how you breathe. This pattern can be trained.
How the negative pressure worksPutting palatal expansion into contextThe key points at a glance
- A high, narrow palate, also called a vaulted palate, forms during the growth period. The genes set the framework, and the function works on it over years. In many cases, we consider “inherited” as the sole explanation to be a false conclusion.
- From below, the tongue supports the palate, held by the negative pressure with a closed mouth and nasal breathing. With mouth breathing, both are missing. In studies, mouth breathers on average have a narrower, deeper palate.
- Palatal expansion creates space, in adults with mini-screws or surgery. It does not change the pattern of breathing, swallowing and head balance; that can be trained.
Video
Mouth breathing and facial shape: how function shapes form
Das Video lädt erst nach dem Klick. Dann werden Daten an YouTube (Google) übertragen.
Fundamentals
High palate: what it is and how it develops
Several names stand for the same finding. The palate is noticeably highly arched in relation to its width, and the upper jaw is often narrow.
The roof of the oral cavity is at the same time the floor of the nose. At the front it consists of bone, the hard palate, followed behind by the mobile soft palate. Down the middle of the hard palate runs the midpalatal suture, a growth zone. As long as it yields, the upper jaw can grow in width.
During the growth period, two influences work on this shape day and night. From below, the tongue acts. In the tongue reference position its tip lies behind the upper incisors and the back of the tongue lies broadly against the palate. In this way it supports the vault from within, while the lips and cheeks counter from outside.
From above, nasal breathing acts, because the hard palate is the floor of the nose. If the tongue lies flat in the lower jaw and the air goes through the mouth, both conditions change at the same time.
Like a tent and its poles
A tent keeps its width as long as the poles push back from inside. If they are missing, the wind presses the walls inwards, and the tent becomes narrow and pointed. In the palate, the tongue is the poles, and the lips and cheeks are the wind.
In many cases, we consider the idea that a high palate is simply “inherited” to be a false conclusion. Twin studies show a hereditary component in jaw dimensions. But early functions such as breastfeeding, sucking and mouth breathing were not measured in the studies on the palate, and what twins experience together can appear as a hereditary share in the models. The genes set the framework, and in our view the function usually helps shape how the palate forms within it.
A high palate is not an LKGN malformation. Lip, jaw, palate and nose malformations are congenital and are treated by a specialised team; the experience report of a mother offers insight. A high palate is also part of the picture in some congenital syndromes.
Negative pressure
Lips closed, nose open: the negative pressure in the mouth
Nasal breathing with the mouth closed has a consequence that you cannot see. A slight negative pressure develops in the oral cavity.
When the lips are closed and the tongue lies against the palate, the oral cavity is sealed. After swallowing, a negative pressure remains there that holds the tongue flat against the palate. You swallow many hundreds to a thousand times a day, continually renewing this state. If the mouth is open, the pressure equalises and the tongue loses this hold.
negative pressure was measured by a Göttingen research group under the palate of 20 adults while the mouth was open1
of negative pressure was present on average under the palate in the same study after swallowing with closed lips1
In our view, this negative pressure is one building block of palate development. If it holds the tongue broadly against the palate, the tongue acts from the inside outwards hour after hour, and the upper jaw can grow in width during the growth period. Without mouth closure, this negative pressure does not develop.
Breastfeeding offers the first practice ground. At the breast, the lips seal tightly, the tongue works against the palate, and breathing takes place through the nose. A dummy that stays in the mouth for hours, by contrast, occupies exactly the space the tongue needs at the palate.
If your child was not breastfed or had a dummy for a long time, that does not condemn them to anything. The pattern can also be sorted out later. Incidentally, the Göttingen measurement shows the negative pressure, not its effect on growth. We describe that step as our model.
The causal chain
From an open mouth to a pointed palate: the chain behind it
In our view, a high palate does not, as a rule, begin with the bone, but long before, with breathing, swallowing and head balance.
The pattern deviates
The mouth is open, the tongue lies low in the lower jaw, the head moves forward. This often begins early, for example with a dummy, bottle, thumb or a frequently blocked nose.
The body compensates
The lips, cheeks and chin take over holding work that the tongue would otherwise do. The nervous system stores this compensation as the preferred pattern.
Form follows
Without support from within and without negative pressure, the upper jaw develops more narrowly and the palate arches high. The pattern becomes structure.
The complaints arrive
Only then do crowding, crossbite, a narrow nose or snoring become noticeable. When and how strongly depends on the extent and age of the pattern.
The chain runs in both directions. A narrow, high palate offers the tongue less contact surface. It has more difficulty reaching its reference point behind the incisors, stays down more easily, and the mouth opens more easily.
Since the palate is also the floor of the nose, a narrow upper jaw affects the nose as well. If nasal breathing becomes harder, the mouth steps in and the circle closes. In many adults it is therefore no longer possible to say what came first.
You can read how this triadic functional circuit affects the teeth after treatment under Retainers and relapse, and what it means for the nose under Nasal septum.
Research
Mouth breathing and palate shape: what studies show
That breathing and palate shape are connected has been well studied. Which side comes first is harder to show in humans.
A research group in Santa Maria, Brazil, compared the plaster models of 76 children aged around nine years. At the level of the back teeth, the mouth breathers had a narrower and deeper hard palate than the nasal breathers. Those who breathed through the mouth purely out of habit even had a deeper palate further forward than children with a blocked nose2.
smaller was the palatal surface area in 21 children who had breathed through the mouth for a long time because of an allergy, compared with 17 nasal breathers3
smaller was the volume of the palate in the same study from Italy3
of 2,594 very preterm children had a highly arched palate at the age of five. Thumb sucking at two years of age was associated with a higher risk4
Such comparisons show a coincidence, not a sequence. A narrow nose can force mouth breathing, and mouth breathing can shape the palate. So far, only animal experiments show the direction. In California, the nostrils of young rhesus monkeys were closed. They kept their mouths open, and over time their facial shape and dental arches changed compared with the control animals5.
A high palate does not prove mouth breathing. It is a reason to ask about it.The shape alone does not reveal which path was taken. The question about breathing, tongue and swallowing therefore belongs in the examination.
Recognising
High palate: how to recognise it
You can see a high palate with a hand mirror and a little light. What accompanies it is more revealing.
Crowded dental arches
The teeth are crowded, or the upper jaw looks narrow next to the lower jaw.
Crossbite
At the sides, the upper back teeth bite inside the lower ones instead of outside over them.
Tongue down
At rest, the tongue lies in the lower jaw or between the teeth, not against the palate.
Tooth marks on the edge of the tongue
The tongue finds little contact above and presses sideways against the teeth.
Open mouth
During the day or in sleep the lips are often open, and the mouth is dry in the morning.
Close your lips, place the tip of your tongue behind the upper incisors and let the whole back of your tongue slide up against the palate. What do you feel?
Putting treatments into context
Palatal expansion: what it achieves
If the upper jaw is too narrow, it is often widened in orthodontics. How well this works depends on age and on the state of the midpalatal suture.
In palatal expansion (rapid palatal expansion, RPE), a screw between the upper back teeth pushes the two halves of the upper jaw apart as long as the midpalatal suture yields. In children this usually works well, and new bone forms in the opened suture. How much of the width remains in the bone and how much comes from tilted teeth is a separate question.
of the expansion measured at the teeth remained in the bone in the long term in adolescents before the growth spurt, according to a review. The authors consider the data weak6
of the midpalatal suture were described by a research group on 3D X-ray images of 140 people aged between 5 and 58. The early stages were typically found up to the age of 137
Age alone says little here, as the suture matures at different speeds. In a Mainz tissue study of 22 palates from people aged between 18 and 63, only a small part of the suture was ossified, even in older people8. Resistance to expansion nevertheless increases over the years, so the suture alone does not explain it.
RPE during growth
A fixed expansion screw attached to the teeth. In children and young adolescents, the midpalatal suture usually yields.
Mini-screw-assisted RPE (MARPE)
The screw is additionally anchored on small screws in the palatal bone. It is used in older adolescents and adults.
Surgically assisted RPE (SARPE)
In an operation the upper jaw is selectively released, after which the screw expands it. For large corrections, repositioning of the upper jaw may also be considered.
Adults
Widening the palate as an adult: benefits and limits
For adults there are now two ways to widen the upper jaw. Both are effective, and both have limits that are part of a good decision.
A review from Nijmegen evaluated eight studies on MARPE in people aged 16 and over. The expansion succeeded on average in 92.5 % of cases. The bone became a good 2 mm wider, and the distance between the first molars around 6.5 mm. In addition, there were tilted teeth and thinner bone on their outer side. The authors rate the quality of the data as very low9.
of the expansion at the first molars was lost again after surgically assisted RPE in 38 patients. The bony expansion of a good 3.5 mm remained stable over two years10
had at least one complication in a Californian clinical evaluation, most commonly uneven or insufficient expansion and gum recession. Serious complications were rare11
This does not speak against expansion. It creates space where it is lacking and makes some treatments possible in the first place in cases of crowding or crossbite. However, the figures show that part of the width is created at the teeth, not in the bone, and that part of it reverts. Which procedure is suitable for you is something to discuss with your orthodontic practice.
Orthodontic treatment aligns the teeth, and a retainer holds them as long as it acts mechanically. In our view, neither usually changes the function that helped shape the position, that is, breathing, swallowing and tongue reference position. Teeth do not move by themselves. If they move back after treatment, the same forces continue to act, and the retainer merely locks them in.
Never change or end ongoing treatment with an expansion screw, braces or a retainer on your own, and plan the gradual reduction of the retainer with your practice as well. The training can be combined with it. You can read more about orthognathic surgery in the article on jaw surgery, and an overview is offered by FaceFormer and other treatments.
Form and function
After expansion: who fills the new space?
An expansion changes the form. Whether function follows is a separate question, and it can be investigated.
In Japan, the oral cavity of 28 children with a narrow nose was measured on 3D X-ray images before and after RPE. The air space between tongue and palate shrank markedly, so the tongue lay higher, and the pharynx became wider12. In Italy, in 23 girls who breathed through the mouth, the nasopharynx became wider after expansion and the head was tilted back less. After twelve months this was unchanged13.
Expansion creates space. Whether the tongue uses it is decided by the pattern.Form and function act in both directions. The question of space goes together with the question of what the tongue, lips and breathing do with it every day.
Whether training changes the bone shape of the palate has not been studied, neither for the FaceFormer nor for other exercises. During growth, the tongue shapes the palate from within. If it rests broadly against the palate in the tongue reference position, its pressure acts there with every swallow. If you follow this logic, the conclusion suggests itself that an orderly pattern in growing children can create the conditions for broader development.
What has been studied are the basic functions. In the Hamburg study with 45 children, the only randomised study with the FaceFormer, the tongue rested against the palate more often during swallowing, and lip closure was achieved more quickly than with exercises without a device14. We classify all studies under Studies and science.
Progress
Recording progress: photos every six weeks
Changes in the mouth, tongue and posture happen slowly. Photos taken under the same conditions make visible what you do not notice in the mirror.
Take a small photo series at the start and repeat it every six weeks, with the same light and the same distance. Photograph yourself relaxed, just as you are standing, not with a deliberately closed mouth.
The series mainly shows function. Does the mouth stay closed at rest? Does the chin tense up? How does the head balance over the body? You record the palate itself with a hand mirror or phone camera. In adults, its shape is a baseline finding; it does not change within a few weeks.
- Photo 1
Face from the front
Relaxed, the lips as they happen to lie, looking straight ahead.
- Photo 2
Profile from the side
Standing, arms loose, gaze at eye level.
- Photo 3
Smile
Shows the dental arches and the width of the smile.
- Photo 4
Palate
Head tilted slightly back, mouth wide open, with light and mirror.
- Every six weeks
Repeat and compare
Lay the photos side by side and compare them with your own starting point, not with other people.
If you train with a practice, bring the photos to your check-up appointments. In growing children, the orthodontic practice measures the palate and dental arches on models or scans. How check-up appointments work is described in Procedure and duration.
Training
Training the pattern: tongue, nose, head balance
Consciously placing the tongue against the palate works as long as you think about it. Its position is a stored sequence, and that changes through repetition, not through insight. Our approach is therefore to train the basic functions of breathing, swallowing and head balance in one sequence. Pressing the tongue forcefully against the palate, as in mewing, is something different.
During training, the FaceFormer sits in the oral vestibule, behind the lips and in front of the teeth. The tip of the tongue rests at the reference point, you breathe through your nose, and your head is balanced upright.
In the basic exercise you press the lip wedge together with your lips, bite down briefly with your back teeth and swallow. The negative pressure draws the tongue to the palate, exactly the state this is about. Later, the pull exercise and night-time use are added.
- From day 1
Basic exercise
A few minutes three times a day with the FaceFormer ZERO; you increase the repetitions week by week.
- From around week 3
Pull exercise and night
The pull exercise is added. At night you wear the ZERO so that lip closure and nasal breathing are also practised during sleep.
- After a few weeks
Switching to the ONE
During the day, you train with the FaceFormer ONE. It is the same size and shape as the ZERO, just made of firmer material.
- Over months
The pattern runs by itself
The basic training runs over several months, followed by maintenance training.
The free app guides you through the basic exercises, and you can find all modules on the exercise pages. Training is possible alongside fixed braces; dental wax protects the mucous membrane. If you wear an expansion screw, discuss getting started with your practice. If the nose is constantly blocked, the airway is clarified first.
Children and everyday life
What you can do for your palate in everyday life
In children, the upper jaw is still growing and the midpalatal suture yields. That is why it is particularly worthwhile here to pay attention early to mouth closure, tongue and nose. Children up to the age of ten train with the ZERO throughout and according to their own playful plan.
You can read more about this, including dummies, thumbs and the nose, under FaceFormer for children and in the article on polyps and adenoids.
Tongue up
The tip of the tongue rests at the reference point behind the upper incisors, the back of the tongue broadly against the palate. Check this a few times a day.
Lips gently closed
The lips rest together without effort. If the chin tenses while doing so, the mouth is working against the tongue instead of with it.
Breathe through your nose
Nasal breathing keeps the mouth closed and the tongue up. Taping the mouth shut at night is not a substitute; more on this under Mouth taping.
Keep an eye on dummies and thumbs
The longer something lies between the tongue and the palate each day, the more it occupies the tongue’s space. A gradual farewell is easier for children.
Keeping the nose clear
If the nose is often blocked, for example with an allergy, it is worth looking at the cause. More under Allergies and nasal breathing.
Questions
Frequently asked
What is a high palate?
A palate that is strongly arched in relation to its width, often with a narrow upper jaw. It is also called a pointed palate, gothic palate or wedge-shaped palate. It is a finding, not a disease. What is revealing is the function that accompanies it, such as mouth breathing or a low-lying tongue.
Where does a pointed palate come from?
The palate takes shape during the growth period. The genes set the framework, and in our view the function usually also plays a part in shaping it, above all the tongue, lip closure and nasal breathing. In many cases, we consider the explanation “it’s just inherited” to be a false conclusion, because the twin studies on the palate did not also measure early functions such as mouth breathing. Very premature birth, long-standing sucking habits and some congenital syndromes also play a role.
Does mouth breathing cause a high palate?
In studies, mouth breathers on average have a narrower and deeper palate than nasal breathers. Whether mouth breathing shapes the palate or a narrow upper jaw constricts the nose cannot be read from the shape in an individual case. Each reinforces the other.
Can a high palate still change in adults?
In adults, the shape of the palate does not change in a few weeks, and whether training changes the bone shape has not been studied. The upper jaw can be widened skeletally with a mini-screw-assisted rapid palatal expansion or surgically. The training addresses the function. If the tongue rests broadly against the palate in the tongue reference position, its pressure acts there with every swallow, in adults too. After an expansion, in our view this pattern helps determine whether the new width is supported from within.
Why does the palate sometimes become narrower again after expansion?
Part of the width gained comes from tipped teeth and goes back more easily than the skeletal part. In our view, the reason usually lies in the pattern, because teeth do not move by themselves. If the tongue stays low and the mouth open, the support from within is missing, and the same forces continue to act. A retainer holds the teeth as long as it acts mechanically, but it does not change the pattern. Plan coming off the retainer and the retention phase with your practice.
What is the best way to record changes?
With a photo series at the start and every six weeks under the same conditions, that is, face from the front, profile, smile and palate. The photos mainly show whether the mouth stays closed at rest and how the head balances. Compare them with your own starting point.
How long does it take to change a high palate?
That depends above all on age and on how long the pattern has existed. In children, the upper jaw is still growing, and there an altered tongue function can help shape development early on. In adults, the palatal suture is often only partially ossified; it matures differently from person to person. Changes in the bone nevertheless take months to years, and not every shape can be reversed. What the training influences at any age is the function: if the tongue rests against the palate in its reference position, it helps shape it from within, instead of the cheeks and lips alone setting the pace from outside. Expect several months of consistent training until the new pattern is consolidated. The training does not replace orthodontic treatment; it complements it.
More articles from the knowledge section
Where to go next
Sources
- Engelke W, Jung K, Knösel M (2011). Intra-oral compartment pressures: a biofunctional model and experimental measurements under different conditions of posture. Clinical Oral Investigations 15(2):165-176. PMID 20127264. Source
- Berwig LC, Silva AM, Côrrea EC, Moraes AB, Montenegro MM, Ritzel RA (2011). Hard palate dimensions in nasal and mouth breathers from different etiologies. Jornal da Sociedade Brasileira de Fonoaudiologia 23(4):308-314. PMID 22231050. Source
- Lione R, Franchi L, Huanca Ghislanzoni LT, Primozic J, Buongiorno M, Cozza P (2015). Palatal surface and volume in mouth-breathing subjects evaluated with three-dimensional analysis of digital dental casts. A controlled study. European Journal of Orthodontics 37(1):101-104. PMID 25016579. Source
- Herrera S, Pierrat V, Kaminski M, Benhammou V, Marchand-Martin L, Morgan AS, Le Norcy E, Ancel PY, Germa A (2022). Risk Factors for High-Arched Palate and Posterior Crossbite at the Age of 5 in Children Born Very Preterm: EPIPAGE-2 Cohort Study. Frontiers in Pediatrics 10:784911. PMID 35498807. Source
- Harvold EP, Tomer BS, Vargervik K, Chierici G (1981). Primate experiments on oral respiration. American Journal of Orthodontics 79(4):359-372. PMID 6939331. Source
- Lagravère MO, Major PW, Flores-Mir C (2005). Long-term skeletal changes with rapid maxillary expansion: a systematic review. Angle Orthodontist 75(6):1046-1052. PMID 16448254. Source
- Angelieri F, Cevidanes LH, Franchi L, Gonçalves JR, Benavides E, McNamara JA Jr (2013). Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion. American Journal of Orthodontics and Dentofacial Orthopedics 144(5):759-769. PMID 24182592. Source
- Knaup B, Yildizhan F, Wehrbein H (2004). Age-related changes in the midpalatal suture. A histomorphometric study. Journal of Orofacial Orthopedics 65(6):467-474. PMID 15570405. Source
- Kapetanović A, Theodorou CI, Bergé SJ, Schols JGJH, Xi T (2021). Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: a systematic review and meta-analysis. European Journal of Orthodontics 43(3):313-323. PMID 33882127. Source
- Chamberland S, Proffit WR (2011). Short-term and long-term stability of surgically assisted rapid palatal expansion revisited. American Journal of Orthodontics and Dentofacial Orthopedics 139(6):815-822. PMID 21640889. Source
- Williams BJ, Currimbhoy S, Silva A, O’Ryan FS (2012). Complications following surgically assisted rapid palatal expansion: a retrospective cohort study. Journal of Oral and Maxillofacial Surgery 70(10):2394-2402. PMID 22516838. Source
- Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kakuno E, Kanomi R, Hayasaki H, Yamasaki Y (2013). Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: a cone-beam computed tomography study. American Journal of Orthodontics and Dentofacial Orthopedics 143(2):235-245. PMID 23374931. Source
- Tecco S, Caputi S, Festa F (2007). Evaluation of cervical posture following palatal expansion: a 12-month follow-up controlled study. European Journal of Orthodontics 29(1):45-51. PMID 16957058. Source
- Korbmacher HM, Schwan M, Berndsen S, Bull J, Kahl-Nieke B (2004). Evaluation of a new concept of myofunctional therapy in children. International Journal of Orofacial Myology 30:39-52. PMID 15832861. Hamburg study; co-author Sabine Berndsen is a co-developer of the FaceFormer. Source
Get started
Ready for the training?
The free FaceFormer app guides you through the basic exercises, counts along and reminds you of your sessions. If you wish, a practice from the practitioner directory can support you.
FaceFormer ZERO + ONE
Both material hardnesses for getting started, day and night. The set for adults.
FaceFormer ZERO
The softer FaceFormer for getting started, for children and for the night.
FaceFormer ZERO Children’s Set
ZERO with hygiene box, plush bag and success book with stamp.
FaceFormer training aims to restore the physiological setting of the basic functions of breathing, swallowing and head balance, with lip closure and the tongue reference position, thereby creating the conditions under which symptoms can improve. It does not replace a medical assessment. You can find practitioners near you in the practitioner directory.
