CHEEKS
The cheeks have moulding effect on the buccal teeth as the lips have on the anterior teeth. The effects of cheeks are counteracted by the tongue.
Effects of cheeks:

When the tongue thrusts forward during atypical swallowing and provide less support to the buccal teeth. as cheek pressure is not counteracted by this tongue, it causes narrowness of the arch and ultimate results mal occlusion (i.e. cross bite)

Fig: Lip, Cheek & Tongue exert balancing force on the teeth & supporting bony structures.

TONGUE

The size position and behavior is important in determining the shape and position of dental arches.

Effects of tongue:

i) Macroglossia- a large tongue which is positioned forward due to any functional need may causes bi-maxillary   

        proclination of anterior teeth with spacing.

ii) Microglossia- a small tongue backwardly placed gives less pressure then cheeks and lips causes narrowing of arch 

        and ultimately results cross bite.

iii) Tongue which is held very high in the roof of mouth may produce a wider upper arch and a narrow lower arch causing 

        cross bite.

iv) Incompetent lip but habitually apart with large overjet-

 Proclination of upper incisor.

 Incomplete over bite.

v) Active tongue thrusting activity during swallowing and speech-

         It may causes certain abnormalities such as-

a) Proclination of anterior teeth.

b) Grossly reduced over bite.

c) Anterior open bite.

d) Bimaxillary proclination.

e) Posterior open bite incase of lateral tongue thrust.

f) Posterior cross bite

Fig: Diagram showing proclination of upper incisors associated with a forward thrust of tongue.

Type of tongue thrusting–

According to cause tongue thrusting is two type.

i) Adaptive behavior- mild intensity and associated with functional need. 

ii) Endogenous tongue thrusting behavior- strong intensity and in born atypical pattern of neuromuscular activity.

Management of tongue thrust:

a) Factors to be considered-

i) Types of malocclusion.

ii) Degree of malocclusion.

iii) Scope of problem.

iv) Maturity of the child.

v) Attitude and the degree of co-operation.

b) Counseling of the parents and patients.

c) Treatment-

i) Correction of the habit – by tongue guard.

         May be-

a) Removable

b) Fixed.

Anterior

Lateral. 

ii)  Appliance to corrected the proclination.

iii) Appliance to correct the any other malocclusion.

Fig: Correction of habit by tongue guard.

FRAENUM

Before eruption of the teeth, the upper labial frenum is continuous with the incisive papilla and as teeth erupt, its attachment to the alveolar process normally recedes to a points midway between the alveolar border and labial sulcus.

In abnormal condition fraenum is thick, wide and fleshy and passes between the central incisors to run into the incisive papilla.

It causes-

Fig: Median diastema and thick labial fraenum.