Dr Shereen Lim

09/06/2026

What happened before the crowded teeth?

Here's a 4-year-old I saw today.

Before I even looked inside her mouth, I noticed that her right cheek wasn't moving as freely as the left. The corner of her mouth looked tighter and there was visible asymmetry when she smiled.

Looking inside, I found multiple cheek and lip ties. On the right side in particular, there were several tight strands of cheek attachment. Interestingly, the upper right molars also showed a greater inward tilt than the left side.

This child has no history of pacifier use or digit sucking. She was breastfed for 10 months.

But when we dug a little deeper into the feeding history, Mum described significant ni**le soreness and bleeding in the early weeks. At the time, she assumed it was simply part of learning to breastfeed as a first-time mum. Looking back, she wonders whether she may have had low supply.

My findings today included increased facial tension associated with four cheek ties and two lip ties. I ruled out an obvious tongue-tie, although I do need to reassess for a posterior tongue restriction in the future. She also has an underdeveloped upper jaw, no spacing between the baby teeth, and reduced tongue space.

Based on the lack of spacing already present, this is likely to become a significant crowding problem as the permanent teeth emerge.

Mum's presenting concerns were teeth grinding from a young age, mouth breathing, snoring, restless and broken sleep, dark circles under the eyes on waking, and emotional regulation impacted by sleep quality. She wants to explore solutions before her daughter starts school.

What I find interesting is how these findings may fit together.

Could the feeding difficulties have reflected poor milk transfer rather than low supply?

Could oral restrictions and facial tension have contributed to a shallow latch, with overuse of the lips and cheeks during feeding?

Could those same patterns have influenced the way the jaws developed, and ultimately sleep and breathing over time?

We can't know for sure.

But when I look at the feeding history, facial tension, oral restrictions, jaw development and sleep symptoms together, I find it difficult to view them as completely unrelated.

Looking at her mouth today, it would be easy to focus on the crowding and structural issues.

What interests me are the clues that might explain how they developed.

09/06/2026

Treating patterns, not parts.

Here’s some of the oral restrictions identified in a 6-week-old baby I saw today.

From the very beginning, feeding had been challenging. Mum described his tongue as “really lazy” and said he struggled to properly latch and “grab the boob.” He was taking in a lot of air, couldn’t tolerate lying on his back without distress, and his sleep was frequently disrupted by obvious discomfort and passing wind.

Mum had repeatedly raised concerns with multiple health professionals. She had spoken with the paediatrician in hospital, the child health nurse, and her midwife. Each time she was reassured that everything was fine and advised to wait.

It was only after seeing a chiropractor for other concerns that she was encouraged to explore oral ties further and connect with an IBCLC virtually (they are regional). Up to five oral restrictions were flagged through photos, videos, and functional assessment, which we confirmed today.

One of the questions I am increasingly asked when multiple restrictions are identified is whether they can be released in stages. For example, should we release the tongue and upper lip first, then wait and see what happens before considering anything else?

These days, I’ve largely adopted an all-or-nothing approach.

The reason is that I can no longer ignore the facial and perioral tension associated with lip and cheek restrictions. In many cases, I suspect these restrictions are an overlooked contributor to shallow latch, poor seal, and compensatory feeding patterns.

If the lips and cheeks remain restricted, the tongue may gain mobility following a tongue-tie release, but the baby may still rely on overuse of the lips, cheeks, and facial muscles. In my experience, optimal suction requires the whole system to function well, not just the tongue.

Now that I’ve been releasing oral ties in infants for more than a decade, I have had the opportunity to follow many of these children over time. Increasingly, I see children presenting years later for orthodontic treatment with facial tension patterns and restrictions that I simply wasn’t paying enough attention to earlier in my career.

I’ve also observed recurring associations between these restrictions and particular patterns of dental and jaw development. Many of the restrictions I now identify in infancy are the same restrictions I often find myself addressing years later alongside orthodontic treatment to help address ongoing oral dysfunction and support stability of results.

This is one of the reasons I have become more proactive.

I increasingly view optimal latch, whether at the breast or bottle, as one of the earliest foundations for good oral function. I want to encourage colleagues and parents to look beyond reduced pain, adequate weight gain, and reduced air intake. Optimising depth of latch, seal, and tongue suction are worthy goals.

I increasingly view shallow latch as more than a feeding challenge. It may be one of the earliest clues that the developing oral and facial system is functioning under tension and compensation.

Today, after releasing the clinically significant restrictions identified in this baby’s assessment, mum reported a good feed post-release.

She described a wider mouth opening, less chomping, a more comfortable latch, and a noticeably more relaxed face with less downturn of the lips.

One feed doesn’t tell the whole story.

But observations like these continue to reinforce my belief that we need to treat the pattern, not just a part.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, seek a second opinion from an appropriately qualified health practitioner.

08/06/2026

How quickly a position can change...

When the survey that eventually became this buccal tie paper was first being circulated, I remember thinking it all seemed a bit over the top.

At the time, my focus was largely on tongue ties, which were controversial enough. I wasn't fully convinced about upper lip ties, let alone cheek ties.

Over the years, though, I've found myself revisiting that position. First paying closer attention to upper lip ties, then lower lip ties, then the upper cheeks, and now the lower cheek ties. Along the way, it has opened up an entirely new set of questions.

The more attention I've paid to lip and cheek restrictions, the more I've found myself observing:

✅ Facial tension patterns
✅ Latch and swallow patterns
✅ Mouth opening and jaw function
✅ Facial growth and jaw development
✅ Cranial and whole-body tension patterns
✅ Smile aesthetics, symmetry, and gum display
✅ Dental arch form and tooth position
✅ Orthodontic stability and relapse
✅ Oral hygiene challenges and food trapping
✅ Comfort and compliance with myofunctional appliances

One of the things I've enjoyed most over the past year is realising just how much there still is to learn.

Almost every day brings new insights through careful observation and by listening closely to patients, parents, and collaborative colleagues.

Over time, I've accumulated thousands of patient photos and videos across different ages and stages in our practice. What has struck me recently is how much more I can see now than I could even a year ago.

Things I would never have noticed before now often stand out immediately. At times, I find myself predicting restrictions before I even look inside the mouth. As I share observations with parents and adult patients, many begin noticing patterns they hadn't previously recognised either.

Some things become difficult to unsee once you've seen them.

Most of us were never taught to look for many of these patterns. We don't learn much about tongue ties, let alone lip and cheek ties.

The most valuable lessons I've learned have come from listening carefully when patients, parents, and colleagues describe similar experiences, and then paying more attention when those observations continue to repeat over time.

I understand why some colleagues may be sceptical. I've been there too.

Today I revisited this paper with a much more open mind and a much wider lens than I had when it was first published.

What have my colleagues already noticed?

And what else might we discover if we continue paying attention?

Link to view full article:
https://onlinelibrary.wiley.com/doi/epdf/10.1111/joor.13609

08/06/2026

On the weekend, I enjoyed catching up and having some inspiring discussions with many of my multidisciplinary colleagues from Perth, Melbourne, and even overseas.

This photo is with Dr Emily Ng, an orthodontist from Singapore! 🇸🇬

She had read Breathe, Sleep, Thrive and was inspired to further explore children’s sleep and airway health. When I was last in Singapore for a conference, she made a point of reaching out, bringing along her copy for me to sign, and making me feel so welcome.

So it was fantastic to catch up again whilst she was here on holiday in Perth.

One of the greatest gifts of writing Breathe, Sleep, Thrive has been hearing from colleagues who have been inspired by it, and the people it has connected me with.

Over the years, I have met so many passionate colleagues from different disciplines, backgrounds, and countries whose sense of purpose and energy has resonated deeply with me.

Emily is one of many people whose curiosity, commitment to learning, and dedication to helping children and families has inspired me in return. I love seeing how others take ideas, build upon them, share them within their communities, and ultimately advance the conversation further.

There is a great energy around a shared sense of mission. It not only drives change for patients, but has also brought many of us together, creating friendships and a growing community of people who are learning, evolving, inspiring, and lifting one another.

Being part of that gives me great hope for the future.

05/06/2026

So pleased to see this discussion on cheek ties in Malaysia 🇲🇾

I perceive they are a very overlooked contributor to facial tension and poor latch, high arch palates, orthodontic relapse, and more.

And I’m grateful to see this area receiving more attention.

https://www.instagram.com/reel/DZMRzQUiCCo/?igsh=N2R2OGxjbnBhbGFy

30/05/2026

If the jaws are an important structural determinant of the airway, and underdevelopment is linked to increased resistance to airflow and increased airway collapsibility during sleep, we need to rethink the watchful waiting approach to orthodontic problems in childhood.

https://youtube.com/shorts/wFJNh96N2I0?si=K9RCTqmJm8tvvWq

Most parents think crooked teeth are just cosmetic… but what if the...

29/05/2026

Is your child restless at night, snoring, or grinding their teeth? What if those sounds are silent signals of deeper airway and jaw development issues?

Discover how early intervention can transform sleep, behavior, and lifelong health.

Snoring isn’t just noise—it’s a warning sign. In this episode of me&my health up, host Anthony Hartcher sits down with Dr. Shereen Lim, one of Australia’s pioneering dental sleep medicine specialists, to uncover the hidden links between mouth breathing, jaw development, and childhood wellbeing.

Dr. Lim explains why silent, nasal breathing during sleep is essential, how poor oral function in infancy can shape lifelong health, and why “convenience culture” (pacifiers, pouch foods, reduced breastfeeding) may be costing our children vitality. Parents will learn practical signs to watch for—like teeth grinding, bedwetting, or restless sleep—and discover holistic pathways to support thriving growth.

This conversation is a wake-up call for parents, caregivers, and anyone concerned about the long-term impact of sleep and breathing disturbances.

https://youtu.be/pvCo0ZB3uDE?si=0WPRv23HrTUBlS2D

Is your child snoring, mouth breathing, grinding teeth, bedwetting, or struggling with focus and behaviour? These may be silent signals of airway and jaw dev...

29/05/2026

A structural problem began in infancy—never named, never addressed—and shaped decades of life. Crooked teeth weren't cosmetic. They were a signal: underdeveloped jaws, narrowed airways, fragmented sleep, a stroke at a young age, exhaustion without explanation.

Dr. Shereen Lim brings clarity to what conventional medicine has left invisible: the connection between infant breathing patterns, facial development, and the chronic conditions that follow into adulthood. She unpacks why 85% of sleep apnea cases go undiagnosed, what tongue ties reveal about ADHD misdiagnosis in children, and why the critical developmental window closes by age twelve. On Health Is a Skill, you'll learn how breastfeeding, nasal breathing, chewing mechanics, and even adult palate expansion can restore what early dysfunction disrupted—and why recognizing these patterns in children prevents them from becoming diagnoses in adults.

Todd Vande Hei has lived this framework's stakes directly. Narrow airways. Sleep apnea since his thirties. A stroke. Problems he now understands may have originated in his own infancy. This conversation is about recognition—seeing the signals before they calcify into systems-wide failure, and knowing that airway health, like every component of Health Is a Skill, begins at birth.

https://youtu.be/fuECr-tpb7M

What if your entire medical history traces back to something that h...

25/05/2026

3.5 years on, and I’m so happy to still be receiving messages from parents and colleagues around the world who have resonated with Breathe, Sleep, Thrive!

And I’m excited to see it featured as a Best Seller in a new category - Dentistry - on Amazon Australia.

When I wrote the book, I never anticipated the international reach it would have. I’d estimate only around 15% of sales from all avenues have been from Australia, which still feels surreal. It has been awesome to connect with readers from all around the world.

I’ve had colleagues eager to help translate the book into various languages to help it reach more people.

On the weekend, my Israeli colleague and inspiration paediatric dentist Dr Hadas Katz Sagi reminded me of her offer to help translate it into Hebrew. She has been so influential in promoting integrative care for children’s airway health, with their Facing Forward event last year attracting 600 colleagues, and early interest for this years event in November very strong!

Whilst she encourages her colleagues to read my book, many of the families they then support cannot access it because of the language barrier, which is what makes translation feel so meaningful.

And I admitted that I’ve honestly been held back by fear of revisiting the book!

Not because I’m not proud of it. But because finishing and publishing it was honestly a little traumatising! There was sweat, exhaustion, and literal tears involved in getting it across the line. And part of me can’t bear opening it and seeing all the places where my thinking has continued evolving and where I know updates are needed, especially around oral ties and how much the adult expansion landscape has continued evolving through ongoing innovation.

But every message, review, and new milestone reminds me that the book still has value, and that I need to give this more focus again.

And with Amazon recently introducing AI generated first draft translation support for languages like Spanish and German, it feels like all roads are pointing for me to get out of my comfort zone and bring it to more people!