Q: Dr. Eppley, I bite down on my cheeks sometime when chewing my food which makes it uncomfortable and sore. Sometimes I can barely eat they are so sore. My cheeks are also sunken in. What are your recommendations for submalar surgery to correct this problem and get it covered by insurance.
A: Biting down on one’s intraoral cheek mucosa is not rare but occurs more frequently in some people. This can occur because of the cant of the occlusion, broken teeth, a swollen cheek lining and particularly if one is wearing hardware on their teeth such as braces. Once the cheek lining gets swollen, it is bigger and creates a protruding ridge which is a viscous cycle for recurrent biting on it.
Having a sunken cheek, however, is not an anatomic reason why one would bite their cheeks. This make seem like a logical explanation but the fat atrophy of the buccal fat pad occurs on the outside of the buccinator muscle and does not effect the shape of the inside of the cheek lining. The buccinators muscle is like a stretched trampoline and what occurs on the outside (visible submalar area) does not effect what lies on its opposite side inside of the mouth. (buccal mucosa) Thus performing submalar augmentation by injecting fat or placing an implant will not improve the shape of the lining inside the mouth…or improve the cheek biting problem.
Submalar augmentation can be performed to improve the aesthetics of the face and would not be covered by insurance under any circumstances. If a palpable ridge of mucosa exists along the occlusal level inside the mouth, its excision may remove the cheek mucosa that is getting in the way of the upper and lower teeth biting together.
Dr. Barry Eppley