Orofacial Myofunctional Therapy
Myofunctional therapy, also called orofacial myology, is the neuromuscular re-education or re-patterning of the oral and facial muscles. It might include muscle exercises, which create a normal airway space dimension. Therapists are trained to eliminate negative oral habits through behavior modification techniques and promote positive growth patterns. Therapy trains people to breathe through their noses if their airways are not compromised, and if the oral breathing is an acquired habit; we teach people how to properly position their tongue at rest; we teach how to chew and swallow correctly, and we emphasize the importance of proper head and neck posture patterns.
The history of myofunctional therapy dates back to the 1400s in Italy. In the United States, in 1906 Alfred Rodgers, an orthodontist experimented with facial muscles exercises and in 1918, wrote a paper titled, "Living Orthodontic Appliances," in which he cited that muscle function alone would correct malocclusion with no need for retention. In 1907, Edward H. Angle, an orthodontist wrote an article on the effects of habits on occlusion. In 1925, Harvey Stallard, a dentist in San Diego, researched 7,000 children on sleep position and malposed tooth buds. He maintained that sleeping on the face, during a child's formative years, could create malocclusion.
In the 1930s, Weston Price, a dentist, researched primitive or traditional cultures. He looked at people all over the world, examined what they ate and evaluated their oral health. He found that primitive cultures, when compared to "modern" cultures, had very little dental disease and their jaw relations and occlusion were healthy. In the 1960s, Walter Straub, an orthodontist, published research on bottle feeding and how it affects occlusion.
Many times oral habits, beginning in infancy, are carried forward into childhood and then adulthood. Some well-known ones are thumb, tongue or finger sucking, cheek, lip or tongue chewing, nail biting, clenching or grinding, hair chewing, leaning on the face, pen or pencil chewing and many others. These habits can be a "remembered endorphin rush," which starts in infancy with sucking. Myofunctional therapy promotes replacement of the habits with having the tongue resting up on the palate. This can stimulate enough endorphins to help stop the noxious habit. Mouth breathing might cause the tongue to rest down and is often associated with "long faced syndrome," orthodontic relapse, allergies, periodontal disease, and sleep disorders. What causes mouth breathing? Otolaryngologists and ENTs cite several causes, including sensitivities to dust, dairy products and animal dander, which might contribute to congestion and nasal airway obstruction and might encourage mouth breathing.
Mouth breathing, sucking habits and tongue thrusting are all etiological factors to orofacial myofunctional disorders. Also, tight lingual frenum attachments can cause a low tongue rest position. A tight labial frenum could be associated with a short upper lip. This leads to a lack of lip seal, which is important for good occlusion. These, in addition to grimacing when swallowing are some things to look for in the evaluation of oral facial myofunctional disorders.
Diagnosis of an oral muscle pattern problem might include chewing with the mouth open, smacking and other irritating noises while chewing, an overdeveloped mentalis muscle and a facial grimace during swallowing, and especially a low tongue rest position. If the tongue habitually rests down, the palate might not develop properly, and a high vault palate is a common occurrence in orofacial myofunctonal disorders.
Mouth breathing and a low tongue rest posture are often associated with a forward head posture. The person brings their head forward in order to open the airway. Carrying heavy back packs or poor posture while working at the computer seem to exacerbate the overall postural problem.
Myofunctional therapy might enhance a person's quality of life. The occlusion (how the teeth fit together), the airway, and posture may change due to the muscle adaptation. Some other etiologies of a myofunctional problem might be artificial or incorrect infant feeding, short or restricted labial or lingual frenum, not being held enough as an infant, genetic predisposition, large palatal tonsils, oral trauma, brain injury, allergies, or macroglossia (large tongue). Also, pacifiers and bottle-feeding might create a sucking habit and push the mandible down and back interfering with proper development.
Frenum attachments, both labial and lingual, that restrict proper function, should be released by an oral surgeon, a periodontist, an ENT, or a trained dentist as soon as possible. Historically, as soon as a baby was born, the baby's frenum was released. Breast feeding was a matter of survival and if the baby had a difficult time latching on the breast, the baby could die. Now we have an option to bottle feed our babies. What we do not realize is that the baby who is bottle-fed exclusively, might later develop an orthodontic problem. If the children are tongue tied, their tongue rests low on the floor of the mouth most likely contributing to a development of tongue thrust or high narrow palate. Also, they cannot swallow properly. At least two percent of all infants born need to have their frenums clipped. It is much easier to have the tongue and lips frenulum done early and prevent as much as possible speech, dental, and orofacial functional problems.
Large or infected tonsils might cause problems with swallowing. If the tonsils are large or infected constantly, the back of the tongue has to come forward to swallow because there is no room or it is painful to swallow correctly. Also, the airway might be blocked and the mouth breathing causes the tongue to rest down and forward.
Periodontal disease is now linked to heart disease and diabetes. If a patient mouth breathes, anterior gingivitis is prevalent. Also, when the tongue is resting down and forward, the pressure of the tongue against the teeth may weaken the periodontal ligaments leading to traumatic occlusion and recession. Anterior or lateral tongue thrust patterns or resting positions are associated with open bites and swallowing pressure is directed forward and down rather than up and back. This might lead to a patient swallowing air, contributing to stomach aches, bloating, hiccups, burping and acid reflux, also called GERD.
Habits might affect the TMJ. Harmonious muscle pattern is important to correct a muscle related TMD. Myofunctional therapists are trained to eliminate habits, which might affect the TMJ. Also, habitual grinding and clenching affect the masseters and temporalis muscle function. It is always best to do the least invasive treatment first.
Orthognathic surgery relapses and orthodontic relapses might, many times, be prevented by myofunctional therapy. We can adapt the muscle patterns to the new bite and bone structure. In this way, we can be an important team player in the maintenance of a stable result. Many dentists and orthodontists are now using functional appliances like the ALF appliance, the Bioblock, or the D&A appliance and myofunctional therapy to get fabulous results. Many times myofunctional therapy is built into the treatment plan from the beginning.
- The goals of oral myology are:
- • Promoting a lip seal.
- • Promoting a palatal tongue rest position.
- • Promoting a posterior, tooth together swallow.
- • Facilitating bi-lateral chewing and correct drinking.
- • Keeping hands and objectives away from the face.
- • Facilitating nasal breathing.
- • Developing a harmonious peri-oral muscle pattern.
- • Correcting dysfunctional habit patterns.