Myofunctional Therapy
ORAL MYOFUNCTIONAL
DISORDERS
TONGUE THRUST--DEVIATE SWALLOW--REVERSE SWALLOW
Your dentist or orthodontist may have told you that you, or your child, has an oral myofunctional disorder. Like most people, you have probably never heard of this before and are unsure of what it means. Very likely, you may not have been very aware of having this specific problem and were actually seeking help for some other oral or dental problem.
“Tongue thrust” refers to a pattern of swallowing in which the tongue pushes forward and/or sideways against and/or between the teeth during swallowing. (Deviate swallow or reverse swallow are older names for the same problem.) Swallowing occurs many hundreds of times each day with little or no conscious thought. When the tongue presses against/or between the teeth during swallowing, the pressure can have adverse affects on the position of the teeth, oral bony growth, soft tissue condition, and mouth functioning.
Resting postures of the tongue, the jaw, and the lips are very important in normal oral growth and condition. When the tongue rests between the teeth, the teeth many not fully erupt, resulting in an “open bite” appearance. If the tongue rests against the upper front teeth (especially if the upper lip is short or weak) the upper teeth may begin to protrude too far forward. When the lips are not in a closed resting position most of the time (when not talking, signing, eating, etc.) the growth and development of the mouth can be adversely affected by the tongue pressures.
Excessive non-nutritive or non-speech oral behaviors, such as clenching, bruxing (grinding the teeth), long term digit sucking, and nail biting, can also affect the condition of the teeth and health and functioning of the mouth, especially the jaw. When any oral behavior is excessive in intensity, duration, and frequency, the pressures or collision forces can have serious impact on normal oral facial appearance, oral facial health, and oral facial functioning.
Upper airway infections and obstructions (enlarge tonsils and adenoids) are frequently identified as causes of oral myofunctional disorders, especially when these problems cause the mouth to rest open most of the time. Reduced oral muscle tone or poor orofacial muscle postures appear to impact negatively on the growing mouth and facial structures. Of course, long term non-nutritive sucking behaviors (thumb and finger sucking) and other oral habits (long term pacifier use, chewing on objects, etc.) can also malform oral structure. (It is normal for infants to suck on thumbs, fingers, pacifiers, and/or other objects. The problems occur when the behaviors persist into childhood past 3 years of age.) Sometimes poor speech articulation patterns may indicate neurological or physical deficits. It is often difficult to determine why an oral myofunctional disorder exists. The oral behaviors can be the result of stimuli which are no longer fully obvious.
Regardless of the causation, once inappropriate oral behavioral patterns are established, they tend to continue until some external stimulus, therapy, or treatment alters enough of the patterns so that new behaviors can be learned. Sometimes changes of the oral environment by orthodontist may bring about improved oral functioning. However, you may be referred for oral myofunctional therapy when there are indications that dental treatment or orthodontic treatment alone may not bring about the desired changes in oral behaviors. Adverse oral behaviors can often interfere with dental and/or orthodontic treatments and your oral stability and condition.
Oral Myofunctional Therapy is a structured, individualized therapy for retraining and restoring normal oral functioning. It is a form of orofacial orthopedics. It seeks to inhibit incorrect muscle movements, and to develop normal, easy functions of oral rest posture, oral stage of swallowing, and speech articulation. Therapy may include any or all of the following:
• Elimination
of damaging oral habits (digit sucking, nail biting, etc.).
• Reduction of unnecessary tension and pressure in the muscles of the
face and mouth.
• Strengthening of muscles that do not adequately support normal functioning.
• Development of normal resting postures of the tongue, jaw, and facial
muscles.
• Establishment of normal biting, chewing, and swallowing patterns.
The length and timing of therapy varies according to the severity and nature of the oral myofunctional disorder. In most cases therapy is a short term process with the active stage lasting about three months. Follow up visits may be required with decreasing frequency over 6-12 months
Robert B. Grider, M. S./C. C. C.
Definitions
Myofunctional therapy or orofacial myology is the treatment of an orofacial muscle imbalance, an incorrect swallowing pattern, TMJ muscle dysfunction syndrome and/or the elimination of bruxing, clenching or sucking habits. The main muscles of concern to the therapist are the temporalis, the masseter, and the internal and external ptergoids, the buccinator, the orbicularis oris and the mentalis. Oral myofunctional therapy is a form of oral facial orthopedics. It involves exercises and stimulation designed to inhibit inappropriate oral behaviors and/or strengthen appropriate oral muscle functioning. The individual patient will need to spend 5-10 minutes a day practicing (with a little more practice time 5 out of 7 days is okay, too).
Goals
The three goals worked on in therapy are appropriate normal oral resting posture, clear and easy speech articulation, and appropriate normal oral stage swallowing. Therapy is not just the working with muscle groups, but also retraining neural memory patterns in the brain.
Tongue thrust (defined by Kim Benkert) is a forceful and more difficult swallow than the physicolologically balanced, synchronized, normal swallow. A tongue thrust pattern may be defined by tongue protrusion, circumoral contraction, a linguadental seal, a tongue-lip seal, or no seal at all. The pressure of the tongue will be pressed either labially, intradentally, or bucally in any case where the sucking and pushing of the tongue to the hard palate has been omitted and transferred forward and/or sideways. This is a tongue thrust pattern.
Some of the many symptoms that may occur with tongue thrust pattern are:
1. Aerophagia--the swallowing and
gulping of air. This is very similar to colic in babies. The symptoms are
similar to colic: Stomach pains after eating, feeling bloated or distended,
or even diarrhea.
2. Difficulty swallowing pills or firmer foods.
3. Poor oral hygiene and/or inability to wear dentures.
4. A residual effect on the hard palate from a former digit habits that has
predisposed the arch to the digit’s shaping.
5. Chronic mouth breathing and a continued nasal stuffiness.
6. Orofacial muscle strain and imbalance.
7. Chronic headaches or orofacial muscle spasms or pain.