What is Myofunctional Therapy?
Myofunctional therapy treats disorders of the orofacial myofunctional complex or the muscles of the tongue, lips and face.
Some signs and symptoms an orofacial myofunctional disorder may be present:
Crooked teeth
Mouth breathing
Periodontal disease
Red swollen gums
Bad breath
Fractured or previously fractured teeth
Clenching and grinding of the teeth
Long narrow face
High vault to palate
Nasal congestion and sinus issues
Ear tube placement or chronic ear infections
Stomach and digestive issues
Gastric Reflux
Tension headaches
Snoring
Sleep disordered breathing
Sleep apnea
Chronic fatigue
Forward head posture
Persistent dark circles under the eyes
Bed wetting
You can think of Myofunctional Therapy, as physical therapy for the tongue and the face. Individualized exercises are done multiple times throughout the day to achieve treatment goals.
Goals of Treatment:
Nasal Breathing
Breathing through the mouth decreases oxygen absorption by 10-20%. If you are not able to breathe through your nose, you cannot filter the air that comes into your body.
Correct Tongue Posture
The whole tongue should rest fully in the roof of the mouth. This gives us enough room for our teeth to come in straight.
Lips Sealed
The sealed lip muscles keep the front teeth in place, assist in proper nasal breathing, and aid in a correct swallowing pattern and TMJ function.
Correct Swallowing Pattern
Improper swallowing may also contribute to digestive issues due to air being swallowed or food not being chewed fully.
Sometimes myofunctional therapy can be hindered by restrictive oral tissues of the lips, cheeks, or tongue. This hinderance is commonly known as a lip, buccal, or tongue ties, or TOTs - tethered oral tissues.
How Do You Develop a Myofunctional Disorder?
In modern society myofunctional disorders are very common, and there are many contributing factors to their development.
Contributing Factors
Many of these things start very early in life or are passed on to us genetically. As genetics research progresses, we are realizing most of these factors stem from our environment.
Tongue &
Lip Ties
Tethered oral tissues may be genetically passed down and do not allow the tongue to rest freely into the palate and/or hinder function of other oral tissues.
Bottle
Feeding
During bottle feeding the baby also uses more facial muscles, to get milk from the bottle, rather than the tongue. This causes overdevelopment of certain facial muscles and a habitual reliance on the facial muscles for swallowing.
Pacifier
Use
The pacifier takes the place of where the tongue should rest (sealed to the roof of the mouth). In turn the tongue begins to learn a low resting posture.
Thumb & Finger Sucking
The pressure of the tongue or fingers molds the child's palate into an unnatural shape. They also take the place of where the tongue must rest for proper development, making it difficult for the tongue to suction to the roof of the mouth.
Allergies
Chronic allergies increase nasal congestion for extended periods of time, which perpetuates more allergens to be taken into the body because the air is not filtered through the nose.
Baby Food
Pureed food encourages swallowing without chewing. Chewing (even with the gums) is vitally important for muscle development and proprioception.
Soft Food
Extremely soft food does not engage the chewing muscles and perpetuates the issue of poor muscle development. With soft food it is possible to chew a few times and then be swallowed.
Media
Look at any modeling ad involving people, you will see at least one person in the ad with an open mouth, perpetuating the normalization that the mouth open is alluring and "sexy".
What is a Tongue Tie?
A restrictive lingual frenum, commonly known as tongue tie or ankyloglossia, is defined by the lack of the tongues ability function properly and rest completely and effortlessly in the palate.
What is a lip or buccal tie?
A lip or buccal tie, also known as a labial, buccal frenum or tethered oral tissue (TOT), is very similar to a tongue tie.
Tethered oral tissues inhibit the proper function of the lips and cheeks. A lip restriction may inhibit a proper lip seal, creating more of a propensity for open mouth posture and in turn mouth breathing.
Why is this an issue?
As a child develops, and a tongue is too restricted to the bottom of the mouth, as with a tongue tie, proper facial development is hindered. The tongue cannot rest freely in the roof of the mouth, thus narrowing the upper dental arch and causing the face to grow long instead of wide.
Improper tongue placement also lends it self to a possible cascade of events that may include but are not limited to:
Mouth breathing
Nasal congestion and sinus issues
Increase in seasonal allergies
Stomach and digestive issues
Tension headaches
Clenching and grinding of the teeth
Snoring
Sleep disordered breathing
Sleep apnea
Forward head posture
Tongue restrictions may also have NONE of these signs or symptoms. It is important to note that treatment of an oral restriction is dictated by a patients negative signs and symptoms. Unfortunately there is no one set of rules to measure a tongue restriction and not all health care professionals are trained to detect a tongue restriction. In my office, to determine if there is a tongue restriction present, measurements are taken to determine a functionality score from grade 1 (being the least restricted) to grade 4 (the most restricted), and compensations are noted.
A simple way to feel for a tongue tie at home:
Suction cup the tongue to the roof of the mouth with the tip of the tongue right behind the two front teeth.
Feel the band that connects the tongue to the floor of the mouth.
If that band feels tight like a guitar string, there may be a restriction in the function of the tongue.
How to Treat a Tongue Tie?
Releasing an oral tie is one of the oldest surgical procedures still being done today.
If treatment of an oral restriction becomes necessary, it is done through a simple surgical procedure called a functional frenuloplasty, sometimes called a frenectomy or a frenotomy. This procedure may be completed by an oral surgeon, ENT, general dentist, or periodontist, ideally with the assistance of a myofunctional therapist.
The procedure is typically done under local anesthesia and recovery ranges from a few days to around a week depending on the depth of the restriction.
This is an example of a functional frenuloplasty of a grade 3 tongue tie which was completed by an ENT.
This patient exhibited: clenching and grinding of the teeth, fragmented poor sleep, sleep disordered breathing, chronic headaches - around six per week ranging from mild to severe, cervical spine issues, and forward head posture. With her chief complaint being headaches.
After treatment, patients headaches drastically improved from almost every day to once a month. Her sleep was improved, although not completely resolved, and her cervical spine issues were stabilized.