Lauren Koroknay, RDH
Myofunctional Therapist
92 Palm Drive, Camarillo CA
Lauren@myoairway.com
CLICK HERE to schedule
What is Myofunctional Therapy?
Myofunctional Therapy is the re-education and strengthening of the muscles of the tongue and face to work as they are designed. It reeducates the tongue to rest fully in the roof of the mouth, strengthens the lips to keep them sealed, and develops a correct swallowing pattern.
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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:
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Crooked teeth
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Mouth breathing
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Periodontal disease
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Red swollen gums at the front of your mouth
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Bad breath
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Fractured or previously fractured teeth
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Clenching and grinding of the teeth
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Long narrow face and/or high vault to palate
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Nasal congestion and sinus issues
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Ear tube placement or chronic ear infections as a child
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Stomach and digestive issues
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Gastric Reflux
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Tension headaches
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Snoring
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Sleep disordered breathing - breathing through the mouth while sleeping
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Sleep apnea
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Chronic fatigue
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Forward head posture
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Persistent dark circles under the eyes
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Bed wetting
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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.
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Goals of treatment:​
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Nasal breathing—all day and all night! Continuous nasal breathing produces nitric oxide which lowers blood pressure and helps disinfect and dilate the nasal passages. 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, causing more illness and allergies. ​​
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Correct tongue posture—all day and night! The whole tongue should rest fully in the roof of the mouth. When the tongue is in the proper position throughout our childhood, our tongues grow our jaws to the perfect size. This gives us enough room for our teeth to come in straight. When the tongue lays in the floor of the mouth during development, gravity takes over and the face grows long, and teeth become crooked due to lack of space.
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Lips sealed—all day and all night! Lips should be sealed when a person is not talking or taking food into their mouth. 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. When the lips do not seal, the mouth may be utilized as an airway, the front teeth may flare, and drooling may occur.
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Correct swallowing pattern—(you guessed it) all day and night! We swallow thousands of times per day. When swallowing, the tongue presses firmly into the roof of the mouth beginning behind the front teeth, but not touching. An example of an incorrect swallowing pattern is a tongue thrust, where the tongue presses forward to the front teeth, which may cause the teeth to flare out and not touch. Improper swallowing may also contribute to digestive issues due to air being swallowed or food not being chewed fully.
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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.
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How do you develop a Myofunctional Disorder?
In modern society myofunctional disorders are very common, and there are many contributing factors to their development. 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.
Some of these contributing factors include:
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Tongue and lip ties - Tethered oral tissues may be genetically passed down. These restrictions do not allow the tongue to rest freely into the palate and/or hinder function of other oral tissues. Sometimes (but not always!) tongue restrictions make breast feeding much more difficult or painful. Breast feeding is extremely important in shaping the palate correctly and toning the tongue so it functions properly. Early detection is vital in prevention of a myofunctional disorder with this etiology, because natures "myofunctional therapy" is breast feeding.
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Bottle feeding - Using a bottle makes feeding significantly easier for the baby, which limits muscle development of the tongue. A weak tongue will rest low in the mouth. 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.
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Pacifier use - if pacifiers are used for too long they can become a problem. 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. Extended pacifier use has also been linked with an increased risk for ear infections.
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Thumb and finger sucking - Thumb and or finger sucking can do a lot of damage to the oral environment. The damage is two fold, the pressure of the tongue or fingers molds the child's palate into an unnatural shape, and the tongue or fingers take the place of where the tongue must rest for proper development. The misshapen palate makes it very difficult for the tongue to suction to the roof of the mouth. This, coupled with the habit of low resting posture, throw the entire orofacial complex into disharmony.
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Allergies - Chronic allergies increase nasal congestion for extended periods of time, causing habitual mouth breathing. Mouth breathing causes the tongue to lay low in the mouth. This in turn perpetuates more allergens to be taken into the body because the air is not filtered through the nose due to the nasal congestion.
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Baby food - Pureed food encourages swallowing without chewing. Chewing (even with the gums) is vitally important for muscle development and proprioception. Through feeding more solid foods when the baby is ready (baby shows interest in food, and can grab and take food to their mouth on their own), this develops the muscles of the tongue and the face to grow. Without muscle development, growth of the upper and lower jaws are limited.
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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. This also risks getting undigested food into the small intestine, causing discomfort and irritation in the digestive system.
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Media - Look at any modeling ad involving people, you will see at least one person in the ad with an open mouth. This subconsciously perpetuates 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?
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As a child develops, and a tongue is too restricted to the bottom of the mouth, as with a strong 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:
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Mouth breathing
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Nasal congestion and sinus issues
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Increase in seasonal allergies
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Stomach and digestive issues
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Tension headaches
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Clenching and grinding of the teeth
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Snoring
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Sleep disordered breathing - breathing through the mouth while sleeping
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Sleep apnea
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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.
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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).
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A simple way to feel for a tongue tie at home
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Suction cup the tongue to the roof of the mouth with the tip of the tongue right behind the two front teeth
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Feel the band that connects the tongue to the floor of the mouth
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If that band feels tight like a guitar string, there may be a restriction in the function of the tongue.
Treatment of an Oral Restriction
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.
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This is an example of a functional frenuloplasty of a grade 3 tongue tie which was completed by an ENT.
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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.
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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.
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Nasal Breathing
We can live without food for weeks, water for days, but without air for mere minutes. It is one of the most important physiological functions that we perform. When talking about health, breathing is rarely discussed. Yet how we breath is a foundation for our health, and with each breath we either promote wellness or illness.
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Nasal breathing is extremely important. As humans we are designed to breathe only through our nose. Nasal breathing has many physiological benefits such as humidifying, warming and filtering our air before it gets into our lungs. Nitric oxide is produced in fully functioning sinuses and when we breathe through our nose, this gas lowers our blood pressure, helps to sterilize the air that is coming into our bodies, and dilates our nasal passages, giving us more room to breathe.
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Alternatively, when we breathe through our mouths the opposite effects occur. When air comes in through the mouth it is unfiltered, cold, and dry. The particulate that comes in from this unfiltered air can exacerbate allergies and nasal congestion, enlarge tonsils, encourage periodontal disease and gingivitis, and give us bad breath.
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The problem is, often times mouth breathing goes undetected by the breather and health care providers. This habit can start very early in life, and health care providers and parents are not educated on the ramifications of an open mouth posture and mouth breathing.