Things a Myofunctional Therapist Looks At

In evaluating a patient’s oral and facial function patterns – how they habitually use their mouth and face muscles – a myofunctional therapist looks at a broad array of factors that may affect the patient’s health or, in the case of children, development, or that may be affected by their orofacial behaviors. Below are descriptions of some of the main ones.

Sucking Habits

When a child or adult habitually sucks their thumb, fingers or other objects, they effectively train their tongue to function down and forward, creating what’s commonly called a tongue thrust pattern. Lip function may be affected, and frequently the dental arch narrows. Vaulting of the palate reduces nasal air space. Often, a speech problem develops. Thus, engaging the individual in a motivational program to end such habits is a key component of orofacial therapy.

Lips Apart Posture During the Day or Night

Breathing habitually through the mouth may be quite detrimental. The nose was designed with the unique ability to clean and condition air for the lungs, which demand air almost totally free of bacteria, grit, smoke and other irritants, moistened to 75-80% and warmed to a temperature in the 90s. The mouth, of course, lacks this ability, which is just one reason why nasal breathing matters.

There are conditions that may interfere with nasal breathing. In the presence of a deviated septum, grossly enlarged turbinate, polyps or adenoidal tissue, surgery may be needed to open the airway. It is imperative, however, that steps are taken after surgery to teach correct nasal breathing and use of the oral and facial muscles.

Resting Tongue Posture

The tongue is meant to support the palate (the roof of your mouth). In the correct posture, the tip of the tongue touches the ridge behind the upper front teeth but not the teeth themselves. The rest of it is arched across the top of the mouth, in contact with the palate and contained within the teeth. When tongue forces spread across the occlusal surfaces of the teeth (their biting surfaces), the tongue will often exhibit a ridge of irritated tissue along the sides. If the tongue is pushing into the teeth, laterally, scalloping edges will be apparent along the sides.

There are many variations of incorrect tongue posture, but all cause stress within the orofacial mechanism. Just as strong, consistent winds compel trees on a bluff to grow at a distinct angle, the consistent pressures from the tongue set against the teeth may play a role in causing conditions such as an open dental bite, gum disease and bone loss, jaw joint breakdown and TMD, recurrent headaches and upper body tension, speech problems, drooling and an altered facial appearance.

The Swallow

Every day, each of us swallows hundreds and hundreds of times – and this isn’t even counting the swallows we take when we eat, drink or are anxious. Each exerts a small amount of pressure. By design, this pressure should be spread evenly over the palate and contained within the palatal arch. In a dysfunctional swallow, there may be inappropriate pressures exerted against or between the teeth.

Oral Frenula

There are three frenula in the mouth – small folds of tissue that secure or restrict the motion of organs. The lingual frenulum is the muscle under the tongue, while the mandibular labial frenulum is between the lower lip and lower dental arch and the maxillary labial freunlum is between the upper lip and the upper dental arch. Each has a range of motion that is acceptable and necessary.

A non-restrictive lingual frenulum is needed to have a proper resting tongue posture and swallowing pattern, sufficient tongue movement for speech and to prevent undue pressure against the dentition. A restrictive frenulum may cause concern and often requires surgery. If the maxillary and mandibular labial frenula are restrictive, stripping of the periodontal tissue or spacing between the upper anterior teeth is possible. You might also see a shortening of the upper lip or creasing of the lower lip.

If you place the tip of your tongue on the ridge behind your upper front teeth, you should be able to open your lower jaw and stretch the lingual frenula 1 to 1 1/2 inches. If there is restriction, the jaw must close for the tongue to still touch the top of the mouth. If such a restriction is surgically removed, it should be soon followed (within 2 to 5 days depending on the type of surgery - shorter for laser surgery) with exercises to stretch the muscle, teach it proper function and keep the restriction from returning as the site heals.

Tonsils

Tonsils are necessary filtering organs of the body. They may be of concern, though, if their size prevents normal swallowing patterns or restricts the posterior airway. In the presence of frequent infections, the tonsil tissue may become scarred and hard. Their firm mass generally pushes the tongue forward, and correcting the tongue thrust becomes a challenge. If the mass is only moderately enlarged and relatively soft, frequently, therapy may proceed.

TMJ Dysfunction (TMD)

Parafunctional habit patterns may have a negative influence on the normal functioning of the temporomandibular joint (TMJ). Dysfunction in the TMJ is signaled by symptoms such as jaw sounds or pain, jaw locking, facial pain or tension, neck/shoulder pain or tension, ringing or buzzing in the ears, head pain, bruxing (grinding), clenching, abnormal jaw carriage and jaw damage.

Sleep Disorders

Obstructive sleep apnea (OSA) is a serious concern in both the child and adult populations. Orofacial myofunctional therapy does not treat this disorder, but if any symptoms are noted during the course of an evaluation, the patient is advised to consult with their referral source, physician or appropriate sleep disorder clinician. OSA may be life-threatening, and proper treatment is advisable.

Orofacial myofunctional techniques have proven to be valuable in mild to moderate OSA as revealed in 2009 study published in the American Journal of Repiratory and Critical Care Medicine.

Speech

Speech issues often accompany orofacial muscle dysfunction issues, but the OMT is not trained to correct speech issues unless they also have a speech degree. When a speech issue is noted during the evaluation by a non-speech specialist orofacial myologist, advice is given to seek an appropriate referral in the field of speech pathology once the muscles and habits have been corrected or in tandem with the orofacial therapy process.

I have seen a number of consistent symptoms that point to a “speech” problem actually being more of a “muscle” problem. Parents will describe vocal qualities such as “mumbling” and “wetness.” They say their child “talks too fast” or that “the words never have endings.” They describe always “seeing the tongue” as their child talks. I, myself, have noticed signs such as jaw shifting, unusual tongue shapes, minor to major facial adaptations and poor air projection. Once the oral-facial musculature is stronger and functioning correctly, these symptoms may be modified or disappear.

Tongue or Cheek Markings

Markings on the tongue, cheek or lips have several causal issues. Generally, a "ridge" marking on the tongue, cheek or lips indicates that the tissue is being placed between the teeth and is being "bitten" by the teeth. "Scalloping" indentations on the tongue indicates the tongue being pushing into or against the teeth, thereby leaving an indentation of the teeth.

When associated with the overall picture of orofacial muscle dysfunction, poor habit patterns (such as tongue, lip or cheek biting, sucking or chewing) and a dysfunctional rest tongue and swallowing posture, significant changes may occur with the therapy corrective process. An interdisciplinary approach to treatment is often necessary.

Jaw Carriage

Lateral and anterior muscle dysfunctions may pull the jaw to the side or forward as a habit during speech, swallowing or bringing the teeth together. Left unchecked, this may place stress on the head/neck apparatus and lead to dental conditions such as crossbite, jaw joint damage or TMD, bruxing and clenching, as well as facial asymmetry.

While there are a number of causes of jaw dysfunction, it’s important not to overlook the function of the oral-facial musculature. I have seen patient after patient correct jaw carriage problems through the course of orofacial therapy.

Poor Eating and Drinking Patterns

A number of poor eating and drinking patterns often accompany the tongue thrust pattern: chewing with the mouth open, making noise while chewing, sloppy eating, eating too fast, taking too large bites, washing food down with liquids, insufficient chewing, poor body posture while eating and gulping of liquids. The tongue thrust also may lead to a tendency to swallow a lot of air while eating. Often, the person experiences more than the usual amount of gas, burping, hiccups and stomach aches. Frequently, I hear reports of “daily” stomach aches.

Poor Habits

An array of poor habits frequently accompany the tongue thrust/orofacial muscle dysfunction pattern. These include lip/cheek/tongue biting or sucking, facial mannerisms, leaning on the face, nail or knuckle biting, pen/pencil/necklace/object/clothing/hair biting or sucking, gum chewing, shoulder phone holding, impact hobbies, biting on a pipe or toothpicks or bobby pins, or poor use of musical instruments. Such habits may be cosmetically unsightly and, over time, cause damage and add to changes in the face.

Through proper education and correction of the orofacial muscle patterns, however, most habits may be easily corrected.