ARE THE MUSCLES OF YOUR MOUTH AND FACE YOUR FRIEND OR FOE?

 What is the issue?

            We use the muscles of the mouth and face 24 hours a day, both consciously and unconsciously. The manner in which they are used effects how we look, the shape and function of the dental bite, our speech, the TMJ/TMD-jaw joint apparatus, the head-neck-body posture, and predicts the level of discomfort, physical, emotional, and/or financial, that we will have to endure in our lifetime.

The phenomenon of disuse of the oral-facial musculature is known by many names. You might be told that you have a “tongue thrust” or “deviate swallow”. Therapy for correction will be called “tongue thrust therapy, “myofunctional therapy”, “orofacial myology”, “oral myology”, or  “oral-facial dysfunction therapy”. The good news is that this therapy program is highly successful, takes a limited amount of time (3-6 months), and is cost effective.  The benefits are far ranging beginning as young as 4 years of age to mature seniors in their 80’s or 90’s.

How would I know if I have correct oral-facial function?

The sad facts of dysfunctional oral-facial muscles:

DIAGNOSTIC CRITERIA:

Sucking Habits:

Thumb, finger, fingers, the tongue, pacifiers, blankets, etc. when sucked train the tongue to function down and forward, creating a tongue thrust pattern. Lip function is affected, the dental arch becomes narrower, vaulting of the palate reduces nasal air space, and, frequently, a speech problem develops.

Introduce your child or yourself to a motivational program designed to correct sucking habits to stop the detrimental effects created by the sucking habit.

Mouth Breathing:

Mouth breathing is a very detrimental habit. The weight of the lower jaw hanging open is a constant downward pull on the muscles of the face, often causing it to shape itself into a long, narrow, flatter facial appearance. The nasal-sinus area is frequently underdeveloped decreasing air availability. The lip tissue frequently becomes full and flaccid, chaps easily, is prone to corner lip sores, and, often, there is a shortening of the upper lip.

 With the lower jaw hanging, the position of the jaw joint is abnormal, a causative factor for early jaw joint damage and dysfunction. Young children will often have symptoms of jaw sounds and/or pain, ear ringing, headaches, neck tension, and/or facial tension or pain.

The nose was designed for the breathing of air with the unique ability to clean and condition the air for the lungs. The lungs demand air almost totally free of bacteria, cleansed of grit, smoke, and other irritants, moistened to 75-80% (like a humid summer day), and heated to a temperature in the 90s.

 It is the sticky mucus, produced by the spongy, red membrane that lines the nasal passages, that provides moisture and acts as a kind of flypaper to trap bacteria and dirt particles. This mucus is removed approximately every 20 minutes by the microscopic brooms in the nose called cilia. These minute hairs whip the film back to the throat for swallowing where strong stomach acids destroy any bacteria swallowed. Lysozyme, also present in the nose, is another microbe slayer.

Warming of the air is accomplished by the turbinates, three bony projections that protrude from the sidewall of each nostril. The turbinates are covered with erectile tissue housing an enormous blood supply used as radiators to heat any air breathed in to a temperature in the 90s instantly.

Lastly, the nose detects odors as a result of a patch of yellow-brown tissue located in the roof of each nasal cavity. Each patch has ten million receptor cells and six to eight sensory hairs that perform the task of distinguishing what scent or scents are near by.

Many of my patients have a significantly reduced capability to breath through the nose due to allergic rhinitis or frequent colds. Asking them to sit with their mouth closed for 5 minutes is a challenge and, sometimes, scary experience. Vernon D. Gray, M.D., Diplomate American Board of Otolaryngology and James F. Garry, D.D.S., F.I.C.D., F.A.A.H.D. created a “Flow Chart” relating upper respiratory allergies to the development of craniomandibular dysfunction. Their findings indicate that an allergic reaction takes place in the nose, separate from the systemic allergies. It is caused by the continued manufacture of mucous, even though the nose is not being utilized for breathing. The mucous then puddles inside the nose and creates a situation akin to a boggy pond. This boggy pond sets up an irritation to the lining of the nose causing it to swell, further reducing the ability of the nose to keep air moving freely.

Over the years, my findings indicate that teaching a person to use the diaphragm for breathing and, no matter how slight, forcing air to move over the nasal passages, we begin to see a reduction in the swelling. In a matter of weeks, we see established, the ability to use the nose for breathing. Spraying the nose with a nasal saline solution to wash the nasal tissues; teaching head-neck-body posture exercises to improve the ability to use the diaphragm and have better tongue posturing; and educating the patient about the importance of nasal/diaphragmatic breathing, we see a dramatic shift in their condition as they begin to breath filtered air.

There are conditions that can alter a person’s ability to establish nasal breathing. In the presence of a deviated septum, grossly enlarged turbinate, polyps, and/or adenoidal tissue, it may require surgery to open the airway. It is imperative, however, that immediately following the surgery, a program is undertaken to teach correct nasal breathing and use of the oral-facial muscles. I have seen several patients who have had surgery, did not correct the mouth breathing habit, and were, once again, in need of surgery.

 The Resting Tongue Posture:

 The resting tongue posture refers to the posture of the tongue when it is not being used for talking, eating, drinking, smiling, yawning, or coughing. The tongue is meant to support the palate. It is your natural palatal expansion device.  

The correct resting tongue posture is with the tip of the tongue on the ridge behind the upper front teeth, but not touching the teeth. The rest of the tongue is arched across the top of the mouth with contact against the palate, but contained within the teeth. Tongue forces spreading across the occlusal surfaces of the teeth will often exhibit a ridge of irritated tissue along the lateral borders of the tongue. If the tongue is pushing into the teeth, laterally, scalloping edges will be apparent along the lateral tongue border.

There are many variations of dysfunctional tongue posturing. All situations cause stress within the oral-facial mechanism. If you think of an area that has consistent wind, such as a bluff overlooking the ocean, trees will be seen growing at a distinct angle in the direction of the force of the wind. The resting tongue posture, when dysfunctional, is a consistent force that can play a strong role in causing an opening in the dental bite, bone loss and resultant gum disease, inability to wear prosthetics such as partials and dentures, breakdown of the jaw joint apparatus resulting in TMJ/TMD problems, consistent headaches and/or neck/shoulder tension, poor articulation/speech capabilities, relapse of dental corrections, drooling, and the altering of the facial appearance.

  The Swallow:

The swallow occurs a minimum of 2000 times each day, once a minute when you are asleep and twice a minute when you are awake. We then have to add swallows that occur while eating, drinking, or when anxious. The average swallow exerts approximately 5 to 8 pounds of pressure. By design, the pressure is disseminated across the palate with no one area receiving excessive amounts of pressure. In a dysfunctional swallowing pattern, the force is of a targeted nature. Therefore, in a swallow with an anterior thrust, the 5 to 8 pounds of pressure is against the anterior teeth resulting in an open bite, splaying of teeth, gum disease, cosmetic relapse, an interdental lisp, and/or jaw joint symptoms.

 A lateral swallowing dysfunction will exert pressure towards the cheeks, unilaterally (to one side only) or bilaterally (both left and right). This pressure can cause a posterior open bite, loss of teeth, tongue irritation, unseating of partials or dentures, bite shifting/instability, tooth sensitivity, relapse of dental treatment, and/or lateral speech lisping.

In the presence of a dysfunctional resting tongue posture and/or a dysfunctional swallowing pattern, I often see the tendency to develop a bruxing and/or clenching habit. Both habits are very destructive to the jaw joint apparatus and to the dentition (the dental bite). People will exhibit excessive tooth wear, facial disfiguration, facial tension, pain in the head, face, neck, and/or upper body, interrupted sleep patterns, and other bizarre symptoms unless the bruxing/clenching habits are corrected. It is imperative to establish an environment free of stress and capable of normal function.

The Frenum:

 There are three frenums in the mouth, the lingual frenum, the muscle under the tongue, the mandibular labial frenum, the muscle between the lower lip and the lower dental arch, and the maxillary labial frenum, the muscle between the upper lip and the upper dental arch. Each frenum has a range of motion that is acceptable and necessary. A restrictive frenum can cause concern and, frequently, necessitates surgery.

If you place the tip of your tongue on the ridge behind the upper front teeth, you should be able to drop the lower jaw open placing a stretch on the lingual frenum of 1 to 1 ½ inches. If there is restriction of the frenum, you will see the lower jaw have to close in order to allow the tongue to touch the top of the mouth. If you open the mouth wide and lift the tongue as far as possible, you will generally see a heart shape form because of the restrictive pull of the lingual frenum. A surgical procedure is necessary to remove the restriction and should be followed within 5 to 7 days with exercises to stretch the muscle, teach it the correct way to function, and keep it from healing with any restriction.

In order to have a palatal resting tongue posture, a palatal-posterior swallowing pattern, tongue movements sufficient for speech sounds, and to prevent abnormal pressures against the dentition, it is necessary to have a non-restrictive lingual frenum.

The maxillary and mandibular labial frenum, if restrictive can cause stripping of the periodontal tissue and/or spacing between the anterior teeth. One might also see a shortening of the upper lip or creasing of the lower lip. A simple surgery can help correct these concerns.

 Tonsils:

 Tonsils are necessary filtering organs of the body. They are of concern when their size prevents the back of the tongue from being able to touch the back of the throat during the act of the swallow. In the presence of frequent infections, the tonsil tissue can become scarred and are hard in their consistency. Because of this firm mass, the tongue is pushed forward. Correcting the tongue to its proper function becomes a challenge and surgery to remove the tonsil mass may be the only treatment of choice. If the mass is only moderately enlarged and are soft in consistency, therapy can proceed.

 We often see a change in the size of the tonsil tissue with correction of the mouth breathing habit and establishing filtered nasal breathing. This often helps to reduce the number of infections each year and reduces the strain on the tonsil filtration system. Improved digestion will influence tonsil health. Digestion often changes as we teach correct eating and drinking techniques and stop air swallowing patterns.

  TMJ/TMD Dysfunction:

 Children and adults can exhibit symptoms of jaw joint dysfunction or TMJ/TMD.

These symptoms include jaw sounds and/or pain, jaw locking open or closed, jaw deviations opening or closing or with speech sounds, headaches, facial pain and/or tension, neck/shoulder pain and/or tension, ear ringing or buzzing, top of the head or back of the head pain, bruxing, clenching, abnormal jaw carriage, and/or jaw damage.

The earlier we restore normal muscle function, the better. Children often are totally free of all of the symptoms at the completion of therapy. Regardless of age, treatment is a vital part of the TMJ/TMD scenario. It is often overlooked completely as a causative factor.

(Please refer to my TMJ/TMD history in my personal history)

 Sleep Disorders:

Snoring, Sleep Apnea, and Restless Sleep are frequently part of the history of a child or adult with oral-facial muscle dysfunction. With an incorrect resting tongue posture, a weak or inactive soft palate and uvula, and oxygen deprivation due to mouth breathing, night concerns are prevalent. In some instances, the presence of these disorders is life threatening.

 Through therapy exercises, a person can learn a new palatal resting tongue posture, strengthen the tongue to enable it to function without dropping back during sleep, strengthen the soft palate and uvula and develop proper function, correct the mouth breathing habit and establish nasal/diaphragmatic breathing for increased air supply, teach back sleeping to remove dysfunctional stomach and side sleeping habits, and stop habits such as sleeping with the hands under the face to prevent facial and dental disfiguring.

The good news is that a child will often be totally free of the original symptoms upon completion of therapy. Adults can achieve favorable results also.

Speech:  

I am not a speech pathologist. Therefore, I do not do speech correction, however, there are consistent symptoms related to speech that I see in the oral-facial dysfunction patient that appear to be associated with the oral-facial muscle dysfunction. I see significant changes at the end of treatment or a complete reversal of symptoms. If not a total change, one will see a dramatic shift to the positive in the ability to move toward correction in a speech program at school or within a private speech setting.

The symptoms that parents most often note are “mumbling”, “wetness”, “talks too fast”, “the words never have endings”, or always   “seeing the tongue” as they talk. Other symptoms that I see are shifting of the lower jaw forward or to the side, unusual tongue shapes just to produce sounds, minor to major facial adaptations, and poor air projection. Once the oral-facial musculature is stronger and functioning correctly, these symptoms are modified or disappear. It is not a “speech” problem, it is a “muscle” problem.

Tonsils:

The tonsillar tissue is a very important part of the body filtering mechanism. I am very anti-surgery, however, when the tonsils are so large as to block the posterior part of the throat, when they are hard and fibrous with built-up scar tissue due to frequent infections, and/or when the health of the person is compromised constant infections, surgery is often necessary.

During a swallow, the posterior portion of the tongue pulls back and touches the wall of the throat. If the tonsillar tissue is slightly enlarged and is soft in texture, it is pushed aside like the swinging of the doors as cowboys entered the bar in old Western movies. I have seen tonsils that are much larger than I desire to work with, but, even though they are inflamed, they are soft. These tonsils often decrease in size as we remove the irritation of the mouth breathing habit, improve digestion through the decrease in air swallowing, and, if necessary, help the patient to think of better dietary habits.

Tongue or Cheek Markings:

Scalloping markings on the tongue indicate a wedging of the

e tongue laterally. This constant force of the tongue against the teeth has a major effect on loss of bone around the teeth and/or influences tooth movement.

Ridge markings on the tongue indicate biting of the tongue laterally. The tongue is placed between the teeth and the person is actually biting on the tongue. Sometimes, in a bite that is too over closed, the body places the tongue between the teeth to gain “height” to protect the jaw joint. If this is the case, if is difficult to correct this habit until a correction of the bite takes place with orthodontic, surgical, or prosthetic treatment. However, this habit will correct nicely when it is associated with the overall picture of oral-facial muscle dysfunction and is part of a unilateral, bilateral, or anterior tongue thrust pattern.

Cheek and lip markings indicate a biting or sucking of the cheek and lips as a result of a habit or by accident. This could be the result of a dysfunction in the dental bite or part of the stress patterns of the oral-facial dysfunction.

Jaw Carriage:

Lateral and/or anterior muscle dysfunctions will pull the jaw to the side or forward as a habit, during speech, during the act of swallowing, or when attempting to find the dental bite position. This can create dental abnormalities, such as a “cross bite”, jaw joint damage (TMJ/TMD), bruxing and/or clenching patterns, facial asymmetry, and place abnormal stress on the head-neck apparatus.

There are other causative factors for abnormal jaw function, but, by-and-large, an overlooked factor is the function of the oral-facial musculature. I have seen patient-after-patient correct the jaw carriage problem with the correction of the oral-facial muscle function.

Poor Eating and Drinking Patterns:

Many a parent loves me dearly just for the correction of the poor eating and drinking patterns that accompany the tongue thrust pattern. You will see chewing with the mouth open, making noise when chewing, being sloppy with the food, eating too fast, taking too large a bite of food, drinking frequently while eating (washing the food down), poor posture at the table, insufficient chewing, and/or the gulping or ballooning of liquids.

Due to the tongue thrust pattern of swallowing and chewing with the mouth open, air is swallowed during the act of eating and drinking. Often, the person experiences more than the usual amount of gas, burping, hiccups, and stomach aches. Frequently, I have reports of “daily” stomachaches.

Through the correction process of tongue thrust therapy, the unsightly habits are corrected and a cessation of symptoms, generally, will occur.

Poor Habits:

A major array of poor habits will frequently accompany the tongue thrust/oral-facial muscle dysfunction pattern. All of the habits can be cosmetically unsightly, over time, cause damage, and can add to the cause of wrinkles in the face.

A few of the habits might be lip, cheek, and/or tongue biting or sucking, facial mannerisms, leaning on the face, nail biting, gum chewing, pen/pencil biting, knuckle biting, shoulder phone holding, impact hobbies, biting on a pipe or toothpicks or bobby pins, or poor use of musical instruments.