Myofunctional Therapy introduces exercises…

related to tongue placement, breathing, speaking, chewing and swallowing, help to address a wide range of health problems and conditions including:

• Sleep apnea
• Upper Airway Resistance Syndrome
• Sleep disturbed breathing
• Tongue-tie
• TMJ pain
• Orthodontic and surgical relapse
• Craniofacial growth and appearance concerns
• Headaches and other facial and neck pain and tension
• Postural issues

The Four Goals of Myofunctional Therapy are:

1. Nasal breathing
2. Lip seal
3. Proper tongue posture
4. Correct swallowing pattern

What causes Orofacial Myofunctional Disorder?

The causes of OMDs are multifactorial but the low resting position and function of the tongue are key contributors. These are some:

• Genetic predisposition
• Genetic defects such as craniofacial abnormalities, cleft palate, tongue ties.
• Habits such as non nutritive sucking, including prolonged finger/thumb/object sucking or prolonged use of pacifier and/or bottle.
• Airway obstructions caused by a deviated septum, enlarged adenoids or tonsils, a soft palate that is long, or prolonged congestion due to allergies/sinusitis/asthma.
• Epigenetics, or how environmental factors affect the expression of genes. Bottle fed babies use different muscles to “eat” and this impacts orofacial development.  Processed foods also impact this development as our masticatory muscles are being used less and/ or are being used incorrectly. The incorrect habitual use of these muscles can develop into orofacial myofunctional disorders.

The Tongue

The tongue is made up of 8 different muscles that intertwine with one another and are anchored to the bones of the face, to a floating bone on the throat called the hyoid bone and to the collarbone.  The base is anchored to the floor of the mouth by a facia, or connective tissue.

The functions include breathing, sleeping, mastication, taste, production of speech and sound. It also impacts the growth and development of the dental arches and development of the airway and orofacial complex.

The ideal resting position of the tongue is at the roof of the mouth, the tip touching “the spot” and the middle and posterior sections also rest up to the palate. This position has a great impact in the craniofacial formation, stability and function from the embryonic stage of life to adulthood.

Ankylogossia, tethered tongue or tongue tie, occurs when the frenum does not dissolve properly during embryonic development. This restriction prevents normal tongue mobility, tone and function as the tongue is forced to sit on the bottom of the floor.  Habits such as finger/thumb sucking and airway problems such as asthma and chronic congestion can also contribute to low resting tongue posture.

Orofacial myofunctional therapy aims to eliminate bad habits and establish new neuromuscular repatterning in order to restore proper orofacial muscular function; that is, the training the muscles of the tongue, lips, and face work together properly.

Conditions & Habits Contributing to OMD Include:

Tethered oral tissue (TOTs)

• Frenums that are short and/or tight on the lips, cheeks and tongue can limit the mobility of the orofacial muscles and impact chewing, swallowing and speech.
• Tongue tie restricts the normal movements of the tongue and forces it to sit at the floor of the mouth. The body compensates for these restrictions in order to chew, swallow and speak as well as possible but these compensatory actions have a detrimental impact on the normal craniofacial development and eventually to OMDs.
• Frenuloplasty, is a surgery that removes the frenum (s)  and thereby releasing the stain.
• Myofunctional therapy before frenuloplasty increases the success rate of the surgery.
• Myofunctional therapy after the frenuloplasty  will establish proper position and function by establishing new neuromuscular repatterning.
• Early intervention is best but any age will see improvements in their health.

Tongue thrust

• This is a habit of pushing the tongue forward between the upper and lower front teeth when you swallow. The forces on the teeth can cause an open bite, an abnormal dental occlusion. If swallowing occurs on average 2000 times a day, this dysfunctional habit causes orofacial changes (elongated facial structure)  dental misalignments (open bite) and can produce a lisp.
• Tongue thrust often arises as a result of the habitual mouth breathing due to airway obstructions such as allergies and nasal congestion.
• Correction of the tongue thrust habit has best outcomes when the myofunctional therapy is at an early age but tongue thrust therapy is effective for any age.
• Orthodontic treatment of this malocclusion can relapse without the correction of the muscular dysfunction via myofunctional therapy.

Myofunctional exercises aim to correct this dysfunctional muscle pattern to promote nasal breathing and lips seal.

Oral Habits

• This includes sucking on fingers/thumbs/hair, extended use of bottle/sippy cups/pacifiers., biting on nails, pencils or other items.
• These oral habits force the tongue into a low position and this becomes a habitual low resting tongue posture.
• Low tone posture leads to OMD, malocclusion (crowding and misalignment) of the teeth.
• Non nutritive sucking habits are common and “normal” in the formative years.

Myofunctional therapy re-educates the movement of muscles including nasal breathing, lip seal, and correct swallowing pattern and chewing function. 

Mouth Breathing

Physiology of breathing

• Breathing is the process of moving air in and out of our lungs for respiration– oxygen is used by cells in our body to  generate energy then expelled out as carbon dioxide, the waste product.
• We are born as obligate nasal breathers; nature designed us to breath through the nose..
• Nasal breathing warms and humidifies the incoming air and filters it from pollutants (good for the lungs).
• Nasal breathing stimulates the production of nitric oxide (NO) which has antimicrobial/antifungal/antiviral/antiparasitic properties. NO is a blood pressure regulator (reducing the potential for cardiovascular disease and stroke) and it improves oxygen absorption by the lungs These benefits are absent with mouth breathing.

• Mouth breathing is a habit that can start with partial or complete nasal obstruction.
  • Physical obstructions include nose size/shape, enlarged tonsils, turbinate, adenoids.
  • Nasal congestion due to colds, sinus infection, and allergies are another form of obstruction.
• Mouth breathing compensates for the nasal blockage. The tongue drops to the floor of the mouth and protrudes to allow for greater intake of air volume.
• Negative impacts of habitual mouth breathing:
  • Impacts the growth of the orofacial muscles, bone and teeth leading to open mouth posture, malocclusion and sleep disorder breathing.
  • Increase in cavities, gum disease, bad breath, dry mouth.
  • Increases upper respiratory infections, ENT infections and asthma due to the decrease in nitric oxide (NO).

Myofunctional therapy re-educates the movement of muscles including nasal breathing, lip seal, and correct swallowing pattern and chewing function.

Orofacial Myofunctional Disorders Sequelae

Early Intervention is crucial.

Orofacial growth and development

• The dysfunctional use of the muscles to compensate for the orofacial myofunctional disorder can lead to a phenotypic appearance: long, narrow face with undefined cheekbones, pointy and smaller mandible or pointy chin.
• Gummy smile from the improper lip development.
• Forward head posture- when the head is positioned forward and is unaligned with the neck and shoulders.  This chronic position leads to strain on the muscles of the head, neck, shoulders and hips and it impinges on the airway.
• Narrow, vaulted maxillae produces a smaller mandible that restricts the airway space.
• The underdeveloped maxilla is the floor of the sinuses and consequently these too will be underdeveloped.
• If the nose and the nasal passages are not used properly as is the case with chronic mouth breathing, then it will not develop normally.

Orthodontic relapse

• This is when teeth which have finished orthodontic treatment shift causing crowding and misalignment. The causes can be an untreated oral myofunctional disorder.
• Orthodontic treatment without the retraining of the orofacial musculature, the poor habits and muscle memory will move the teeth.
• If the tongue isn’t resting completely at the roof of the mouth, the maxillae is not being properly supported and will, with time, narrow and collapse.
• The severe pressure from tongue thrust swallow pattern on the anterior top teeth can cause a diastema (space) and/or move out of alignment.
• Proper form and function of the orofacial complex can also make the treatment shorter.

Orofacial myofunctional therapy to correct incorrect tongue posture, lip seal, and correct swallowing pattern and chewing function will optimize the success of orthodontic treatment.  

Speech

• Orofacial myofunctional disorders affect the muscles used to produce sounds causing  articulation errors. These errors are often corrected in childhood with a speech therapist.
• Removal of the restriction with the proper myofunctional exercises before and after the surgery will improve the articulation.

Myofunctional therapy will improve speech by strengthening proper muscular function, use, coordination, tone.

Headaches/migraines, Jaw Pain, TMJ Disorder (TMJD)

• A low resting tongue posture can affect the stability of the temporomandibular joint (TMJ).  This will inevitably lead to TMJ disorders and pain.
• More often the TMJD is muscular in origin; affecting the facial muscles and muscles of mastication. These muscles have been compensating for the oral dysfunction; they may be tense or sore, or may be compressing nerves.
• Neck pain may be due to the tethered tongue pulling on the hyoid bone in the neck thereby creating the tension, pain and decreased range of motion.

Orofacial myofunctional therapy can help as it strengthens and retrains these muscles. This type of disorder is complex and will most likely need a skilled, multidisciplinary team and I will help you get the best care.

Sleep Disorder Breathing such as snoring, sleep apnea

• Airway anatomy is directly related to craniofacial growth and development.  Underdeveloped jaws lead to airway deficiency and muscular compensations.
• A narrow maxilla with a high arched palate is associated with increased resistance in nasal airflow and the posterior displacement of the tongue blocks the airway.
• Snoring is a form of hyperventilating; exhaling out an abnormal amount of CO2 .  The decrease in CO2  in the body leads to a decrease in pH which in turn decreases the amount of O2 released to the organs/cells by the hemoglobin.  Every cell on the body is not being properly oxygenated.  The brain responds by stopping the breathing to increase the CO2 and re-establish the O2/ CO2 homeostasis to deliver a proper level of O2  to the cells.  Hypoxia or the Inadequate oxygenation to the brain, heart and other tissues damages these cells.
• Sleep apnea is when the brain is not getting enough O2 and causes a micro-arousal. These microarousal can happen a lot and restful sleep is never attained.
• Children with Sleep disorder breathing (SDB) can have behavioral problems, poor academic performance, ADHD.
• SDB is also associated with chronic fatigue, anxiety, depression
•  SBD has been associated with heart disease, high blood pressure, cardiac arrhythmias, diabetes, stroke, sexual performance.
• SDB is progressive;  it gets worse with time if not treated.  Mouth breathing → Upper Airway Resistance → Snoring → Mild Sleep Apnea → Moderate Sleep Apnea → Severe Sleep Apnea → Obesity Hypoventilation Syndrome.

Myofunctional therapy helps retrain and strengthen the orofacial complex so that the tongue does not occlude the airway and establishes nasal breathing to keep the oxygenation of our cells normal.

How does a typical exam work?

This is a list of all the things I look at during a myofunctional therapy examination:

• Tonsils and adenoids
• Mouth breathing vs. nasal breathing
• Where the tongue rests in the mouth
• Tongue-tie
• Orthodontic treatment
• Speech and articulation
• Jaw pain and dysfunction
• Head, neck, and facial pain
• Snoring and sleep apnea
• Facial structure
• Habits such as thumb and finger sucking

I teach my patients exercises that relate to tongue placement, breathing, speaking, chewing, and swallowing.

I want the tongue to rest in the right place and the mouth to stay closed. When these two simple things happen, troublesome symptoms disappear and the big picture problems around braces, speech, jaw pain, and sleep apnea become much easier to treat.