Educational objectives

Upon completion of this course, participants should be able to achieve the following:

• Define orofacial myofunctional therapy.
• Recognize oral and facial muscle pattern abnormalities.
• Understand proactive intervention modalities that a dentist or orthodontist in private practice can utilize.
• Educate the professional as to the value of early treatment and prevention.
• Learn how noxious habits might affect growth and development.

I have been a dental hygienist and a myofunctional therapist for more than 30 years. I learned about myofunctional therapy in 1978 from the dentist I worked with. My son, who had TMD, a low tongue rest posture, no lip seal, crowding, mouth breathing, (I am sure he had apnea symptoms), and chronic headache pain was helped tremendously by a combination of myofunctional therapy, cranial osteopathic therapy and a bite splint. Not only did his headaches and TMD issues improve, but his palate widened and allowed his teeth to erupt in a more normal position. I continue to spread the word that this treatment works to stabilize the muscles and address the cause of many problems instead of chasing the symptoms.

This is a "green" treatment, which your patients will love. They want this treatment because they actually have an active role in correcting the problem, which is proactive in preventing major issues and in treating orofacial myofunctional problems when they do occur.

The purpose of this article is to give you an overview of oral myology, which is the critical missing element to complete patient care. You can find a qualified therapist in your area by visiting the directory page on www.iaom.com. The interdisciplinary approach to patient wellness is important because the teeth, the bones and the muscles must work in harmony to attain occlusal stability.

The goals of oral myology are.

• Promoting a lip seal.
• Promoting a palatal tongue rest position.
• Promoting a posterior, tooth together swallow.i
• Facilitating bi-lateral chewing and correct drinking.ii
• Keeping hands and objectives away from the face.
• Facilitating nasal breathing.
• Developing a harmonious peri-oral muscle pattern.
• Correcting dysfunctional habit patterns.

Myofunctional therapy, also called orofacial myology, is the neuromuscular re-education or re-patterning of the oral and facial muscles. It might include muscle exercises, which create a normal freeway space dimension.iii Therapists are trained to eliminate negative oral habits through behavior modification techniques and promote positive growth patterns. We train people to breathe through their noses if their airways are not compromised, and if the oral breathing is an acquired habit; we teach people how to properly position their tongue at rest; we teach how to chew and swallow correctly, and we emphasize the importance of proper head and neck posture patterns.

The history of myofunctional therapy dates back to the 1400s in Italy. In the United States, in 1906 Alfred Rodgers, an orthodontist experimented with facial muscles exercises and in 1918, wrote a paper titled, "Living Orthodontic Appliances," in which he cited that muscle function alone would correct malocclusion with no need for retention. In 1907, Edward H. Angle, an orthodontist wrote an article on the effects of habits on occlusion. In 1925, Harvey Stallard, a dentist in San Diego, researched 7,000 children on sleep position and malposed tooth buds. He maintained that sleeping on the face, during a child's formative years, could create malocclusion.

In the 1930s, Weston Price, a dentist, researched primitive or traditional cultures.iv He looked at people all over the world, examined what they ate and evaluated their oral health. He found that primitive cultures, when compared to "modern" cultures, had very little dental disease and their jaw relations and occlusion were healthy. In the 1960s, Walter Straub, an orthodontist, published research on bottle feeding and how it affects occlusion.

Many times oral habits, beginning in infancy, are carried forward into childhood and then adulthood. Some well known ones are thumb, tongue or finger sucking, cheek, lip or tongue chewing, nail biting, clenching or grinding, hair chewing, leaning on the face, pen or pencil chewing and many others. I call this the "remembered endorphin rush," which starts in infancy with sucking. As a myofunctional therapist, I promote replacement of the habits with having the tongue resting up on the palate. In my experience this seems to stimulate enough endorphins to help stop the noxious habit.

Some of my patients are habitual gum chewers. Gum chewing is not damaging if done in moderation. I have three rules when it comes to gum:

1. Chew only after eating.
2. Alternate chewing on both sides to prevent a TMD or bite problem.
3. Limit chewing to five or 10 minutes only. (Of course, with xylitol gum only!)


Mouth breathing might cause the tongue to rest down and is often associated with "long faced syndrome," orthodontic relapse, allergies, periodontal disease, and sleep disorders.vi

What causes mouth breathing? Otolaryngologists and ENTs cite several causes, including what I call "sensitivities to the three Ds: dust, dairy products and animal dander, which might contribute to congestion and nasal airway obstruction and might encourage mouth breathing. Mouth breathing, sucking habits and tongue thrusting are all etiological factors to orofacial myofunctional disorders. Also, tight lingual frenum attachments can cause a low tongue rest position. A tight labial frenum could be associated with a short upper lip. This leads to a lack of lip seal, which is important for good occlusion.vii These, in addition to grimacing when swallowing are some things to look for in the evaluation of oral facial myofunctional disorders.