Myofunctional Therapy
How Your Tongue Affects Your Smile
Much research has pointed to the impact the tongue’s function and positioning has on jaw and airway growth. Bone forms in relation to muscle function. The tongue is one of the most powerful muscles in the human body which means it’s positioning and function greatly impacts both the alignment of the teeth as well as the development of the jaws. When the tongue is in it’s ideal position, seated fully in the palate, the teeth will align properly in a wide arch form. The tongue also helps to establish a wide and flat palate and wide floor of the nasal cavity. This optimizes nasal breathing and air circulation through the nasal cavity. When the tongue is unable to stay high in the palate, either because of habit or a physical restriction, it rests low in the mouth and causes a myriad of dental and growth abnormalities. The palate will narrow due to the force of the facial muscles pushing inward and no counter force from the tongue. This leads to dental crowding as well as a narrow nasal passage that is less efficient at filtering and processing air. The upper jaw will not grow forward as much as it should because of the lack of muscle pressure from the tongue. This can lock the lower jaw behind it and lead to a long face appearance while simultaneously shrinking the airway space behind the jaws and tongue. Sometimes, instead of a patient having a small lower jaw and long face, they may develop more of a “bulldog bite” appearance where the lower jaw sticks out further than the upper jaw. This prevents an ideal relationship between the teeth and can lead to excessive wear and force on the teeth, eventually causing fracture of teeth and potentially jaw pain.
What Is Myofunctional Therapy?
Myofunctional Therapy is a program of exercises prescribed to the patient in order to provide neuromuscular re-education and compensation elimination. Orofacial Myofunctional Therapy(OMT) specifically focuses on the function of the muscles of the face and mouth. The exercises are designed to encourage the tongue to function independently from other facial muscles. Through a series of exercises based on the patient’s specific needs, our program is designed to strengthen the tongue and slowly build up the endurance necessary to hold the tongue in its proper position to promote proper facial growth, stability, and breathing. The goals of OMT are to have the tongue in the proper position (in the roof of the mouth), the lips sealed all day and all night, have the patient breathing through their nose all day and all night, and have proper swallowing mechanics (no tongue thrusting, reverse swallowing, etc.)
Mouth Breather vs. Nose Breather
This child had proper jaw development until he got a gerbil that he was allergic to. Due to his allergic response he became a mouth breather. The difference between these pictures show the impact that mouth breathing can have on facial development.
Photo Courtesy of John Mew
Does Myofunctional Therapy Work?
Yes! Please see the below iCat image below of one of our patients before and during OMT to see the difference in their tongue position.
iCat Image – Before
iCat Image – After
Who Can It Benefit?
Most people can see some benefits from myofunctional therapy, but it is especially helpful for patients that:
• Are chronic mouth breathers
• Have jaw development that has deviated from ideal
• Were or are thumb suckers, finger suckers, nail biters
• Snore
• Have obstructive sleep apnea
• Are anxious or have difficulty regulating emotions
• Have had braces before and have relapsed
• Are struggling to move through braces as quickly as planned
What Does Our Program Entail?
The Braces For All Ages Orofacial Myofunctional Therapy Team consists of a series of prescribed exercises based specifically on each patient’s unique needs. Typically patients will complete 12 therapy sessions (lasting approximately 30 minutes each) over the course of 6-9 months. We meet every 2-3 weeks and new exercises are given at each session. Patient involvement and dedication are paramount to success. The amount of time required outside of therapy sessions is typically 10 minutes of active practicing per da. This consists of 3 different “active” exercises that take a total of 5 minutes (1-2 min per exercise) to complete and they are to be repeated 2 times per day. Patients are also given one “passive” exercise that can be done at any time throughout the day (ex. When the patient is watching TV, riding in the car, doing homework, reading, etc.) and the amount of time devoted to the passive exercise depends on the phase of treatment.
The Braces For All Ages Orofacial Myofunctional Therapy Team consists of a series of prescribed exercises based specifically on each patient’s unique needs. Typically patients will complete 12 therapy sessions (lasting approximately 30 minutes each) over the course of 6-9 months. We meet every 2-3 weeks and new exercises are given at each session. Patient involvement and dedication are paramount to success. The amount of time required outside of therapy sessions is typically 10 minutes of active practicing per day. This consists of 3 different “active” exercises that take a total of 5 minutes (1-2 min per exercise) to complete and they are to be repeated 2 times per day. Patients are also given one “passive” exercise that can be done at any time throughout the day (ex. When the patient is watching TV, riding in the car, doing homework, reading, etc.) and the amount of time devoted to the passive exercise depends on the phase of treatment.
The initial consult appointment must be completed in office. At this visit, one of our OMTs (Orofacial Myofunctional Therapists) will go through a detailed history and complete a comprehensive exam focused on the tongue and facial muscle movements and compensations, as well as evaluating tongue position, function, and restriction.
Subsequent visits can be done in-office or via Zoom, depending on the patient and OMT’s preference.
Orofacial Myofunctional Therapy and Frenectomies
When the tongue cannot move independently from the other muscles because of a restriction, a tongue release (frenectomy) is necessary. In this case, the therapy is broken into exercise sessions that must be completed prior to release and another series of exercises that are completed after the release. The pre-release exercises focus on strengthening and stretching the tongue so that when the release is performed, the tongue has the “memory” and strength to go where it should once the restrictive tissue is removed. The pre-release exercises are also designed to help the patient build the endurance to hold the tongue in a position that creates the safest environment for laser release. After the frenectomy is completed, the patient will continue on through the program and begin working on the more challenging exercises that would not be able to be performed properly prior to the restrictive fibers being released.
*For patients who need a frenectomy, an orofacial myofunctional therapy program must be completed in conjunction with the release. This is done in order to obtain the best results from the procedure.