At The Institute of Myofunctional Studies, we use Myofunctional Therapy to treat 3 different kinds of patients: dental patients, speech patients, and patients with eating difficulties. The following symptoms are present in one or more of these categories – sometimes all of them!
A dentist or orthodontist will refer patients with an overbite, underbite, or crossbite if they have a deviated swallow that is impeding the progress of their dental treatment. The following symptoms may indicate a dental case in need of treatment:
Malocclusion is a misalignment of the teeth. Orthodontists work to provide a patient with the proper form of the teeth and jaws but that may not be enough. If a patient does not correct a deviated swallow or “tongue thrust” it can slow down or cause relapse of orthodontic treatment. This happens when there is too much pressure from the tongue against the inside of the teeth coupled with an unequal amount of facial muscle pressure from outside the teeth. When orthodontists find it difficult to correct alignment, it may be because the patient has a deviated swallow interfering with the purpose of the braces. Many orthodontists use a variety of appliances to discourage incorrect tongue placement, however this cannot retrain the tongue and brain to form a new habit of correct placement. Relapse of a malocclusion will occur if a swallow is not normalized before removing braces. Some orthodontic patients are not diagnosed with a deviated swallow until after the braces come off and their tongue is still pushing against the teeth and forcing them out of alignment.
Periodontal Disorder is a condition relating to or affecting tissues and structures surrounding and supporting the teeth. Myofunctional Therapy treatment can be used to compliment dental treatment for this disorder. The constant pressure of the tongue against the dentition can weaken the tissue that surrounds and supports the teeth.
Temporo-Mandibular Joint (TMJ) Pain / Myofacial Pain / Bruxism
(TMJ) Temporo-Mandibular Joint Pain, Myofacial Pain and Bruxism are conditions of the jaw often caused by the grinding and clenching of the teeth due to oro-facial muscle weakness. Myofunctional Therapy aimed at strengthening the facial muscles and alleviating the bruxing behavior, in conjunction with appropriate dental intervention, will relieve myofacial pain. Correcting an abnormal swallow allows some pressure to be released, which can possibly keep Bruxism from becoming full-fledged TMJ.
Thumb-Sucking / Nail Biting
Thumb-sucking and nail biting are noxious behaviors that encourage the downward resting posture of the tongue, furthering the deviate swallow pattern. Myofunctional therapy provides specific regimens to help the individual break these detrimental habits so that a correct swallow pattern can evolve.
Speech patients are often referred to the Institute by other therapists, doctors, and previous patients. Children and adults may have difficulty in producing intelligible speech. When a child has spent a long time in speech therapy without success it may be determined that myofunctional therapy can resolve their issues.
Speech Disorders are disorders that have oral muscle and swallow difficulties that require an adjunct treatment of myofunctional therapy, and they include:
Articulation difficulty is incorrect production or substitution of speech sounds. This may affect as little as one sound or multiple sounds. The most commonly affected sounds with a deviate swallow at the core of the difficulty are “s”, “z”, “r”, “l”, “sh”, “ch” and “th”. Very often the “t”, “d”, “l”, and “n” sounds will be made in a dentalized posture because of the downward tongue resting posture resulting from a tongue thrust. This may affect the teeth after orthodontics, or cause less intelligible speech in conversation. Children and adults may tend to sound less intelligible in connected speech resulting from a downward tongue resting posture. Parents will say their child mumbles or has a “mush mouth”.
Oral Apraxia is a term widely applied to children who do not develop verbal speech at an appropriate age. Oral apraxia or dyspraxia of speech affects motor planning and sequencing difficulties that impact the ability to produce speech on demand. Individuals with oral apraxia do not develop a normal swallow pattern, which contributes to oral muscle weakness. Correcting the swallow pattern and/or developing oral muscle strength allows for the mobility and correct placement of the tongue for then teaching the correct motor sequence for each speech sound.
The following symptoms may present themselves in any patients with eating difficulties, dental problems, or speech issues.
High-arched palate is a raised palate occurring from the absence of the tongue against the roof of the mouth during early development – the tongue does not have the opportunity to flatten out the palate. This may lead to breathing issues, malocclusion, difficulty creating pressure for eating certain foods, and misarticulated speech sounds. This condition is less likely to occur with the early development of a correct swallow pattern.
Mouth breathing is the result of a downward resting posture of the tongue and an open mouth posture for breathing. When occurring on a daily basis this will affect a patient’s overall health, body strength, posture and appearance. Provided there are no intervening medical causes, correcting a deviate swallow will allow for closing of the mouth to create nasal breathing. This can also be corrected after medical intervention such as the removal of tonsils and adenoids.
Swallowing difficulty is lacking the ability to swallow in a normalized pattern. This can hinder a person’s ability to breathe easily, eat, and speak correctly. Lacking proper mechanics will affect eating and diet, form of the teeth, stomach comfort, ear aches, and reflux. Swallowing difficulty also may result in excessive belching, stomach discomfort, and inability to swallow pills.
Weak Lip Structure
Weak lip structure may result in asymmetry of the lips due to oral facial muscle weakness. It can contribute to lack of anterior oral muscle support for the occlusion. Often a thicker or more protruded lip is visible. Without proper lip resistive strength and lip compression strength, it is difficult to maintain the lip closure necessary for dental support, creating a balanced smile, nasal breathing, and developing negative pressure for a correct swallow. If the oral facial muscles are not strengthened appropriately, the teeth can shift.
Poor Oro-facial Muscle Development
Poor oral facial muscle development may result in asymmetry of the face muscles not resulting from nerve damage. It can present as low facial tone, lack of definition of cheek muscles, under-eye droop lines, and in general a "droopy" facial appearance. Myofunctional therapy enables strengthening of the lip and masseter muscles to improve these conditions. Often it may be combined with oral motor techniques such as oral facial muscle massage.
Facial Grimace when Swallowing
Facial grimace when swallowing occurs as a counter force to the tongue in a reverse or tongue thrust swallow pattern. It is a means to maintain the tongue in the mouth at the moment of swallow. The lips appear tight, and sometimes downward in the corners. Facial grimace can develop unwanted facial creases and lines over time. Individuals that do not create a facial grimace will often protrude the tongue through the lips at the time of swallow.
Ankylosed or Shortened Lingual Frenum
Ankylosed or Shortened lingual frenum or labial frenum commonly called “tongue-tied” limits the mobility of the tongue. If the tongue cannot fully function a deviated swallow is likely to be present. These cases often require the lingual frenum be clipped in order to restore the functionality of the tongue. Myofunctional therapy would be necessary to train the patient to have controlled tongue movement and a correct swallow pattern.
Protrusion of the Tongue when in Repose
Protrusion of the tongue when in repose is seen when a patient is unable to maintain adequate lip closure. The tongue rests downward and forward in the mouth. This will impact the development of the anterior teeth. the tongue appears bulky and too large for the mouth (which it may not be) and affects general facial appearance. Generally, this is not a well-toned tongue and can also impact the clarity of speech.
Overdeveloped or Tightened Mentalis Muscle
Overdeveloped or tightened mentalis muscle is usually a bulbous and protruded chin muscle. This develops over time as a result of trying to maintain lip closure when a shortened upper lip exists and lip closure does not occur at midline. A tightened mentalis muscle is usually presented as a wrinkling of the chin muscle at the time of swallow or attempts at mouth closure.