What are the Symptoms?

Does your infant have difficulty feeding? Is your child a picky eater?

Has your dentist pointed out an overbite caused by “tongue thrust”?

Are you frustrated that speech therapy has not fixed the speech problem?

Do you have chronic jaw pain?

Has your child been diagnosed with a disorder such as Apraxia?

Have you been diagnosed with reflux, sleep apnea, or aerophagia?

There are a multitude of symptoms or signs that may be present if you have a deviated swallow. Some of the most common symptoms to look for are: misalignment of the teeth, articulation problems; tongue protruding in the mouth when speaking, eating or at rest; dry, chapped lips or mouth breathing; poor facial tone; excessive belching or stomach aches; poor eating and feeding mechanics; sleep apnea; and reflux.

A person exhibiting symptoms such as malocclusion, oral Apraxia, TMJ, and protrusion of the tongue in repose is likely to have a deviated swallow, or “tongue thrust.” A complete Myofunctional Evaluation is the first step to fully diagnosing oral motor issues and developing treatment plans.

At The Institute of Myofunctional Studies, we use Myofunctional Therapy to treat many different kinds of patients: dental patients, speech patients, patients with eating difficulties, sleep apnea, and reflux. The following symptoms are present in one or more of these categories – sometimes all of them!

Speech Patients

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 Oral Motor/Myofunctional Therapy, and they include:

  • Cleft lip and palate
  • Hyper nasal vocal quality
  • Dysarthria, which is a motor speech disorder that may affect phonation, articulation, feeding, intelligibility of speech, respiration and swallowing.

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.

Dental Patients

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 / Bruxismare 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 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.

Special Needs Patients

Individuals that exhibit various conditions/syndromes, such as Autism, Cerebral Palsy, Hearing impairment, Learning Disabilities, Attention Deficits, are more than likely to have oral motor/myofunctional difficulties.

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 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 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 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 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 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 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

Other Conditions

Some Myofunctional Therapy patients have several symptoms, such as eating and breathing difficulties or poor facial muscle tone, that are rooted in a mild oral deformity or bad habits.

The most common form is obstructive sleep apnea. It is best recognized by snoring and brief periods of not breathing. In milder cases of sleep apnea there may be weakness in the soft palate region causing obstruction when breathing. Also mouth breathing may result in a lesser amount of air intake for breathing. Correction of the swallow can help in creating more force back towards the region of the soft palate and assist in the lifting and decrease in obstruction. A correct swallow results in a closed mouth posture creating both nasal and abdominal air intake. With the closing of the mouth there is no further snoring.

Acid from the stomach moves up the esophagus causing chest pain (heartburn). Some symptoms are regurgitation, excessive burping, and dysphasia where there is a narrowing of the esophagus creating the sensation of food being stuck in the throat. Often in infants there can be excessive air swallowing creating an air pocket and discomfort and excessive spitting up. Correcting the swallow pattern can help contribute in treating this condition and lesson some of its affects. A stronger swallow helps in decreasing air swallowing, creates more force in initiating the push of food down the esophagus, and speeds the rate of motility to help in keeping the stomach acids from coming up.

Excessive swallowing of air creating excessive belching, burping, gastrointestinal discomfort and possible abdominal distention. A reverse swallow pattern can contribute to the added trapping and swallowing of air and in part help cause this condition. Correcting the swallow decreases the amount of air that is likely to be taken in through the mouth.

There are often times that an earache can occur, but upon physical examination there is no physical observable problem. On occasion hearing can be affected as though it is blocked, similar to conditions felt when in an airplane, but it does not clear in a short period of time.

This can be the result of a reverse swallow pattern where air pressure is being pushed up the Eustachian tube causing discomfort from the inside of the ear. It can occur in infants, children and adults.