What Is Orofacial Myofunctional Therapy?

It’s All About Your Airway!

With your guidance your child has control over the airway he or she develops. Image Courtesy of Dr. Gelb

With your guidance your child has control over the airway he or she develops. Image Courtesy of Dr. Gelb

What could matter more than developing a great airway for delivering whole body health? After all, establishing an airway is a primary objective of the ABCs of life-saving CPR rescue. (Establish an Airway, rescue Breathe, restore Circulation.) The performance order has changed, but there is no getting around the fact that Breathing Matters. And to breathe well, it is important to have great facial architecture. Muscles move bone, so it is important to have great oral posture from birth as described in Facial Meltdown, Birth to Death and How it Affects Your General Health. [ Access additional studies here. ]

Carol’s blog Fragmented Sleep and Brain Death explains a few reasons many adults suffer from low testosterone, memory loss, depression, anxiousness, diabetes and weight gain via poor sleep quality including apnea, then explores solutions.

Who Wants To Be a Millionaire asks: What is the strongest muscle in the human body, pound for pound? 

  1. Biceps
  2. Gluteous Medius
  3. Tongue
  4. Masseter
  5. Hamstrings
Masseters, a set of major chewing muscles, are highlighted in red.

Masseters, a set of major chewing muscles, are highlighted in red.

Answer: 3. Masseters. Your masseters are the thick cheek muscles located at the back of your jaw,  responsible for opening and closing your jaws as you chew. With all muscles of you jaws working together they can close  teeth with a force as great as 55 to 200 pounds (90.7 kilograms) or more.

The tongue doesn’t qualify because it is a system of paired muscle groups. Still, where it rests and how it habitually functions can affect facial growth. Its absence in the roof of a child’s mouth allows the body’s strongest muscles (masseters) to compress the face and harm the airway in several dimensions as mentioned in Facial Meltdown. After all, teeth sit between the muscle forces of the lips, cheeks, and tongue. Muscles shape bone. If these forces are properly “balanced” the face and airway will develop properly and teeth will naturally be aligned in a beautiful, wide arch.

ExtrinsicTongueMusclesYour tongue is made up of a most amazing matrix of 8 paired muscles called a muscular hydrostat, similar to an elephant’s trunk or an octopus’s tentacles. Four groups are extrinsic muscles. These anchor your tongue to your head and neck structures. One muscle connects to the base of your skull, another to a bone in the throat. A third grabs on to your lower jaw and the last wraps around your palate. These propel your tongue from side to side, front to back and up and down.

The other four muscle groups allow your tongue to be agile and playful – to shorten, lengthen, curl, flatten, and round. In short, these muscles allow you to eat, speak, and swallow – and play – correctly. What happens if these muscles are tied to the floor of your mouth with vestigial embryonic tissue, called a tongue tie?

Tongue Tied?

Note the "pull" on the tongue tip when the tongue is lifted, a tell-tale heart shape.

Note the “pull” on the tongue tip when the tongue is lifted, a tell-tale heart shape.

Answer: The first [extrinsic] group of muscles can keep the second group from functioning optimally and may well contribute to head, shoulder and neck tension and poor general posture. 

What else? As mentioned in Facial Meltdown, the tongue rest position is one of the most important factors in facial development. If the tongue rests down and forward, many times the palate (roof of the mouth) will narrow, thus crowding teeth, sinus spaces, and eyeball orbits. Developing a lip seal and establishing nasal breathing is critical to establishing and maintaining teeth that fit together properly and an airway that works! 

Learning a proper swallow can reinforce proper tooth relationships. A person swallows 80-1000 times a day. If a person swallows with the tongue pressing forward against the teeth with 50 grams of pressure per centimeter, many dentists feel this contributes to orthodontic problems, jaw joint problems, airway problems and gum disease problems. Mouth breathing strongly contributes.

Developing an airway through correct oral posture is most successful when started young so head and neck muscles can structure the face and neck correctly, thus provide more room for the tongue and sinuses, but is it too late for adults to improve their airways? Absolutely not! A recent research literature review shows myofunctional therapy for those whose tongues block their airway during sleep can reduce these choking events by approximately 50% in adults and 62% in children and that lowest blood oxygen saturations, snoring, and sleepiness outcomes improve in adults. The study analysis concludes that myofunctional therapy is a great adjunct for other obstructive sleep apnea treatments. Most of the speakers, if not all, at a recent International Orthodontic Association conference, highly recommend myofunctional therapy in tandem with orthodontic treatment to speed and hold results.

So, what is Orofacial Myofunctional Therapy? As with developing an excellent golf swing, tennis swing, or other sport move, you must develop muscle tone and a style, then use repetition to build connections between your brain and muscles (neuromuscular training) to make the moves automatic. In the same way, myofunctional therapy is the neuro-muscular toning and re-education of oral, facial, and pharyngeal muscles (lips, tongue, cheeks, face, and throat) through a series of activities which helps normalize the developing or developed, head and neck structures and function. The therapy includes behavioral modification and also eliminates dysfunctional habits. It disorganizes, the repatterns related functions of these muscles such as breathing, sucking, chewing, swallowing and speech as well as the rest position of the tongue and cheeks. Therapy forms, balances, and stabilizes, the mouth, jaws and their associated structures as well as systems of the skull.

If you think you ace the three critical oral postures I promote in the article Facial Meltdown, I thought I did too until long after I’d researched and written this material, so I “get” denial! It took a long time for me to develop personal awareness, so I know it is hard to grasp one’s need for myofunctional therapy as part of a collaborative approach.[1] If you want a faster learning curve than I had about the possibilities you might need help, check out this Questionnaire – Do I Need Myofunctional Therapy? and the following associated video that illustrates some of the questions and analysis techniques:

If at all possible, it is best to work one-on-one with a myofunctional therapist. You can find one here.  However if scheduling or financial constraints hamper access, the following video and its accompanying charts can help move you forward.

Your Mouth Matters! Myofunctional Therapy Companion Guide: (Click on the title to watch trailer/purchase. You then create a Vimeo password to access the video from any of your devices any time.)

The Myofunctional Therapy Companion Guide can help you:

  1. Help guide your child to attain the forward facial growth he or she deserves
  2. Increase your own airway space
  3. Ease snoring or jaw joint problems
  4. Sculpt and tone head and neck muscles
  5. Learn a correct swallow

You begin your journey of metamorphosis as I guide you through two weeks of jaw stabilization exercises and 16 weeks of intensive therapy designed to re-pattern face, head, and neck muscles and learn to swallow correctly. You will strengthen, tone and stretch some muscle groups while diminishing others. During this phase, you get tremendous results if you do each roughly 8 minute set 3 X a day; Good results if 2 X a day. The “Do Not Disturb” 30-60 minute simple activity, done while you are doing another task like reading, is always required 1 X a day for best muscle memory.

Check your progress with proficiency tests along the way. Finish your therapy with the tips given to ingrain these new muscle memories into both daytime and nighttime hours. This journey will likely surprise you as you reap benefits. [Click on the title or trailer of the above self-help video to access a year’s rental – more than enough time to complete the self-paced, life-changing activities. Twenty minute introduction plus a demonstration/explanation of 125 brief activities divided into 9 short sessions. “Proficiency Tests” to let you know if you are ready to advance, bonus segments, and habituation ideas to finish out the year are included. Ideally, you advance to a new 8 minute segment every other week!]

Bonus segments cover pill-swallowing plus head and neck stretches to ease shoulder and neck pain associated with Forward Head Posture. A final bonus covers two weeks of post-frenum release therapy, also available separately.

Make sure you read Facial Meltdown Birth to Death and How It Affects Your Overall Health to learn how the above Companion Video helps you attain the health you deserve. [Click here and here for a few studies regarding children and apnea.]

Use the video-embedded password to download and print helpful Myofunctional Therapy Companion Video Charts and Word Lists to track your progress. An optional Myofunctional Therapy Activities Kit is also available.

Tongue Tied (Tethered)?

Tongue tieAs I’ve said, a tongue-tie or tethered tongue leads to compromised general health because it enforces a lower tongue rest and resultant poor airway development. It also prevents good myofunctional therapy results. Additionally, a tethered tongue “tugs” upwards on the hyoid bone. Think of the hyoid as a ring or sphincter onto which gather many interconnected head and neck muscles. Muscles attached to hyoid boneWhen a tethered tongue elevates this ring upwards in the neck, it restricts the airway and initiates a forward head posture in order to open the airway. It results in incorrect upper (cervical) spine curvature, and it stresses accompanying muscles from the upper neck and reaching all the way to the shoulder and shoulder blade. [Infra hyoid, supra hyoid and middle pharyngeal constrictor muscles via the omohyoid muscle]

The accompanying muscle tightness can result in labored breathing. This can create forward, excessive negative pressure in the sinuses and the upper airway, another reason the mid-face airway doesn’t experience expansive growth, as it should. Sinus problems and rapid orthodontic relapse is common without a tongue tie release and orofacial posture correction. [After a restrictive tissue release, a person should undergo myofunctional therapy retraining to change the swallowing, speaking and breathing habits acquired as a result of the tether. Without it, the incorrect swallow, speech impediments and compensatory posture and breathing habits remain.]

To learn if an obvious tongue-tie may have affected your oral posture therefore facial and airway development, click on the title or the trailer: Maximize Your Motion! Making the Most of Your Frenum Release! The trailer offers access to a critical series of exercises to start immediately after a frenum release to prevent reattachment and/or scar tissue.

Keep in mind frenums are vestigial embryonic tissue with almost no blood vessels or nerves. Also make sure you have ozonated oil on hand to help heal and reduce any discomfort. [Click here to get a list of Texas practitioners skilled in posterior tongue tie release.]

A posterior tongue tie in which the frenum is buried by tissues under the tongue, is more subtle than what the above video demonstrates. With your tongue tip on the “SPOT,” if you can’t open more than half of what you can when your mouth is fully open but you can’t figure out why, suspect a posterior tongue tie. Dr. Kotlow, a top frenum release instructor shows how to check for it on a newborn, though the simple technique works for anyone with a posterior tongue tie:

I can’t emphasize enough how important it is to assess and release tongue ties in newborns for proper latching and muscle, thus facial development for newborns. If you must supplement breast-feeding with bottle feeding, this article on supportive bottle-feeding offers excellent tips. The suggestion to hold a child almost vertically is important and not well-known. This article does not mention that more important than the type of nipple used, is one with a slow flow rate.

Does Your School-Aged Child Suck His/Her Thumb?

If so, that habit has to go! Initially babies suck to nurse and of course they associate it with all good things: warmth, mom, love. Sucking produces the feel good brain chemicals called endorphins. Eventually some children figure out they can suck on substitutes to reproduce the same warm feelings ­– thumbs, toes, clothing, lips or cheeks – and this self-soothing simply becomes a habit that staves off distress, fatigue, or boredom.

anterior open bite2

But as you know, bone responds to the pressure of the thumb on the palate and the sucking action of cheek and lip muscles. Your child’s tongue and thumb can move bone and his/her teeth go along for the ride!

When should you be concerned?

Which thumb do you suppose this child sucked?

Which thumb do you suppose this child sucked? Sucking can change both bone and soft tissue!

Age 5 is a great time to start eradicating sucking habits – certainly before permanent teeth start erupting. This is when your child still has the power to reverse much of the damage to the roof of his mouth. Keep in mind, the more fingers involved, the more damage. Know also that your child should start myofunctional therapy afterwards to help reverse some of the swallowing patterns and other negative oral postures he or she likely developed that affect growth and function. For instance, thumb sucking requires the tongue to rest on the floor of the mouth. With a finger or two in the mouth, there is not enough room for the tongue to fit in, especially during swallows. The tongue is forced to move forward into an incorrect, reverse swallow.

Between ages 4-6, children begin to transition into normal adult swallows, but 80% of those who sucked their thumbs do not transition to a correct swallow. At age 5, most children are mature enough to understand it is in their best interest to curb oral stimulation like thumb sucking.

Applied Behavioral Analysis (ABA) to the rescue! Many parents are daunted by helping a child stop the thumb-sucking habit because they worry about their child’s emotional well-being. Putting the principles of applied behavior analysis helps bring mastery to learners trying to acquire many different skills – from healthier lifestyles to new language mastery. Put it to use to help your child stop sucking his or her thumb! The following video will help you help your child give up this habit. The first 3 minutes I talk directly to your child about how moving on to adult postures benefits them, then demonstrates several acceptable activities your child can substitute to release the same feel-good chemicals while beginning to adopt oral posture that will benefit rather than hurt him. Use the code embedded at 3:17 and the end of the following video (My Mouth Matters! Growing Up!) to access the ABA-based program steps to achieve success, a list of materials to have at hand, a contract he/she signs, and a congratulatory certificate here.

My Mouth Matters! Thumb Sucking Cessation Trailer (Click on this title or the video to watch trailer/purchase)

Can Children Have Sleep Apnea?

 Image courtesy of Dr. Gelb

Image courtesy of Dr. Gelb

Yes! And it affects more than their facial development and general health – it affects IQ and behaviors. For instance 25-81% of habitually snoring children exhibit AD/HD tendencies. More than 25% of all children with this could eliminate their AD/HD if they got rid of their snoring. [Chervin, Ronad. Symptoms of sleep disorders, inattention, and hyperactivity in Children. SLEEP. 20; 12: 1185-1192. ]

WAKE UP: The Problems of a Sleepy Child; The Silent Airway Problem.

Watch this incredible story in the video below and see how sleep apnea, snoring and other sleep issues can affect even a child. Of course you can read more in Mouth Matters, the blog Facial Meltdown – Birth to Death – and How It Affects Your Overall Health.

What Could Happen If This Problem Is Left Untreated?

  • Poor airway development
  • Ear and sinus infections
  • Early wrinkles
  • Deviated nasal septum
  • Apnea with elevated subsequent stroke, diabetes, high blood pressure risks, etc.
  • Crowded teeth or orthodontic relapse
  • Jaw joint problems/head and neck pain
  • Psychological problems
  • Digestive disorders
  • Postural irregularities
  • Gum disease complications

See this trailer for a more complete list.

What Are the Goals of Treatment?

  • Proper tongue rest position
  • Create more space for tongue – “freeway space” to avoid choking, apnea, and better tooth support
  • Establish nasal breathing
  • Habituate normal, healthy chewing and swallowing
  • Habituate a lip seal
  • Noxious habit elimination

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[1] This could include osteopathy, cranio-sacral therapy, functional orthodontics, sleep dentistry, and/or ENT care.

Academy of Orofacial Myofunctional Therapy Member [AOMT]