Dental News - Myofunctional therapy

Stephanie Wall, USA

Thu. 2 June 2011

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Orofacial myology, or myofunctional therapy, is the treatment of an orofacial muscle imbalance, incorrect swallowing pattern, TMJ muscle dysfunction and/or the elimination of bruxing, clenching or noxious oral habits. The main muscles of concern to the orofacial myologist include the temporalis, masseter, internal and external pterygoid, buccinator, orbicularis oris and the mentalis.

Orofacial myofunctional therapy is a form of oral facial physical therapy. It involves exercises and stimulation designed to inhibit inappropriate oral behaviors and/or strengthen appropriate muscle functioning.

Resting postures of the tongue, jaw and lips are very important in normal oral growth. When the tongue rests between the posterior teeth, they may not fully erupt, resulting in an open bite appearance. If the tongue rests against the maxillary anterior teeth, especially if the upper lip is short or weak, the teeth may begin to protrude too far forward. When the lips are not in a closed resting position, the growth and development of the mouth can be adversely affected.

Excessive non-nutritive or non-speech oral behaviors, such as clenching, bruxing, thumb or digit sucking and nail biting, can also affect the condition of the teeth and health and functioning of the mouth, especially the jaw. When any oral behavior is excessive in intensity, duration and frequency, the pressures or collision forces can have a serious impact on normal facial appearance and orofacial health and functioning.

One of the most commonly seen disorders, tongue thrust, refers to a pattern of swallowing in which the tongue pushes forward and/or sideways against or between the teeth during swallowing. Swallowing occurs hundreds of times each day with little to no conscious thought. When the tongue presses against or between the teeth during swallowing, the pressure can have adverse effects on the position of the teeth, bone growth, soft-tissue condition and mouth functioning. Some of the symptoms that occur with tongue thrust include:

aerophagia,
difficulty swallowing pills or firm foods,
the inability to wear dentures,
a residual effect on the hard palate from a digital habit,
chronic mouth breathing,
continued nasal stuffiness,
orofacial muscle strain and imbalance,
chronic headaches or facial spasms or pain.

Additional types of patients the orofacial myologist may treat include individuals with the following:

high arched hard palate,
weak lip structure,
facial grimace when swallowing,
ankylosed lingual frenum,
protrusion of the tongue when in repose,
over developed mentalis muscle,
sleep apnea.

Upper airway infections and obstructions are frequently identified as causes of orofacial myofunctional disorders, especially when these problems cause the mouth to rest in an open position. Reduced oral muscle tone or poor orofacial muscle postures appear to negatively impact the growing mouth and facial structures.

Long-term non-nutritive sucking habits can also malform the oral structure. Sometimes poor speech articulation patterns may indicate neurological or physical deficits. It is often difficult to determine why an orofacial myofunctional disorder exists because the behaviors can be the result of stimuli no longer fully obvious.

Regardless of cause, once inappropriate oral behavioral patterns are established, they tend to continue until some external stimulus or treatment alters enough of the patterns so that new behaviors can be learned. Sometimes the changes of the oral environment by an orthodontist may bring improved oral functioning.

However, orofacial myofunctional therapy may be necessary when there are indications that dental treatment or orthodontic intervention alone may not bring about the desired changes in oral behaviors. Adverse oral behaviors can often interfere with dental or orthodontic treatment and the stability and condition of the mouth.

Orofacial myofunctional therapy is a structured, individualized treatment for retraining and restoring normal oral functioning. It seeks to inhibit incorrect muscle movements and develop normal, easy functions of oral rest posture, oral stage of swallowing and speech articulation. Therapy may include any or all of the following:
elimination of damaging oral habits,
reduction of unnecessary tension and pressure in the muscles of the face and mouth,
strengthening of muscles that do not adequately support normal functioning,
development of normal resting postures of the tongue, lips, jaw and facial muscles,
establishment of normal biting, chewing and swallowing patterns.

The length and timing of therapy depends on the severity and nature of the disorder. In most cases, therapy is a short-term process with the active stage of treatment lasting about three to six months. Follow-up visits may be required with decreasing frequency over a period of six to 12 months.

Orofacial myofunctional therapists have received specialized training to evaluate and treat a variety of orofacial disorders. Many clinicians have additional professional training in the areas of speech language pathology, dental hygiene, dentistry or another health-related field. Most are members of the International Association of Orofacial Myology (IAOM).

The IAOM regulates how orofacial myology is practiced, how the course material is constructed and delivered, and monitors the certification process that assigns the credential of Certified Orofacial Myologist (COM). Certification is not required in order to practice, however, it is highly recommended.

To learn more about the IAOM and the profession of orofacial mycology, please visit www.iaom.com.

About the author

Stephanie Wall, RDH, MSDH, MEd has been a dental hygienist for more than 25 years. She owns her own business, Cranioral Health Solution, where she practices orofacial myology and craniosacral therapy. You may contact her at walls879@aol.com.

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