WHAT IS MYOFUNCTIONAL THERAPY?

Neuromuscular reeducation and exercises or functional movement patterns to develop balance, coordination, kinesthetic sense, posture, core stability, efficiency of muscle contraction, and improve motor recruitment patterns. This phase of rehabilitation is necessary to promote the patient’s independence, and maintain or improve the benefits of the therapy treatment.

Myofunctional therapy uses a combination of personal training exercises to improve the bite, breathing, and facial posture of those with orofacial myofunctional disorders (OMDs). The training targets the face, neck, and mouth's soft tissues to reach optimal tongue position and oral rest posture.​

Most OMDs originate with insufficient habitual nasal breathing or with oral breathing. The subsequent adaptation of the muscles and the orofacial functions to a disordered breathing pattern creates many OMDs. Orofacial Myofunctional Disorders may impact treatments by orthodontists, dentists, dental hygienists, speech-language pathologists, and other professionals working in the orofacial area.

Individuals with predominant mouth breathing (or insufficient habitual nasal breathing) often develop maladaptive habits and patterns of orofacial function that may impact various conditions.

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Proper diagnosis allows for targeted and effective personal training exercises for oral posture to promote better health with goals to improve breathing, reduce pain, and enhance the quality of life.

Myofunctional Therapy & Swallowing

Correct swallowing depends on a proper relationship between muscles of the face, mouth, and throat. The act of swallowing is one function that depends on the body’s vital balance. To swallow properly, muscles and nerves in the tongue, cheeks, and throat must work together in harmony. When a person swallows normally, the tip of the tongue presses firmly against the roof of the mouth or hard palate, located slightly behind the front teeth. The tongue acts in unison with all the other muscles involved in swallowing. The roof of the mouth absorbs the force created by the tongue.

Because a person swallows 500-1000 times a day, improper swallowing can cause a variety of problems. But it is actually the resting position of the tongue that does the most damage because it is more constant.

A myofunctional therapy program is used to help correct the improper function of the tongue and facial muscles. It involves strengthening the tongue and orofacial muscles by teaching individuals how to engage the muscles in the appropriate position.


Please refer to the Academy of Orofacial Myofunctional Therapy for a more detailed explanation of the impact of maladaptive orofacial posturing on maxillofacial growth and development:  https://aomtinfo.org/myofunctional-therapy.

 

COMPREHENSIVE FUNCTIONAL ASSESSMENTS

Myofunctional Therapy has been proven to treat an array of chronic ailments. Please click on any of the underlined conditions to learn more about how we can help.

 

MOUTHBREATHING

Breathing provides your body with the oxygen it needs to survive. It also allows you to release carbon dioxide and waste.

You have two air passageways to your lungs — the nose and the mouth. 

Breathing through the mouth all the time, including when you’re sleeping, can lead to problems.

In children, mouth breathing can cause crooked teeth, facial deformities, or poor growth. In adults, chronic mouth breathing can cause bad breath and gum disease. It can also worsen symptoms of other illnesses.

The nose produces nitric oxide, which improves your lungs’ ability to absorb oxygen.

Nitric oxide increases the ability to transport oxygen throughout your body, including inside your heart. It relaxes vascular smooth muscle and allows blood vessels to dilate.

Nitric oxide is also anti-fungal, antiviral, anti-parasitic, and antibacterial. It helps the immune system to fight infections.

Advantages of nose breathing

The nose acts as a filter and retains small particles in the air, including pollen.

The nose adds moisture to the air to prevent dryness in the lungs and bronchial tubes.

The nose warms up cold air to body temperature before it gets to your lungs.

Nose breathing adds resistance to the air stream. This increases oxygen uptake by maintaining the lungs’ elasticity.


People who breathe through their mouth at night may have the following symptoms:

For some people with sleep apnea, it may become a habit to sleep with their mouth open to accommodate their need for oxygen.

Stress and anxiety can also cause a person to breathe through their mouth instead of their nose. Stress activates the sympathetic nervous system leading to shallow, rapid, and abnormal breathing.

Testing for Mouth Breathing. 

There’s no single test for mouth breathing. A doctor might diagnose mouth breathing during a physical examination when looking at the nostrils or during a visit to find out what’s causing persistent nasal congestion. They may ask questions about sleep, snoring, sinus problems, and difficulty breathing.

A dentist may diagnose mouth breathing during a routine dental examination if you have bad breath, frequent cavities, or gum disease.

If a dentist or doctor notices swollen tonsils, nasal polyps, and other conditions, they may refer you to a specialist, like an ear, nose, and throat (ENT) doctor, or myofunctional therapist.

Problems with mouth breathing.

Mouth breathing is very drying. A dry mouth means that saliva cannot wash bacteria from the mouth. This can lead to:

Mouth breathing may result in low oxygen concentration in the blood. This is associated with high blood pressure and heart failure. Studies show mouth breathing may also decrease lung function, and worsen symptoms and exacerbations in people with asthma.

In children, mouth breathing can lead to physical abnormalities and cognitive challenges. Children who aren’t treated for mouth breathing can develop:

  • Long, narrow faces

  • Narrow mouths

  • Gummy smiles

  • Dental malocclusion, including a large Overbite and crowded teeth

  • Poor posture

Contact About Face today to see how we can help increase nasal breathing and reduce inflammation. 

 
 

TONGUE THRUST & OPEN BITE

 

Tongue thrust, or a tongue thrust swallowing pattern: 

The most recognizable sign that someone may need myofunctional therapy. A tongue thrust occurs when the tongue pushes forward during a swallow. The most problematic aspect of this condition is where the tongue rests in the mouth.

When someone has this condition, the tip of the tongue rests against or between the front teeth, and the entire tongue is positioned low in the mouth. Ideally, the tongue should rest at the top of the mouth and provide an internal support system for the upper jaw.

It is important to recognize that a tongue thrust is a symptom. Having a tongue tie is typically the root cause. It can be an indicator of other health concerns involving the airway and breathing. When this kind of swallowing pattern is present,

it’s almost inevitable that mouth breathing and an open mouth resting posture will also be found.


An Open bite is primarily caused by four factors:

  1. Thumb or pacifier sucking. When someone sucks on their thumb or a pacifier (or another foreign object like a pencil), they strain the alignment of their teeth. This can cause an open bite.

  2. Tongue thrusting. An open bite can occur when a person speaks or swallows and pushes their tongue between their upper and lower front teeth. This can also create gaps between teeth.

  3. Temporomandibular joint disorder (TMD or TMJ). TMJ disorders cause chronic jaw pain. Sometimes people use their tongue to push their teeth apart and comfortably reposition their jaw, which can cause an open bite.

  4. Skeletal problem. This occurs when your jaws grow apart as opposed to growing parallel to each other and is often influenced by genetics.

Open bite occurs as the adult teeth are replacing the baby teeth and behavior modification is be the best course of action. This involves an integrated myofunctional therapist to correct tongue thrusting.

An orthodontist may recommend getting custom braces to pull the teeth back but if the tongue thrust is not corrected then orthodontic relapse is highly likely. 

For adult teeth, a combination of braces and behavior modification should always be suggested. In severe cases, jaw surgery to reposition the upper jaw with plates and screws may be recommended and an airway evaluation. 


 

SLEEP APNEA & SLEEP DISORDERED BREATHING

Mouth breathing, sleep apnea, and tongue thrust are all symptoms of a much bigger issue– an airway problem.

Our airway and ability to breathe are our lifelines! Dentists and doctors of the AAPMD approach their patients looking at the airway first and the alignment of the teeth last. What an incredible concept!


After working in sleep dentistry, I feel that I have a greater responsibility to take a closer look at the signs and symptoms of airway issues in all of my patients.  We cannot allow you, your spouse, or your children to fall through the cracks of our healthcare system.

 
Snoring And Sleep Apnea

WHAT IS OBSTRUCTIVE SLEEP APNEA?

Many people suffer from a severe lack of quality sleep.  Sleep disruption can come from a variety of causes. One cause of sleep disruption is a medical disorder caused by your tongue as it blocks your airway while you sleep.  This type of blockage of your airway is called obstructive sleep apnea.  About 6 million people in the US have been diagnosed with sleep apnea and it is estimated that 23 million people are suffering the effects of apnea without being diagnosed. 
Your tongue is attached to your jaw bone mostly in the front of your mouth.  When the muscles in your throat, soft palate, and tongue do not work properly, your tongue drops to the back of your throat while you sleep.  If the tongue causes a partial blockage, the vibrations of the tongue tissue cause a snoring sound. If the tongue blocks your airway completely, you cannot breathe and your body reflexes cause you to grind your teeth, partially wake up, move, kick, and gasp for air.

TREATMENT OPTIONS FOR SLEEP APNEA

Airway appliances are such an important treatment option for those who have been diagnosed with sleep apnea. For those with obstructive sleep apnea it's a lifetime of use.

C-PAP / A-PAP

A medical device prescribed by a physician that hooks up to your nose and mouth and blows air. The air pressure pushes the tongue and other tissues out of your airway so that you can breathe. This is a very common treatment for OSA, however many people find they cannot tolerate the machine and the side effects of the use.

ORAL APPLIANCES

A dental device that hooks onto your upper and lower teeth while you sleep.  The device is specially fitted to you so that it comfortably prevents the lower jaw from slipping back.  The tongue is attached to the jaw and when the jaw is positioned forward, snoring and apnea are prevented.  This is a more comfortable treatment for sleep apnea.

JAW SURGERY

MMA - jaw advancement

OROFACIAL MYOLOGY

In cases with mild to moderate sleep apnea, studies have shown a significant decrease in overall AHI ( apnea/ hypopnea index) greatly reducing if not eliminating the need for sleep applainces.

 

TONGUE TIE

A tongue-tie is also known as a restricted lingual frenum or a tethered oral tissue (TOT). The frenum is the line or band of tissue under the tongue - we all have one. It connects the tongue to the floor of the mouth. In some people however, the frenum is too tight or too short, and it can actually restrict the movement of the tongue, as well as prevent it from resting in the correct place. Lips can be tied as well.

WHY DOES IT MATTER?

Your tongue should fill up the entire roof of your mouth. When it does, it provides an internal support structure for the upper jaw. If your tongue is in the right place, your teeth will grow in straighter and your face will develop properly.  A tongue-tie keeps your tongue in the bottom of your mouth. People who are tongue-tied often mouth breathe, so they  experience a variety of myofunctional problems and symptoms. Chronic jaw pain, facial pain, headaches, and clenching and grinding, along with dental and orthodontic issues are common in people with tongue-ties. Studies show that children who are tongue-tied are more likely to develop sleep apnea and airway issues.

Tongue Tie
Tongue Tie

PRE-OPERATIVE EXERCISES

It's critical to have a holistic approach to exercises and muscular health before the procedure for a successful outcome! As a myofunctional therapist, I will prescribe a series of exercises to help strengthen and prepare the muscles of the tongue for the new range of motion they'll experience post-surgery.
As a Massage therapist, I help release muscular knots and fascia to help the tie release specialist as well as help with post-operative care and wound healing.

The tongue and oral muscles will need to be retrained and strengthened after the fascia is released. Think of it just like any other surgery where rehabilitation is required. The muscles in the tongue have never learned to move or rest properly, so in this case, myofunctional therapy and intraoral massage are just like physical therapy, only for the mouth.

 

MANUAL THERAPY FOR SWALLOWING DISORDERS

Also known as dysphagia is difficulty swallowing. It means it takes more time and effort to move food or liquid from your mouth to your stomach.

According to the Mayo Clinic " Dysphagia may also be associated with pain. In some cases, swallowing may be impossible.

Occasional difficulty swallowing, which may occur when you eat too fast or don't chew your food well enough, usually isn't cause for concern. But persistent dysphagia may indicate a serious medical condition requiring treatment.

Dysphagia can occur at any age, but it's more common in older adults. The causes of swallowing problems vary, and treatment depends on the cause."

The key to successful dysphagia rehabilitation is to address the underlying impairments that are causing the dysfunctions. Myofascial release and manual therapy have become increasingly used components of swallowing treatment.

Myofascial release (MFR) involves a low load, long-duration stretch to the myofascial complex to mobilize adhesive tissue to restore optimal length, decrease pain, break up adhesions, and improve function.  Fascia is the connective tissue that surrounds muscles, nerves, and organs, and it tightens and hardens over time in response to trauma.

Manual therapy (MT) involves the skilled passive movement of joints and soft tissue to restore range of motion.

 

HAIR PULLING (TRICHOTILLOMANIA)

Symptoms

People with trich feel an intense urge to pull their hair out and they experience growing tension until they do. After pulling their hair out, they feel a sense of relief.

A person may sometimes pull their hair out in response to a stressful situation, or it may be done without really thinking about it.

Most people with trich pull out hair from their scalp, but some pull out hair from other areas, such as their:

  • eyebrows

  • eyelashes

  • genital area

  • beard or mustache

Bald patches on the head may have an unusual shape and affect 1 side of the head more than the other.

Trich may cause feelings of shame and low self-esteem. Those affected may try to keep their condition to themselves.

According to Sandra Coulsion, 

"Some feel that “TRICH” is created by a sense of stress and tension before the person pulls, and a huge sense of relief when the hair is pulled. I feel that it is more related to tongue posture.

 Trichotillomania (“trich”) might be considered on the obsessive-compulsive spectrum, similar to other compulsive behaviors like nail-biting and skin picking.

These conditions might share genetic components however, there are only slight differences in the ages of onset between males and females.


Treatment approaches in practice are similar for all age groups. It does depend on whether the trich is “automatic” or “focused.” Children are more in the “automatic” mode where it is simply an unconscious habit. However, teens and adults tend to be more in the “focused” mode as they have rituals associated with their hair pulling which might include specific hairs or types of hairs to pull." 

If you or someone you know has a hair pulling problem, About - Face may be able to help. 

Asian beautiful child girl pulling her hair with her fingers in mental health problems,ner
 
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GAG REFLEX RELIEF

The gag reflex is natural to prevent us from choking. But what about the hyperactive gag reflex?
Having a background in dentistry we get it. The gag reflex is really no laughing matter & for some, it can really be debilitating & embarrassing. Clients avoid dental visits because of radiographs and others can not even seem to have the ability to brush their teeth. 
If we told you that there is hope in desensitizing the hypersensitive gag reflex, would you try it? Most of the time the hyperactive gag reflex stems from an orofacial dysfunction that may be easily addressed with massage, breathwork, & myofunctional therapy.

 

HYPERACTIVE GAG REFLEX RELIEF

Gagging is considered normal in young children due to immature oral functions. Once we start eating harder more controlled foods we naturally should grow out of the gag reflex. Adults prone to gagging may have difficulty swallowing. This condition is known as dysphagia


There are two reasons we may gag:

  • A physical stimulus, known as somatogenic

  • A mental trigger, known as psychogenic**

These two types of gagging aren’t always separate. You may find yourself gagging from physical touch, but also because of the sight, sound, smell, or thought of some object or situation that triggers the reflex.

The face of a fat man is gagged in order
 

Our Role

The nerves responsible for this signal are the trigeminal, glossopharyngeal, and vagus nerves.

The tongue alone has eight muscles within it that each work independently for the same function. Seven of those muscles are connected to the same nerve (the hypoglossal nerve (CN XIII) but one stands out. The palatoglossus is connected to the vagus nerve (CN X) via branches of the pharyngeal plexus (throat). When this muscle is overstimulated it causes us to gag. It also means that it is compensating for the other muscles. 


By applying orofacial myology, acupressure, and breathing concepts we may be able to help desensitize the gag and get you back to living a worry-free life. 

Our program for the gag reflex is definitely unique. You can find a good amount of information online on how to desensitize and manage your gag reflex on your own, however, we take a different approach and our goal is to guide and coach you every step of the way.

**About - Face may be able to help with physical triggers but may not be able to help with mental triggers.