March 1, 2015
by Dr. Janice Goodman
Recently I have been introduced to an emerging treatment modality called orofacial myofunctional therapy (OMT). “Orofacial Myofunctional Therapy is neuro-muscular re-education of the oral facial muscles through a series of exercises, to assist in the normalization of the developing or developed, craniofacial structures and function”. It is behavioral modification to eliminate dysfunctional habits. It works with the muscles of the lips, tongue, cheeks and face and their related functions such as breathing, sucking, chewing, swallowing and speech as well as the rest position of the tongue and cheeks (AOMT Q and A booklet). It is used to form, balance, and stabilize, the stomatognathic and cranial systems.
Since 2012, over 30+ universities are doing PhD level research in OMT. In Japan, dental hygienists are being trained in OMT. Having Orofacial Myofunctional Therapists to refer to would be great. We need to train individuals to be competent at this. There are not enough in Canada.
Orofacial Myofunctional Therapy is about recognizing and treating orofacial myofunctional disorders such as: parafunction and other dysfunctional oral habits. It attempts to eliminate oral habits, which create dysfunction in muscle patterns such as mouth breathing, low tongue rest position, improper chewing, swallowing and freeway space. It is based on sound scientific principals and can be very successful.
What Myofunctional therapy does:
• Eliminates oral habits – e.g. nail biting, thumb sucking, lip licking
• Improve the position and tone of the tongue and oropharynx
• Improve lip seal
• Promote proper swallowing and chewing
• Nasal breathing promotion and oral breathing correction
Goals of Myofunctional therapy:
• Correct dysfunctional habits including grinding, clenching, reverse swallow (which may be linked to GERD);
• Attain lip seal/normalize freeway space, which can lead to orthodontic relapse, malocclusion, psychological, cosmetic, structural issues;
• Correct tongue rest position, speech problems, malocclusion, decay, periodontal disease, forward head posture, high narrow palate, TMD;
• Develop a posterior tooth together swallow. Failure to masticate food properly and incorrect swallow (dysphagia, tongue thrust), can lead to: malocclusion, GERD and other digestive issues (Lieberman, 2011; Phua et al 2005); speech problems (Reed,2007); periodontal disease (Gulati, 1998); high narrow palate(Kilaris, Katsaros,1998); grinding and clenching (Wong, 2011) and TMD (de Felicio et al,2010);
• Establish nasal breathing and eliminate dysfunctional mouth breathing: Proper airway patency and OSA. OMT helps mouth breathers learn to use their noses properly. Mouth breathing leads to head forward posture, and cervical and myofascial issues (Harvold monkey experiments). It leads to reduced Nitric Oxide levels in the blood, lower CO2 levels, reduced immunity, greater pain and poor sleep;
• Develop coordinated and harmonious facial muscle patterns OMT exercises have been demonstrated to help alleviate snoring and sleep apnea (OSA) (Guimaraes,K et al 2009; Guilleminault,C 2013). When we fabricate an Oral Sleep Appliance we could be offering coaching with exercises to help tone the oropharyngeal tissues also. There are very few offices that offer this service and patients will be demanding it in the near future as they desperately want to get off their CPAP machines and stop snoring;
• These exercises can be used to open the patency of the oropharyngeal and oronasal airways (Guilleminault,C) and can improve tonsil and adenoid surgical results. If given a series of oral exercises and some coaching for these patients pre and post surgery, they have shown to have better and longer lasting results. (Valera, FC, 2006; Oulis CJ, 1994; Linder- Aronson 1970).
Treatment with Myofunctional Therapy has several stages:
1. Habit Elimination (30 days)
2. Intensive phase (eight weeks)
3. Generalization/Maintenance (every two to three weeks for four months)
4. Habituation (monthly appointments until year complete)
5. Follow-up depending on complexity, age, compliance.
Dysfunction needs to be recognized in the dental chair, noted in the chart, and discussed with the patient. I believe that it could be considered standard of care in the future. Most orthodontic therapy can benefit from co-treatment with a myofunctional therapist. A lot of periodontal treatment would be more successful with it, too.
Be aware. Try to find an OFM therapist that can help your patients and develop a referring relationship. Look for relationships of the tongue, lips and the teeth. For example, every patient with an open bite has a tongue thrust, but not every patient with a tongue thrust has an open bite. (Proffit and Fields, 1986)
Learning more about Orofacial Myofunctional Dysfunction will benefit your patients and make you a better dentist.OH
Janice Goodman is the General Dentistry member of the Oral Health Dental Journal editorial board. She is presently completing a Master of Science degree in Oral Medicine and Orofacial Pain at USC, and practices general dentistry in downtown Toronto. She can be reached at DentistryInTO@gmail.com and is happy to assist members of the profession to explore the treatment modality of Orofacial Myofunctional Therapy. Several articles in this month’s journal are complimentary to this editorial.