Post Script to “Cranio” Editorial

by Joy Moeller, BS, RDH, BBE

Since I wrote this editorial, the field of sleep disorders has exploded and included myofunctional therapy as an adjunctive treatment. Many studies are now showing that airway surgery such as tonsillectomy and adenoidectomy alone are not enough to reverse the effects of obstructive sleep apnea.

A new meta-analysis of 331 studies, which was recently accepted for publication in Sleep, concluded that myofunctional therapy decreases AHI by approximately 50 percent in adults and 62 percent in children. Lower oxygen saturations, snoring and sleepiness outcomes improve in adults.

This new information is very exciting to me because at last patients will have access to care to treat not only the symptoms of sleep disorders but the cause. The options of treatment will be expanded to include a therapy program, which may change the patients breathing, chewing and swallowing: thus addressing one of the reasons why the airways may have collapsed in the first place.

This may also lead the way to more research on prevention and reversal of sleep disorders beginning with infants and young children through education and early intervention. Studies showing the importance of breastfeeding for growth and development of the pharyngeal structures have made breastfeeding not a lifestyle choice, but a serious health enhancement for the patient long term.

A frenum inspection bill was passed into law in Brazil starting in 2015. Restricted frenums may be one cause of myofunctional disorders and may lead to posture problems, breastfeeding problems, orthodontic problems, especially in Class III malocclusion. My professional experience suggests that restricted frenums may lead to sleep disorders by preventing the back of the tongue from lifting to the palate properly, required to maintain an open airway.

Orofacial pain treatment is now a standard of care treatment in Brazil using myofunctional therapy as an adjunctive treatment. A new study showing the impact of impaired orofacial motor functions on chronic temporomandibular disorders included rehabilitation using increased activity of the muscles by balancing sides during chewing which improved the orofacial motor control.

Orthodontic relapse has been noted in patients with myofunctional disorders including hypotonia. Moreover, there are more studies showing that the habits must be dealt with to insure occlusal stability long term.

So who does myofunctional therapy? Is it speech pathologists, dental hygienists, physical therapists, nurses, occupational therapists, physicians or dentists? The truth is we need everyone to do it and we need everyone to apply myofuctional principles and treatment to the type of work they do, within their own scope of practice. Even lactation consultants and respiratory therapists can contribute their knowledge and learn how to identify orofacial myofunctional disorders. We also have an epidemic of sleep disorders that needs our help now.

The future is happening now with the addition of more and more studies suggesting myofunctional therapy is a viable adjunctive treatment in sleep disorders, orofacial pain, and orthodontics. To quote Professor Christian Guilleminault from Stanford, “If you do not look at myofunctional therapy for the treatment and prevention of sleep apnea, you will miss the boat.” And if you miss the boat, it will sail without you.OH


Joy Moeller is a Registered Dental Hygienist and is a former associate professor Indiana University School of Dentistry, and has been practicing orofacial myofunctional therapy for over 30 years.

REFERENCES

1. Guilleminault, C, Sullivan, S. 2014. Guilleminault, C, et al, 2013, Diaferia, G, et al, 2012, Huang, Y., Guilleminault, 2013.,

2. Villa, Maria Pia, et al, 2014, Guilleminault, C. et al, 2013

3. Camacho M, et al, 2014

4. Machado Junior, Crespo, A.

5. Olivi, G, et al. 2012

6. O’Callahan, C, Macary, S, Clemente, S.

7. Jang, So-Jeong, et al. 2011, Melink S., et al 2010

8. Ferreira, C. et al. 2014

9. Saccomanno, S. et al. 2012

RELATED NEWS

RESOURCES