What a Myofunctional Therapist Looks At

Certain conditions and habits can have a negative impact on oral posture and function. The result is what we call a myofunctional disorder. Though there are different kinds of disorders, all involve a change in the amount of vertical space between the dental arches when the mouth is at rest, or freeway space. One of the main goals of myofunctional therapy, then, is to normalize this space by teaching new ways of chewing, breathing and swallowing – proper function instead of dysfunction. It helps you quit poor habit patterns (e.g., thumb-sucking, nail-biting, tongue thrust) and develop positive ones such as closed-lip nasal breathing and proper tongue function and swallowing patterns. It aims to create a normal and harmonious oral-facial muscle environment, and restore balance to the mouth, face, head, neck and body.

From imbalance to harmony

Once you see the difference between normal function and dysfunction, you realize how we’re surrounded by it every day. You can see it in family members, friends and coworkers; in popular media and on the street; even, perhaps, in yourself. Why so prevalent? Unfortunately, it’s seldom diagnosed. Instead, vast sums of money are spent on treating the problems it can cause – TMJ pain and dysfunction, sleep apnea, headaches, speech and sinus issues…just to name a few. Fortunately, corrective therapy doesn’t take long, is widely affordable and – most importantly – has a dramatic effect on the rest of your life.

What “Normal” Looks Like, What Dysfunctional Looks Like

What “Normal” Looks Like In a normal face, chin, nose and lips are aligned. There are nice facial contours. The eyes are bright and the nose is open for adequate air. Head, neck and body are properly aligned. Of course genetics play a big role in facial appearance, but so do myofunctional disorders. The lips-apart posture causes the chin to drop down and back. The mouth becomes like a weight dragging down the face and pushing the muscles inward. The eyes take on a droopy, sleepy appearance, and often show more white in the lower part. The nose becomes smaller and the nasal/sinus area is flattened in what’s called “long face syndrome.” Problems with congestion or allergies are common. The upper lip shortens, and the lower lip becomes fuller. The palate narrows or becomes vaulted, which over time can cause bite deformities. The resting posture of the tongue can make a big difference, too. After all, though swallowing has more force, the resting tongue exerts continuous pressure over long periods of time every day. So whenever we’re not talking, laughing, eating, drinking, yawning or coughing, the tip of the tongue should rest 1/4″ behind the upper front teeth. The rest of the tongue should lie against the palate, with both sides contained within the teeth. In an incorrect posture, on the other hand, the tip of the tongue rests against the teeth – upper or lower – or between them, while the rest of the tongue drops down. Often, the sides flare between the teeth. See in this second drawing how the palate is higher and narrower, while the nasal airway is smaller and compromised? Correct swallow depends on correct tongue posture. The tongue pulls back, making contact with the throat. The uvula and soft palate pull up and back, and the chin and lips are relaxed. There’s no backward pull in an incorrect swallow, though, which allows air to be swallowed. The tongue tries to go back, but its middle begins to lose contact with the palate. The tip moves against the teeth, and the sides flare out, touching the insides of the cheeks – sometimes on just one side, sometimes flaring against or between the teeth. The chin and lip muscles tighten to gather saliva instead of muscles in the back of the mouth and face. Let’s look at some images of these issues from real life…

Myofunctional Factors & What They Look Like

Sucking Habits

A sucking habit trains the tongue to work down and forward, creating a “tongue thrust” pattern, narrowing the dental arch and affecting nasal air space.

Thumb Sucking The amount of damage is determined by intensity, duration and position.

Finger Sucking A motivational program often stops the habit in as little as a day.

Unattractive Lips Unattractive lips; obstructive sleep apnea (OSA); TM joint disorder (TMD); periodontal (gum) problems; significant health issues.

Long-Face Syndrome Long-face syndrome: Long, flat face; retruded chin; narrow dental arches; nasal congestion; beginning jaw issues; snoring and disrupted sleep; speech issues.

Tongue Sucking Tongue sucking is especially damaging to arch form and tooth position.

Nasal Airway

The nose warms the air you inhale to 98.6 degrees, moistens and filters it, and kills bacteria with every breath.

Those things don’t happen when you breathe through your mouth.

Surgery may be necessary to remove obstructions from the nose.

These can include a deviated septum, enlarged turbinates (spongy bones in the nasal passage), polyps and enlarged adenoids (tonsils).

The lining of the nose may be swollen due to a “boggy swamp” effect from stagnant mucous irritation. But learning proper breathing techniques and developing a lips-closed posture can often establish nasal breathing.

Resting Tongue Posture

Except when swallowing, talking, eating, drinking, yawning, laughing or at the dentist, the tongue is always at rest.

Poor rest posture can wreak havoc with other oral structures!

In correct posture, the tip of the tongue rests on the ridge behind the upper front teeth. The remainder rests across the top of the mouth, fully contained within the teeth (and not pushing against them). The teeth are held slightly apart and the lips are closed.

Lips closed + tongue up = no facial stress

The Swallow & Dental Bite

Correct tongue posture lends to a correct swallow. From this position, the teeth come together, the soft palate and uvula lift back and the back muscles of the tongue pull back to touch the wall of the throat. This occurs hundreds of times daily, day and night.

In an anterior (front of the mouth) swallow, the tongue presses forward, against or between the teeth.

An anterior open bite.

In a unilateral (one-sided) swallow, the tongue presses between the teeth on just one side.

A unilateral bite.

In a bilateral (two-sided) swallow, the tongue presses between the teeth on both sides.

A bilateral open bite.

In some swallow patterns, the tongue is completely between the teeth.

Not all bites are open. Some are over-closed. A person with an over-closed bite will instinctively place their tongue between their teeth, so as to gain enough height to protect the jaw joint. Often, the habit can’t be corrected with myo until the bite itself is corrected through orthodontic, surgical or prosthetic treatment.

Dysfunctional muscles can lead to orthodontic relapse of the bite. (Learn more about orthodontic relapse and the difference myo can make [PDF].)

Like any bite pattern, this affects the swallow, as well.

Frenula

Frenula are small folds of tissue that connect various organs in the body. There are three in the mouth: the lingual frenulum (under the tongue) and one inside each lip. When the lip frenula are restricted, the lips don’t flare properly, which prevents a good seal during breastfeeding.

When the upper lip frenulum is too long, it shortens the lip.

Although lips-apart posture isn’t a sign of a restricted frenulum, it often occurs with a shortened lip.

Surgery is needed to release the frenulum. Similarly, surgery is needed when the lower lip frenulum is attached too high on the mandibular (lower jaw) arch. Therapy must follow quickly – within a few days – to stretch the muscle, promote proper healing and retrain proper lip function.

The lingual frenulum helps lift the tongue to the top of the mouth.

This frenulum has anterior (front of the mouth) restriction. It interferes with resting tongue posture, the swallow, speech and dental arch development. It can cause sleep disruption, TMJ problems and more. Surgery is needed to release the muscle attachment, allowing the tongue to lift freely.

With a posterior (back of the mouth) tongue-tie, it’s impossible to arch the tongue to the top of the mouth. Often overlooked, it’s a major cause of breastfeeding problems, speech issues and poor arch development.

This child had problems breastfeeding due to a posterior tongue-tie.

Notice the beautiful upward arch of the tongue after surgery. Visit Dr. Brian Palmer’s site to learn more about frenulum and breastfeeding issues.

Tonsils

Tonsils help filter the air we breathe.

When they’re enlarged, they interfere with the airway and push the tongue forward, preventing normal function. They can cause breathing issues, sleep disruption, speech problems and trigger disease. Surgery is needed to remove the excess tissue. If the adenoids – one of the four sets of tonsils in the human mouth – are also enlarged, they may be removed at the same time.

These tonsils are just moderately inflamed. They may shrink naturally once therapy corrects a mouth-breathing habit and nasal breathing is established.

Temporomandibular Joint (TMJ) Dysfunction (TMD)

Each of us has two TM joints – one on each side of our head. They form the hinge that lets you open and close your mouth.

The lips-apart posture, tongue rest position and swallow all have an impact on the jaw joint. When there’s a tongue-thrust pattern, there’s no stability for the joint. Here, you can see what a healthy, properly functioning TMJ looks in action in comparison to dysfunctional joints.

Symptoms of TMD include jaw sounds, pain or locking; pain and tension in the face, head, neck or shoulders; ringing or buzzing in the ears; clenching or bruxing (teeth grinding) habits; abnormal jaw carriage and jaw damage. Abnormal muscle pulls that affect TMJ function are often corrected with myo, though other factors must be ruled out first.

Parafunctional habit patterns such as nail-biting or bruxism also have a negative impact on TMJ function. A team approach to TMD treatment – dental, orthopedic and myofunctional – is often needed and most effective.

Learn more about TMD:
My own history of recovery from TMD Dr. Wolford on ortho relapse and TMD

Speech

Addressing oral-facial dysfunction is often key to speech correction, as poor tongue posture and habits can contribute to speech impediments. Once myo has corrected muscle function, better correction with a speech pathologist is possible.

No speech sound requires a lateral shift of the jaw…

…or the tongue to do gymnastics.

Excessive or restricted lip movement is a sign of oral-facial muscle dysfunction. Others include mumbling, poor clarity, saliva pooling, poor word endings, needing to repeat speech for others, spitting while talking and the tongue being visible a lot while speaking.

Tongue, Cheek & Lip Markings

Scalloping on the sides of the tongue indicates a lateral wedging of the tongue against the teeth. This constant force may cause bone loss or tooth movement. It can also mean the arch is “too small” and is a diagnostic sign of obstructive sleep apnea (OSA).

Ridge markings on the tongue indicate a tongue-biting habit.

Cheek and lip markings can indicate a biting or sucking habit.

The habit may be part of the stress patterns of oral-facial dysfunction, but it can also result from malocclusion (an out-of-alignment bite) or dental bite dysfunction. A team approach may be needed to fully correct it.

Jaw Carriage

Anterior or lateral muscle dysfunction can habitually pull the jaw forward or to the side while speaking, swallowing or biting. Untreated, this places extra stress on the head and neck. It also may lead to dental conditions such as crossbite, TMD, clenching and bruxing, as well as facial asymmetry.

Head/Neck/Body Posture

Though jaw dysfunction has many causes, poor oral-facial musculature and habits are often involved.

Good posture is the goal

Mouth open + slumped shoulders + slouching + non-diaphragmatic breathing (not breathing with the belly) = over-breathing.

Notice the changes…

Following myofunctional therapy

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea (OSA) is a serious concern in children and adults alike. If symptoms are seen during myofunctional evaluation, the patient is advised to consult with a physician or appropriate sleep disorder clinician. But while myo doesn’t treat this disorder, it has been proven to help with mild to moderate cases. Early treatment of dysfunctional muscle patterns and poor habits can also help prevent it.

Use of a C-PAP machine…

...Is not the goal

Good oral-facial function and habits are key. Learn more about sleep apnea and myofunctional therapy’s effect on it [PDF].

Poor Eating & Drinking Patterns, Poor Habits

Tongue thrust is a big contributor to problems with the action of eating and drinking, as well as some digestive complaints, as it leads to a tendency to swallow a lot of air while eating. Often, the person experiences more than the usual amount of gas, burping, hiccups and stomach aches. Frequently, I hear reports of “daily” stomach aches that subside once therapy has begun. Often, tongue thrust and other dysfunctional patterns are also accompanied by any number of poor habits. Over time, these can cause damage and change the face in undesirable ways…