Month: March 2013

Orofacial Myofunctional Therapy: Why Now?

cranio_logoJoy L. Moeller, R.D.H., B.S.
Volume 30 Issue 4 October 2012

 

Editorial:

It is said that timing is everything. You may have heard of orofacial myofunctional therapy (OMT) popping up here and there in the U.S. over the past few decades. In 1978, I ventured into this field eager to learn more about the mouth exercises my son had benefited from as a patient with TMD. I studied the therapy rigorously, attending several courses with Dan Garliner and others who, at the time, were leaders in this field. While U.S. institutional interest in the field over the past few decades has waxed and waned for various reasons, early OMT specialists have continued to practice, train others, and steadily build awareness through clinical success.

You may have seen an increase in discussion of the field in the last year or two. A quick search using Google will show a seven-fold rise in “myofunctional therapy” searches from 2011 to 2012. Why is this interdisciplinary field, which has shown promise of success yet not quite taken off as a profession, suddenly come into greater prominence? With new research from Brazil and OMTs proven efficacy in treating TMD1 and OSA,2 the field is poised to explode like never before.

Around the time I began, a few Brazilian speech pathologists, visionaries like Drs. Irene Queiroz Marchesan and Esther Mandelbaum Goncalves Bianchini, studied these same courses. Bringing this knowledge home, they enhanced and implemented OMT into academic environments and successfully fought for national recognition.

Three factors combined to make the profession take off: strategic leadership, the healthcare marketplace, and a vigorous research environment. These ingredients, under the banner of “Ordem e Progresso” have resulted in Brazil being the first and only country to have federal licensure in the field. With over 20 universities engaged in research, Brazil has effectively thrust OMT into the spotlight. We now have the evidence-based research we need to support the benefits of OMT as it relates to TMD and OSA. Just this year in June at the Brazilian Orofacial Myology Association Congress, hundreds of new OMT research posters were presented, and this November in Brazil at the Brazilian Speech Society (SBFa) Congress, there will be hundreds more.

OMT, also known as neuro-muscular re-education of the oral facial muscles, is a modality that promotes the stability of the stomatognathic system. Studies have been done for centuries to understand the relationship of form and function.3 When the tongue is resting against the hard palate (thus maintaining the proper oral volume) it enhances and/or creates stability for the TMJs. If the tongue is habitually resting down and forward in the mandible, as may happen with a lack of patency of airways and/or excessive use of bottles, pacifiers, digit sucking4 or a restricted frenum,5 normal form and function may be disrupted.6

While a primary function of the tongue is to protect the airway, improper oral resting posture of the tongue will have a negative influence on the development of the oral cavity. Add that to the modern diet of processed foods (soft foods may lead to low muscle tone by diminishing the frequency and intensity of mastication7), a smaller oral volume may not support proper upper airways, the stability of the TMJs, or the development of optimal dental arches.8

OMT specialists are trained to promote functional posture9 (in absence of mechanical obstruction) with behavior modification. The goals for the patient are to become aware of, and eliminate, noxious habits and achieve nasal breathing, lip seal, and proper mastication. OMT specialists also promote patient compliance in the proper care and use of oral appliances that treat TMD and OSA, as well as minimize muscular discomfort due to the use of those appliances.

Contributing to the creation of orofacial myofunctional disorders (OMDs) are restricted lingual frena.5 It used to be that a baby’s tongue was checked immediately upon birth to make sure the baby could breastfeed easily. Possibly due to the proliferation and universal acceptance of bottle-feeding, a restricted lingual frenum is not only overlooked by healthcare professionals, but its detrimental effects are not fully understood.

Tight lingual frena have a critical impact on normal function and the development of the orofacial complex. The restricted frenum not only may affect the oral resting posture of the tongue, but it also disrupts the tongue muscles, both intrinsic and extrinsic, of their normal functions. If the frenum is restricted, the genioglossus muscle may not function normally and may impact the airway patency and contribute to sleep disordered breathing.11 Furthermore, the attachments of the tongue to the mandible may restrict forward growth and development. Lingual frenectomies are essential if the tongue is restricted for a full range of mobility. And even more essential is the follow-up with an OMT specialist so that the patient who has just undergone a lingual frenectomy may be assured success. The OMT specialist will work with the patient to re-pattern the muscles, ensure full range of motion of the tongue, and make sure the tissues do not re-attach after surgery.

It is ideal to release the restricted frenum as early as possible-meaning at birth-because the tongue will achieve optimal function through the activity of breastfeeding. Breastfeeding promotes tongue-palatal contact and requires the back of the tongue to activate by making a suction seal. These actions promote optimal muscle function of the entire orofacial complex.

Much more research is needed in this field to fully embrace how we may all benefit from OMT, practitioners and the public alike. Not a week goes by where a patient doesn’t say, “How come I didn’t know about this sooner? It could have saved me so many years of pain.” It breaks my heart that more people don’t know about OMT. I dream of a day when the United States will “catch up” to Brazil and implement this field into academic arenas, where research is promoted, where studies open doors to more physicians, more dentists and more patients who need this treatment. We are poised to rapidly advance this field. In just the past year, several leading professional healthcare organizations have sought speakers on OMT, and several of our leading universities have begun discussions about starting research. If timing is everything, I feel like I’m finally arriving, but it took me 30 years to get here. Our patients are asking for help. Don’t we owe it to them to offer this adjunctive treatment?

Joy L. Moeller, R.D.H., B.S.

Orofacial Myofunctional Therapist

Pacific Palisades, California

www.myofunctional-therapy.com

joyleamoeller@aol.com

www.facebook.com/oralmyology

References

1. de Felicio CM , de Oliveira Melchior M, Antonio M, da Silva MR: Effects of orofacial myofunctional therapy on temporomandibular disorders.

J Craniomandib Pract 2010; 28:249-259.

2. Guimaraes K, et al.: Effects of oropharangeal exercises on patients with moderate sleep apnea. Am J Respir Crit Care Med 2009; 179:962-966.

3. Levrini A, Favero L: The masters of functional orthodontics. Quintessence, 2003.

4. Romero C. et al.: Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition. J Appl Oral Sci 2011; 19:2:161-168

5. Northcutt M: Overview the lingual frenum. JCO 2009; 18:557-565.

6. Rogers AP: Exercises for the development of muscles of the face with view to increasing their functional activity. Dental Cosmos LX 1918; 59:857-876.

7. Rapley G, Murkett T: Baby-led weaning. England: Vermilion, 2008.

8. Price W, Pottenger F: Nutrition and physical degeneration: a comparison of primitive and modern diets and their effects. New York: P.B. Hoeber, 1939.

9. Okuro R., et al.: Mouth breathing and forward head postural effects on respiratory biomechanics and exercise capacity in children. J Bras Pneumol 2011; 37: 4:471-479.

10. Hsu H-Y, Yamaguchi K: Decreased chewing activity during mouth breathing. J Oral Rehabil 2012; 39(8):559-567.

11. Mathur R, et al.: Effect of breathing, pressure and posture on palatoglossal and genioglossal tone. Clin Sci (Lond), 1995; 89:441-445.

© 2009-2013: The Journal of Craniomandibular Practice. Site by Medium

Pediatric obstructive sleep apnea ~ critical role of oral-facial growth

frontiers

Yu-Shu Huang1 and Christian Guilleminault2*

1Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University, Taiwan, China
2Sleep Medicine Division, Stanford University, Redwood City, CA, USA

Aims: Review of evidence in support of an oral-facial growth impairment in the development of pediatric sleep apnea in non-obese children.

Method: Review of experimental data from infant monkeys with experimentally induced nasal resistance. Review of early historical data in the orthodontic literature indicating the abnormal oral-facial development associated with mouth breathing and nasal resistance. Review of the progressive demonstration of sleep-disordered-breathing (SDB) in children who underwent incomplete treatment of OSA with adenotonsillectomy, and demonstration of abnormal oral-facial anatomy that must often be treated in order for the resolution of OSA. Review of data of long-term recurrence of OSA and indication of oral-facial myofunctional dysfunction in association with the recurrence of OSA.

Results: Presentation of prospective data on premature infants and SDB-treated children, supporting the concept of oral-facial hypotonia. Presentation of evidence supporting hypotonia as a primary element in the development of oral-facial anatomic abnormalities leading to abnormal breathing during sleep. Continuous interaction between oral-facial muscle tone, maxillary-mandibular growth and development of SDB. load testing website Role of myofunctional reeducation with orthodontics and elimination of upper airway soft tissue in the treatment of non-obese SDB children.

Conclusion: Pediatric OSA in non-obese children is a disorder of oral-facial growth.

Create your own summer camp!

As school comes to a close and I meet with parents to report on their child’s progress and plan for the next school year, the question that comes up every time is “What can I do with my child this summer?” For many of the families that I work with, summer camp is not an option. Here is a list of some of the activities I suggest to families, to keep their children engaged and actively learning throughout the summer months.kids-summer-water_300

1. Make ice pops

Who would have thought that an activity so simple could be such a rewarding language experience? You can bring your child to the market to pick out fresh fruits to use. You can talk about the different sizes and colors of the fruits and examine the seeds. Have the child tell you the steps you took to make the pops. At the end, everyone has a nice, cold ice pop to enjoy!

2. Visit a local museum, zoo, or aquarium

In Brooklyn, we have access to some of the world’s best art and culture. Take advantage of this, in a child-friendly way! Before going, you can read a book about some of the things you may see. For example, if going to the museum (on a rainy day, of course!), you could read “When Pigasso met Mootisse” by Nina Laden before going. This way, the child will have some background knowledge/new vocabulary before your adventure! Afterwards, you can talk about what you’ve seen and create your own artwork!

3. Create an outdoor scavenger hunt

Don’t keep the kids cooped up in the air-conditioned house! Send them out into the fresh air. Together with your child, you can create a list of things to find in your backyard/on a walk/in the park…For younger children, the list can be visual. For older children, you can make a list that they must read.

4. Keep a journal

Many of my students leave New York City for the summer months. This is a great time for them to record what they are doing. I advise children to tie together sheets of paper or to get their child a small notebook and a disposable camera. The child can then have fun taking pictures and writing about all the interesting things they saw. Plus, they will have something to share with their classmates when they return in September!

5. Go to the beach

Everyone goes to the beach at least once during the summer. Why not take the opportunity to enhance language skills? There are some great picture printouts that you can color and use before going.

Let your child enjoy and benefit from the summer months. These simple activities will help you both have a fun and rewarding summer.

For more information, contact Jocelyn M. Wood

American Speech-Language Hearing Association

About the American Speech-Language-Hearing Association (ASHA)

ASHA is the national professional, scientific, and credentialing association for more than 166,000 members and affiliates who are audiologists, speech-language pathologists, speech, language, and hearing scientists, audiology and speech-language pathology support personnel, and students. Audiologists specialize in preventing and assessing hearing and balance disorders as well as providing audiologic treatment, including hearing aids. whois . dns server Speech-language pathologists identify, assess, and treat speech and language problems, including swallowing disorders.

Vision
Making effective communication, a human right, accessible and achievable for all.

Mission
Empowering and supporting speech-language pathologists, audiologists, and speech, language, and hearing scientists by:

Advocating on behalf of persons with communication and related disorders
Advancing communication science
Promoting effective human communication

Visit their website at: http://www.asha.org/

The National Association of Young People Who Stutter

If You Stutter…You have FRIENDS!

FRIENDS is the only national organization dedicated solely to empowering young people who stutter and their families. Our mission is to provide support and education to children and teens who stutter, their families and clinicians.

stutterFRIENDS is a non-profit, volunteer organization directed by Lee Caggiano, a mother of a son who stutters and a Speech-Language Pathologist specializing in stuttering. Founded by in 1997 by John Ahlbach, an adult who stutters and Lee Caggiano. Painfully aware of the urgent need of support for young people and their parents, and of the paucity of available services, FRIENDS was founded to provide this much needed support. Years of personal and professional involvement in the self-help/support movement have allowed us to create a compassionate, knowledgeable and empowering organization. Our members include the young people who are our focus, their parents and siblings but also adults who stutter and Speech Language Pathologists that have a special interest in stuttering.
visit their website at: http://www.friendswhostutter.org/

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