Introduction
Orofacial myofunctional therapy is usually a comprehensive treatment plan for the pediatric patient planned by the dentist and the myofunctional therapist. This therapy is indicated primarily for pediatric patients with detrimental habits like tongue thrusting or other conditions such as sleep apnea.
What Is Oral Myofunctional Therapy?
Orofacial myofunctional therapy includes mainly a set of exercises recommended for tone improvement in the cervical and facial muscles resulting in improved proprioception, functions, and movements. This would also be termed as a neuromuscular re-education of the muscle function in the patient by the dentist to improve multiple functions, such as swallowing, tongue movements, preventing oral breathing, and maintenance of rest posture of lips, tongue, cheeks, etc.
Orofacial myofunctional therapies are mainly used for the correction of tongue thrust habit in children that mainly helps to ensure the following functions to correct potential tongue-related dysfunctionalities and malocclusion in children.
What Are the Uses of This Therapy?
The uses of this therapy are as follows:
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Improvement in tongue elevation and tongue movement strength.
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Correction of the resting posture of the tongue.
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Correction of the tongue placement, especially while swallowing and resting (the tongue usually rests with the tip against the hard palate, located behind the maxillary anterior or upper front teeth).
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Improvement of tongue motility.
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Improvement in maxillary constriction.
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Prevention of potential relapse that may occur after a corrected malocclusion.
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Improving sleep apnea-related or sleep-disordered breathing patterns.
What Are the Goals of This Therapy?
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The myofunctional therapist will aim to create an individualized program for the patient considering their habit history and tongue thrust frequency.
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Based on this design, the dentist or myofunctional therapist will retrain the orofacial muscles to improve tongue functions.
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The goals of this training will subsequently, as elaborated above, tend to normalize the tongue's and lips' resting posture, establish the correct nasal breathing patterns, and eliminate any adjunct habits developed from childhood, like thumb-sucking.
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As the dentist or myofunctional therapist regularly retrains these patterns, the patients often notice a definitive increase in self-awareness of their mouth and facial muscle movements.
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The therapists will also extend their care by home-bound exercises that should be done daily as part of treatment, focusing on ideal swallowing, breathing, and resting patterns.
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Regular daily practice of these positions and movements will increase tongue muscle strength and oral motor coordination.
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Apart from being used as an adjunct aid to support speech therapy and orthodontic corrections, preventing malocclusion, etc. This can also be an effective way to bond and communicate with the child (dentist or the parent) and improve their oral awareness.
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Though there is no common indication regarding the right age for starting OMT in children with tongue thrust habits, pediatric dentists recommend them due to the high success rates in children, especially those below ten.
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Tongue thrust is also responsible for producing anterior open bite in children, which is a leading cause of altered bite and malocclusion.
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Though some dentists would recommend a wait-and-watch approach till the age of 10 (because in some children, there would be a spontaneous open bite closure), some clinicians prefer OMT even before that age.
What Methods Are Involved in Oral Myofunctional Therapy?
Orofacial myofunctional therapy is intended to serve as an adjunct to conventional orthodontic treatment in children and adults, depending on their oral myofunctional disorder issues, and helps harmonize orofacial functions. It is essential for the dentist to recognize any anatomical abnormality or variation in the child's oral cavity, for example, tongue tie, that should be corrected first. Only after the resolution of such anatomic-based oral issues that tend to cause dysfunctionality can the dentist refer to the myofunctional therapist or proceed with OMT. Also, in some children, the surgical reduction of excessive lymphoid tissue should be considered which may otherwise hinder the treatment progress before initiating myotherapy.
The clinicians' attention to detail in correcting the patients' oral musculature and its functions is a mainline strategy for successfully treating oral dysfunctionalities related to tongue thrust. The patients may also experience post this myofunctional treatment, even cosmetic changes in their faces and smile because of correctly trained tongue movements.
It includes a set of exercises such as
Exercise 1:
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Push Up the Tongue.
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Place the tip of the tongue against the hard palate on the roof of the mouth, on the back of the upper teeth, and push upwards and hold for 5 seconds.
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Repeat the procedure ten times.
Exercise 2:
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Touch Nose
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Bring the tongue outside
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Try touching the nose tip and hold for 10 seconds,
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Relax.
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Repeat ten times.
Exercise 3:
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Touch chin.
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Stick out your tongue
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Try to lick the bottom of the chin.
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Hold for ten seconds.
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Relax.
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Repeat ten times.
Exercise 4:
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Push Tongue Left
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Stick out your tongue and move it as far as the person can to the left
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Hold for ten seconds
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Relax.
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Repeat ten times.
Exercise 5:
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Push Tongue Right
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Stick the tongue out and move it as far as possible to the right.
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Hold for ten seconds.
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Relax.
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Repeat ten times.
Exercise 6:
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Roll Tongue.
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Roll the tongue by folding the edges toward the middle lengthwise.
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Stick it out as far as possible while keeping it folded and hold for ten seconds.
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Relax.
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Repeat ten times.
Exercise 7:
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Click the Tongue
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Make a loud clicking sound with the tongue against the roof of the mouth.
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Click the tongue for 15 seconds.
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Repeat ten times.
Exercise 8:
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Push the Tongue Against a Spoon
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Push the tongue firmly against a spoon held in front of the lips for 10 seconds.
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Keep the tongue straight.
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Don't let it point downwards.
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Repeat ten times.
Exercise 9:
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Hold a Spoon.
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Place the handle of a metal spoon between the lips.
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Hold it in place with only the lips for 10 seconds.
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Do not place the handle between the teeth.
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Try to keep it parallel to the floor.
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As the strength improves, try using other small objects, such as sugar cubes on the spoon for added weight.
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Repeat ten times.
Exercise 10:
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Hold a Button.
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For children and adults not at risk of swallowing a button, tie one to a piece of string at least 10 centimeters in length.
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Place the button between the teeth and lips. Press the lips tightly and pull on the string, not letting it slip out.
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Pull for 10 seconds, then relax.
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Repeat ten times.
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For added difficulty, place the button flat between the lips.
The treatment program planned for the child is recommended ideally by dentists for a minimum of 20 sessions. The first ten sessions only teach the proper tongue position and posture.
The next ten sessions should deal with tongue exercises improving motility. The myotherapy session duration should be at least 30 minutes so the child can also inculcate a subconscious learning pattern. The frequency of visits can be weekly at first, followed by every 15 days later until the treatment is successful.
What Are the Limitations of Oral Myofunctional Therapy?
It is important to understand that OMT or oral myofunctional therapy is not a replacement for conventional orthodontic correction or treatment. As such, it cannot give the patient the morphologic or skeletal benefits of orthodontic treatment related to tooth alignment and positioning. OMT relies only on concepts of active exercise that need to be done effectively by the patient regularly to succeed in habit-breaking patterns. This mainly in children depends on the awareness given by their dentist, their motivation levels, and the compliance of children along with their parents equally.
Conclusion
To conclude, the goal of myofunctional therapy is to improve oral myofunctional disorder (OMD) symptoms, resulting in improved speech, efficient eating, and sound sleeping, which are all added benefits of this therapy. A dental diagnosis of an OMD issue or tongue thrust and subsequent help from getting these habit patterns treated by a professional like a myofunctional therapist plays a major role in the inculcation of correct tongue movement, rest, and coordination in children. Successful management of tongue thrust, including OMT treatment, requires a multidisciplinary and team approach that includes general dentists, orthodontists, pediatric dentists, speech therapists or pathologists, and even pediatric physicians if needed.
