Myofunctional Therapy

The tongues natural resting position should be on the roof of the mouth. The tongue serves as a guide for the proper growth of the palate (maxilla) and the face. With each proper swallow of food, water and saliva, the forces of the tongue muscles form the shape of the roof of the mouth. For a person with a tongue tie, their tongue may not be able to reach the top of the mouth because it is physically restricted. As a result, the palate will develop smaller and narrower, the teeth grow in crowded and overlapped. The lower jaw tends to follow the lead of the upper jaw developing smaller and crowded as well. You might notice the sides of your tongue have a “scalloped” appearance, this is from the teeth either partially resting on the tongue or the tongue pressing against the sides of the teeth because it is cramped in a space that is too small for it. The airway becomes restricted, especially during sleep, due to lack of space for the tongue which has nowhere to go other than back to block the throat. The now restricted airway leads to a pandora’s box of health issues.

What is a Tongue Tie?

Many people I talk to think that the term “tongue tie” is just a figure of speech. They are always surprised to learn that it is actually a real medical condition which affects the oral and facial development and has a range of health consequences that may take years to manifest. A tongue tie or ankyloglossia is a restriction of mobility in the tongue. Under the tongue is a tissue called the lingual` frenum or frenulum. The lingual frenum attaches from the tongue to the floor of the mouth. If the frenum is short, it will limit the range of motion the tongue has. There are different degrees of restriction and different types of tongue ties. The tongue should be able to elevate and “suction up” across the roof of the mouth without compensating by using the muscles of the neck and the floor of the mouth. It should be a natural motion and not an effort or struggle for the tongue. Part of the comprehensive evaluation is to check for the tongue’s range of motion and function.

Signs there might be a Tongue Tie

  • Speech issues
  • Jaw pain, clenching & grinding
  • Head/neck/shoulder tension
  • Forward head posture-dry mouth which can cause increased risk for gum disease/cavities
  • Slow orthodontic movement
  • Orthodontic relapse
  • Tongue thrust
  • Snoring/sleep disordered breathing/upper airway resistance syndrome/mouth breathing

What can happen if tongue tie isn’t addressed:

  • Speech issues
  • Feeding issues
  • Improper swallow
  • Mouth breathing
  • Ear infections
  • Unable to clean teeth

What is a Tongue Thrust?

Basically, it is an abnormal swallowing pattern developed from compensations and or habits such as thumb sucking. There are different types of tongue thrusts. Varieties of thrust include when the tip of the tongue protrudes forward over the front teeth, in other thrusts the tip and/or sides of the tongue push or spread between the teeth. The force of the tongue muscle against the teeth can cause alignment issues, excessive overjet and orthodontic relapse.

Babies have an infantile thrust but as they grow, they develop motor skills and oral muscles through breast feeding, chewing foods (around 6 months) and drinking from real cups (not sippy cups). By age 6-7 we should have matured into an adult swallow pattern.

During a healthy swallow the tip of the tongue elevates to “the spot” on the roof of the mouth located behind the front teeth. The rest of the tongue raises up against the roof of the mouth in a wave like pattern as the swallow progresses. The lips should remain sealed with the teeth lightly touching. The swallow that is ideal is what we in myofunctional therapy call the “silent-swallow,“ you can’t really see it or hear it. The lip muscles, chin and muscles of the neck should be calm and uninvolved.

How can it affect my health?

Airway is always the number one concern, without proper breathing all else suffers. Tongue thrusts are notorious for airway issue. A person with tongue thrust may have airway and digestive issues as well. Imagine that every time a swallow occurs in thrust-swallow pattern a parting of the lips occurs. The air that is sucked in and then swallowed, can cause digestive issues such as reflux, bloating and tummy aches. The airway of the tongue thruster will be more prone to throw off the O2/Co2 balance we addressed earlier. At night- time the favored mouth position will be open due to anterior and or lateral open bite created by the thrust (and possible tongue tie as well) which brings us to issues of snoring, sleep apnea and poor sleep quality resulting in lack of cognitive restoration. Over years of poor sleep quality and gas exchange imbalance can take its toll on the different body systems.

How does a tongue thrust affect my teeth?

  • The thrust will lead to misalignment of the teeth which makes them harder to maintain clean. As the tongue thrusts forward it can cause narrowing and crowding, it can cause food traps that are hard to keep clean which long term can result in gum disease, decay and or tooth loss.
  • Open bite or cross bite can form as a result of improper tongue and muscle patterns during swallowing.
  • The facial muscles can experience soreness, tension, inflammation and dysfunction such as limited opening of the mouth.
  • The Temporomandibular joint or TMJ can be affected by an open bite. Temporomandibular Disorder or TMD can occur due to lateral shifting of the jaw during chewing.
  • Tooth eruption can be delayed. Improper swallow can delay teeth from erupting as the tongue pushes forward can interfere with tooth eruption and the alignment as well.
  • Relapse of orthodontic treatment is frustrating. The tongue is more often than not the culprit.

After years in braces the teeth will shift back if the tongue is not retrained to be in the proper rest position and swallow pattern. Myofunctional Therapy can help eliminate the tongue thrust pattern.

Causes of Tongue Thrust:

  • Sippy cups/Digit/habitual sucking
  • Tongue Tie
  • Mouth breathing-associated to low tongue rest posture
  • Allergies, large adenoids, tonsils, nasal congestion, Natural jaw anatomy, steep jaw angle
  • Down’s syndrome/muscular/neurological development

Tongue Thrust signs:

  • Chapped lips or area around lips are red, dry, cracked from frequent licking
  • Habitual mouth breathing (mouth breathing when not congested or sick)
  • Open mouth rest posture with lips apart and/or tongue resting against top and or bottom teeth
  • Swallow requires lower lip to come up/forward to keep food/drink in
  • Tongue protrudes against top and/or bottom front teeth when articulating /s/,/z/,/t/,/d/,n/,/l/,or /sh/

How do you fix a Tongue Thrust?

Myofunctional Therapy uses functional exercises based on the individuals muscle patterns to establish new neuromuscular behaviors. The “cookie cutter” approach to our program doesn’t work in Myofunctional Therapy as each person usually has multiple factors contributing to the muscle dysfunction. By evaluating and identifying the patient’s unique patterns and behaviors we are able to create a program plan that addresses the factors involved in the OMD.

Why do I need Myofunctional Therapy?

As an example, we can say sometimes poor posture is caused by improper or lack of use of our musculature, whether it be during use or at rest. Over time, due to lack of use, the under used muscles weaken or become flaccid. The muscles that are dominantly engaged will start to overcompensate for the weaker ones. Eventually this can result in physical deformity (slouched appearance), pain in joints(hips and knees) or pain in the overworked muscles(muscle spasms). A similar scenario can occur in the muscles of the face and mouth resulting in an OMD.

The tongue is an extremely strong and pivotal muscle to our health. It is comprised of 8 muscles, 4 intrinsic and 4 extrinsic. Not only is the tongue muscle important to form speech but it is vital to chewing and swallowing our food, helping to clean the mouth, aides in nasal breathing, and it literally shapes our mouth. Just like poor body posture, if all of the tongue muscles are not functioning properly there will be over compensations and OMD’s will occur. The ideal natural resting spot for the tongue is the roof of the mouth. If the tongue has not been “living” on the roof of the mouth during rest, breathing, swallowing and food chewing it will take time to retrain the muscles by creating new neuromuscular memory. The tongue resting on the floor of the mouth is considered poor oral rest posture. The habit of mouth breathing, which can be caused by poor oral rest posture, is just one of the many habits myofunctional therapy helps to eliminate.