The development of orofacial myofunctional therapy

The questions below can lead to discussion about the signs and symptoms of a patterning problem with orofacial muscles. They can be addressed by a hygienist who has training in the growing field of orofacial myofunctional therapy. OMT is a uniquely interesting specialty, rising out of orthodontics, TMD and later motivated and honed by individuals from speech-language pathology’s The field is uniquely special because the hygienist/therapist is making major life-enhancing changes that affect the entire body.

Asking patients, the following questions will help find the patient’s needs. A list of symptoms to consider are:

1. Patient’s who complain about chronic headaches
2. Patients who exhibit an open mouth rest posture.
3. Patient’s that have had orthodontic treatment and complain their teeth have shifted.
4. Does your patient exhibit an open bite?
5. Does your patient complain jaw, neck, arm pain, & back pain?
6. Is the patient’s tongue always “in the way “during treatment?
7. Do you see a scalloped tongue from pressing against the teeth?
8. Does the patient have the following habits, thumb or finger sucking, nail biting, lip licking, or hair chewing?
9. Does your patient “:lisp” when saying the “:s” sounds?
10. Do you see the tongue come forward against the teeth when swallowing?
11. Does your patient grind or clench his/her teeth?
12. Is your patient “tongue-tied”?
13. Golden Proportion (LVI) has helped many doctors see the patient lean forward, backward or on one side to help diagnosis.

Hygienists have welcomed the opportunity to learn and have taken a large lead in working with patients and collaborating with the dental provider when treatment of TMD and or Sleep Apnea are being diagnosed. The other large part is when we are performing frenectomy for a person to chew and swallow and a baby to breast feed. Corrective exercises would develop tonicity and proper muscle function and thereby influence proper occlusion.

Today, many hygienists are taking courses to learn how to help their patients develop healthy muscle patterns. These patterns, when permanently habituated, can be proactive in preventing orthodontic problems, as well as articulation disorders and breathing disorders leading to allergies, TMD, digestive disorders, sleep apnea, and posture problems.

I have now been practicing orofacial myofunctional therapy for 30 years and have treated thousands of patients. My son experienced a problem when he was seven years old, and I witnessed the change in his teeth, headache pain, ADD issues, and TMD. The dramatic results motivated me to study everything available (at the time).

Habit elimination therapy — My program for habit elimination treatment consists of three to five visits. I work with thumb and finger sucking, nail biting, hair chewing, tongue and lip sucking and chewing, and many other oral habits. I have a 95% success rate.

Everyone is born with a sucking habit; it is how one nurses for survival. Usually, at age nine months to 3 1/2 years, the child starts drinking from a cup and eating more solid foods and does not need to suck. However, many times a pacifier is used, or the child finds his or her thumb or another object, and the sucking habit is continued. At this point, the tongue is unable to rest and swallow correctly, leading to an open bite, cross bite, or some other type of malocclusion.

The program I developed uses behavior modification and positive reinforcement. The patient feels so proud to have ceased the habit finally! I feel the success of this program will empower the patients to control many obstacles in their lives that feel good, but they know is wrong for them. As a dental hygienist, I know the value of proactive therapy.

• 60% of malocclusion is caused by prolonged digit sucking
• 10% of 6-11-year-old suck
• 85% of digit suckers show an open bite
• Open bites many times lead to TMD due to laterally shifting of the jaw in order to chew
• 49.9% of orthognathic surgery patients experience an open bite relapse
• 59% of digit suckers experience atypical root resorption
• 40% of digit suckers had learning and behavior problems in school
• Orofacial myofunctional therapy —standard program Noxious habit elimination working in collaboration with other treatments such as ortho and TMD, or laser have really helped many patients.
• Teach nasal cleansing and nasal breathing
• Many different muscle therapy exercises to stretch, tone, and develop proper neuromuscular proprioception of the facial muscles
• Introduce the proper chewing and swallowing patterns
• Develop proper head and neck posture
• Habituation of the new patterns.

TMD and special needs therapy — These patients need an individualized program based on their physical limitations, pain factors, and ability to cooperate. I will always determine a specific treatment plan for the best result possible. The goals are the same as the other programs, but the methods are customized for the ability of the patient to perform. Special needs patients include those with autism, cerebral palsy, Down syndrome, chronic TMD caused by habits, attention deficit disorder, Bell’s palsy, and sleep apnea.

These patients are scheduled on a per appointment basis and I take them as far as possible. I make no promises due to the compliance limitations. The patients really appreciate the help that no other specialty has been able to provide.

Cosmetic muscle toning for facial fitness — There are more than 40 facial muscles which are different from other muscles in the body because they are all interconnected. Also, the facial muscles are the only muscles in your body that are attached to the skin. This allows for facial expression. What affects one muscle will affect others. I feel that this type of treatment will be the way of the future for orofacial myofunctional therapists.

People are tired of being cut, burned, injected, creamed and acid etched only to have gravity pull the muscles down again. The natural way would be to develop tone and fitness in the facial muscles like going to the gym to work out. A personal trainer will tell you that you must stretch, lift weights, and do cardio three to four times a week to be fit. Why not exercise your face as well? This is another program a therapist can incorporate into his or her therapy program. The patients can come in groups or individually, and it is fun to bring the cosmetic value to them.

Providing TMD in our offices is no longer one type of treatment fits all. Some have integrated the following information to update their treatments to meet the needs of their patients and the types of treatments they can choose from

1. Orthotic
2. Surgery
3. Botox administered for TMD function
4. Trigger Point
5. Orofacial myofunctional therapy
6. A combination

Find the best treatments that you can provide in your office and we can teach you how to set up for billing and they ways to bill medical for all of the above.