By Sanda Valcu-Pinkerton
Myofunctional Therapy is far more than just a regimen of exercises designed to improve the musculature of the tongue, cheeks, jaw, and neck. It is a functionally practical treatment that develops in compliant patients an awareness of what a healthy oral rest posture is supposed to be. For most of the day, we do not engage the 57 muscles of the orofacial region, however we are impacting their ability to function by the way we allow them to rest. A healthy oral rest posture means placing the tongue on the palate, maintaining lip seal, and exclusively utilizing nasal breathing. One of the most effective methods of focusing awareness on their behavior is to teach patients how to identify a correct resting posture for their orofacial muscles.
Breathing is one of the most important functions our body performs, and most of the time the act of breathing is mostly subconscious. One of the key priorities or a myofunctional therapist is ensuring that a patient has nasal patency. One can go without food for months, without water for weeks, but lack of oxygen precipitates death in a few minutes. So what does proper oral resting posture have to do with nasal breathing? When the tongue and lips are in an incorrect rest posture, one’s ability to breathe is impaired. The consequence is people establishing the oral myofunctional disorder of mouth breathing and the resultant litany of dysfunctions. A myofunctional therapist, should educate their patients that a patent airway is achieved through nasal breathing only when the tongue is properly placed on the roof of the mouth.
The tongue is another organ that is more critical to breathing than many people realize. It has eight separate muscles. This small organ manipulates food placement as one chews solids, implements the swallowing of solids and liquids, and, through various movements, and facilitates articulation. In addition, through continuous pressure exerted by placement on the roof of the mouth, the tongue stimulates proper upper jaw growth, much like how a retainer can alter the position of teeth and oral structures, the tongue plays a major role in the development of the human airway and orofacial complex. Proper tongue placement, which begins in infancy, is responsible for the formation of a wide, u-shaped upper jaw. The upper jaw, or mandible, is extremely prominent in facial development and the wider the mandible and palatal arch, the more patent the airway. It is through the formation of a voluminous airway than an individual develops an efficient ability to perform nasal breathing. Who could have thought how much the tongue accomplishes while at rest?
Sometimes people are born with conditions they have little or no control over which prevent them from attaining proper oral rest posture. An example of a congenital, or present at birth, condition which can prevent proper tongue placement, lip seal, and nasal breathing is “Ankyloglossia,” or “Tongue Tie.” For those who have lived with a shortened or thickened tissue membrane, called a frenum, throughout their lives, (i.e. tongue-tie), myofunctional therapy becomes more than an awareness of learning proper oral rest posture. These individuals have learned to compensate by incorporating other muscles of the orofacial region (i.e. cheek, lip, and neck areas) in an attempt to perform the basic functions of breathing, chewing, and swallowing. This learned behavior leads to dysfunction and various disorders, known as compensatory behaviors. Unfortunately, the individual is often unaware of the behavior until he/she suffers harm. The perniciously insidious effect of orofacial myofunctional disorders (OMDs) is that one becomes cognizant of the symptoms before they can identify a cause.
Through the extended use of muscles other than the tongue to perform functions designated specifically for the tongue, the tongue’s muscle tone and mobility diminishes. As a means of correcting this deficiency, compensatory behaviors, executed by a union of muscles whose functions should otherwise be separate from the tongue’s, are developed. This is the body’s attempt to compensate for, or balance out the loss of, proper tongue function. These patients have learned to improperly integrate or associate their cheek, jaw, and neck muscles when chewing and swallowing. Myofunctional Therapy is used to teach individuals how to strengthen the tongue and prepare it for its natural functions by dissociating the tongue’s movements from other muscles.
An especially prevalent compensatory behavior involves a prominent activation of the jaw and neck muscles in swallowing. As a means of coping with the diminished tongue mobility caused by a shortened frenum, a person (usually subconsciously) attempts to correct the defect by using the jaw or neck muscles to swallow. As a person swallows anywhere from 500 – 1000 times day, these muscles, that were never intended to aid in the function of swallowing, gradually begin to grow in size. The excessive and prominent growth of muscles in the face, jaw, and neck region is not only dysfunctional, but is for the most part unattractive. From a functional point of view, the priority is: 1) to bring awareness to the patient of what muscles they are using to perform the functions of chewing and swallowing, and 2) to teach patients how to separate cheek, jaw, and neck muscle use from tongue movements. Jaw dissociation is separating the jaw and neck muscles from the acts of chewing and swallowing.
Ideally, the muscles of the orofacial region should work in concert with each other, not as substitutes for one another. Every muscle and organ we have is specifically designed for a purpose. Inter-muscle relationships must be clearly defined, with each muscle performing its discrete function. Myofunctional Therapy is not simply a regimen of exercises and stretches, but ultimately it is about being able to breathe, chew, and swallow efficiently.
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