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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Dr. Soroush Zaghi, Medical Director of The Breathe Institute, has been invited to join PLOS ONE’s Academic Editorial Board as an Academic Editor, where he will participate in the review and selection of scientific manuscripts submitted to the journal for publication. Dr. Zaghi was selected for this honor because he was recognized by the journal as an international expert in his field of study and practice.
PLOS ONE is an organization dedicated to giving researchers a faster path to publishing in a high-quality peer-reviewed journal. All work that reaches their rigorous technical and ethical standards is published and freely and immediately available to everyone. In a nutshell, providing open access to outstanding research for the furthering of science and medicine.
Peer reviewed studies serve a critical purpose in science and medicine especially. Besides offering valuable information to professionals and researchers in many industries, once published, peer reviewed studies can generally be understood to have been heavily scrutinized by professionals in that field. This lends not only credibility, but confidence to decisions that are supported by such research.
Most studies that pass the peer review process go on to be published in a an industry/field specific journal or magazine so that the knowledge can be shared and spread. One unique organization; PLOS ONE, is the world’s first multidisciplinary Open Access journal. They accept scientifically rigorous research in many fields. PLOS ONE’s broad scope provides a platform to publish primary research, including interdisciplinary and replication studies as well as negative results. The journal’s publication criteria are based on high ethical standards and the rigor of the methodology and conclusions reported.
Dr. Soroush Zaghi has been invited by PLOS ONE to join it’s the Academic Editorial Board. Dr. Zaghi has previously served PLOS ONE as a guest editorial editor. The editorial staff at PLOS ONE poured through the many reviews of the myriad of papers and studies being entered into the journal for peer review and selected Dr. Zaghi to oversee the review process of these manuscripts for publication given his demonstrated commitment to accuracy and clarity.
In his role on the Academic Editorial Board, Dr. Zaghi will be conducting independent assessments of submitted manuscripts to decide whether they fit within the journal’s scope and publication criteria. He will be also be evaluating other reviews already collected and weighing them against his own judgments before rendering a decision, and submitting the final version for publication.
The editorial staff at PLOS ONE poured through the many reviews of the myriad of papers and studies being entered into the journal for peer review and selected Dr. Zaghi to oversee the for his demonstrated commitment to accuracy and clarity.
Specializing in the treatment of sleep and airway disorders, Dr. Zaghi has already published over 60 peer reviewed articles during his career so far, and looks forward to continuing to contribute to education and research as well as in his clinical capacity at The Breathe Institute.
The Breathe Institute offers whole health, for the whole family by integrating dental and medical healthcare under one roof. Our multidisciplinary center for precision diagnosis and comprehensive treatment of nasal obstruction, snoring, obstructive sleep apnea (OSA), and breathing disorders is at the forefront of airway management. The Breathe Institute serves the Greater Los Angeles Area, and also patients from around the globe who are attracted to the world class care offered by it’s field leading professionals.
In Support of Myofunctional Therapy and Functional Frenuloplasty as a promising collaborative therapeutic approach to addressing tongue-tie and Obstructive sleep apnea
Recently, our practice, our Medical Director, and several of our dedicated colleagues have been the target of some rather slanderous blogging by a fellow leader in the field of sleep medicine. His article questioned our approach, and ultimately our integrity. Although we appreciate the opportunity to learn from others perspectives, we are disappointed anytime someone (especially in the medical arena) refuses to exercise their own right to maintain an open mind and possibly learn something new that could have a positive impact on our field in a meaningful way.
In essence, what we do here at The Breathe Institute is simple; We promote and facilitate a healthy roadmap to natural and exclusive nasal breathing. Our whole focus is on helping our patients optimize their health by restoring lip competency, exclusive nasal breathing and improving tongue resting posture to the roof of the mouth. We have learned and seen that some patients with sleep apnea have low resting tongue posture, and in some cases this is associated with restrictions in tongue mobility due to a restricted lingual frenulum. We have also learned that restoring the tongue to its natural biological position at the roof of the mouth helps improve CPAP compliance, helps reduce snoring, and can reduce the severity of obstructive sleep apnea indices as measured by many sleep studies. We stand by our experience thus far of 2+ years specifically dedicated to a functional approach to sleep medicine. We have successfully treated hundreds and hundreds of patients locally as well as many who fly in from all over the world specifically for our unique approach of patients using our functional approach. Based on our experience, including 350 cases specifically of functional frenuloplasty that we have documented to date, we proudly endorse a satisfaction rate of 88% or more in regards to post-treatment health as well as a reported improved quality of life.
We firmly believe that patients deserve to be offered an alternative to aggressive surgeries. If surgery ends up being the best option for a patient, then that would indeed be the recommendation of our practitioners, and Dr. Zaghi is a brilliantly skilled surgeon who practices conventional surgeries as well. But we are of the mind that less invasive, more holistic modalities ought to be considered when appropriate. We are fortunate to have recruited Dr. Zaghi to be our Medical Director because of not only his demonstrated commitment to individualized patient care, but his passion for driving research and growing and sharing the compendium of medical knowledge. Dr. Zaghi is dedicated to presenting patients with an entire roadmap of different surgical and non-surgical treatment options - our patients are offered both conservative and functional approaches and we do see benefits to both of these individualized approaches depending on the patient.
Working alongside Dr. Zaghi, our Myofunctional Therapy Director, Sanda Valcu-Pinkerton has also extensively studied and researched both the scientific work of our colleagues abroad as well as those actively teaching content in the States including, but not limited to; AOMT/Joy Moeller, IAOM, Sandra Coulson, Mary Billings, Linda D'onofrio and Diane Bahr to name a few. After witnessing numerous amazing emotional, dare we say almost spiritual releases from our patients, we have even started delving deeper into research and information from the 1800’s and even further discussing the significance and health benefits of nasal breathing. In many ancient cultures, children were trained to breathe through their nose so not to become mouth breathers. Thousands of years ago, Vedic Yogi’s discussed the benefits of “Kechari Mudra” which is a breathing mudra involving touching the tip of the tongue to the uvula, and other such orofacial and nasal breathing exercises. Some of these practices reach back many thousands of years and are continued to this day.
We agree completely on one thing with the author of the piece that sparked this one: We need the standardization of protocols, scientifically rigorous research, university-based programs and institutional accreditation, so that what we are working diligently to produce alongside AAMS, and many other great organizations, educators and practitioners in the field.
Dr. Zaghi, Sanda and our entire team continue to dedicate ourselves and our time to refining our treatment protocol that incorporates a specific set of myofunctional exercises aimed at achieving lingual palatal suction and floor of mouth/jaw disassociation and awareness which we believe to be key elements of our therapy success.
We fully support the field of myofunctional therapy and wish to thank the thousands of myofunctional therapists from Boston to Brisbane, to Brazil who are pushing this field forward, and as a result seeing legitimate improvements in sleep and breathing issues in their patients (Often this is the first thing to improve after tongue-tie release).
We would love to hear from more of you, so that we can learn from your experiences as well.
It has been said that curiosity killed the cat, but in reality it's often a lack of curiosity that kills (or fails to help) patients. How are new approaches to anything tested if no one ever conducts the research required to fully determine efficacy?
At The Breathe Institute, we whole-heartedly believe that:
We wouldn’t ask anyone to just take our word for it. In that light, we are happy to here share a link to a collection of some of our patient testimonials and we very much look forward to releasing the findings of our ongoing study for you, the good readers of this post to review for yourselves and make up your own minds. Meanwhile we at The Breathe Institute shall continue to work diligently at treating our wonderful patients, and finishing our research publications.
We will continue to do what we can to propel the research forward, building upon the work of Dr. Christian Guilleminault whose research has been cited well over 51,800 times, as well as other leaders from Europe, Brazil and the US who are dedicating so much of their time, energy and ability to the field of myofunctional therapy. We will always strive to be patient-centered in that pursuit, even if it means questioning or venturing outside the warmth of the status quo. We can not refute the wonderful results we are seeing in our practice - especially as we continue to get thank you card after thank you card from patients and families whose lives are being positively impacted and changed for the better.
At one point in history the majority of people were calling Galileo a heretic for having the audacity to suggest that indeed the Earth might be round. Today it seems a small number of others, seem disinclined to consider that perhaps, there could be something they don't know. Perhaps out of genuine concern for patients, or perhaps out of fear that if patients realize there may be an alternative to highly invasive surgery in some cases, they might choose to explore a more conservative treatment approach first. While some practitioners who claim to be innovators are balking at anyone who suggests more tolerable and accessible alternatives to the methods they've been proselytizing for years (entire careers in some cases), we always reserve the right to get smarter.
We now have experience and data from 350+ cases to support specifically our functional approach to treatment of sleep and breathing issues as helpful adjuncts and honestly are honored to be singled out and identified as pioneers and leaders in this approach. Furthermore we are grateful for the continued requests from many outstanding institutions, organizations and practitioners for us to lecture, teach and share our methodologies and protocols worldwide. As awareness is rapidly spreading about the benefits of our functional approaches to frenuloplasty and sleep medicine, we are seeing our own in-house courses in Los Angeles filling up as well. This is surely an indicator that the zeitgeist is on the side of health and progress.
A series of research publications on our experiences will be available soon. For more information, please do not hesitate to reach out to us at anytime. We do hope that our research will plant the seeds of a more positive, curious and collaborative perspective moving forward.
What is needed now is a united front, pushing for awareness and undertaking investigative studies to give us more tools to use in helping all of our patients better!
We want to hear from you:
Child development and craniosacral therapists who understand the importance of establishing nasal breathing, a normal swallowing pattern, and an adequate tongue position in growing children. the interaction between orofacial structural growth and muscle activity starts early in development, and the physiologic functions of suction, mastication, swallowing and nasal breathing in infancy play an important role in developing healthy oral habits and craniofacial development, and in stimulating subsequent growth.
Dentists who understand how low tongue resting posture causes the maxilla not to fully develop from the oral habit of resting the tongue on the floor of the mouth (rather than the palate), as well as causing improper deglutination/swallow habits. Narrow palatal vaults restrict the airway, and left untreated lead to sleep disordered breathing symptoms.
Myofunctional therapists and speech and language pathologists (SLP’s) who understand that a low tongue position can contribute to improper muscle functioning and that Increased labial muscle tone, proper positioning of the tongue on the anterior palate, and labial seal at rest contributed to the development of nasal breathing.
ENT’s and Sleep MD’s who are treating patients in a myriad of ways and understand that myofunctional therapists can be a great ally in identifying and treating patients that may have not otherwise been referred to an ENT due to obstructions present in breathing.
In the words of Thomas Jefferson, “Be bold in the pursuit of knowledge, never fearing to follow truth and reason to whatever results they lead.”
It has been estimated that over 20 million Americans suffer from nasal airway obstruction (NAO). This is actually a bigger issue, than most people realize. Approximately 70% of the air that we take into our lungs comes in through the nose. So one can easily imagine how blockages of the nasal cavity can lead to numerous more serious health consequences down the road.
Sinus blockages are never fun, and can develop for a number of reasons. The root causes can be anything from irritated nasal tissues to excess mucus production in response to an allergen, virus or bacteria.
If you are suffering from chronic nasal congestion and/or problematic snoring, you could be at risk for a potentially life threatening condition that is characterized by numerous intermittent periods of interrupted breathing due to obstruction. This condition is known as obstructive sleep apnea (OSA),
Some common factors that can contribute to nasal obstruction and congestion are:
Nasal obstruction and congestion can be a significant contributors to impaired sleep, snoring, and other sleep disordered breathing. Nasal based snoring is typically caused by nasal stuffiness or collapsing nostrils.
The human body is designed to breathe through the nose. When nasal breathing is interrupted by congestion, the body forces you to begin mouth breathing, which is a less than optimal way to pass air into the lungs. Mouth breathing creates more negative pressure (vibrating) behind the soft palate and uvula, which can result in snoring during sleep. Allergies and nasal congestion are both considered to be a primary causes of snoring and impaired sleep.
In a study that was conducted by the University of Wisconsin Sleep and Respiratory Research Group, it was found that nasal obstruction leads to increases in sleep disordered breathing events, such as snoring, apneas (suspensions in breathing), and hypopneas (episodes of extremely shallow breathing). Study participants with nighttime rhinitis (irritation and inflammation of the mucous membrane inside the nose) reported more:
Other risks of impaired sleep due to nasal congestion include:
Alleviating nasal obstruction can also occur with decongestant, allergy, and nasal spray medications, but if there's not much improvement, one can consider surgical options if there are anatomic factors present.
In-office treatments provided for nasal obstruction
Since the formation of the Breathe Institute in early 2017, more than 350 patients of all ages have been treated for varying classes of ankyloglossia (tongue-tie/lip-tie) and are experiencing terrific results.
In response to the overwhelming number of requests (domestically and internationally) coming in for speaking engagements, courses and lectures on our protocols, we are excited to introduce our 2018 Course Curriculum.
1. A Functional Approach To Frenuloplasty, which covers:
2. A Functional Approach To Sleep Medicine, focused on:
The purpose of these course offerings is to give other professionals in the field the skills and tools they need to most effectively help their patients experiencing airway issues, sleep apnea, snoring, tongue-ties, and lip-ties, as well as other airway obstructions and sleep disorders.
With a patient centered approach, and a precision focused diagniostic regimen, these conditions can be addressed and treated for the betterment of our patients and our practices.
Dr. Zaghi and Sanda Valcu-Pinkerton will review and demonstrate Step by step surgical technique (scalpel and scissors and myofunctional therapy) will be presented with both infant and adults (different procedures for both) for surgical revision of ankyloglossia.
The objective of this course is to improve the outcomes of tongue-tie release surgery through group discussion and demonstration. Live surgical demonstrations will be performed.
We thank you in advance for your curiosity and are available to speak directly at 310.579.9710 if you have any questions.
We are thrilled to announce the newest member of the Breathe Institute team; Dr. Chelsea Pinto. Dr. Pinto is a skilled dentist and infant tongue-tie specialist. She provides a great blend of top-notch clinical education and knowledge with a strong passion for providing community-based care. As a member of the International Affiliation of Tongue Tie Professionals, Dr. Pinto proudly offers a comprehensive approach in her treatment modality, including myofascial and myofunctional therapy and breastfeeding support to best address tongue function and its impact on the rest of the body.
After graduating as a Doctor of Dental Surgery from USC’s Herman Ostrow School of Dentistry, Dr. Pinto furthered her dental education by completing the LAC + USC General Practice Residency program in Los Angeles.
Dr. Pinto began her fascination with the airway and the role that proper breathing plays in overall health. Since then she has treated hundreds of patients in the Greater Los Angeles areas.
Dr. Pinto has also been an active member of Big Smiles, a non-profit dental organization that addresses oral health concerns and offers in-school mobile dental care. During her work, she truly discovered her love for working with children. Now, as a mother of her own 6 month old baby, these skills are being honed further.
Since beginning her career in private practice, Dr. Pinto has branched out to specialize in areas of practice that are aligned perfectly with our Modus Operandi here at The Breathe Institute. Dr. Pinto has an uncanny way with infants and children, and much of her focus here will be related to infant tongue tie releases.
The infant frenectomy is a straightforward outpatient procedure that can be completed during the same visit as the initial assessment. If a release is recommended by Dr. Pinto, the treatment takes only a few minutes and a baby can go to the breast immediately following.
We are fortunate to have such a thoughtful, insightful, and caring practitioner join our team, and look forward to many years of healing our community together!
For more information on our practice or to schedule an appointment with Dr. Chelsea Pinto, please contact 310-579-9710.