Can we do Myo Treatment while people are in expansion, in braces, or in Invisalign?

This common and relevant question has three different parts to it. I’ll touch upon each one generally (while there are exceptions to every rule, this information covers usual situations related to expansion, braces and Invisalign).

Expansion: The main reason for expansion is that the palate is too narrow for the tongue to fit within the palatal arch. This information should be examined during a full Orofacial Myological evaluation. If the tongue is overlapping moderately to excessively and the arch is more V-shaped, it will be necessary to expand before starting therapy. On the other hand, if the tongue can fit with slight overlap during suction, and you believe that within a few additional sessions the tongue will fit adequately, then therapy can begin. Usually, the client will be in expansion for about 6 months creating changes in the oral structures. This can compromise the quality of Myo treatment. There may be exceptions on occasion. For example, if the client has an open lips rest posture, but has a patent airway (nose breather) and no labial frenum restrictions, you may assign some appropriate lip exercises. In short, the answer is not to do treatment during expansion (with the rare exception of certain lip exercises when necessary). Wait!

Braces: It’s best to complete Myo therapy prior to placing braces. If therapy is completed prior to braces, it will reduce the wearing time since the tongue, lips and mandible will be in their correct rest postures. Of course, this is dependent upon the form/structures. If a Myo client comes to you with braces already on, and the form of the palate is not an issue, by all means proceed with treatment. If the client’s braces have been removed, absolutely work with the client as the probability of orthodontic relapse is highly likely. This is an excellent reason for an orthodontist to have an Orofacial Myologist as part of their adjunct team!

Invisalign: If your client is wearing Invisalign, it is quite possible to work with them in therapy with some considerations. Do check behind the maxillary arch to see if the tongue can touch the Spot (distal of the incisive papilla). If the Invisalign is slightly covering it, the orthodontist/DDS can shave it down, allowing the client to place the tongue to spot and rest the body of the tongue on the palate. Of course, they might not be able to create the same suction with it in as they can when it is out. As you can see, there are no simple answers!