Class III and concerns

Hello Sandra,  I first wrote to you last year when I was inquiring about one of your seminars. In the past, I have treated one adult and two children by adapting the protocol created by Daniel Garliner (The Deviate Swallow, A Functional Approach, 1964),  as well as using information from other sources including the guidelines and information provided in the 1996 ASHA publication and video Orofacial Myology: Beyond Tongue Thrust (which, sadly is not longer available!) In my ongoing quest to find new information regarding orofacial myology, I found you and your website, and purchased your MyoManual last year. I still want to attend your seminar, but in the meantime,  I currently  have a 7-year-old male client in the public schools (I am contracting) who presents with visually distracting forward movement of the tongue upon speaking (affects sibilant sounds both visually and acoustically and alveolar sounds (t,d,n) visually). It also appears he has forward tongue movement while swallowing. He holds a drink with both hands, tilts his head down to greet the cup, and tips his head back to drink. He cannot trap water in his mouth using his tongue.  I am used to seeing open bites on clients who present this way; this boy, however, has an underbite.   I am assuming that this underbite is not related to tongue thrusting but a separate issue. I would love your thoughts on this!  Thank you so much in advance,

Hi, I have been away teaching a course, attending a convention, exhibiting, and going to two sets of board meetings.  Please accept my apology for not getting back with you until today. We do get into greater detail in our course about how to determine whether someone is a candidate for orofacial myology, whether we should institute certain exercises and then wait, whether orthodontics is needed prior to or in conjunction with therapy, etc.  Many times, someone with a CLASS III occlusion (which you referred to as his “underbite”) must receive either orthodontic intervention or even surgery if our treatment is to be needed or helpful.  There are usually some things that can be done in the mean time, but each case is different.  Sometimes it is possible to address mouth breathing or open mouth posture, for example.  Other times, it is unfair to ask the client to attempt to close the mouth or place the tongue in the “desired” position.  If the forward mandible is that way because of a structural condition (as opposed to merely carrying the jaw forward for a functional reason), then it might be expected to see his tongue forward in order to produce certain sounds since his mandible is carrying his tongue naturally into that resting position; then that is where his sounds will naturally begin and end.  In this case, it would not be fair to ask him to move his tongue back. I know this isn’t as thorough an answer as you would like, but it cannot be given a simple response because of these above possibilities and issues that might be related to his symptoms.  You seem very astute and concerned…..I hope you can come to take a course and challenge me further!!! My best, Sandra