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Myo Articles & Papers

Sleep Disordered Breathing

& Obstructive Sleep Apnea

LeighAnne D'Avanzo, RDH, QOM

Zohara Nguyen, CCC-SLP, QOM

An architectural perspective can enhance our observations and descriptions of the hard palate during an orofacial myology evaluation.

Sandra Holtzman, MS, CCC-SLP, QOM

While most of us know that the term “tongue thrust” is antiquated and does not describe an orofacial myological (myofunctional) disorder, we continue to see that term used.

Dr. Karen Wuertz, DDS, QOM

What criteria is considered for insurance companies to cover frenectomies, and is it billed as medical or dental?

More Myo Articles

The following papers are provided so that professionals can consider the various factors involved when making decisions about assessments and treatment for their clients. Neo-Health Services does not necessarily endorse everything included in the papers.

Question When my 2 yr old had her adenoids and 2nd set of tubes done last July it was discovered that she has a "bifid uvula consistent with a submucous cleft palate." Her speech regressed extensively after the surgery but I was told to "wait and see".

The modern oral and maxillofacial surgeon has the capability of surgically placing the jaws in virtually any new position. Individual who suffer functionally or cosmetically from skeletal dysplasia (abnormality of development) can benefit from surgery on the upper or lower jaw or both.

This article addresses many myths that have persisted over the years in dentistry and orofacial myology regarding the nature of orofacial myofunctional disorders (OMD’s). Myths include 1) the concept that the term “tongue thrusting” includes the rest posture; 2) that there is an excessive amount of pressure exerted against the anterior teeth in swallows, that swallowing pressures add up, and the frequency of swallowing has an impact on the dentition; 3) the idea that the tongue is the strongest muscle in the body; 4) the view that a muscle will be the winner in any tug of war between muscle and bone; 5) the claim that a tongue thrust can cause an open bite malocclusion; 6) the claim that a tongue thrust can cause a Class II malocclusion; 7) the claim that the tongue molds the palatal vault; 8) the notion that a low tongue tip posture at rest presents a problem; and 9) the claim that OMD’s represent a muscle imbalance that can be brought into balance with therapy. Each of these false claims or “myths” is discussed and corrected, with the positive acknowledgement that clinicians are abandoning the incorrect notion of muscle balance and imbalance as had been claimed previously.

The purpose of this editorial is to alert otolaryngologists to Orofacial Myofunctional Disorders (OMDs) and their primary causes of airway interferences including allergies. An understanding of the variety of OMDs should facilitate improved communications between otolaryngologists and orofacial myologists.

BACKGROUND: If you have some free time and want to have some fun, try Googling chewing pattern. You will find a variety of opinions, study methods, and conclusions that will affirm almost any idea you may have about chewing. If you feel that children chew in a different manner from adults, or not, both conclusions can be easily found. It will become quickly obvious to you that the physiology of mastication has been a topic of considerable dispute.

X-Ray films of the head and neck (roentgencephalograms) have been used for over fifty years in clinical practice in medicine, dentistry, and to some extent in spech pathology. Cephalometrics x-ray films provide a means of evaluating the interrelationship of cranial, facial, and pharyngeal structures either on s longitudinal or serial basis.

This document responds to questions from an orofacial myologist about how to collect data in orofacial myology for clinical research with orofacial myofunctional disorders (OMDs).

Like most other specialty areas, orthodontics has a rich special literature containing disagreement and debate on a number of topics. One are of controversy since the inception of orthodontics in the late 1800s is the relationship between tongue functions and the development of malocclusion.

The goal of this study was to verify the prevalence of nutritive (breast-feeding and bottle-feeding) and non-nutritive (pacifier) sucking habits, the methods used to eliminate them, and success of these methods.

The buccal corridor is the area of darkappearance space, both horizontally and vertically, that can be found between the inside of the lip commissure (the outer/lateral margin of the lips), and the outside (buccal area) of the posterior dental arches.

Non-nutritive sucking habits may adversely affect the orofacial complex. This systematic literature review aimed to find scientific evidence on the effect of pacifier sucking on orofacial structures.

Although the growth cycles of the adenoid mass and faucial tonsils are similar, one cannot accurately evaluate the size of the tonsils and presume that adenoid size follows the same pattern of growth and involution for that individual.

We have a very interested ENT in our town who is on board with OFM and wanting to help our patients. He asked me an interesting question the other day and I told him I would seek some information for him. He has an 8 year old patient that has velopharyngeal insufficiency and also has Eustachian tube dysfunction. He was wondering if there are any palatal exercises for the Eustachian tube dysfunction. What do you think??? Is there such a thing?

The following description of tongue thrusting and tongue rest posture is intended to be copied by clinicians and used as needed with patients, parents, or colleagues. You have my permission to copy and use this document as you see fit. If you have a need for additional information and data to support the claims made here, please go to www.OrofacialMyology.INFO, and under the heading "Myo-Research" find the article: For Dentists and Physicians. ~ Dr. Mason

Question from a clinician: Dr. Mason - I have heard many clinicians say that the tongue shapes the hard palate. It seems logical to me that the tongue plays an important role in the development and shape of the hard palate and maxillary dental arch. Is this true? Am I wrong? Will you please verify this?

A clinical procedure for evaluating the dental freeway space is needed. This need presents an opportunity for interdisciplinary collaboration and cooperation.

Nasal polyps are greyish masses of tissue that resemble a bunch of grapes. They are generally multiple, nearly always bilateral (anteriorly only), and produce nasal blockage by restricting the nasal airway. Anterior nasal polyps are easily seen with anterior rhinoscopy and may even be seen at the nostril. Less frequently, and more related to OMDs, they may occupy the posterior choanae (the posterior entrance to the nasal cavity). In this location, they are more commonly large, single and unilateral.

A perspective related to how dental eruption might be affected by an orofacial myofunctional disorder can be appreciated and understood if one first distinguishes between: 1) A functional orofacial myofunctional disorder; and 2) a postural orofacial myofunctional disorder.

Some patients who claim that they are not able to breathe freely through the nose experience a dramatic opening of the airway when the liminal valve is surgically widened.

This informational report is intended to provide information about the field of orofacial myology and treatment issues of interest to dental professionals, orofacial myologists, speech language-pathologists and other health professionals.

Informacion sobre miología orofacial y actualización de algunos diagnósticos y temas de tratamiento de posible interés.

Dr. Mason’s response: When I was a university professor in speech pathology, I taught the clinical perspective that the wider the maxillary posterior dental arch the flatter and lower the palatal vault, while the narrower the upper dental arch, the higher the hard palatal vault. Also, the narrower the posterior maxillary dental arch, the more often a posterior dental crossbite will be found.

This informational memo is intended to inform you of current clinical practice guidelines regarding the factors involved in the decision to perform a tonsillectomy in children along with, in some instances, an accompanying adenoidectomy. The Foundation of the American Academy of Otolaryngology – Head and Neck Surgery, issued the guidelines shown below, which were published on January 3, 2011, on the website Medscape Medical News. Medscape is a leading online destination and is part of WebMD that healthcare professionals can go to for timely and trusted medical information that provides support for them at the point-of-care.

The procedure used by some orofacial myologists of lightly taping the lips to help stabilize a lips together rest posture is discussed. Since airway needs change during sleep, this technique could result in harm to patients, and should be discouraged. A minimum prerequisite for use of lip taping, even during the daytime, is clearance from a physician that the patient’s airway is clear and can tolerate this procedure without fear of creating medical problems.

The purpose of this report is to share background information about the complex nature of abnormalities associated with Down syndrome, and to offer clinical guidelines that may help orofacial myologists determine whether or not to treat individuals with Down syndrome.

The term lip incompetence is a poor descriptive term that should be changed. The chances of this label being changed, however, appear to be slim to none. At present, lip incompetence remains a universally-used term in dentistry and medicine to describe individuals who can close their lips together but are unable to achieve a relaxed, consistent, lips-together rest posture. The lips remain open, with some upper front teeth (maxillary incisors) showing. Why this is described as incompetence is a mystery.

Opinions about a possible role for orofacial myologists in providing services for sleep apnea and other sleep-related conditions. As most orofacial myologists know, professionals from a variety of fields have begun to solicit the services of orofacial myologists in the treatment of sleep apnea.

Colleagues: The American Association for Dental Research has recently (March 3, 2010) revised its policy statement regarding temporomandibular disorders. A new standard of care for TMDs has been approved. This policy statement regarding TMDs has implications for orofacial myologists who may wish to participate in treatment protocols for TMDs. The policy statement is provided here, followed by information, guidelines and recommendations

Clinicians aspiring to a career in the area of orofacial myology have a desire and need to assimilate dental terminology and concepts pertinent to the discipline. Many dental/orthodontic concepts and terms are not easily located in the dental literature. Our purpose here is to provide useful selected dental information for myofunctional clinicians that can aid in communicating evaluation findings to dental personnel. The selected topics will be presented in a question and answer format.

Most professional groups have a particular vernacular that permits effective and rapid communication among members. In clinical report writing, it is easy to forget that when information is transmitted outside of the group to parents or other professionals, the private vernacular and abbreviations acceptable among group members are not always understood or appreciated by those outside of the group. With a goal of clarifying terminology in the clinical reports of speech-language pathologists and orofacial myologists, some examples of potentially confusing terms often used will be discussed.

While much appropriate attention has been directed toward the evaluation and treatment of tongue-tie, the labial frenum can also become problematic and may need to be released. Although there are normally several labial-gingival frenulae around the upper and lower labial and buccal vestibules, the midline maxillary and mandibular frenums are the ones that can become problematic.

Treating children with lip incompetency raises several questions that should be asked and answered: 1) Since the growth of the lips continues up to age 17, and since lip competency should be expected around age 13 (Vig and Cohen, 1979), on what basis should therapy be offered, or declined, for those children under age 13, or even up to age 17? 2) How can clinicians who provide lip exercises for children determine whether the gains achieved in lip length are related to the therapy provided or to spontaneous lip growth? and 3) What morphological factors can account for lip incompetence?

Concerns about the inclusion of the terms “low muscle tone” and improving muscle "tone" in the reports and discussions of many orofacial myofunctional clinicians. Descriptions of "muscle tone” are out of place in orofacial myology. Here is why:

The consequence of a freeway space open beyond the normal range for 6 or more hours per day due to airway interferences or allergies can result in changes to the dentition that can take three basic forms:...

Question for Dr. Mason: When an adult individual has an interdental tongue rest posture with the mandible hinged open beyond the normal vertical dimension (freeway space), why isn’t the root structure of erupting teeth exposed?

On occasion, myofascial release has been mistakenly considered part of orofacial myology treatment. Since this procedure is a physical therapy technique, it is not appropriate for use by non-physical therapists.

Dr. Bob: I have a question for you regarding a statement made by a referring orthodontist regarding a 16 year old female patient. The patient originally underwent orthodontic treatment (completed at age 14) which included palatal expansion, corrected posterior crossbite/crowding and extraction of four 1st bicuspid teeth to level and align teeth and close her anterior openbite. Approximately one year following treatment, the patient's anterior openbite reopened 1 - 2 mm and has continued to worsen. The patient's original orthodontist felt that the anterior open bite relapsed largely due to the steep angle of her mandible and strong skeletal openbite tendency in addition to continued jaw growth of the mandible. Both the original and referring (current) orthodontists do recognize the presence of an abnormal tongue habit/lip incompetence. Airway issues were suspected and have recently been evaluated and are currently being managed.

When a dentist or orthodontist refers a patient with the complaint that tongue thrusting is causing dental relapse after the completion of orthodontic treatment, how can orofacial myofunctional clinicians respond appropriately to this referral complaint?

Protrusion of the tongue is normally seen in infants and can persist for many years past infancy as a habit pattern.

Most professional groups have a particular vernacular that permits effective and rapid communication among members. In clinical report writing, it is easy to forget that when information is transmitted outside of the group to parents or other professionals, the private vernacular and abbreviations acceptable among group members are not always understood or appreciated by those outside of the group. With a goal of clarifying terminology in the clinical reports of speech-language pathologists and orofacial myologists, some examples of potentially confusing terms often used will be discussed.

How to handle patients after the braces come off. In this article Robert N. Pickron, DDS talks about his 43 years of experience and his personal treatment of a multitude of patients, and how they taught him more than a few lessons. In addition, his role as owner/manager of a multi-doctor practice with more than 3,000 finishes per year gives him a lot of insight on what is working and what is not.

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