Space for tongue posteriorly

Good morning, Sandra, I have a young lady who has progressed nicely through the program except for one thing-her tongue in the back continues to cover her molars when she is suctioning up. She has worked hard and does all of the exercises well. She can do a beautiful fat tongue/skinny tongue, great “ah” position and bowl nicely inside her teeth everywhere, does water trap swallows well and her tongue is not coming through during ea/drinking swallows. She uses hairdresser tape at night as a cue to keep her mouth closed. She continues to have a small but open bite on the right and less so on the left, both only in the molar area, which tells me that the tongue is probably resting between her teeth in the back, even though not evident during swallows. I asked her to place 2 Neon Elastics in that posterior area on the edge of the tongue and work on suction hold. I also asked her to consciously move her tongue back further into the palatal groove during rest to see if that helps. We talked about stroking/tapping back to front with a coffee straw on the edge to see if that will stimulate a muscle contraction. Do you have any other ideas?? Thanks always, P, Nebraska

Hi P,      I’ll put my thoughts below.  I hope they are helpful.  Let me know.

• Several position papers and informative papers have been introduced over the past several years.  They are all  up on our site, www.OrofacialMyology.com.
  • Among them is a strong message about taping the mouth.  I removed that section from the Myo Manual  many years ago.  Although I taught the proper method and warnings in my courses, I felt it safer to eliminate that section.  There are cases where taping the mouth can be dangerous, such as with apnea patients for example, and some therapists might decide to use a different type of tape, to fasten it tightly, or otherwise put the patient at risk; thus, it is better to use safer reminders such as the breathing adhesive pads on the nasal bridge and other suggestions in the Myo Manual.
• When she places the Neon Exercise Elastics on the posterior borders, can she then get the tongue within the arch?  I haven’t had anyone put the elastics back so far; usually placing several elastics more anteriorly tends to encourage a more correct placement.  Have you used multiple elastics for the exercises calling for elastics, such as the DND, Fruit Loop Swallows, and Goldfish Swallows?  You always use one on the tip, of course.  Then you can line up others on either side, each barely touching the one more anterior to it.  You can also add one more just behind and touchng the one on the tip.
• It might be necessary that expansion or other orthodontic treatment is addressed if you find that this difficulty with the earlier exercise causes problems as you progress.  Do keep in touch and keep me informed of her progress and any challenges that continue forward.