Have you noticed that some patients tend to have more lunch stuck on their teeth then others?
You know the patient that comes in and apologizes for eating on the way to her appointment. You tell her that it is fine, that you are just glad she had lunch. When she opens her mouth, you are shocked. It appears that the entire bagel is still in her mouth, smashed up against her teeth. How is that possible?
Then there is the 60-year old man that instantly falls asleep when you lean the chair back and starts snoring just as you are going to give him an injection. How about the cute little six-year old girl that has a speech impediment, or the five-year old boy with an overjet and long skinny face with dark circles under his eyes.
You may have thought that the lady with the bagel mouth was just not kind enough to clean up before her appointment, and left you to do it for her. Well, it is very likely that she has an ankylosed tongue that does not allow her tongue to reach up high enough to clean food debris off of her teeth.
It may be obvious to you right away that the 60-year old man is suffering from sleep apnea, but did you know that is could be due to his tongue not being able to reach up to the roof of his mouth. It is literally blocking his airway at night because it rests on the floor of this mouth.
That cute little six-year old girl hasn’t been able to develop proper speech patterns due to a tongue thrust. And you got it, the five-year old boy is a thumb sucker. These are all signs of an Orofacial Myofunctional Disorder (OMD).
HOW TO SCREEN FOR OROFACIAL MYOFUNCTIONAL DISORDERS
Dentists and hygienists are in a prime position to screen for Orofacial Myofunctional Disorders. There are several signs we can screen for to determine if the patient may have a disorder and benefit from seeing a trained therapist. The following are some of the most commons signs:
Upper or Lower Lip Frenum Restriction
Jaw Pain or Clicking/Popping
Ankyloglossia (tongue tie)
Forward Head Posture
Narrow Palate or Crooked Teeth
If you are new to learning about OMT, keep it simple by starting with these five signs and symptoms:
Commonly referred to as “tongue-tie” occurs when the lingual frenulum is too short to allow for normal tongue movements. Best if done with the patient in an upright position. Have the patient open wide and lift his tongue to the roof of his mouth. Determine is he is able to reach his tongue up to his incisive papilla easily or if he struggles. Then have him stick his tongue straight out, if the tip appears heart shaped, this is a sign that he is tongue tied. The heart shape apex happens when the frenum is short and pulls down the center of the tongue.
Low tongue rest posture
Think mouth breather. When nasal breathing is impaired, the jaw drops and the tongue rests low and forward in the mouth in order to open the airway for breathing. It may be that nasal breathing is not impaired, but mouth breathing has become a habit. Watch for your patients resting position. Is the mouth open? Is he breathing out of his mouth or nose?
Tongue thrust is in which the anterior surface of the tongue makes repeated contact with any of the anterior teeth, or protrudes between the arches. Have the patient swallow for you while you are holding his bottom lip. If he has a tongue thrust he may have a very hard time swallowing. He may need to pull the lower lip out of your hand in order to complete the swallow. In a healthy swallow, the tongue rests in the palate, the teeth come together, and then the person swallows. The facial muscle should not move, so any lip puckering or licking of the lips before swallowing should be warning signs of tongue thrust. Another sign will be an anterior open bite.
When you place a patient in the supine position and he immediately falls asleep and starts to snore, this is a sign that he may have sleep apnea or other conditions keeping him up at night. Luckily for us trying to get work done, this does not happen very often. In most cases you will need to question the patient. You will often get the response of “my wife tells me I snore, but I don’t know”. If nothing else, this is an opportunity for them to become mindful of possible snoring and to question their spouse or use a sleeping app to record their sleeping patterns and sounds. Referring the patient to have a sleep study or consult with his medical doctor is a good place to start.
Although there are adults that suck their thumb, odds are that most of your thumb sucking patients will be children. It may be an easy screening if you see the child suck his thumb, but often they will not do it in public and you will have to look for signs and question the parents. Look for an anterior open bite and a swollen nub on the patients thumb or fingers. One reason a child may suck his thumb at night is to help open his airway so he can breathe. If he has a tongue tie he may be using a digit to press the tongue down out of the way. Resting the tongue on the incisive papilla area is also soothing and if his habit is hold the tongue down, he is missing out on this natural soothing technique. OMT specialists have ways to help break the child of this habit and can help with underlying causes.
WHAT IS OROFACIAL MYOFUNCTIONAL THERAPY
Orofacial Myofunctional Therapy (OMT) is the neuromuscular re-education or re-patterning of the oral and facial muscles. It is the establishment of correct functional activities of the tongue, lips and jaw, so that normal growth and development may progress in a stable, homeostatic environment. OMT specialists obtain training in this field in order to work with patients to correct disorders that are affecting their well-being. Think physical therapy for the mouth.
HOW TO BECOME A TRAINED OROLFACIAL MYOFUNCTIONAL THERAPIST
Orofacial Myofunctional Therapists include dentists, dental hygienists, speech pathologists and occupational therapists. Although OMT may be in the scope of our license, further training is required in order to properly treat patients. Training opportunities for those interested in learning more about Myofunctional Therapy include private mentoring from a current Myofunctional Therapist, courses through academies or associations, or information learned within the educational curriculum.
Proper treatment of OMD’s require a collaboration of dental and medical professionals. By being aware of the signs for these disorders, you are able to provide a screening for potential issues and refer them to seek treatment with a trained OMT. When you become aware of OMD’s you will start to see them everywhere- maybe even in the mirror.
International Association of Orofacial Myology- www.iaom.com
Academy of Orofacial Myofunctional Therapy- www.aomtinfo.org
Academy of Applied Myofunctional Sciences- www.aamsinfo.org
American Speech-Language-Hearing Association- www.asha.org
Cindy Rogers, RDH, BS, OMT is the lead hygiene advisor for Dental Practice Solutions. She started in dentistry as the front desk girl in 1998, and has since been a business leader, dental hygienist, writer and untiring advocate of Orofacial Myofunctional Therapy.