Myofunctional Therapy

If we accept that we are the result of the interaction between our genetic material and our environment — and that among the most important environmental factors for the teeth and jawbones are the more than 20 pairs of muscles around them — then I believe orthodontics and dentistry should start with the muscles. In my everyday practice, they are the factor most often ignored. In recent years I have turned my attention to this subject, and I have been glad to see treatments evolve better for it.

What can myofunctional therapy do?

What is myofunctional therapy?

In our field it is a complex process that leads to dental and facial change. It can be a simple re-education of muscle behaviour, or re-education combined with a myofunctional appliance.

Unfortunately, doctors often assume that a myofunctional appliance also does the re-education. The appliance only provides an environment in which re-education may or may not happen — which is where the inconsistent results come from.

This material is meant as a guide to the muscle re-education component. A patient can apply it alone, but ideally it is done under medical guidance.

When do we use our muscles?

1. Swallowing
2. Chewing
3. Speech
4. Passive/Subconscious
   • Relaxed — what are my muscles doing while I scroll through social media?
   • Under stress or concentration

Swallowing

The tongue has three parts that can move independently in the three planes of space.

The Right Way to Swallow The tip of the tongue rests on the palate, on the gum, just above the upper teeth. Swallowing starts with the lips in contact and the teeth in contact. The tongue presses on the roof of the mouth, behind the upper teeth, touching them only very lightly. The middle part of the tongue touches the palate. The back of the tongue touches the palate. The lips do not move or tremble during swallowing.

Chewing

I believe chewing does not need re-education in itself: it re-educates itself automatically, following the occlusal relationships obtained through dental and/or orthodontic treatment.

Speech

It is very important to find a speech therapist interested in investigating how speech is executed, not just how it sounds. A ventriloquist can speak in his own voice without moving his lips — so the fact that it "sounds" right does not mean it is "executed" right.

Passive

Passive, relaxed
- while watching TV -

The Correct Resting Position
Lips in contact Teeth slightly apart The tip of the tongue in light contact with the palate, just above the upper incisors The rest of the tongue in gentle suction against the palate

Passive, under stress or concentration

Under stress, or when concentrating, some people bite their nails or tap their feet.

In our field, patients may chew their lips or cheeks, suck a finger or the tongue, push the tongue in various directions, clench or grind their teeth (bruxism), prop their head on a palm or a fist, or simply hold their mouth twisted in various positions — and I leave the list open, because some of our fellow humans can be downright surprising...

If these behaviours add up to more than 10-15 minutes a day, they can have a significant impact on the teeth and the facial bones.

Just stop doing it. - easier said than done, you will say, and I agree...

This behaviour is the hardest to re-educate. The best advice I have today, to shorten the process: pair the habit with something you dislike, and every time you catch yourself doing it, consciously bring up that unpleasant "something" as well.

About the exercises - They take real time in the first month, until the limbic system learns and automates them. After 24-30 days of repetition you basically only need to start them voluntarily; they then run on their own (like walking or driving) while you do something else.