Today, I want to give you some basic information about myofunctional therapy, a perspective which underlies our treatment plans at Kidstown Dental. Myofunctional therapy is a minimally invasive, holistic approach to treating children in the dental office. This post will provide historical information, a broader context, and hopefully get you excited about what myofunctional therapy can do!
Before the Industrial Revolution, or only 200-300 years ago, our diet, eating patterns and habits were much different. All babies breastfed, as there were no bottles or pacifiers. There was no such thing as baby food or pureed foods. Children were started on whole foods (though some foods would be pre-chewed). We ate such fibrous diets that our molars were ground flat by age 40. The forces created by breastfeeding, whole foods, and fibrous diets directed our jaw growth, so we could fit all of our teeth into our mouths — even our wisdom teeth. Best of all, due to all of these factors, hardly anyone needed braces or fillings!
The dietary shifts that came with the Industrial Revolution have caused a series of epigenetic changes in our jaws, teeth alignment, airway development and face shape. Significant dietary changes include the introduction of processed foods and bottled milk.
In the early 1900s, only 5% of babies were born in hospitals, and a majority of births were still attended by midwives. Midwives used to evaluate the latch of the newborn on it’s mother’s breast, and, if the tongue or lip were found to be restricted, they would use a sharp instrument or even a sharpened fingernail to release the restriction so breastfeeding could be assured. Prior to bottled milk, if a baby couldn’t breastfeed, they would not survive. (How I would love to have my OB, lactation consultant, pediatric dentist and ENT all wrapped up in the person attending my child’s birth today!)
Widespread Myofunctional Problems
Following these dietary and social changes, most people’s mouths today are deficient in anterior¬-posterior growth (from the back of your head forwards) and transverse growth (from cheekbone to cheekbone). This has created an epidemic of things like “long face syndrome,” and “gummy smiles” — especially in the younger generation.
Sometimes parents bring in their child and say something like, “Allergic shiners run in our family!” What I see as a pediatric dentist trained in myofunctional concepts is that the child has mid¬face deficiency. What those “allergic shiners” represent is a lack of growth. His cheek bone area hasn’t grown forward enough, and instead his upper jaw has grown in a downward and backward pattern. Everyone has venous pooling under their eyes to some extent, but it’s much more evident when you have this midface growth deficiency.
Myofunctional difficulties start in early childhood. If babies are not able to breastfeed properly, they are often incapable of swallowing correctly. The poor swallow leads to more problems as the child grows. Parents typically describe children like these as picky eaters or as gagging easily, when the truth is that they cannot move the food correctly “down the hatch.” These are myofunctional issues.
If we don’t jump in and correct things, the next problem that often occurs is speech difficulties around the age of 2. By the age of 5, 75% of children in the US already display signs of malocclusion (misalignment of the teeth) and future orthodontic issues. The longer children go without treatment, the worse things get. By the age of 14, 90% of facial growth is finished. Though orthodontics can still often make the teeth look straight, it cannot significantly change the shape of the face.
Structural treatments vs functional treatments
There are two schools of thought in orthodontics: structural and functional. When orthodontics first started, a little over 100 years ago, dentists used structural devices like orthodontic appliances, as well as incorporating functional therapies to help restore form and function. Over time, structural devices like braces have become more sophisticated. Orthodontics are really good at moving teeth around and making them look great. However, as a mentor of mine once said, braces are like hanging curtains. They make things look pretty — but they don’t deal with the foundational issues.
Problems with structural methods used alone
A 20-year study of 900 patients at the University of Washington has shown that structural treatments alone have a 90% relapse rate. This means that 9 out of 10 people are going to relapse to some degree, after completing and paying for braces.
The way that the dental orthodoxy has addressed this issue is by making lifetime retainers the standard of care. If you lose your retainer and return to your dentist later, you’ll have to pay for braces all over again, which seems a bit counter¬intuitive.
Worse, comparing before and after orthodontic treatment, cephalometric X¬-rays (side view of skull) shows that often patients have a diminished airway capacity after treatment. How does this affect the person? Imagine breathing through a large straw versus breathing through a cocktail straw — you’d notice the stress on your body after as little as 5 minutes.
In adulthood, these airway restrictions show up in so many different ways. In adults they are associated with cardiovascular disease, sleep problems, chronic fatigue syndrome, and much more. In children who have airway diminishment the most significant problem is sleep issues which are highly correlated with behavioral problems and cognitive delay over time. I often see parents who have suffered from these issues themselves and do not want their children to have the same experience.
Myofunctional Therapy in Practice
“Form follows function” is a common phrase you may have heard. Put more simply: if you exercise, you will be able to see the physical effects of your actions on your body.
So how is this related to teeth? In a growing child, what they do with their mouth will determine how their teeth, face, jaws and most importantly airway grow. Myo means muscle, so the term myofunctional describes muscle function of the oral structures. Myofunctional therapy is looking at poor muscle function and correcting it. The younger it is corrected, the less problems later in life.
Myofunctional therapy seeks to prevent or repair the issues of diminished airway, poor facial growth patterns and improperly aligned teeth by addressing the underlying etiological issues. In other words, myofunctional therapy is aimed at the cause rather than symptom management. It is best defined as physical therapy of the oral musculature.
There are 3 primary goals of myofunctional therapy:
- Restore Nasal breathing
- Correct tongue placement at rest
- Correct swallow
The first thing to focus on is nasal breathing. Many children have their lips apart when breathing and breathe through their mouths. Mouth breathing exposes the tonsils and adenoids to dirty air, allergens, and pollutants and initiates a stress response in the nervous system. Open mouth breathing also disrupts the feedback to the upper jaw, leading to the downward, backward growth pattern seen in long-faced children with allergic shiners. Conversely, nasal breathing cleans, warms and humidifies the air and causes a relaxation response. If children can’t breathe through their nose, we may send them to an ENT doctor to get their airway sorted out before we can start with myofunctional therapy.
Secondly, we teach children where their tongue needs to be at rest. It is important that it rests at the top of the mouth, at the point where it resides when most people say “N.” When the tongue rests away from the N¬spot, perhaps at the floor of the mouth or between the teeth, it can lead to different bite issues and problematic facial development patterns. Correct tongue placement is the crux of myofunctional therapy.
The third component is teaching children how to swallow correctly, which begins with the tongue on the N¬spot. As swallowing begins in utero, this normally requires at least a year of neuromuscular repatterning while the brain trains itself to swallow differently.
This is a quick introduction to the basic concepts of myofunctional therapy. I hope it has piqued your interest. In subsequent blog posts, we will break things down into smaller pieces and give more detailed information.