In our earlier articles, we’ve covered how myofunctional issues can appear in infants and in young children, and today we’re continuing this theme by looking at how such issues can present in older children. During the school years, from five years old up to adolescence, myofunctional issues can appear or worsen and require treatment. We’ll describe some of the symptoms that we commonly find in children of this age so that you can know what to look out for in your child.
When myofunctional issues are present in school age children, there are often clues that have been present throughout their childhood. Sometimes parents will have noticed issues but tolerated them up until this point, or sometimes these issues only become apparent as the child gets older. A typical history of myofunctional issues may include problems with feeding as a baby, picky eating as a young child, thumb or digit sucking, and sleep problems. Sleep problems are particularly serious, and parents may not recognize that their child has been struggling with them – they may think that their child always had a hyperactive personality, for example, and not realize that this behavior could be due to disturbed sleep. Often, once a diagnosis has been made, parents will recognize many of the symptoms from throughout the child’s life.
Growth and development issues
The examination of a school aged child would begin with looking at the growth and development of the face, jaw, and mouth. Even with the mouth closed, a skilled dentist can often look at a face and guess what the teeth are likely to look like. Common issues which you can see in growth and development include an underbite or overcrowding of the teeth, and you can also observe swallowing issues like lateral tongue thrust. The tongue is a very powerful muscle – in fact, it is stronger per inch than any other muscle in the body – and its use shapes the face. Therefore, problems with the tongue can radically change the way that the face looks as it develops. Consider the boy observed by Dr. John Mew (http://mahb.stanford.edu/wp-content/uploads/2015/03/FIG.-5-Gerball-e1425506401545.jpg) who was given a pet gerbil for his birthday which caused him problems breathing through his nose and lead to his developing a long, narrow face with an open mouth and a double chin. These are the changes which can occur in facial development due to myofunctional issues.
Another set of growth problem caused by myofunctional issues which can appear in the teenage years are temporomandibular joint problems. The temporomandibular joints are the two joints of the jaw which are found on either side of the head, and which connect the skull to the jawbone. Problems with this joint can be indicated by the jaw “popping” when it opens. This popping may be painful for the child, but even if it is not painful then it can still cause serious problems as they get older, and may result in chronic pain in adulthood. This is a common issue among those with an overbite or deep bite, as in both cases the incorrect positioning of the jaw means that the temporomandibular joint is shoved into an unnatural position. This puts the disk of the joint, which contains nerve endings, under considerable pressure, causing pain. Other problems can include a displaced disk, or crepidus, where the bones in the joint grind against each other. These are the kind of problems which can be reduced or avoided by starting myofunctional therapy.
A serious effect of incorrect tongue positioning and incorrect swallowing is restriction of the airway. This is assessed by asking the child to stick their tongue out and say “ahh”, and seeing how much of their airway you can see. If the tongue is sitting too far back, then you can’t see much of the airway. Next, you can look at the tonsils. If the tonsils are too big, then can restrict or block the airway, making breathing difficult. Often, if you find enlarged tonsils, you will also find enlarged adenoids, which can further cut off the airway.
Restriction of the airway has many serious consequences. Some children’s airway can be restricted to the size of a drinking straw – imagine trying to breathe through something this narrow, and how much stress it would cause you. This is what happens to the child during the day when they are awake, and it may be even worse at night. This leads to sleep problems like night terrors, bed wetting, frequent waking during the night, difficulty waking up in the morning, and falling asleep during the day. Sleep apnea becomes common at this age, and tongue restriction and low tongue posture are both indicative of apnea problems.
You can also observe changes in the body posture which are due to airway issues. Typical body posture from airway issues will be with the shoulders slightly rolled, and the head sticking out. Finally, an open mouth posture is common in children – if your child always has their mouth open when at rest, this indicates myofunctional issues and will affect facial growth.
Relationship between myofunctional issues and orthodontic work
One common reason which parents seek the advice of a pediatric dentist is if they have noticed that the teeth of their child of 8 or 9 are not straight, and they are concerned that the child may need braces in the future. Myofunctional therapy can be of great use here, as it can correct issues while the child is still growing and prevent them from needing braces in the future. The problem with braces is that they treat the symptom of the problem (crocked teeth) without fixing the underlying cause (incorrect positioning of the tongue and incorrect swallowing). Traditional braces have a very high relapse rate of 90%, so most children’s teeth will return back to bad positioning over time. If myofunctional therapy is begun alongside the use of braces, it can help reduce this relapse rate by fixing the underlying issue.
If you notice that your child’s teeth are growing in a way which you find concerning – they may be too crowded or flared out – then before you opt for braces, consider dealing with the root of the problem through myofunctional therapy. Alternatively, if your child has already had braces but you can see signs of relapse like teeth not fitting together properly, then myofunctional therapy can help prevent this relapse. The earlier that myofunctional therapy can be started, the more good it can do in removing or lessening the need for braces.