Are There Any Specific Guidelines for Identifying Whether the Hard Palate

Founded 2000 Orlando, FL, July 2015 Published Quarterly Welcome to our Summer edition Are there any specific guidelines for identifying of the Orofacial Myology News. whether the hard palate is high-vaulted? Your input has Dr. Mason’s response: When I was a university thumb would require wearing a glove. It is also been incredible professor in speech pathology, I taught the clinical very difficult for the examiner to place his/her and we thank own thumb, with nail down, into the palatal you so very much perspective that the wider the maxillary posterior for contributing dental arch the flatter and lower the palatal vault, vault when positioned in front of the patient. your ideas, suggestions and articles. while the narrower the upper dental arch, the Although the "Rule of Thumb" is a good tool to For those of us who have several higher the hard palatal vault. Also, the narrower use to determine if the patient has a high, narrow children on our caseloads, we meet the posterior maxillary dental arch, the more often palate, the finding of a high vaulted hard palate up with certain challenges along a posterior dental crossbite will be found. has a greater significance and the finding should with the summer sun: our clients go off to camp, on family vacations, or In orofacial examinations, there is a “Rule of serve a larger purpose. A high, narrow hard on extended stays with grandpar- Thumb” that can be used in assessing the hard palatal vault should be considered by OMTs as a ents. Do not despair! is obstacle palate. The recommended procedure is as "red flag" to check for a dental crossbite, can be overcome. is is how I did follows: The patient is instructed to put his/her especially a posterior crossbite. If a crossbite is it….I created “doable” lessons for thumb up into the palatal vault. It is best to identified, a referral to a dentist is needed. Any vacations to hold them at their guide the patient's thumb into the mouth and crossbite that is identified may signal a possible current level of achievement. For up against the palate since most children will need for maxillary dental arch expansion. example: “See how many other barely insert the thumb into the mouth when With experience, you will be able to subjec- campers you can find who chew instructed to do so. After placing the thumb tively determine whether a palatal vault is with their mouths open.” Or “ink correctly, ask the patient to close the lips narrow and heightened just by looking at a about your tongue placement while patient's hard palate. You will also become singing camp songs.” One 16 year around the thumb. Then, gently rock the old CIT/counselor in training, was thumb from side to side so the patient can feel proficient at identifying dental crossbites. permitted to send me an email each if the thumb "fits". Finally, instruct the patient These skills will become ingrained habits in clinical observations and will serve you well. evening to report on how she was to keep the thumb in place and to open his/her doing. Another was directed to mouth slightly so that you can visually inspect suction and swallow correctly while the thumb against the hard palate. A high, narrow hard palatal doing a particular craft project. For vault should be considered family vacations, it is even easier to The patient's thumb will fit comfortably in the by OMTs as a "red flag" to be creative because the parents or hard palatal vault if the vault is normal in check for a dental crossbite. other adults can participate. height and width. If there is not enough room As with all patients, creativity and and the thumb becomes “squeezed” when I remind clinicians that the hard palate grows instilling a self-fulfilling prophesy inserted in the hard palate vault, the palatal and expands according to the V-principle of are keys to success… vault will most likely be high and narrow. growth; that is, the hard palate expands like an upside-down V when viewing it from the oral ank you for reading our Orofa- Using a patient's own thumb is the preferred cavity. As the V widens, the midline flattens in cial Myology News and my best method since patients thumbs are a better size response to the amount of expansion and regards to all of you, for their mouths than adult thumbs. As patients grow, so will their thumbs. Using your own Continue reading this article on page three Sandra 1 Question to Dr. Mason about old, outdated studies “I have heard the claim research value of the Payne Black Light findings from such studies be made that “old” technique was questioned and dismissed early-on, dismissed due to the age of the original CLINICAL PEARLS studies should be many clinicians continue to find value in the Payne technology? What explanation is given when dismissed because of technique as an educational and motivational tool the technology used in classic studies contin- their age and because in therapy. The “button-pull” exercise and the lip ues to be used today in other applications? “old” and “out of force scale used to measure lip resistance/lip Instead of questioning the procedures and date” technology was strength are both clinical tools that were also conclusions of studies applicable to OMDs used in the studies. developed during this time period. Consistent with according to the age of publication, the efforts of This doesn’t sound the claim that old studies and technology should be orofacial myologists would be better spent right to me. I would discarded, should these old but still useful clinical designing and implementing studies of the many appreciate your opinion. technologies be discarded simply because they presumed clinical truths that remain undocu- Thank you”. were developed 50 or so years ago? mented about OMDs and their treatment. The Dr. Mason’s Response: Thank you for asking The oral pressure-transducer technology devel- need for clinical research with OMDs is a major about this rather misguided claim. Those who oped by world-famous physiologist and ortho- deficiency and challenge facing the discipline of would make such a claim should respond to the dontist Dr. William Proffit and colleagues orofacial myology in achieving the goal of wider following questions: elucidated many of the facts underlying the recognition and acceptance. discipline of orofacial myology. The series of On this website under the heading of Dr. Bob’s Would anyone recommend stopping the use of studies that utilized this creative technology were the vaccine for polio developed by Jonas Salk Clinical Pearls are two documents that address subjected to stringent peer-review in convention the dearth of clinical research with OMDs by because he did the research that resulted in the presentations, in editorial reviews prior to publi- vaccine more than 50 years ago? Or, should we USA orofacial myologists. One is: “Gathering cation, and by a committee of the National Clinical Research Data in Orofacial Myology” stop using antibiotics because they were devel- Institute for Dental Research, National Institutes oped many years ago? Of course not. and the other article is: “Suggested Clinical of Health, that provided funding for the research Research Projects in Orofacial Myology”. Also A claim of studies being old and outdated projects. Peer-review provided opportunities for on the website under the heading Myo-Research presumes that there is a "life-span" for the value the technology and study findings to be is an article titled: "Information, Perspectives of a research publication. What criteria would challenged. The studies and technology passed all and Aspirations for New I.A.O.M. Members one use to determine when a study or technol- stringent reviews by dental and speech scientists. and Those Seeking Certification". I hope that all ogy has become too "old" and "out of date"? Is Oral pressure-transducers have more recently orofacial myologists will become conversant it five years, ten years, 20 years, or more? been applied to the study of factors controlling regarding the tenets of the field discussed in the dental eruption. Should this application of article and also detailed in the many publica- What credentials should a person have to qualify tions listed in the reference section. as the arbiter of when a study is outdated and pressure-transducers also be dismissed because when the findings need to be dismissed? I suspect of the time-frame of its original development? Those who would rather criticize the research that those who would make such a claim have not Surface electromyography (EMG) was contributed by dental scientists and others read the classic studies that have defined the employed in my doctoral study in speech according to the age of studies done or technol- many characteristics of OMDs and do not science in 1964 (before most of you were born!) ogy used rather than replicating the studies or adequately understand the technology involved. I Brazilian speech pathologists continue to use conducting other much-needed research, are not also suspect that those who would claim that old this technology to study and quantify many contributing positively to the growth of the field. studies are outdated have not conducted and applications of orofacial myofunctional The original studies that constitute the tenets for published any research of their own and lack therapy. Should we stop reading such research the field of orofacial myology deserve our experience in performing and interpreting clinical reports because the development of the technol- respect, appreciation and full understanding research. The intent here is not to confront ogy precedes the year of birth for all of you? rather than being subjected to ill-conceived individuals who have made such a claim, but criticisms.

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