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Orofacial Myofunctional Therapy is an interdisciplinary practice that works with the muscles of the lips, tongue, cheeks and face and their related functions (such as breathing, sucking, chewing, swallowing, and some aspects of speech). It acts in the prevention, evaluation, diagnosis and treatment of people who may have these functions compromised or altered. It can also act in improving facial aesthetics. In this area, the Specialist in Orofacial Myofunctional Therapy can work in partnership with other professionals such as dentists, doctors, physical therapists, occupational therapists, nutritionists, nurses and psychologists. As an emerging field, questions are quite common when we talk about Orofacial Myofunctional Therapy. Below are some answers of frequently asked questions. ON THE FOLLOWING PAGES, WE HAVE COMPILED THE MOST IMPORTANT QUESTIONS AND ANSWERS THAT PEOPLE ASK ABOUT OROFACIAL MYOFUNCTIONAL THERAPY > WHAT IS OROFACIAL MYOFUNCTIONAL THERAPY (OMT)? Orofacial Myofunctional Therapy is neuro- logical re-education exercises to assist the normalization of the developing, or devel- oped, craniofacial structures and function. It is related to the study, research, preven- tion, evaluation, diagnosis and treatment of functional and structural alterations in the region of the mouth (oro), face (facial) and regions of the neck (oropharyngeal area). WHAT IS THE LINK BETWEEN FEEDING AND WHAT ARE THE MAIN PROBLEMS RELATED SPEECH? TO OROFACIAL MYOFUNCTIONAL DISOR- Feeding a child stimulates the orofacial DERS (OMDS)? muscles and this promotes the growth of The main problems related to OMDs are the face. In the same way, proper suction alterations in breathing, sucking, chewing, and chewing prevents dental alterations swallowing and speech, as well the position and difficulties when structures such as the of the lips, tongue (including what is known lips and tongue are moving. This is funda- as oral rest posture), and cheeks. mental in the production of speech sounds. WHY SOME INFANTS HAVE DIFFICULTY SUCKING? WHAT ARE THE ADVANTAGES OF BREAST- Difficulties of sucking in infants may FEEDING? occur due to: lack of sucking reflexes Besides all the nutritional and immunolog- which decrease the suction force, frenulum ical benefits, the practice of breastfeeding restriction, lack of coordination between stimulates the proper functioning of the the actions of sucking, swallowing and structures of the mouth and face. Breast breathing; improper positioning of the feeding strengthens the orofacial muscles mother and /or the baby; absence of sealing of the infant, reducing risk of future prob- (closing) of the lips around the breast nip- lems in important functions such as breath- ple, and inadequate movement of tongue ing, chewing, swallowing and speaking. and jaw during breast feeding. WHAT TO DO WHEN BREASTFEEDING IS NOT POSSIBLE? Failing to breastfeed the infant directly at the maternal breast, milk may be collected HOW TO FEED A BABY WITH CLEFT LIP AND from the mother’s breast, or other milk may PALATE? be recommended by a pediatrician, which For breastfeeding infants with a cleft lip, also may be offered by a bottle, a spoon or the guidelines are the same as given to a small cup. The evaluation of a specialist infants without clefts. Many babies with a in Orofacial Myofunctional Therapy, with cleft lip may breastfeed with no alterations. advanced training in this area, must be However, in cases with a cleft palate, many individualized in each case, and may assist children may fail to have an adequate milk in indicating the most appropriate way to intake with breastfeeding alone. In these breastfeed the infant, along with a lacta- cases, the milk can be offered using special tion consultant. feeding bottles. HOW CAN FINGER SUCKING AND PACIFIER USE HARM A CHILD? Depending on the child’s facial features, functions, chewing, swallowing, and may the intensity, frequency and the duration also lead to slurred speech, such as an of these oral habits may cause changes in anterior lisp (placing the tongue between facial growth, alteration of tooth position the teeth). The pacifier soothes the baby, (anterior open bite), problems in the because it satisfies the need to suck, but its orofacial muscles, impairment of breathing use can be eliminated as soon as possible. WHY DO SOME YOUNG CHILDREN LOVE TO EAT VERY SOFT FOOD? The preference for soft foods may be HOW CAN ONE SUPPRESS HABITS, SUCH AS related to the reduction of the strength of FINGER SUCKING AND PACIFIER OVERUSE? the muscles of mastication (chewing) and The first step is to understand how these also because of enlarged tonsils. Some chil- habits began and why are they still occur- dren prefer foods with such consistency, as ring. The child must be understood and they would not need to chew much or at not ridiculed. Awareness is crucial to gain all. Feeding early on with different consis- the cooperation of the child. Depending tencies may stimulate the strength of the on the case, the Orofacial Myofunctional orofacial muscles and enhance harmonious Therapy Specialist may indicate exercises development of the face. for strengthening the orofacial muscles (especially the lips and tongue), and the WHAT IS A LISP? balance of the stomatognathic functions A lisp is a distortion of speech, character- (breathing, chewing and swallowing). An ized by placing the tongue between the occupational therapist may also be indi- front teeth during the production of the cated for consultation. sounds /s/ and /z/. CAN CHEWING ON ONE SIDE ONLY BE HARMFUL? Yes it is. By chewing only on one side, only the muscles of one side of the face are emphasized. This can cause a facial asym- metry over time. In addition, the bite can be altered and the temporomandibular joint SHOULD OROFACIAL MYOFUNCTIONAL (TMJ, the joint that connects the jaw to the THERAPY OCCUR BEFORE OR AFTER skull and allows the mouth to open and ORTHODONTIC TREATMENT? close) on the opposite side of mastication, Orthodontic and Orofacial Myofunctional may suffer an overload. Therapy can be closely related with each directly impacting the other. Each case must WHAT CAN CAUSE AN OPEN BITE? be analyzed and discussed by the professionals An open bite corresponds to a problem involved. Treatment may be indicated before, of occlusion caused by multiple factors. during, and or after orthodontics. Orofacial Harmful habits (such as finger sucking Myofunctional Therapy specialists promote a or pacifier use) as well as the presence balance of the muscle and orofacial functions, of functional disorders (such as mouth improving the oral rest posture of the tongue breathing and inadequate pressure for and thus the stability of these cases treated by an optimal position of the tongue during orthodontists by helping diminish orthodontic swallowing and /or speech). relapse after the removal of braces. WHAT CAUSES TMD? TMD may be related to various factors such as dental changes (loss or wear of the teeth, poorly fitting dentures), unilateral chewing, mouth breathing, lesions due to trauma or degener- ation of the TMJ, muscle strains caused by psychological factors (stress and anxiety) and poor habits (nail biting, biting objects or food too hard, resting a hand on the chin, grinding or clenching teeth during sleep). WHAT ARE THE MAIN SIGNS AND SYMP- TOMS OF TMD? Pain may be present around the TMJ (it WHAT IS TEMPOROMANDIBULAR JOINT may radiate to the head and neck), along DYSFUNCTION? with earache, tinnitus, ear fullness, sounds The term temporomandibular dysfunction when opening or closing the mouth (pop- (TMD) is used to define some problems ping or other noises in the TMJ), pain or that can affect the temporomandibular joint difficulties when opening the mouth, and (TMJ), as well as muscles and structures pain when moving the jaw and the muscles involved in chewing. involved in chewing. WHO CAN PROVIDE OROFACIAL MYOFUNC- HOW IS OROFACIAL MYOFUNCTIONAL TIONAL THERAPY? THERAPY CARRIED OUT FOR PATIENTS The stomatognathic system is supported by WITH TMD? an interdisciplinary team including speech Most cases of TMD should be treated by language pathologists, otolaryngologists, a team of allied health professionals such orthodontists, dentists, dental hygienists, as an Orofacial Myofunctional Therapy physical therapists, occupational therapists, Specialist, dentist, psychologist, physical kinesiotherapists and others. Each country’s therapist, neurologist and otolaryngologist. healthcare system is different, with one spe- The Orofacial Myofunctional Therapy Spe- cialty having differing degrees of leadership cialist, after conducting a thorough assess- roles. In some countries speech patholo- ment, working in an allied approach, may gists may take a leading role where in others apply techniques to rebalance the muscles another profession such as physical therapy of the mouth, face and neck, and restore the or dental hygiene may have a more promi- functions of breathing, chewing, and swal- nent role. It’s a truly interdisciplinary ther- lowing. With this, there may be attenuation apy, with several professions contributing, and/or elimination of the signs and symp- each according to their own scope of prac- toms of TMD. The patient should be made tice. It is incumbent upon the professional aware about any harmful oral habits and to complete additional training in orofacial oriented to contribute to the evolution of its myofunctional therapy and to abide to local clinical case. laws in the country in which they reside. HOW MAY AN OROFACIAL MYOFUNC- WHAT CAUSES FACIAL PARALYSIS? TIONAL SPECIALIST WORK WITH PATIENTS There are two types of facial paralysis: WHO HAVE FACIAL PARALYSIS? Peripheral Facial Paralysis, that affects the A specialist in Orofacial Myofunctional facial nerve (lesion outside the brain) and Therapy may work, with advanced training can be caused by trauma, tumors, infec- and according to their particular specialty’s tions or unknown factors, and Central (brain scope of practice, on the underlying mus- injury) caused by cerebral vascular accident cles that may be involved. This work should (stroke), head injuries and brain tumors. be performed in conjunction with otolar- yngologists and neurosurgeons.
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