Much of this information was originally published on Mercola.com.
Oral Myofacial Therapy—A Breakthrough Technique to Treat Symptoms Relating to Breathing Problems, TMJ, Headaches and Other Common Ailments
Oral and MyoFunctional Therapy can be a game changer. It is not just an exercise or a series of exercises but rather a year long program to change a lifetime of tongue habits and improper usage of orofacial muscles with an improved functional matrix.
Much of the following is reprinted from a Dr Mercola interview with Joy Moeller, the researcher and practitioner of oral Myofunctional Therapy. I have heard Joy speak several times including at ICCMO meetings that I also was a speaker, at the Academy of Applied Myofunctional Sciences which I attended with my wife Anna and most recently Anna and I took her Myofunctional Therapy course in Chicago through the Academy or Oral Myofuntional Therapy.
According to Dr Mercola “Orofacial myofunctional therapy is a profoundly useful treatment that may help treat the symptoms of a a wide variety of health issues, from opening airways to headaches, temporomandibular joint disorders (TMJ), to poor digestion, just to name a few. It may be the most profound therapy available for the treatment of mild to moderate sleep apnea, which is a pervasive problem that affects many.” My practices is primarily focused on treatment of TMJ disorders, Chronic Pain, Trigeminal Neuralia, Craniofacial pain, orofacial pain and physiologic dentistry and orthopedics.
Mercola states “Myofunctional therapy is the “physiologic re-education or re-patterning of the oral and facial muscles.” Physiologic Dentistry is based on the same foundation but uses advanced biomedical engineering to correct the underlying issues associated with occlusal patterns .
According to Dr Mercola “The therapy includes facial and tongue exercises and behavior modification techniques to promote proper tongue position, improved breathing, chewing, and swallowing. Proper head and neck postures are also addressed. There are good studies to substantiate that it may resolve jaw problems and orthodontic relapse working in a multi-disciplinary team.”
Dr Shapira: It is for exactly this reason that my Highland Park office Think better Life office was established to create a multidiscipliary center for treating of these problems.
My office serves as the hub with other medical specialists all coming together to form the entire wheel. Because of the importance of oral and myofunctional therapy I wanted it to be an integral part of the practice. There were no easily available oral myofunctional therapists in the area so I was trained along with my wife Anna who has also attended the AAMS (Association of Applied Myofunctional Sciences) I will be primarily involved in diagnosis and referral and Anna with her wonderful people skills will do the bulk of hands on training.
Dr Mercola: “It may also be an alternative or adjunctive treatment to facial plastic surgery, to help get rid of lines and saggy facial muscles, which is exciting. In fact, in Brazil, some myofunctional therapists work with plastic surgeons.” The previous statement made by Dr Mercola is accurate to a fault with the health of facial muscles acting as a foundation to the skin and connective tissues.
Dr Shapira: This is the essence of the physiologic dental facelift that can make age melt away and restore a youthful healthy look to the face, eliminate dark circles under the eyes, and correct wrinkes thru the old medical adage: Form follows function. Creating a more ideal function of the jars and cranial musculature and a far better facial form develops.
Joy Moeller in my opinion is the leading expert in this form of therapy in the US.
Dr Mercola continued after being shown that he was tongue tied that” A large population of Americans are estimated to have health problems related to poor orofacial function, and the vast majority have no idea their problems stem from the dysfunction of their mouth (primarily the tongue), breathing habit, and forward head and neck muscle function. Turns out I was one of them. As a result, I got on a treatment plan with Joy, who is the premier expert on myofunctional therapy in the US. We’ve been doing regular Skype sessions for about the last six months, and not only am I making great progress in resolving my tongue tie, it’s had a profoundly beneficial effect on my posture and amount of deep sleep as well.”
Dr Shapira: This is an amazing statement coming from a leader in natural health care in the U.S. and Internationally. Dr Mercola experiences a “profoundly beneficial effect” and is only six months into treatment. Six months is halfway through therapy. A oral Myofunctional Therapy program is normally a full year long but is most intensive in the first three months. Dr Mercola experienced this profound effect on top of all the other therapies he has utilized to improve his health and quality of life.
I personally lecture nationally and internationally on the Common Developmental Pathways of TMJ, Sleep Apnea, Migraine, Chronic Daily Headache, ADD, ADHD, and behavioral disorders.
I felt great joy reading Dr Mercola’s comments that: ” Of course, adult problems associated with tongue-tie are best prevented in infancy beginning with ensuring the normal duration of breastfeeding. However, tongue-tie often goes undetected by OBGYNs and pediatricians who, having been educated in a bottle-feeding culture, fail to connect the related breastfeeding issues. When feeding issues are present, such as recurring maternal pain, thrush or mastitis, poor latch, inefficient emptying of the breast, poor infant growth, reflux, sensory issues, poor gut function and poor sleep, it is best to immediately contact an IBCLC (International Board Certified Lactation Consultant) who can do an assessment and direct you to resources for proper revision (using laser or scissors) and supportive structural therapy.”
Dr Shapira: Eliminating tethered tongues or tongue tie is an additional therapy that works physiologic dentistry and myofunctional therapy as part of an overall team effort.
The field of Oral and Myofunctional Therapy is part of language pathology in Brazil, a country that speaks Portuguese which requires a great deal of tongue precision especially for rolling “R’s” It was this combination of specialties that caused embracement of these procedures..
Dr Mercola stated “In Brazil, a country that has really embraced this therapy and applies it in a number of medical fields, there are more than 20 universities doing PhD level research in orofacial myofunctional therapy. In the US, it’s currently a post-graduate course. Fortunately, it is gaining in popularity, and according to Joy, this year there will be a big push to get more dental hygienists, speech pathologists, and physical therapists to adopt the technique. Stanford School of Medicine has just come out with compelling research this year.”
Dr Shapira: At the recent meeting in Chicago that Anna and I there were several dentists including a periodontist and a leading orthodontist from the orthodontic program at Penn, a physical therapist, an occupational therapists, several speech pathologists, two Korean hygenists sent from their organization as part of a program to institute myofuctional therapy in Korea, a PHD in Speech Pathology and Oral Myofunctional Therapy in Brazil, Kevin Boyd, a Chicago pediatric dentist working on a PhD in anthropology at Penn who also works closely with Children’s Memorial Hospital, a physician, a chiropractor and several rehabilitation specialists who work with swallowing problems in stroke victims.
Dr Shapira: The following part of Dr Mercola’s article is word for word how Joy describes her search for helping her son with his problems. I strongly appreciate her sentiments because it is so similar to the battles I had to find proper help for my son , Billy in the early 1980’s that led me into being a professor in the sleep department at Rush Medical School with Rosalind Cartwright and a founder of the Dental Sleep Medicine movement worldwide.
“In addition to teaching with the Academy of Orofacial Myofunctional Therapy (AOMT) and practicing for nearly 35 years, Joy has authored 15 articles, a children’s book called Tucker the Tongue Finds His Spot, and is currently writing chapters for two textbooks. Joy encountered myofunctional therapy 35 years ago, as a result of tirelessly seeking to resolve the many health problems her young son was experiencing. At the time, she was a dental hygienist, and the dentist she worked with had taken a course in the field.”
Joy Moeller: “My son had many problems. He was born through a breech birth. He had severe colic as a baby. He couldn’t latch on. He was bottle-fed and had a pacifier and a sippy cup,” she says.”By the time he was three, he had severe ADHD, and he couldn’t breathe easily. He was breathing through his mouth. He had failure to thrive. He wasn’t chewing his food properly. Everything had to be liquid or soft in order for him to eat it. By the time he was seven or eight, he had severe headaches. His headaches were so bad that he couldn’t go to school.”
Dr Mercola: “She sought help from numerous doctors, from psychologists, neurologists, to vision therapists. One doctor even suggested brain surgery. Fortunately, her dentist employer finally asked to have a look at the boy and discovered his tongue placement was incorrect.
Dr Shapira: It is very frequent for migraines, and chronic daily headaches to have underlying causes associated with the jaws, the TMJoints, the jaw muscles, the tongue muscles and associated tissues.
“So, we started doing these exercises,” she says. “Within three weeks, his headaches stopped completely. ”
The following section How Does Myofunctional Therapy ‘Work’?
Myofunctional therapy doesn’t just address your oral cavity and tongue—it addresses all the facial muscles; the head and neck. It teaches you to breathe through your nose and rest your tongue against the roof of your mouth. You also exercise all your facial muscles, and work on functional posturing and chewing.
“You have to look at function, the way the body functions,” Joy says. “If you’re not chewing your food enough, your body is working overtime to try to digest it. It’s having the ability for the muscles to support the [oral] arches. I see so many people that have had orthodontics, after which their teeth move. They feel it’s their fault, because they didn’t wear their retainers. However, it is because the muscles are not retaining that [position], because the muscles have not adapted to the structure.
Dr Shapira: This function starts at birth and even before and it influences how each and every body system develops. I love that Joy looks at all the same problems I work with but from a different angle. It is easy to get caught up in cause and effect theories but to correct the problems long term we need to attack and correctit by multiple avenues.
“If we can do more preventive work at a younger age to prevent the problem or the disorder (because it is a disorder even from the start), then we’re ahead of the game.”
Chewing is very important, but most people don’t chew their food enough. This may lead to poor digestion, poor nutritional uptake, and other related health problems. When you chew adequately food is not only physically broken down, thus increasing its surface area, it chemically augments the enzymatic activity of salivary amylase to partially digest starch. This enzyme works to pre-digest the food, and signal your stomach that food is “on the way.” There’s a very specific reflex that goes from your jaw, down into your stomach and digestive tract, which stimulates the secretion of digestive enzymes. Unless you’re chewing, you’re not going to have optimum enzymatic power to break apart your food and metabolize it properly.
Dr Shapira: Dr Robert S Corruccini a dentist with a PhD in Anthropology wrote the book “HOW ANTHROPOLOGY INFORMS THE ORTHODONTIC DIAGNOSIS OF MALOCCLUSION’S CAUSES” He explains in his book that there have been drastic and sudden changes in development of the jaw and cranial bones in the last 400 years. These are not changes in the genes but rather changes in Phenotype. The genetic part of DNA is the genes but environmental changes can cause these genes to be expressed differently. These are called Epigenetic Effects.
According to Joy:
“There is this condition called failure to thrive in which the child finds it difficult to chew comfortably. Our kids just stop growing like they should. Dr. Karl Nishimura, a DDS from Orange County, California states that if the tongue is not going up to the roof of the mouth when a person swallows; the sphenoid bone does not rotate properly and growth hormones are not being released from the pituitary gland. The whole pumping action of your tongue going up to the roof of your mouth during swallowing (500-1000 times a day), may help to expand the nasal cavity and also stimulate the sphenoid bone to rotate and secrete hormones from the pituitary gland.”
Dr Shapira: The process of peristalsis or movement of food through the entire gut begins with the swallow, a disturbed swallow will affect the entire digestive treat.
Joy: The pituitary gland is the master hormone gland. It secretes many different hormones that are critical for your optimal health. A major focus of myofunctional therapy is exercises that train your tongue to spontaneously rest on the roof of your mouth. Many mistakenly believe that the tongue is a muscle, but it’s actually an organ, which has very strong muscles in it. It contains one of the strongest working groups of muscles in your body. The job of the tongue is to protect the airway, encourage normal forward facial growth when postured correctly in the roof of the mouth, aid speech, and move food around when chewing.
If your tongue is restricted due to a lingual frenulum (the string underneath your tongue being too tight) you’ll have a hard time moving food into the molar area where chewing is concentrated, and consequently you will not be able to chew it properly. The tongue is also connected to the hyoid bone which is in your neck, so if your tongue is not functioning properly, it may lead to forward-head posturing. In this position your tongue is resting down and forward, and it’s just enough to pull your entire head forward, thus throwing you out of balance.
Many Have a Disorder That May Benefit from Myofunctional Therapy
A large percentage of people have some type of oral-facial disorder that would benefit from myofunctional therapy. The reason for such high numbers is because so many people have been exposed to situations that prevent their tongues from functioning correctly and naturally. Such items include:
Mouth breathing
Tongue tie
Thumb and/or Digit / non-nutritive sucking habits
Processed foods (even baby foods)
Baby bottles
Sippy cups
Pacifiers
According to researchers from Albert Einstein University, when a child mouth breathes this in turn may lead to learning disabilities and behavior problems due to lack of oxygen to your brain. Mouth breathing also promotes allergies and other common ailments. Once your tongue doesn’t function properly, it may also affect your oral posture and your ability to breathe correctly as it may cause your airway to collapse. More importantly, mouth breathing encourages a low tongue posture
“Everybody is going to the gym now, working out, lifting weights, but they forget about their face muscles,” Joy says. “Your face and tongue muscles are so important, because they influence your ability to speak, chew, swallow, and breathe correctly. It’s so critical.”
Why You Should Consider a Myofunctional Therapist
The initial myofunctional therapy evaluation is extensive, starting with an in-depth look at habits, such as: Is the cat sleeping with you? What temperature do you keep your bedroom at during sleep? Do you consume dairy products? Seemingly innocent factors such as these can cause one to mouth breathe. Experiencing frequent nosebleeds, colds, or wearing ill fitting glasses that slip down your nose can also “teach” you to breathe through your mouth rather than your nose.
This initial evaluation is very important in order to devise an effective treatment protocol. There are hundreds of exercises, and each individual is unique. It’s a grave mistake to think that you can just do a few basic exercises from a book for a few weeks and be done. In order to really repattern all the muscles involved, you need to do it slowly, over time, to reprogram your muscle memory.
Dr Shapira: Typically Oral Myofunctional Therapy will be a full year program of evaluation and treatment; evaluation and treatment repeatedly.
Joy: “You really need somebody to support you over time in order for it to hold. Otherwise, just like everything else, in two years, it’ll relapse. We have to look at everything,” Joy says.
So, we will not be posting a series of simple exercises to solve your problems. Rather, I would urge you to find a trained therapist who can customize the exercises based on your specific anatomy, and enter into a long-term coaching relationship. I hired Joy to work with me for a full year. As explained by Joy:
“Each person is like a snowflake, they’re different. There are different parts to the therapy. We have to sequentially activate the orofacial muscles. The first part is just for all the muscles working to get the lips to stay together. We activate the masseter muscles in a symmetrical pattern and develop nasal breathing as primary by developing a lip seal and a palatal tongue rest position… I use some of the Buteyko breathing exercises as well. The Buteyko Breathing Method is a powerful set of health-care guidelines and methodology for reversing over-breathing or hyperventilation. I incorporate the breathing exercises into my therapy.
The second part is actually chewing (being able to masticate and manipulate the food in the correct place), and swallowing, where your tongue is going up and back rather than down and forward. In order to habituate this even in our sleep, we must swallow correctly.
We can then work more aggressively on functional posturing. If someone is sitting with a forward upward tilted head, it’s virtually impossible to swallow comfortably. A forward head posture causes an alteration in the swallowing mechanism due to muscle tension. We can correct the actual functional posturing, give you exercises, and make you aware of where your tongue is at all times. Pretty soon, correct tongue posture becomes a habit. It becomes a different function that your body adapts to.
Another one of our goals is to get your lips closed all the time, except when you’re speaking or eating Your nose’s primary function is inhaling oxygen, followed by filtering air, warming, and moisturizing it, and also killing micro-organisms with the natural production of nitric oxide.There’s also an enzyme that’s excreted by the little hairs in your nose that actually has an anti-allergy effect on the body. Actually, it’s healthier to breathe through your nose on every level because your body gets more usable oxygen thus maintaniing a more normal carbon dioxide level which is better.”
Many Health Professionals are Starting to See the Benefits of Myofunctional Therapy
Orofacial myofunctional therapy can be used in a number of areas to address a wide range of problems. It’s an obvious fit for speech pathologists, for example. If your tongue is restricted, or if you’re swallowing down and forward, you’re going to talk with the “S” lisp. If the sides of your tongue are not activated, you’re going to sound a bit like Donald Duck when pronouncing words like “sucker” or “succotash.” This happens because the sides of your tongue are too lax. By tightening, toning, and re-patterning the muscles of your tongue, it will enhance some speech disorders. Physical therapists are also learning about its benefits.
“In the last class that we did, we had three physical therapists who were so excited because they had TMJ problems themselves, and they’ve worked for over 20 years in TMJ treatment for jaw problems,” she says. “They knew that there was something with the tongue, but they didn’t know how to fix it. They’re starting to get involved in it now.”
Dental hygienists are another obvious “fit” for myofunctional therapy, as mouth-breathing is one major cause of dental diseases. According to Joy, who has a background as a dental hygienist, it’s one of the major causes of periodontal disease, malocclusion and decay. The bacteria in your mouth need air to live, so when mouth breathing, or just resting with your mouth open; you’re supplying them with much-needed oxygen. This makes them stronger and more virulent, and the plaque and biofilms they form is much thicker. Also, if a person is mouth breathing, the tongue drops down and the arches may collapse, leading to crooked teeth.
Might Myofunctonal Therapy Benefit You?
Some of the risk factors indicating you might be able to benefit from this approach include those on the following list (please note this is not an all-inclusive listing). Interestingly, if you consume a high-sugar diet, the myofunctional therapy treatment is not going to be as effective because of your ability to focus and have strong muscles. So, if you decide to enter into a coaching relationship with an myofunctional therapist, please be sure to pay careful attention to your diet as well, as this could have a huge impact on your results.
Orthodontic Relapse Bottle Feeding Developmental delays, such as low muscle tone Long Face syndrome
Speech problems Allergies Frequent headaches TMJ problems
Thumb sucking Bloating due to air swallowing Food texture sensitivities Neck pain
Nail or lip biting or other oral habits Frequent choking, gagging or trouble swallowing Mild to Moderate Sleep Apnea Snoring
Simple Techniques to Try Right Now
While I highly recommend working with a trained myofunctional therapy professional, there are some simple techniques you can do without seeing anyone. One of the most important ones is to simply sleep on your back, as this helps your posture and helps open up your airway so you can breathe better. If you have sleep apnea or GERD, just raise the headboard of your bed the size of a brick so that your tongue does not drop into your airway. Also sugar is refined and people do not have to chew to break down the food. Unrefined foods must be chewed more and therefore the muscles are working. Another one is to stop touching your face, and instead remember to keep your tongue firmly placed against the roof of your mouth.
Dr Shapira: While I generally agree with everything Joy says it is essential that before you switch to back sleeping you be screened or evaluated for sleep apnea because supine sleep can make apnea more severe!
“People have a tendency to do like the thinker, leaning, just touching and playing with their hair, biting their lips, and all these little habits. They don’t realize what they’re doing is they’re trying to get that remembered endorphin feeling, as in thumb sucking because it feels good to touch your hair or your face. When you exhibit these habits, you affect your posture and put pressure on your jaw or face and distract the muscle function.”
As explained earlier, if your tongue is functioning in the right place, the result will help maintain proper development of the arches, thus encouraging the teeth to line up correctly and enhance the ability to breathe properly. You want your tongue to rest behind the first ridge on the roof of your mouth. All those ridges on the roof of your mouth is the natural resting place of your tongue. Some people have very sharp ridges as a result of it not resting there.
“If your tongue is resting in between your teeth, or against your teeth, or when you swallow it’s pushing or it’s resting down in the floor of your mouth, it may prevent your jaw joints from functioning normally.,” Joy explains.
“A lot of people have this TMD pain and headaches that radiate from the TMJ. They may have had a splint or some kind of an appliance fitted. Sometimes this treatment may help, and sometimes it doesn’t because of the associated patterning of muscles. According to Oral Pain Management Specialists, at least 90 percent of TMJ problems are related to the muscles (not working right), because of habits or because of swallowing disorders.”
A scalloped tongue is almost always seen in both TMJ and Sleep Apnea patients due to the importance of the tongue in all oral functions and/or disfunction.
Grinding and clenching your teeth is another sign you may need to retrain your orofacial muscles. Grinding is often related to some form of sleep disorder. It’s an upper airway obstruction that the body attempts to move the jaws in order to open the airway because things aren’t functioning properly. To get all your oral-facial and neck muscles working correctly can make a huge difference. It will also change the way your face looks, as it actually may change the facial structure. Your skull bones may shift in a slow, comfortable manner.
“Everybody thinks, ‘Oh, your face is your face.’ But you know, I see a lot of people that have these long-face syndromes from sleeping on their sides or stomach, mouth-breathing, and resting their tongue in the wrong place. You change that and there are little cells called osteoblasts and osteoclasts. They break down and build up, break down and build up, and within a very short time – months – the whole shape of their face changes.”
How to Find a Myofunctional Therapist
The Academy of Orofacial Myofunctional Therapy (AOMT) has developed a website where you will be able to find both training schedules for professionals seeking education, and a listing of qualified practitioners worldwide. The name of the site is www.myoacademy.com. ( THIS HAS BEEN CHANGED AND IS NOW https://aomtinfo.org/ AND THE SITE IS AOMT: THE ACADEMYOF OROFACIAL MYOFUNCTIONAL THERAPY)
Fortunately, you don’t necessarily need to find a practitioner in your local area, as nowadays the therapy sessions can be done via Skype, using the video feature. We do all our sessions via Skype privately. In the US, there are as many as a few hundred practitioners. However, stay clear of anyone who is just going to give you a page from a book. That doesn’t work. Make sure the therapist you select is going to give you a thorough evaluation and customize the exercises to your needs. Joy recommends looking for someone with a health background who has taken a continuing education course in Myofunctional Therapy, such as:
Speech pathologist
Dentist, orthodontist, or dental hygienist
Sleep medicine doctor
Physical and/or occupational therapist
Pulmonologist
Anna and I will work together to evaluate and treat patients in my office where patients are routinely treated for TMJ disorders, Sleep Disorders and chronic pain. Dr Mark Freund is opening an office across the hall to address postual issues through Atlas/Orthoganol Chiropractic Treatment, Chirodontics as taught by Dr Bob Walker, Crainosacral Therapy and cranio manipulation and SOT Chiropractic. He will be working with Dan Hoglum a Physical Therapist who is well trained in treating chronic pain and TMJ disorders and a Myofascial Release Therapist.
Dr Shapira: The American Academy of Dental Sleep Medicine was orignally the Sleep Disordered Dental Society when 20 of us founded it 25 years ago. I had already been a Visiting Assistant Professor at Rush Medical School working with Rosalind Cartwright (The mother of dental sleep medicine research)and doing research into similarities in jaw position in male sleep apneics and female TMJ patients.
Dr Mercola: Life is a journey, and I’m constantly learning new information. Here, at the age of nearly 60, I finally found out about myofunctional therapy, and it’s making a major health difference for me. I’m deeply grateful for all that Joy has taught me, and for her persistence and dedication over these last three and a half decades to help increase the awareness of this profoundly effective approach.
Dr Shapira: During my life journey, now 66 years old I have been working treating sleep apnea, TMJ disorders, and chronic pain for almost 40 years. I have worked with Mariano Rocobado who created the current physical therapy protocols used for TMJ dysfunction patients. I now find myself deeply involved in Orofacial Myofunctional Therapy due to my role as chair of the Alliance of TMD Organizations which recently approved membership of the Academy of Applied Myofunctional Sciences. I attended their meeting and was blown away by how far the Science of Myofunctional Therapy had evolved.
Christian Guilleminault, widely recognized most prominent and influential sleep researcher in the world from Stanford declared that all sleep apnea patients should be evaluated and treated with myofunctional Therapy. This is especially true of pediatric patients, all patients having tonsils or adenois out, but also all CPAP/ BiPap users, and all patients using oral appliances.
Dr Mercola: Ultimately, you can have the best health, you can eat an absolutely perfect diet, or you can have the perfect exercise plan, but if you’re not sleeping, breathing and chewing well, it’s physically impossible to be optimally healthy. Fortunately, it’s never too late. No matter what your age, you can retrain your oral-facial and neck muscles to help you achieve better sleep and proper breathing and digestion.
Link to Dr Mercola article:
http://articles.mercola.com/sites/articles/archive/2013/04/07/orofacial-myofunctional-therapy.aspx
