Myofunctional (Tongue Thrust) Therapy

We may have come across a child whose tip of the tongue always rests between the front teeth and also the tongue may always be positioned low in the mouth. Many people will think that their kid is just playing or they have licked something sour or pepper. What should be learned is that there is a disorder with exactly these characteristics, the tongue thrust. In this disorder, the tongue always pushes forward when swallowing food and the more severe problem with the disorder is when the tongue rests in the mouth (Mason, 2010). The tongue thrust has an effect on speech whereby children with the symptom have certain sounds such as “sh,” “ch” pronounced differently from common pronunciation (Levy, 2017). What is important is that the tongue thrust is a symptom and not the disease or an infection. The tongue thrust can sometimes be an indication of a further complication in the airway and breathing system in general. Under this background, therefore, the aim of the excerpt is to address tongue thrust therapy.

Orofacial myofunctional therapy also denoted as OMT is an inclusive term for the treatment of numerous abnormal conducts that may interfere with normal facial functionality. Ever since the development of the OMT, the primary focus has been on the retraining of the tongue habits and posture. However, in the recent approaches to the procedure, there has been an expansion into an inclusion of management of the disorders that includes mouth breathing, forward head posture, speech pathology, obstructive sleep apnea, dysphagia and numerous parafunctional habits (“Orofacial Myofunctional Therapy in Traditional Dental Settings,” 2017). In the current medical environment, the Orofacial myofunctional therapy has the goals of modifying behaviors, eliminating parafunctional habits as well as establishing a lip seal.

Conflicting and the Current Theories on Orofacial Myofunctional Therapy (OMT)

Since the discovery and the beginning of exercising the Orofacial Myofunctional Therapy (OMT) in the wake of the 20th century, there have been major theories trying to explain the aspects of the tongue thrust disorder and how it can be corrected. Amongst the prominent theories that have sought to contribute to Orofacial Myofunctional Therapy (OMT) is the equilibrium theory. The method tries to argue on the question as to why the teeth remain in a stable position in normal occlusion or the malocclusion. Many studies have answered the question. However, the prominence of the arguments on the topic is based on the equilibrium theory developed in the last quarter of the 20th century, some decades after the invention and exercise of the Orofacial Myofunctional Therapy (OMT).

For the dentition to be preserved in a stable position, some equilibrium might need to be involved to enable the stability of the dental arches. The argument was by Proffit (1978) who, backed up by other studies, asserted that there are numerous influences that in conjunction may result to dental equilibrium. The identified factors that may cause dental stability are like intrinsic pressures (gingival fibers and the periodontal fibers), the external forces which are like the habits as well as orthodontics, and finally, the tooth contacts (swallowing and the masticatory acts).

Proffit (1978) emphasizes that the freeway space is amongst the multiple contributors to the dental equilibrium. In any normal activity and the freeway is disturbed, or in any way altered in the presence of an Orofacial Myofunctional Disorder, the expected dental consequences are like horizontal and vertical impacts. The stability of the position of tooth together with the resting of the freeway space is an activity that includes cortical switch mechanism which is mediated by the mandibular as well as the maxillary divisions of the trigeminal nerve up and down the trigeminal nucleus situated inside the pons. The biochemical activities that are found in the periodontal membrane position have the operation of allowing changes in tooth positions from a consistent orthodontic force applied against the dentition.

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In any way the normal occlusion is altered by an airway factor, the dental equilibrium on its side is disturbed. As a result, the consequence is an altered occlusion, and consequently, it can remain or maintain its new position or an altered state of equilibrium until the moment or the time when a physician addresses the airway issue. Further, in theory, it is asserted that resting tongue pressure is vital factors to dental change as well as the malocclusions and o the other hands the tongue thrusting may not be a chief cause (Umberger & Johnston, 1997). The tongue thrusting alone is not linked with the dental change or alteration but can contribute together with the accompanying of forwarding interdental tongue rest posture.

In the modern medical discoveries, however, there are no controversies concerning the relationship that exist between the unresolved airway issues about the appearance and the maintenance of oral behaviors as well as postures as explained by the OMT. The controversy in the matter rests in the concern of the overuse of the term mouth breathing. The debate is based on the clinical assertions of mouth-open rest posture. In the contemporary interventions to the tongue thrust therapy, it is well accepted in the pediatrics as well as the dental art that mouth breathing is a psychological reference. In this case, it is meant that the term should be used for the results of the aerodynamic assessment of the airway. Further, the controversies have it that there should be no correlation between the mouth breathing habit and the facial appearance of a child.  

The dentistry research indicates that many children may have a poor oral hygiene. Also, though there is no clinical evidence, the children at early ages are associated with poor nasal hygiene.  In these two theoretical perspectives, therefore, an aerodynamic assessment of the human airway has concluded that poor nasal hygiene as observed in children may have mouth breathing habits. Research by Hanson and Mason, (2003) shows that the simple activity of just blowing the nose serves as a way to reduction of nasal resistance and also, it serves to eliminate facial posturing which is perceived by other schools of thought to be a mouth breathing problem.

Critical Assessment Procedures in Tongue Thrust Therapy and Strategies

The critical evaluation of the tongue thrust is done by the general dentist, speech therapist, orthodontist, the pediatrician and the otolaryngologist. The diagnosis is frequently carried out at the moment the child shows a speech or any dental problem such as mouth breathing and tongue thrust. A critical assessment of the Tongue thrust disorder is done by evaluating the case history, an oral facial examination, swallowing where there is an evaluation of a complete swallowing assessment and finally articulation. 

In articulation, speech evaluation is carried out. Due to tongue thrust, some victims may incorrectly articulate voices such as /s/ and /z/. Because of the weakness of the tongue muscles, some sounds may also be produced incorrectly, and such sounds are like /t/ and /d/. In the swallowing assessment, the patient is carefully observed as she swallows solid foods and liquids. The clinician may squirt water in the mouth of the client and then part the lips with the fingers immediately the swallowing process begins. In a typical food swallowing, there is an observation of posterior tooth contact, a tongue is positioned on the plate and the lips relaxed. In an abnormal swallowing, which is mostly exhibited in people with tongue thrust disorder, the teeth are apart (Sahad et al., 2008). Also, in an abnormal swallowing, the hyperactivity of the orbicular together with the muscles (mentalis muscles) trying to generate an anterior seal. 

In the Orofacial Myofunctional Therapy (OMT), the recommended strategy is the operant technique. The operant habituation ideologies can efficiently control the components of the tongue thrust. The operant techniques can also assist in the treatment of the tongue thrust as well as in the control of its associated problems (Thompson et al., 1979). Further, the tongue trivia is another useful strategy that can be utilized in the Orofacial Myofunctional Therapy (OMT). Language Trivia is a useful exercise in the Orofacial Myofunctional Therapy (OMT) as it assists in the control of the tongue as well as in the development of placement awareness.  The children who have the Orofacial Myofunctional Disorder (OMD) ought to learn the incorrect placement. Playing games can facilitate such a process. 

As a conclusive remark, in the tongue thrust disorder, the tongue always pushes forward when swallowing food and the more severe problem with the disorder is when the tongue rests in the mouth. The tongue thrust disorder has a consequence of speech whereby children with the symptom have certain sounds such as “sh,” “ch” to look differently from usual pronunciation. Many theories are conflicting over the Orofacial Myofunctional Therapy (OMT) one of them being the equilibrium theory developed in the late 20th century. The method tries to contend on the question as to why the teeth remain in a stable position in normal occlusion or the malocclusion. The assessment in the Orofacial Myofunctional Therapy (OMT) is typically carried out at the moment the child shows a speech or any dental problem such as mouth breathing and tongue thrust. The recommended approach to the Orofacial Myofunctional Therapy (OMT) is the operant strategy.