What is Temporomandibular Joint Dysfunction?

The term temporomandibular dysfunction (TMD) is used to define some problems that can affect the temporomandibular joint (TMJ), as well as muscles and structures involved in chewing.

What causes Temporomandibular Joint Dysfunction?

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 degeneration 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).

How is orofacial myofunctional therapy carried out for patients with TMD?

Most cases of temporomandibular dysfunction (TMD) should be treated by a team of allied health professionals such as an orofacial myofunctional specialist, dentist, psychologist, physical therapist, neurologist and otolaryngologist. The orofacial myofunctional specialist, after conducting a thorough assessment, working in an allied approach, may apply techniques to rebalance the muscles of the mouth, face and neck, and restore the functions of breathing, and chewing. With this, there may be attenuation and/or elimination of the signs and symptoms of TMD. The patient should be made aware about any harmful oral habits and oriented to contribute to the evolution of its clinical case.

What are the main signs & symptoms of TMD?

Pain may be present around the TMJ (it may radiate to the head and neck), along with earache, tinnitus, ear fullness, sounds when opening or closing the mouth (popping or other noises in the TMJ), pain or difficulties when opening the mouth, and pain when moving the jaw and the muscles involved in chewing.

What is open mouth breathing?

Open mouth breathing refers to breathing while the lips are parted or open. In this way of breathing, the individual does not use, or uses very little, the nose to inhale and exhale the air. Open m outh breathing is considered rescue breathing and encourages the body to stay in a state of “fight or flight.” During this state the body must prioritize the most important functions for survival. Functions like digestion, growth hormone production and being able to concentrate are put on hold.

How do I know if I am breathing through my mouth?

A person may have one or more of the following characteristics: nasal congestion, open mouth at rest; chapped lips, appearance of a large tongue that may be recessed and projected forward; long face syndrome; forward head posture; dark circles under the eyes, sagging cheeks, wheezing, and snoring. In such cases it is recommended that an otolaryngologist (ENT) and/or allergist be consulted.

Is there a difference between nasal & oral/mouth breathing?

Yes, when breathing is done through the nose, the air is filtered (cleaned), warmed and humidified, and thus it reaches the lungs with less impurities that are in the air. When you breathe through your mouth the air does not go through this process and reaches the lungs full of impurities. The oral rest posture of the tongue and the mandible when mouth breathing may also alter mandibular posture, palate width, and other craniofacial growth patterns as well as posture of the head, neck, and upper body.

What can cause mouth breathing?

The most common causes of mouth breathing are: allergic rhinitis, sinusitis, bronchitis, enlarged adenoids; enlarged tonsils; weakness of facial muscles that may lead to open mouth rest posture, habits such as thumb sucking, tumors in the region of the nose, enlarged turbinates, and nose fractures, amongst others.

How can mouth breathing cause changes to the structure of the mouth & face?

Keeping an open mouth posture can cause: dry and chapped lips, short and fast breathing; diminished strength of the muscles of the lips, cheeks, jaw, and tongue; a lowered and more anterior rest posture of the tongue, leading to changes in the position of teeth ; elongated face, retruded mandible or small chin , and palate (“roof of the mouth”) becoming more narrow and /or deep.

How can mouth breathing affect functions related to the mouth & face?

Mouth breathing leads to chewing food with lips apart, which becomes faster, noisier, and less efficient than with lips closed. This can lead to greater digestive problems and potential for choking due to the poor coordination between breathing, chewing, and an increase in the swallowing of air. It’s hard to breathe through the mouth when the mouth is full, thus an individual will need to choose whether to chew or to breathe. In the process of swallowing, one may also notice changes such as anterior projection of the tongue, noise, contraction of muscles that wrap around the mouth, and movements of the head. There may also be excessive production of saliva and an anterior lisp: which is a distortion of speech characterized by placing the tongue between the front teeth during sound production of /s/ and /z/.

What are key issues that may be caused by mouth breathing during sleep?

When sleeping with the mouth open, a person may have some of these characteristics: restless sleep, snoring, headaches, drooling on the pillow, thirst when waking up, morning sleepiness, sleep apnea (breathing interruptions during sleep), and decreased oxygen saturation in the blood.

How can mouth breathing affect learning and behavior?

Sleep disturbances can generate agitation, anxiety, impatience, decreased levels of alertness, impulsiveness and discouragement. All of these changes can cause difficulties with attention, concentration, memory problems, and subsequent learning difficulties in children. During the critical periods of a child’s development, mouth breathing can be more detrimental to learning.

What is a tongue-tie?

Tongue-tie is a popular term used to characterize a common condition that often goes undetected. It occurs during pregnancy when a small portion of tissue that should disappear during the infant’s development remains at the bottom of the tongue, restricting its movement. When an infant is born with tongue-tie, it is important to have other family members evaluated, since this change can be genetic.

How & when should a tongue-tie be treated?

When the tongue cannot perform all the necessary movement s or rest in the roof of the mouth, it affects breathing, sucking, swallowing, chewing or talking. A sma ll surgery or frenotomy in the tongue is indicated. The “snip” of the frenum in infants is a simple procedure done with scissors, scalpel, or laser and anesthetic gel, which lasts about five minutes. In older children and adults the most common procedure is the frenectomy (partial removal of the lingual frenulum).

When is a surgical procedure indicated to release the lingual frenulum?

In infants, surgery is usually indicated when the lingual frenulum restricts the tongue’s movement and compromises breastfeeding or breathing. A lactation consultant may also be indicated for consultation. In older children and adults, the indication is made when the tongue is visibly restricted, is unable to adequately reach the palate, or when possible distortions in speech are caused by limitation of the elevation of the tongue tip (especially in producing the sound of the “L” and “R”) that could not be corrected in speech therapy.

What can happen with a child if orofacial myofunctional disorders are not corrected?

Many people with tongue-tie suffer the consequences without knowing the cause. There are infants who have changes in the feeding cycle, causing stress for the infant and for the mother. There are also children with difficulties in chewing, children and adults with speech problems affecting communication, social relationships, and professional development. Disordered breathing may cause developmental delays, poor sleep, exhaustion, hyperactivity, learning difficulty, emotional outbursts, anxiety, depression, or difficulty with self-regulation.

FAQs about Orofacial Myofunctional Therapy

Insurance

Will orofacial myofunctional therapy be covered by my insurance?amanda2024-04-26T00:50:23+00:00

Will orofacial myofunctional therapy be covered by my insurance?

Unfortunately, orofacial myofunctional therapy is not usually a covered service. However, I will provide you with a superbill so that you can submit for reimbursement from your HSA (Health Savings Account) or FSA (Flexible Spending Account).

General Questions

What is Orofacial Myofunctional Therapy?Amanda Jeffrey2024-04-26T01:31:50+00:00

What is Orofacial Myofunctional Therapy?

Orofacial myofunctional therapy consists of retraining the muscles of the face and mouth to assist with normal development of the facial structures and function of the mouth.

What are the main problems related to Orofacial Myofunctional Disorders (OMD’S)?Amanda Jeffrey2022-07-20T15:35:16+00:00

What are the main problems related to Orofacial Myofunctional Disorders (OMD’S)?

The main problems related to OMDs are changes in breathing, chewing, swallowing and speech. The proper resting position of the lips and tongue may also be affected.

What conditions may be referred for orofacial myofunctional therapy?Amanda Jeffrey2024-04-26T00:43:39+00:00

What conditions may be referred for orofacial myofunctional therapy?

The following list reflects different conditions that are referred for therapy:

Sucking habits
Parafunctional habits
Mouth breathing
Lip incompetence-the inability to close the lips without muscle strain
Drooling
Chapped lips
Red swollen gums; excess plaque
Incorrect tongue posture at rest
Sleep-disordered breathing
Bruxism-clenching or grinding the teeth in other than normal function
Jaw muscle pain
Cracking or fracturing teeth
Tongue thrust
Incorrect relationship between the upper and lower arches
Malocclusion or crooked teeth
Orthodontic/orthognathic surgical relapse
Eating dysfunction
Choking or aspiration
Lazy speech muscles

Anyone or a number of specialists may recognize a problem in a child, adolescent, or adult and want the patient to go through orofacial myofunctional therapy.

What are the benefits of correct chewing?Amanda Jeffrey2024-04-26T00:46:36+00:00

What are the benefits of correct chewing?

Research indicates that we chew during the process of eating 1000 to 3000 times per day; therefore it is important to use the lip, tongue, and jaw muscles correctly.

Lip closure during chewing strengthens and develops the lip muscles which in turn helps establish lip closure for all the mouth functions.

Lip closure prevents ‘smacking’ or noisy eating and keeps food from spilling out or corrects the messy eater.

Lip closure while chewing limits the side-to-side movement of the jaw which is beneficial for the temporomandibular joint.

Thorough chewing dissolves substances in the food to make them more accessible to the taste buds. Chewing a semi-hard to hard diet in a child helps to develop the mandible.

Proper chewing on both sides of the mouth helps to develop the two sides of the jaw evenly, promotes equal muscle development in the temporomandibular joints, helps distribute the force used by the chewing muscles evenly between both sides, helps produce a more uniform wear pattern on the teeth and contributes to facial symmetry.

Proper tongue sweeping while chewing cleans debris to prevent premature entry of food into the throat which may cause choking.

Thorough chewing increases saliva production which helps to digest bacteria that can lead to plaque buildup, thoroughly mixes the food with saliva which is rich in digestive enzymes that begin the process of starch and fat digestion. When food is chewed thoroughly the less work there is for the stomach and intestines reducing gas and bloating. The intestines will have an easier time pulling micronutrients out of thoroughly chewed food and providing the body with more vitamins, minerals, antioxidants, and amino acids.

Chewing releases serotonin, a neurotransmitter that helps us relax, go to sleep, focus or concentrate and elevates our mood.

What are the benefits of proper muscle function for speech?Amanda Jeffrey2022-07-20T15:16:43+00:00

What are the benefits of proper muscle function for speech?

All speech sounds except the /th/ sounds are based in the neutral position. Speaking within the neutral position keeps the tongue from putting incorrect pressure on or between the teeth. Proper muscle tone in the tongue muscles helps the tongue to move quickly and accurately to produce various sounds. Orofacial myofunctional therapy is not a replacement for speech therapy but can be important to the progress and success of speech therapy.

What contributes to orofacial myofunctional disorders?Amanda Jeffrey2022-07-20T15:16:27+00:00

What contributes to orofacial myofunctional disorders?

The mouth is a complex organ composed of three systems: the myofunctional system, the dental system, and the medical system. There is no one specific cause for orofacial myofunctional disorders. There may be multiple contributing factors within these three systems that negatively influence how the 5 basic mouth functions will work.

OROFACIAL MYOFUNCTIONAL SYSTEM: Conditions within this system make it difficult for the orofacial muscles to function correctly.

There are different conditions that affect the function of the lips:

Short upper lip
Restricted maxillary frenum
Everted lower lip
Flaccid muscles of the lips
Tight muscles of the chin and neck

There are different conditions that affect the function of the tongue:

Incorrect development of the tongue muscles
Restricted lingual frenum
Enlarged tonsils
Restricted palate

There are different conditions that affect the function of the jaw:

Jaw muscle pain, injury, nerve damage, etc.
Disc displacement
Dental discrepancies

DENTAL SYSTEM: Conditions within this system make it difficult for the orofacial muscles to function correctly.

Shape of the hard palate
Relationship between the upper and lower arches
Alignment of the teeth
Dental appliances on the palate, on the teeth or between the teeth

MEDICAL SYSTEM: Conditions within this system make it difficult for the orofacial muscles to function correctly.

Restricted nasal airway
Enlarged tonsils
Allergies, asthma, respiratory problems, etc.
Syndromes, neurological conditions, injury, etc.

All of these systems and structures work together as a team. A dysfunction or altered functional pattern in any one of them affects the others, contributing to orofacial myofunctional disorders.

What does progress in orofacial myofunctional therapy depend on?Amanda Jeffrey2022-07-20T15:16:08+00:00

What does progress in orofacial myofunctional therapy depend on?

Progress with orofacial myofunctional therapy, whether the client is a child, adolescent, or an adult depends on a number of factors:

The number of myofunctional problems that need to be corrected.
Any medical condition/s that would compromise the goals of therapy.
Dental conditions affecting the palate or teeth that make it difficult for the muscles to function correctly.
Client compliance with the myofunctional therapy exercises and the daily practice to retrain the muscles to function correctly.
Parental involvement with young patients to supervise the exercises and give guidance on proper function.
Keeping the therapy appointments.
The frequency of interruptions in the routine of doing the exercises or practicing the proper functions, i.e. holidays, vacation, illness, school issues, work situations, etc.
Controlling any other habits, actions or behavior that works against the goals of therapy.

What is the benefit of physiological rest posture?Amanda Jeffrey2022-07-20T15:15:53+00:00

What is the benefit of physiological rest posture?

Lip closure aids in the development of the muscles in the lower third of the face.
Comfortable lip closure looks attractive.
Lip closure helps keep the lips from drying out.
Lip closure helps keep the mouth moist with saliva which has many benefits: saliva provides a defensive barrier against bacteria, fungi and viruses; it has a buffering action which protects teeth against bacteria producing acids; and there is a remineralizing benefit that helps repair the early stages of tooth decay.
Lip closure helps eliminate or reduce bad breath.
The lip and cheek muscles form a band that circles the teeth which determines the dimensions of the arch and establishes the position of the teeth.
Lip closure helps to guide the anterior teeth into position and acts as a retainer to hold them in place.
Lip closure establishes nasal breathing while awake and sleeping.
Nasal breathing increases the lung’s ability to absorb oxygen from the inspired air.
Diaphragmatic breathing, as part of the physiologic rest posture, pulls air into the lowest part of the lungs where oxygen exchange is most efficient.
Diaphragmatic breathing lowers the heart rate and blood pressure, relaxes muscles, calms the mind and stops anxiety.
Nasal breathing filters the air of debris and pathogens.
Nasal breathing helps to shrink the nasal turbinates.
Nasal breathing contributes to the normal development of the nasal cavity and the maxillary sinuses.
Nasal breathing while sleeping helps reduce the dry or sore throat associated with mouth breathing.
Nasal breathing produces a pattern of airflow which helps to suck the tongue up in the palate. The proper posture of the tongue in the palate is known as the neutral position.
The neutral position aids in the normal development of the palate.
The neutral position helps to support the palatal transverse arch width.
The neutral position helps to maintain an open pharyngeal airway.
The neutral position brings the tongue up off the floor of the mouth to facilitate free flow of the salivary glands under the tongue.
The neutral position helps support the mandible allowing the teeth to separate in freeway space.
The physiologic rest posture with freeway space helps to relax the masseter muscles.
The physiologic rest posture with freeway helps keep the temporomandibular joint ‘loose packed’ to maintain the proper disc space width.
The physiologic rest posture with freeway space stops clenching or grinding while awake or sleeping.
The physiologic rest posture helps to maintain proper head posture.
The physiologic rest posture is the starting point for the correct saliva swallowing.