A basic overview
It can take most individuals between 12 and 20 weekly sessions to complete a full orofacial myofunctional therapy program and generate long-term neuroplastic changes.
The phases of our program
Our program can commence after complete baseline assessments, including screening for possible risk factors and treatment limitations, appropriate referrals to other medical and dental providers, and elimination of oral habits.
Our full orofacial myofunctional therapy program is 4 phases in length.
- Phase 1: This phase is exercise intensive. During this phase, we break down the basic movements for a good swallow and oral rest posture (tongue up, lips closed, breathing through the nose, and the upper/lower teeth a few millimeters apart).
- Phase 2: This phase involves functional performance. During this phase, we piece together the things we have learned in phase 1 to achieve more complex muscle activities. This includes oral rest posture for longer periods of time and balanced muscle functions during activity. We may work on saliva swallows, balanced unilateral chewing, bolus formation, eating and drinking. For individuals with speech and articulation concerns, treatment with the speech-language pathologist can begin during phase two, after oral rest posture has been established.
- Phase 3: This phase focuses on the habituation of good oral rest posture (day and night) and swallows during all meals.
- Phase 4: This phase involves maintenance and habituation of all learned skills.
Phase 1 – Exercise Intensive
First we work on:
- Oral rest posture education, including finding “the spot” where the tongue should rest and touch during swallows
- Body posture
- Breath Control
- Oral proprioception and awareness
- Tongue movement without the support of the jaw and/or lips (tongue/lip/jaw disassociation)
- Strength and endurance activities for muscles of the facial, jaw, tongue, lip. and soft palate
- Jaw stability and grading
- Shaping the tongue and lips
- lip strength and closure
- suctioning the tongue on the roof of the mouth
- Pre and post operative activities for frenectomy and orthognathic surgery, if needed
- And more
Phase 2 – Functional Performance
Then we train:
- Muscle coordination
- Suctioning and trapping
- Bolus control and formation
- Saliva swallows
- Hard and complex food swallows
- Oral rest posture for longer periods of time
- Speech therapy, if needed*
- And more
Phase 3 – Habituation
We finally focus on:
- Good swallows during all meals
- Habituation of good oral rest posture and swallow – day and night
Phase 4 – Maintenance
Lastly, we monitor for:
- Long-term maintenance of good oral rest posture
- Retention of good chewing/swallowing mechanics
* Orofacial myofunctional therapy is not speech therapy. This is a different service.
Breaking it down even further
While our orofacial myofunctional therapy programs are strategic, structured, and hierarchical with well-defined long-term goals, treatment is totally customized to the patient’s particular needs and concerns.
In the graphic below, you can see the basic structure to each individual phase of our three-phase program. The skills we cover build upon one-another in a sequential and systematic way, typically following normal patterns of oral motor movement development.
what are the goals of treatment?
The main goals of this treatment are:
- The habituation of oral rest posture, including nasal breathing, lip competence and maintenance of lip seal/closure, high/palatal tongue rest posture, and a few millimeters of freeway space between the upper and lower teeth.
- Optimization of chewing and swallowing functions. This includes the ability to properly accept food from a spoon or fork, even chewing patterns, bolus control and formation, good swallows for all foods and drinks, clean-up swallows as needed, and proper saliva swallows.
Orofacial myofunctional therapy has been associated with incidental gains in things we do not directly treat. For example, lessening the severity of sleep disordered breathing (including snoring, upper airway resistance syndrome, and obstructive sleep apnea), reducing TMJ pain, improving oral health, facilitating orthodontic treatment, and decreasing the chances of orthodontic and surgical relapse.