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A case study on myofunctional therapy and malocclusions created by oral habits
Abstract
Purpose:
To demonstrate the effect of an orofacial myofunctional therapy intervention by an interdisciplinary team composed of a registered dental hygienist who is also a certified orofacial myologist (COM®), a general dentist, and an orthodontist on the elimination of oral habits and changes in dental malocclusion.
Method:
This case study describes a 7-year-old female who underwent an individualized myofunctional therapy program and was given supervised education on a series of exercises targeting the muscles of mastication and facial expression over 5 months. Correct oral rest postures of the tongue and the lips were also established through therapy.
Results:
The intervention enabled the client to eliminate multiple oral habits, which corrected oral rest postures of the lips and tongue. This correction consequently improved the client's malocclusion and further prepared the client for future orthodontic treatment.
Conclusion:
Myofunctional therapy facilitated the elimination of unfavourable oral habits that led to malocclusion. Eliminating oral habits better prepared the client for orthodontic treatment and retention. Use of an interdisciplinary team facilitates optimal client care.
... Жевательная резинка относится к средствам гигиены полости рта. Но ни одно средство гигиены не вызывает такого спора среди врачей-стоматологов [5]. Это связано с бесконтрольным применением между основными приемами пищи. ...
INTRODUCTION . The relevance of the study is related to the increased uncontrolled consumption of chewing gum by children.AIM. The aim is to study the functional state of masticatory muscles in patients with changeable dentition using chewing gum in different modes. MATERIALS AND METHODS . The study was carried out on 31 children, the average age of whom was 8.5 ± 1.2 years. It is at this age there is an active formation of facial morphology, which is directly related to the activity of the masticatory muscles. Therefore, it is very important to assess the condition of the masticatory musculature in order to timely identify imbalance in muscle activity, hypo and hypertonus of the musculature and to start therapy. Electromyographic study was performed on the Synapsis apparatus. RESULTS . There is a violation of coordination in the work of masticatory muscles with predominance in the work in the right temporal muscle and left proper masticatory muscle. This is due to the fact that additional chewing was present in this group. CONCLUSION . The provided analysis of masticatory function showed that children who frequently use chewing gum have a pronounced discoordination and imbalance in the work of masticatory muscles.
... The effect of NNSH depends on the nature, onset and duration of the habit. Sucking behaviors are physiological habits in newborns that stimulate the orofacial muscles and contribute to normal growth; however, the persistence of non-nutritive sucking habits can lead to long-term problems and create defects in the stomatognathic system [2][3][4][5][6][7][8]. ...
The development of the craniomandibular system is guided by genetic interactions and environmental factors, including specific habits such as breastfeeding, bottle feeding, thumb sucking and the use of pacifiers. These habits can have a considerable impact on the growth of the developing jaws and can lead to malocclusion in children. This review aims to investigate potential associations between non-nutritive sucking habits (NNSHs) and malocclusions compared to the presence of nutritive sucking habits (NSHs). To carry out this systematic review, we followed the PRISMA protocol and performed a bibliographic search of the existing literature until April 2023 in the following electronic databases: Medline, PubMed, The Cochrane Library and Embase. Out of a total of 153 records, we included 21 studies. We found that the chances of diagnosing a malocclusion were higher for children with bottle nutrition when compared to breast-fed children. Breastfeeding provides protection against malocclusions. In the same manner, persistent NNSH habits appeared to be associated with increased chances of having malocclusions. The longer the child was breastfed, the shorter the duration of the pacifier habit and the lower the risk of developing moderate/severe malocclusions. The duration of the habits has a positive influence on the appearance of occlusion defects.
Background
A functional definition of ankyloglossia has been based on assessment of tongue mobility using the tongue range of motion ratio (TRMR) with the tongue‐tip extended towards the incisive papilla (TIP). Whereas this measurement has been helpful in assessing for variations in the mobility of the anterior one‐third of the tongue (tongue tip and apex), it may be insufficient to adequately assess the mobility of the posterior two‐thirds body of the tongue. A commonly used modification is to assess TRMR while the tongue is held in suction against the roof of the mouth in lingual palatal suction (LPS).
Objective
This study aims to explore the utility and normative values of TRMR‐LPS as an adjunct to functional assessment of tongue mobility using TRMR‐TIP.
Study Design
Cross‐sectional cohort study of 611 subjects (ages: 3‐83 years) from the general population.
Methods
Measurements of tongue mobility using TRMR were performed with TIP and LPS functional movements. Objective TRMR measurements were compared to subjective self‐assessment of resting tongue position, ease or difficulty elevating the tongue tip to the palate, and ease or difficulty elevating the tongue body to the palate.
Results
There was a statistically significant association between the objective measures of TRMR‐TIP and TRMR‐LPS and subjective reports of tongue mobility. LPS measurements were much more highly correlated with differences in elevating the posterior body of the tongue as compared to TIP measurements (R² 0.31 vs. 0.05, p<0.0001).
Conclusions
This study validates the TRMR‐LPS as a useful functional metric for assessment of posterior tongue mobility.
To reduce drooling and facilitate food transport in rehabilitation of patients with oral motor dysfunction, lip force can be trained using an oral screen. Longitudinal studies evaluating the effect of training require objective methods. The aim of this study was to evaluate a method for measuring lip strength, to investigate normal values and fluctuation of lip force in healthy adults on 1 occasion and over time, to study how the size of the screen affects the force, to evaluate the most appropriate measure of reliability, and to identify force performed in relation to gender. Three different sizes of oral screens were used to measure the lip force for 24 healthy adults on 3 different occasions, during a period of 6 months, using an apparatus based on strain gauge. The maximum lip force as evaluated with this method depends on the area of the screen size. By calculating the projected area of the screen, the lip force could be normalized to an oral screen pressure quantity expressed in kPa, which can be used for comparing measurements from screens with different sizes. Both the mean value and standard deviation were shown to vary between individuals. The study showed no differences regarding gender and only small variation with age. Normal variation over time (months) may be up to 3 times greater than the standard error of measurement at a certain occasion. The lip force increases in relation to the projected area of the screen. No general standard deviation can be assigned to the method and all measurements should be analyzed individually based on oral screen pressure to compensate for different screen sizes.
Purpose:
Alterations of the lingual frenulum may contribute to oromyofacial dysfunction, speech and swallowing impediments, underdevelopment of the maxillofacial skeleton, and even predispose to sleep breathing disorder. This study aims to assess the utility of existing instruments for evaluation of restricted tongue mobility, describe normal and abnormal ranges of tongue mobility, and provide evidence in support of a reliable and efficient measure of tongue mobility.
Methods:
A prospective cohort study of 1052 consecutive patients was evaluated during a 3-month period. Age, gender, ethnicity, height, weight, BMI, maximal interincisal mouth opening (MIO), mouth opening with tongue tip to maxillary incisive papillae at roof of mouth (MOTTIP), Kotlow's free-tongue measurement, and presence of severe tongue-tie were recorded. Secondary outcome measures include tongue range of motion deficit (TRMD, difference between MIO and MOTTIP) and tongue range of motion ratio (TRMR, ratio of MOTTIP to MIO).
Results:
Results indicate that MIO is dependent on age and height; MOTTIP and TRMD are dependent on MIO; Kotlow's free-tongue measurement is an independent measure of free-tongue length and tongue mobility. TRMR is the only independent measurement of tongue mobility that is directly associated with restrictions in tongue function.
Conclusions:
We propose the use of tongue range of motion ratio as an initial screening tool to assess for restrictions in tongue mobility. "Functional" ankyloglossia can thus be defined and treatment effects followed objectively by using the proposed grading scale: grade 1: tongue range of motion ratio is >80%, grade 2 50-80%, grade 3 < 50%, grade 4 < 25%.
The ratio of bad habits, mouth breathing and malocclusion is an important issue in view of prevention and early treatment of disorders of the craniofacial growth. While bad habits can interfere with the position of the teeth and normal pattern of skeletal growth, on the other hand obstruction of the upper airway, resulting in mouth breathing, changes the pattern of craniofacial growth causing malocclusion. Our crosssectional study, carried out on 3017 children using the ROMA index, was developed to verify if there was a significant correlation between bad habits/mouth breathing and malocclusion. The results showed that an increase in the degree of the index increases the prevalence of bad habits and mouth breathing, meaning that these factors are associated with more severe malocclusions. Moreover, we found a significant association of bad habits with increased overjet and openbite, while no association was found with crossbite. Additionally, we found that mouth breathing is closely related to increased overjet, reduced overjet, anterior or posterior crossbite, openbite and displacement of contact points. Therefore, it is necessary to intervene early on these aetiological factors of malocclusion to prevent its development or worsening and, if already developed, correct it by early orthodontic treatment to promote eugnatic skeletal growth.
© Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.
Background
A reduced mouth opening capacity may be one of the first clinical signs of pathological changes in the masticatory system. The aim of this retrospective cross-sectional study was to create age related percentiles for unassisted maximal mouth opening capacity (MOC) of healthy children.
Methods
All recordings of MOC as measured at the yearly dental examinations of school children in the city of Zurich, Switzerland, between August 2009 and August 2010 were extracted from the database. The program LMSchartMaker Pro Version 2.43, Huiqi Pan and Tim Cole, Medical Research Council, 1997–2010 was used to calculate age and sex related reference centiles.
Results
Records from 22′060 dental examinations were found during the study period. In 1286 (5.8%) the maximal interincisal measurement was missing. Another 55 examinations were excluded because of missing data for sex (7), age at examination (11) or because the value was deemed to be pathologically low (37). Thus, a total of 20′719 measurements (10′060 girls, 10′659 boys) were included in the analysis. The median age (range) was 9.9 years (3.3-18.3) for girls and 10.0 years (2.8-18.7) for boys. The mean MOC (range) was 45 mm (25–69) for girls and 45 mm (25–70) for boys. Age related percentiles were created for girls and boys separately, showing the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentile from 3 through 18 years of age.
Conclusions
In these 20′719 unselected school children MOC increased with age but showed a wide range within children of the same age.
An efficient lingual frenulum protocol with scores is presented. From a specific lingual frenulum evaluation used until 2004, a new protocol was designed. Ten speech language pathologists experienced in orofacial myology used the new protocol with different groups of subjects. 1235 subjects were evaluated during 3 years. From the experience of these ten speech language pathologists, the protocol was re-structured, and a scoring system was added. Absence of alteration (normal tongue and frenulum) was scored zero. The alterations observed were scored in ascending order. Four additional speech language pathologists experienced in orofacial myology were trained by the researcher to administer the final version of the protocol. The protocol was administered in 2008 and 2009 to 239 subjects: 160 children between 7 years and 2 months old and 11 years and 7 months old; and to 79 adults from 16 years and 8 months or older. From the results of administration of the protocol, a new lingual frenulum protocol with scores was designed. According to the scores, the frenulum can be considered altered or normal. When the sum of general tests is equal or higher than 3, the frenulum may be altered. The interference of the lingual frenulum in the oral functions may be considered when the sum of the functional tests is equal or higher than 25. This new lingual frenulum protocol with scores was designed and has been an efficient tool to diagnose an altered lingual frenulum.
Mimicry facilitates the ability to understand what other people are feeling. The present research investigated whether this is also true when the expressions that are being mimicked do not reflect the other person's true emotions. In interactions, targets either lied or told the truth, while observers mimicked or did not mimic the targets' facial and behavioral movements. Detection of deception was measured directly by observers' judgments of the extent to which they thought the targets were telling the truth and indirectly by observers' assessment of targets' emotions. The results demonstrated that nonmimickers were more accurate than mimickers in their estimations of targets' truthfulness and of targets' experienced emotions. The results contradict the view that mimicry facilitates the understanding of people's felt emotions. In the case of deceptive messages, mimicry hinders this emotional understanding.
The aim of this review is to create a complete analysis about tongue-tie (or short lingual frenum or ankyloglossia) according to the most important works published in literature. The analysis allowed us to do a complete evaluation of this problem, from embriology to the therapeutic approach we could use today, focusing our attention on laser-assisted therapy. This review is based on the research on the PubMed Database (www.ncbi.nlm.nih.gov) of studies about lingual frenum written in English between January 1980 and May 2014. The keywords inserted were “lingual frenum”, “frenectomy”, “laser therapy”. We have analyzed: case series, case reports, clinical studies, and also literature reviews in which embryology, physiology, diagnosis and treatment of ankyloglossia were described. We excluded laboratory studies, studies based on animal tests and studies about patients with particular syndromes in which we can also find tongue-tie. The selection criteria allowed us to select 42 articles. The treatment options for the releasing of the frenum are surgically represented by frenotomy (i.e. simple horizontal cut of this training) and frenectomy (i.e. removal). In both cases, the intervention on the short lingual frenum is simple, short-lasting, and without particular complications. Furthermore, this kind of treatment can be carried out with different devices: with the typical cold blade scalpel or by the use of laser, a new method that shows more advantages over the prior art. Laser-assisted therapy permits to intervene on newborns (from 0 to 20 days, when there are breastfeeding problems) without total anesthesia and suture. The Er:YAG, CO2 laser (according to literature data) and Diode laser (according to our experience) are advantageous, safe and effective in tongue-tie treatment.
Atypical deglutition is correlated not only with posture and orocraniocervical morphology, but also with the subject's general posture. The tongue is capable of perturbing postural balance due both to its connections with the key anatomical structures, and to other neurophysiological reasons. The hyo-glossus apparatus, owing to its links with the maxillaries, the skull, the cervicals, the scapula, the pharynx and the larynx, is the true "trait d'union" be-tween the oral and postural functions of the body. Due to the prevalently transverse arrangement of its fi-bres, the tongue may be considered a diaphragm link-ing the body's anterior and posterior muscular chains. In this report, we present a new nosographical entity, glosso-postural syndrome, which is characterized by postural imbalance and atypical deglutition. The most important traits of type I and type II glosso-postural syndrome are described.
Successful breastfeeding is dependent upon an infant's ability to correctly latch onto a mother's breast. If an infant is born with oral soft tissue abnormalities such as tongue-tie or lip-tie, breastfeeding may become challenging or impossible. During the oral evaluation of an infant presenting with breastfeeding problems, one area that is often overlooked and undiagnosed and, thus, untreated is the attachment of the upper lip to the maxillary gingival tissue. Historically, this tissue has been described as the superior labial frenum, median labial frenum, or maxillary labial frenum. These terms all refer to a segment of the mucous membrane in the midline of the upper lip containing loose connective tissue that inserts into the maxillary arch's loose, unattached gingival or tight, attached gingival tissue. There is no muscle contained within this tissue. In severe instances, this tissue may extend into the area behind the upper central incisors and incisive papilla. The author has defined and identified the restrictions of mobility of this tissue as a lip-tie, which reflects the clinical attachment of the upper lip to the maxillary arch. This article discusses the diagnosis and classifications of the lip-tie, as it affects an infant's latch onto the mother's breast. As more and more women choose to breastfeed, lip-ties must be considered as an impediment to breastfeeding, recognizing that they can affect a successful, painless latch and milk transfer.
The major primary factors in the dental equilibrium appear to be resting pressures of tongue and lips, and forces created within the periodontal membrane, analogous to the forces of eruption. Forces from occlusion probably also play a role in the vertical position of teeth by affecting eruption. Respiratory needs influence head, jaw and tongue posture and thereby alter the equilibrium. "Deviate swallowing" is more likely to be an adaptation than a cause of tooth changes. Patients with failure of eruption have been recognized and alterations in the eruption mechanism may be more important clinically than has been recognized previously.
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