Resurrecting a long forgotten piece of the dental diagnostic puzzle
Have you ever stopped and wondered why out of all the animals with teeth, humans have tooth crowding while all the all other animals have perfectly straight teeth and well formed jaws?
What is the cause and what are the sequelae of this phenomenon? While there may be many reasons for tooth crowding, facial muscular imbalance may be the root cause. The key to understanding Myofunctional Syndrome is to realize that the muscles of our body form and shape our bones. In the contest between muscles and bones, the muscles always win. The tongue, being the biggest muscle positioned in the center of the head, along with the facial muscles are critical in developing the proper shape of the upper jaw. People who are “tongue tied” or have an abnormal tongue position during swallowing often suffer from the Myofunctional Syndrome. Since the upper jaw is also the base of the skull, its shape affects the upper airway, tonsil position and the shape of the face. Disruption in normal breathing pattern can affect head posture resulting in neck pain, TMJ pain and facial muscle pain. In addition, airway issues have major consequences and varied symptoms.
Many people live with these symptoms their entire life not knowing that it is not normal or there is a solution.
Why do maxillas become narrowed in the first place?
The skull deformation from improper swallowing and tongue position and facial muscle imbalance has its beginnings in 2 phenomenons: reduced tongue mobility and lack of or not enough breast-feeding.
The way the facial muscles work and move during natural breast-feeding is radically different form the way a baby feeds from a bottle. Natural breast-feeding correctly shapes the bones of the skull while bottle feeding causes unnatural forces in the mouth over stimulating some muscles and under-stimulating others. In the few remaining pockets of hunter-gatherer populations, and from the observation of now extinct hunter greater populations, children are routinely weaned at 2.5 years of age, In the USA six months of breast feeding is considered a great achievement.
In the turn of the 20th century, a fellow dentist, Dr. Weston Price traveled the world studying populations, still living in the traditional way. Time after time he discovered perfectly shaped dental arches, and straight teeth in these people. While the more “civilized populations” had a large percentage of crooked teeth and narrow arches.
A tongue restricted by short lingual frenums is not able to perform its normal swallowing pattern, which pushes the tongue against the palate. It is critical to understand that the roof of the mouth is shaped and supported by the normal tongue swallow. A narrow maxilla is a sequel of the tongue NOT functioning normally and is a huge clue in identifying Myofunctional Syndrome.
Dental health care providers are in a unique position to identify the Myofunctional Syndrome because they primarily deal with the mouth and see patients on a recurrent basis. However, there are only a handful, which are trained to identify the Myofunctional Syndrome because it is simply not part of our dental education and the training is extremely costly, time consuming and almost non-existent for the dental profession.
Improper swallowing and tongue position are one of the single most damaging effects on the correct performance of our head and neck. This imbalance can lead to a variety of seemingly unrelated health problems. Dental problems secondary to improperly functioning tongue and facial muscles may lead to tooth flaring, tooth spacing, increased incidence of tooth decay and gum disease, anterior and posterior open bites, narrow aches and tooth crowding. Tongue position. Not identifying patients with Myofunctional Syndrome is a huge blind spot in the dental profession and may be a factor in dental treatment failure. Such as orthodontic and orthognathic surgery relapse. Unrelenting gum disease and tooth decay, leading to tooth loss despite patient and doctor efforts is also common. Facial and oral pain such as TMJ pain, migraines or tension headaches, tinnitus, neck and facial muscle pain can be caused by improper swallowing and tongue position. Facial structure imbalance, deformity and unevenness are also a frequent finding.
Airway issues such as snoring and Obstructive Sleep Apnea and forward head posture can be caused by tongue position issues. People suffering from any of the above-mentioned conditions, Referred as the Myofunctional Syndrome, often spend years going from one doctor to another. Treatment costing hundreds of thousands of dollars over the course of decades of suffering is met with frustration due to non-resolution of their symptoms. Many people feel hopeless and even suicidal.
Below is a list of symptoms that may be caused by the Myofunctional Syndrome. The more of these conditions a patient has, have the higher the likelihood you may have the Myofunctional Syndrome.
- Tongue tie or tongue restriction
- Large upper midline frenum or space between the upper front teeth
- High vaulted or narrow palate
- Narrow smile
- Large dark space between corner of mouth and side teeth when smiling
- Cross Bite
- Lower back teeth tipped toward the tongue
- Tongue too big for the mouth (scalloped tongue)
- Bicuspid (premolar) extraction during Orthodontics (braces)
- Front open bite (gap between upper and lower front teeth)
- Large tonsils or tonsil removal surgery
- Mouth breathing
- Mouth constantly open
- Dry Lips, dry mouth
- Small nostrils
- Forward head posture
- TMJ pain, clicking or popping
- Chronic Neck Pain / neck stiffness
- Face burning / tingling
- Snoring/obstructive sleep apnea
- Front teeth crowding/flaring/spacing
- Long face
- Acid reflux/GERD
- Ringing in the ears (tinnitus)
- Speech issues
- Orthodontic relapse
Myofunctional Therapy is an approach that is used to correct the improper function of the tongue and facial muscles used for chewing, swallowing as well as the relaxed state. The bones in our body are dynamic. They change their shape and form based on the muscles that attach and pull on them. Therefore improper muscle function has a detrimental effect on our bones. Oral-Myofunctional Therapy uses muscle-retraining techniques and improving tongue mobility to create new muscle memory and brain networks to re-establish normal jaw, face and neck function.
The human the body needs to maintain a specific harmonious pattern called Homeostasis. However, as with any complex biological system, when an important function of the body is thrown off, breakdowns and problems ensue. Establishing a correct relationship between muscles of the face, mouth, tongue and airway is the goal Dental Myofunctional Therapy.
Incorrect swallowing and tongue position can have devastating as well as far-reaching health effects.
Since a person swallows approximately 2000 times a day, improper swallowing, formally know as the deviant swallow now called the reverse swallow, can cause a variety of seemingly unrelated health problems.
Rethinking Orthodontic relapse
Orthodontic treatment is almost every kids right of passage today in the USA. The sad fact is that many will experience relapse and their teeth will get crooked again. Nearly half of our adult patients who want to straighten their teeth had braces as children and their teeth are crooked again. Most dentists blame “not wearing the retainer” as the cause of relapse as the primary reason. In the first 6 months following orthodontics, that may be true. However, the re-crowding of teeth in the long term may not have anything to do with not wearing the retainer after all.
Tooth crowding occurs because there is not enough room for the teeth to come in straight within your jaw arches. While this may occur because the patient inherited the mothers mother’s small jaws and the father’s large teeth, what seems to be occurring in many people is a jaw arch constriction caused by unnatural infant feeding and incorrect swallowing and tongue position.
The forward trusting tongue during the reverse swallow literally pushes the front teeth out, and orthopedically narrows the actual bone of the upper jaws in the process. Cross bites and lower teeth tipping lingually is a common sequel of a constricted maxilla. This causes the deformation of the well-rounded jaw arches we are genetically programed to develop. If improper swallowing is not corrected via Myofunctional Therapy, the risk for orthodontic relapse is very real.
We owe it to our patients to help them maintain a healthy functioning mouth for a lifetime. Ignoring Myofunctional Syndrome is one of our professions greatest blind spots. Hopefully this article gives you some food for thought and will encourage you to pursue further education and ultimately better help your patients.