Whether you have been contacted by a myofunctional therapist, in your area, have just stumbled into the world of myofunctional therapy (MT), or have patients who are asking about MT; you are in the right place. Beginning screening patients for MT is relatively easy and not time consuming for you or your practice.
Begin with some case history screening questions that will point you in the right direction. Remember that while having a few or a majority of these history items does not guarantee a orofacial myofunctional disorder (OMT), it does guide you on the best patients to screen for referral.
Case history in pediatric fields:
- Any complications in pregnancy/labor and delivery? Were you induced?
- Were you able to breastfeed? Duration?
- How is the child sleeping at night? Is the mouth opened or closed?
- Any snoring, grinding, drooling, restless sleep, sleep walking/talking, night terrors, bedwetting?
- Any history of prolonged pacifier, sippy cup or bottle usage?
- Any habitiual thumb sucking or nail biting?
- Is the child a picky eater? Does the child chew hard foods?
- Is the diet high in gluten, dairy and processed foods?
- Is there frequent congestion?
- History of asthma and/or eczema?
Case history in adult fields:
- Do you snore, grind, have restless sleep, drooling, sleep walk/talk, or experience bedwetting?
- Have you experienced daytime sleepiness?
- Have you ever had a sleep study done?
- Do you experience any TMJ or jaw pain?
- Do you wake in the morning with dry mouth?
- Do you frequently mouthbreathe?
- Have you had braces or orthodontic treatment in the past that has since relapsed?
- Is your diet high in gluten, dairy, primarily soft or processed foods?
- Do you have difficulty swallowing pills?
- Are you frequently congested?
- Any history of asthma and/or eczema?
Why ask these questions? Well, there are common connections between tongue thrust and mouthbreathing, with sleep apnea, ADHD, asthma, eczema, inability to chew hard foods (such as raw carrots), frequent congestion, noxious oral habits and difficulty breastfeeding or maintaining supply prior to weaning. These questions may lead you towards determining the underlying cause of their problems.
In office screening
Start with occlusion. Dental open bites (posterior or anterior), class II and some class III occlusions are prime candidates for a swallow and speech test. If you are not familiar with dental occlusion classifications, you can still look into the mouth and observe whether the patient has a narrow and high palate. The palate is also indicative of malocclusion.
Also look for these clinical signs:
No visible restriction, full mobility in lift and extension
Mild: Partially restricted lift and extension that may or may not need release
Moderate: slight heart shaped tip with lift and extension
Severe: Requires revision to lift and extend
- Thrust in swallow and speech
- Observed oral resting posture
In the duration of time that the patient is with you, have you noticed mouth-breathing prominently? Or does the patient have lips closed and patent nostrils?
Ring of dry skin around lips from habitual lip licking
Other things to look for include, but are not limited to:
- habitual lip licking or biting
- audible breathing
- allergic shiners (venous pooling under eyes)
- underdeveloped cheek muscles
These quick assessments will help you determine the best candidates to refer for myofunctional therapy. However, there is nothing wrong with sending a patient for evaluation that the orofacial mycologist determines does not need treatment. There are no rights and wrong in interdisciplinary care. Every evaluation and consultation your patients get, brings them one step closer to resolution.