Mouth breathing can serve a purpose during moments of danger, as it prepares our bodies to enter the “fight or flight” sympathetic state. However, when mouth breathing becomes habitual practice, it can perpetuate this heightened state of alertness, making it challenging for both the body and mind to relax, even in the absence of actual threats. During sleep, mouth breathing is linked to sleep disordered breathing and obstructive sleep apnea. This type of breathing activates the upper chest and leads to shallow, over-breathing. In contrast, nasal breathing engages the “rest and digest” parasympathetic nervous system and encourages deeper breaths through diaphragm use.

Mouth breathing can develop as a postural habit for various reasons, including nasal blockages from allergies, chronic congestion, enlarged adenoids or tonsils and deviated septum. It may also arise from thumb or finger sucking, nail biting, low tongue posture or a tongue tie. While the underlying causes may differ, the negative effects remain consistent.

Myofunctional therapy can be incredibly effective for treating mouth breathing. By addressing improper tongue posture and muscle function, myofunctional therapy helps to retrain the muscles to maintain a closed mouth with the tongue resting on the roof of the mouth. This not only enhances breathing patterns but also improves overall oral health and function. By encouraging nasal breathing, it helps to reduce the incidence of related issues like dry mouth, dental problems, and poor sleep quality.

Everyone has a band of connective tissue beneath their tongue known as the lingual frenum or frenulum. If this tissue is restrictive and causing functional problems, you may have a tongue tie. The way our tongue is anchored to the floor of our mouth has a significant impact on facial growth and oral functions such as breathing, speaking and swallowing.

The tongue acts as nature’s palate expander. Its gentle suction against the roof of the mouth promotes optimal growth and development. When tethered oral tissues (TOTS), like a tongue tie, restrict the tongue from resting in its ideal position, it can lead to underdeveloped jaw and facial structures. This can cause the palate to grow narrowly, resulting in malocclusion or “crooked teeth”. Additionally, the maxilla (upper jaw) may drop downward instead of growing outward, causing excess vertical growth due to low tongue posture and an open mouth state.

In terms of eating and swallowing, a properly functioning tongue fully contacts the hard and soft palate during swallowing to guide food down the throat. However, if there is a restriction, the tongue’s movement toward the palate is limited, making individuals feel as though food is lodged at the back of their mouth. These individuals may avoid certain textures that are more likely to get stuck, leading to the misconception that they are simply picky eaters. In reality, they are often protecting their airway.

Regarding food clearance, both children and adults with tongue ties experience limited tongue mobility. The tongue serves as an essential tool for clearing food debris from the mouth. With restricted motion, food residues can become trapped around the teeth, gums and cheeks increasing an individual’s risk for cavities and periodontal disease.

As for speech issues, when the tongue is tethered to the floor of the mouth, many sounds become difficult or even impossible to produce. While myofunctional therapy is not the same as speech therapy, there are cases where releasing the togue tie can enhance a child’s ability to pronounce certain sounds effectively.

Currently, tongue tie restriction is evaluated in five dimensions: how far one can stick out the tongue, how high one can lift the tongue to the incisive papilla (located behind the upper front teeth with an open mouth), how much help floor of the mouth, neck and other muscles provide in suctioning or lifting the tongue, and muscle tension linked to the first three.

During the comprehensive myofunctional exam your tongue’s range of motion will be assessed along with your swallowing ability. Any compensatory patterns will be identified, and we will discuss any potential restrictions present. If a togue tie release is recommended, you will receive a referral to a qualified provider who has received specialized training in tongue tie assessment and treatment. The release is typically performed mid-therapy after you have developed muscle tone and coordination in the muscles surrounding the frenulum. Following the release, we will work together to build strength, coordination, and function in your newly released tongue, striving for optimal oral muscle function.

A tongue thrust refers to a dysfunctional swallowing pattern where an individual pushes their tongue against or between the teeth while swallowing. Often, a low resting tongue posture or tongue thrust is simply a symptom of a more significant issue. Individuals with a tongue thrust swallowing pattern often develop anterior open bites, where the front teeth do not meet when biting down on the back teeth, or posterior open bites, where the back teeth do not come together due to the consistent pressure of the tongue against the teeth when swallowing.

Form follows function; when the muscles of the tongue do not perform correctly, it can lead to a range of facial and airway issues. If a tongue thrust is not addressed, it may result in underdeveloped craniofacial structures, a high vaulted palate, sleep disordered breathing and dental concerns such as crowding, periodontal disease and decay.

Myofunctional Therapy is an effective method for addressing tongue thrusting. A myofunctional therapist plays a crucial role in helping patients retrain their facial and tongue muscles. They specialize in guiding both children and adults in overcoming muscular habits associated with tongue thrusting.

Myofunctional therapy targets and improves various aspects, including elevation and strength of the tongue, correct tongue resting posture, proper tongue placement during swallowing, enhanced tongue mobility, help with maxillary constriction and helps prevent relapse of treated malocclusion.

Thumb or finger-sucking habits can be common in infancy and early childhood. Many children engage in these behaviors during their early years but typically outgrow them without intervention. It is generally not advisable to draw excessive attention to these habits at a young age, as it can do more harm than good. However, sucking habits can become of concern when they are excessive and determining this can depend on factors like intensity, frequency and duration of the habit. Consider the following questions to evaluate your child’s sucking habit:

-Intensity: Is the thumb or finger being sucked with enough force to cause calluses or alter its shape? Do you notice strong contractions in the cheeks during sucking?

-Frequency: Does the sucking occur throughout the day and night? Is it seen in public or around non-family members?

-Duration: How many years has the habit continued? If it involves the permanent teeth, there is heightened concern about developmental issues.

Excessive sucking habits can cause developmental problems in dental and facial structures, especially if they persist beyond the age of three. The front teeth are usually the visibly affected, but the entire growth pattern of the face can be altered as well. Common growth issues linked to sucking habits include:

-Dental Effects: Open bites or crossbites can develop and the upper jaw may become narrow and high, reducing space for the nasal sinuses and potentially affecting the airway of breathing.

-Tongue Positioning: The togue may struggle to rest comfortably in the palate, where it naturally belongs.

-Jaw Development: The lower jaw may become smaller and less pronounced, which can create a weaker chin appearance. The profile of the face can change dramatically due to the pressure from the thumb resting on the jaw and teeth.

Myofunctional therapy can play a crucial role in helping with habit elimination of sucking habits. Some children may need external motivation from a supportive figure to encourage them to stop. Addressing myofunctional disorders is vital for treating thumb sucking and similar habits. Myofunctional therapists are trained to assist both children and adults in regaining control over their habits in a positive way.

Even if a child successfully breaks the habit, consulting a myofunctional therapist remains valuable. Stopping the habit doesn’t guarantee that the oral musculature will revert to normal on its own, as dysfunction can persist. The obstacle may be gone but the incorrect oral posture and tongue thrusting may remain, necessitating retraining of the facial and oral muscles that have been improperly used for years

Children with sleep disordered breathing often exhibit inattention or hyperactivity, and some are diagnosed with attention deficit/hyperactivity disorder (ADHD) until their sleep disorder is identified. Mouth breathing triggers a fight or flight response in the sympathetic nervous system, while nasal breathing engages the parasympathetic system. The sympathetic nervous system is primarily known for its reaction to dangerous or stressful situations; when activated, it increases your heart rate to send more blood to areas needing oxygen, helping you escape danger. When a child’s body remains in this state throughout the night, it prevents them from achieving deep sleep, the crucial restorative phase that everyone requires. This means that even if a child is getting enough sleep, the quality may be lacking. These factors together can significantly impact a child’s developing body, affecting hormone balance, physical growth, overall development and mental well-being. It is essential for every child, especially those showing ADHD symptoms or diagnoses, to be screened and evaluated for sleep disordered breathing and myofunctional issues.

Millions of individuals experience a significant deficiency in quality sleep, with disruptions stemming from various causes. One of the more serious medical conditions contributing to this issue is obstructive sleep apnea (OSA), which occurs when the tongue blocks the airway during sleep. In the United States, around 6 million people have been diagnosed with sleep apnea, while it is estimated that 23 million more are suffering it effects without a diagnosis.

When the muscles in the throat, soft palate and tongue do not function properly, the tongue can fall back into the airway during sleep. If this results in a partial blockage, it causes vibrations in the tongue tissue, leading to snoring. In cases of complete blockage, breathing becomes impossible, prompting the body to reflexively grind teeth, partially awaken, toss and turn, and gasp for air in an effort to clear the airway for oxygen.

Traditionally, it was believed that being overweight increased risk of sleep apnea. However, it has become clear that young children, women, teenagers and even physically fit individuals can also be affected by this condition. Treatment options for sleep apnea include CPAP and APAP therapies, sleep appliances and in some cases surgery.

Recent studies have indicated that myofunctional therapy can reduce the apnea-hypopnea index by 50% in adults and 62% in children.

Untreated obstructive sleep apnea can significantly impact quality of life, increasing the risk and severity of heart disease, high blood pressure, heart attacks, arrhythmias, sexual dysfunction, diabetes, stroke and other chronic health issues. This condition prevents the body from entering restorative sleep, resulting in daytime sleepiness, chronic fatigue, short-term memory loss, early onset dementia and personality changes.

Many patients consult a myofunctional therapist as part of their treatment for temporomandibular joint (TMJ) pain. Low tongue posture, open mouth breathing, tongue thrusting, swallowing issues and other dysfunctional patterns that can develop over a lifetime increase the risk of TMJ pain, which can originate from the joint itself or the muscles that support its function.

Common causes include:

1. Clenching and grinding: This activation of the sympathetic fight or flight response of the nervous system, driving the need to open the airway for better breathing. This often causes facial muscles to engage while sleeping, pushing the lower jaw forward. The activation of these facial muscles can exert up to 1,000 PSI of force on the teeth, leading to wear, cracks, and breaks overtime.

2. A forward head posture combined with a low tongue position, reduces the airway space leading to mouth breathing and further compromised airway function. This adjustment is often subconscious, as individuals instinctively try to breathe better. This misalignment can happen both during the day and at night, causing neck muscles to become fatigued and strained, contributing to pain in the head, neck, back and shoulders. The additional weight from an improperly positioned head can exacerbate existing TMJ problems.

3. Another consideration is fascia, a thin layer of connective tissue that supports and surrounds every organ, blood vessel, bone, nerve fiber and muscle in the body. Recent studies indicate that the “deep front line” fascia connects the togue to various body parts, such as the lungs, diaphragm, hip, knees and feet. When there is restriction in the tongue movement or habit of low tongue posture, it alters the functioning of this fascia throughout the body. Such habitual tension in facial muscles due to tongue ties or improper tongue usage can place additional strain on the jaw joint and its associated muscles, leading to more pain and potential changes in occlusion, like a narrowing of the upper arch or flattening of the chewing surfaces of the teeth, which can cause disc compression and displacement of the TMJ.

4. The position of the tongue significantly affects growth and development. When the tongue is low, the maxilla (upper jaw) tends to grow downward rather than outward and forward, and the mandible (lower jaw) also shifts down and back, which restricts its forward movement and leads to disc compression within the TMJ. Chronic pain often arises from a combination of these issues, impacting both occlusion and craniofacial development. Additionally, a lack of contact between the tongue and palate means there is insufficient stability and support for the jaw joints.

   Symptoms of TMD can include limited jaw opening, a history of nighttime grinding/ need of night guard, headaches or migraines, facial pain or tension, clicking, popping, grinding sounds from the jaw joint, and pain or tension in the neck or shoulder muscles around the jaw joint or above the ear. Myofunctional therapy can help alleviate the underlying causes of TMJ pain by restoring normal function of the muscle and joint through proper tongue posture and appropriate swallow patterns. For optimal results, myofunctional therapy for TMJ pain should be combined with other treatments such as dental appliance therapy, chiropractic care by specialists trained in TMJ, and both intraoral and extraoral massage therapy.