Myofunctional Therapy 101

Today we discuss my favorite topic! An orofacial myofunctional disorder (OMD) is a disorder characterized by improper tongue, jaw and lip positioning during swallowing, feeding and speaking. Patients with this disorder often present with mouth breathing, low tongue posture (resting the tongue on the low teeth versus the roof of the mouth), an imbalanced bite, and forward protrusion of the tongue during swallowing. The impaired movement patterns of an OMD can result in abnormal growth of the mouth, jaw, face, teeth and even airway.
Orofacial Myofunctional Therapy (OMT) is the “neuromuscular re-education” or “re-patterning” of the oral and facial muscles. Learn how it can eliminate mouth breathing, support healthy facial growth and development, optimize feeding and swallowing and reduce symptoms related to TMJ and disordered sleep breathing!

[@dannyblue8382]

When I was younger 10-12 years old I had a perfect jaw with enough space for all my teeth but then I eventually developed some bad habits mouth breathing/open mouth/bad tongue and neck posture/ wrong swallowing/ tongue thrusting/ no hard food And in puberty where I grew a lot my facial structure and space in my mouth went to the worse Had then orthodontics and 4 premolar extractions bc of crowded teeth Braces unfortunately made my dental arches even narrower And soon I have to have my 4 wisdom teeth removed Since I developed these bad habits everything turned to the bad But I started relearning those good habits Started mewing I'm 3 months in and my upper dental arch or palate has already widened I'm now almost 19 and trying to get some things turned round Better now than never Don't develop bad oral habits

[@daniellekleeslp4625]

Hi Danny, thank you for sharing your experiences. It sounds like you've experienced the impacts of atypical tongue posture and mouth breathing first hand. There is a great need for increased awareness around these topics. While many indigenous cultures knew the great importance of continuous nasal breathing and typical tongue posture, the modern world has lost this sense of awareness. Have you read "Jaws: The Hidden Epidemic" or "Breath: The New Science of a Lost Art?" I think you'd find both of these texts insightful and helpful. I'm glad that you've developed some strategies to learn and implement new and healthy habits. I wish you the best on your health journey!

[@harikaparuchuri3484]

Hello Danielle, I’m 26 and unfortunately I was diagnosed TMD lately and it’s been 1 year. Now the pain was extremely high with swelling, even the headache, tinnitus, sleep apnea, neck pain. These all are piling up and the shape of my face is changing rapidly. These all are making me depressed and hopeless. After watching your videos, I realized the root cause for my tmj. When I was a kid until 5 years I used to suck my 2 fingers (index and middle) and now I noticed my tongue is not resting at the correct position. I’m suffering with my neck and upper back pain since I was 14 years and went to many physicians and none helped me because they were not aware that my tongue position is not good. These all things happened just because of lack of awareness. You are doing a great job🙏 and I’m looking for your myofunctional Exercises videos for tmj.

[@kzfingerprint]

Girl. This is me. Any hope for someone in their 30's or later?

[@Julez-]

Very informative Danielle, thank you.

[@Kaan_is_myname97]

Thank you so much

[@evanlavizadeh4032]

Super informative!

[@daniellekleeslp4625]

I'm so glad you enjoyed the content! Please feel free to submit requests for future video topics in the comments section :)

[@shubhampokhriyal2811]

Thanks a lot. RESPECT from India

[@daniellekleeslp4625]

I’m glad you enjoyed it!

[@christinehedblom3029]

HI! Can you please share where you got this amazing lip/tongue/ teeth demo model from ? BEST VIDEO!

[@daniellekleeslp4625]

Super Duper, a speech therapy materials company, sells the large mouth. It's my most utilized therapy material!

[@doctorxennial1728]

Hi! Thanks for the informative video! I am a PT who treats TMD and a patient was referred to me for Myofunctional Therapy, and I’d never heard of it before so here I am learning! Do SLP’s typically use this technique? Trying to figure out how to help this patient or who to refer her to. She is in her 70s with a significant underbite that has progressively worsened over time. Side note, I have an anterior open bite and hx of surgery, orthodontics, TMD, and sleep apnea, so I’m super interested in this as a patient myself!

[@daniellekleeslp4625]

Hi Natalie, it's great to connect with you! I've learned so much from PTs over the years and am so grateful for the meaningful work you do to support patients. In the US, SLPs and dental hygienists are the primary providers of Orofacial Myofunctional Therapy/Orofacial Myology, although SLP's and dental hygienist's scopes of practice are very different. I went through graduate school without a single course that mentioned orofacial myofunctional disorders. I was always passing out PDFs of peer reviewed articles to faculty members all the time! In contrast, some programs/care facilities (i.e. Cincinnati Children's Hospital) have a strong emphasis on OMDs. Talk Tools has had some great CE seminars centered around OMDs and OMT that are offered to PTs, OTs and SLPs. I'd also recommend "The TMD Healing Plan." It was written by a PT and is a fantastic resource for patients with TMD.

[@charleswhitefullbusteruchi1972]

correct tongue posture dries my mouth up

[@annafarr582]

When I was a kid, it was suggested that my jaw be broken, thank God my dad said no. I guess in the 60's that was the only treatment.

[@Nitrinix]

Hello, do you scoop the saliva with the tip of the tongue to the roof?

[@kava3957]

Hello Danielle, do you have any advice for how to chew our food properly? I notice it is difficult to chew my food however I am swallowing correctly. It makes me believe that I am doing something wrong. I know that our mouth should be closed, but is there a correct way to chew our food or does it matter? Any help would be greatly appreciated.

[@r.aprajapati5698]

thanks info but when is books reading time tongue rest position always roof of the mouth ? soft pressure or hard pressure roof of the mouth?

[@kateboard7875]

On the alveolar ridge but not against the incisive papilla right? When i Thouch the the papilla it touches my teeth

[@williamhood6929]

Is this the same process to swallow food?

[@MKF30]

Do you have any advice foe trouble swallowing by any chance? I have anxiety and lately suddenly a twitchy, spasms. My ent said there's nothing wrong with my throat even though it feels like it sometimes. I saw one video of a guy on here said to swallow liquids and food the same way but he had to retrain himself to do so since he forgot once the anxiety was making him hesitate. Thsts what its doing to me that feeling when you're trying to swallow a pill but hesitate due to fear of choking. Which I also have due to a childhood trauma chockingnon a mint as a kid...so I never swallow pills anymore I have but past few years can't do it so I smash, bite or chew or put in pudding. Nice video.

[@daniellekleeslp4625]

I would highly recommend following up with your primary care doctor and discussing these concerns in greater detail. Mental health professionals are also an important part of the team when it comes to managing anxiety, especially anxiety that is impacting activities of daily living.

[@MKF30]

@@daniellekleeslp4625 Damn autocorrect haha. I meant to say a twitchy tongue that spasms, But yes I've told my regular doc and wrote me a script for an ENT, saw the ENT said there's nothing in my throat no bumps, growths, cysts or polyps. He did say he suspects two things, anxiety and acid reflux(which has lots of symptoms not just heartburn or food coming up) it can cause painful swallowing, pain in the throat, inflammation etc, etc Now he did prescribe something but due to insurance issues couldn't afford it so going about how to solve that in the meantime I called the office call center) they don't have an actual direct office number for some reason so I have to call the call center then they have to contact the office, and hopefully office or doc contacting me. So far haven't heard back, yesterday I called super early before hours and spoke to a part time doc there who is an emergency doc part time he tells you how to go about one of the full time docs. So I spoke to him and he said, sometimes acid reflux can effect the tongue's base which affects the muscle itself since it is a muscle and can spasm. There's also a condition forget the name at the moment, where I think medicine can help relax it as well as a valium. But I'm already on xanax so if that's the case I wouldn't be able to take the two at once which I get. I rarely take the xanax anyway, only when I'm having a really, really bad anxiety attack and am having trouble calming down. Most of the time I ride it out which you pretty much have to do anyway. Yes I agree, and I do speak to a counselor once a week. She's helped me these past 6 months, the swallowing issue is something new that just triggers my anxiety unfortunately since right now I'm not able to eat my normal food, some of it I can some I can't. I mean I can swallow, I've had eggs, yogurt, pudding, ice cream, bananas and snack bars etc yet if I try a slice of pizza I'll struggle or bread due to it being very, very dry though I have had slices of bread in ketchup and dipped in soup but I have to eat very carefully since I'm hesitating before I swallow and my throat hurts as I swallow. That part is physical, the hesitation may be mental. Similar to with the pill issue though the pill issue I just chew it then take small swallows, swish swallow etc or I can put into pudding so I'm less anxious getting that down at least. Thanks for the advice appreciate it, just figured or wondered if you encountered anyone who has a swallowing issue and had to help the remember but I understand your job is a little different but cool. When I was a kid I sucked on my thumb then switched to my index finger(I know weird) so my front teeth were protruding so the doc told my parents to make sure I don't suck on that finger specifically so I stopped and my teeth went back in thankfully, and my binky was always a pillow case *laughs* was not really into sucking toys that was my finger haha. Thanks again for the advice you're very nice and pretty. God bless!

[@nitrodubz]

I've recently discovered that it is not normal to swallow with your tongue thrusting forward! For as long as I can remember in my 18 years on this Earth, I've always swallowed like that. Everybody that I know has always told me that I chew and swallow very loud and wonder if tongue thrust is the cause of that. Also, surprisingly, I never developed the tongue thrust gap in my teeth, but I do have overcrowding teeth since I too realized that I had a bad habit of resting my tongue on the bottom, especially when I'm playing the violin, but I have been Mewing for 2 months as of now. (Mewing also helped slow down my bruxism!)

[@daniellekleeslp4625]

I'm so glad that you've found this content helpful. Dr. Mew is a big proponent of Orofacial Myofunctional Therapy. Chewing with the lips open and noisy eating can be co-morbidities of a tongue thrust. I'd recommend following up with a provider in your local area.

[@nitrodubz]

@@daniellekleeslp4625 Thanks for the feedback! 👍🏼

[@carlgadoury4453]

Hi! My palate width is 25mm. Is this why I have big difficulties mewing? I’ve heard that the palate width need to be atleast 36mm to fit the tongue on the roof of the mouth comfortably

[@daniellekleeslp4625]

I'd recommend following up with an orthodontist to further discuss your specific needs.

[@planet_rasberry2913]

My overjet makes it very difficult to always have my lips together

[@daniellekleeslp4625]

Hi Brittany, I often tell my patients that structure impacts function and function impacts structure. Atypical, early oral habits (i.e. thumb sucking, mouth breathing, prolong bottle and sippy cup use) can often play a big role in the atypical development of the teeth and facial bones. That's why it's so important for young children to learn healthy eating, drinking, swallowing, breathing and oral rest habits early in life! For those of us who didn't receive the necessary early intervention, it can be helpful to work with an orthodontist and Myofuncitonal Therapist simultaneously. The orthodontist can address the structures and the Myofunctional Therapist can function. Healthy new habits (i.e. healthy function) can even impact structures in some adult patients.

[@rihamahmed4183]

I’m a tongue thruster, I learned lots of exercises for swallowing and the right position of the tongue and I always make sure to make my tongue on the right position but while I’m sleeping I can’t control it and when I wake up I notice that I thrust so hard on my teeth, do you have any tips for me?

[@daniellekleeslp4625]

Hi Riham, I'd recommend following up with a therapist. An important part of Myofunctional Therapy is ensuring that skills generalize (i.e. carryover) to all parts of your daily life. If you're practicing exercises in a drill-based setting but these skills aren't carrying over to functional feeding and swallowing tasks I'd recommend seeking out additional support. I've worked with many patients who initially tried to remediate an OMD by watching KZbin videos. KZbin videos can be extremely helpful tools! But they do not offer the feedback, clinical insight and/or scaffolding that a live therapist can provide.

[@jasobehera4205]

Hi Danielle , how do you treat Tmd patients . I have tmd , ear aches and tension headaches .

[@daniellekleeslp4625]

Hi Jaso, TMD symptoms are often multi-causal and multi-maintained, meaning that there are a variety of factors that can contribute to the causation and continued experience of TMD symptoms. Patients with TMD often (but not always) demonstrate behaviors such as atypical rest tongue posture, habitual mouth breathing, tongue thrusting, atypical feeding and swallowing skills, clenching, grinding and other oral habits. Myofunctional Therapy has been shown to effectively remediate/significantly decrease these behaviors. In my clinical experience, patients often experience positive changes in their TMD symptoms with the remediation of these behaviors. There is peer reviewed research to support these observations as well. Myofunctional Therapy centers on the neuromuscular reeducation of the muscles of the tongue, mouth, jaw and face.

[@tewodrosasrat6908]

I like it regarding mewing but does the teeth must be in contact with lower teeth when we are mewing?

[@daniellekleeslp4625]

There is debate between clinicians and researchers regarding the resting posture of the jaw. Some clinicians and researchers are very adamant that the teeth should rest together. Others teach "freeway space" or very minimal separation of the teeth.

[@matteobarbera9250]

Scuse me but the is mewing the name of this exercise? So if a adult have a minute face, little maxilla, and jaw can improve own line? Ok I know maybe a person can't became very nice like Sean Connery, but he can improve? I make this question ti you because I am ugly 😔.... and I want improve☹️

[@racheljuillet2420]

Where could I get one of those mouth puppets?

[@aneesh7m]

I cannot touch full tongue on my palate. I can touch tip and back tongue but it is tough for me to touch middle tongue.

[@brandonlee131]

Do you know what tongue pops or clicks are? In myofunctional therapy my therapist said when your tongue is suctioned before your click your tongue that suction is how your tongue should be rested

[@MKF30]

@@brandonlee131 mine spams, clicks and feels like it twitches sometimes like your eyelids or muscles etc. The tongue is a muscle afterall but sadly mine is due to anxiety disorder, dry mouth so its torture and nowni have trouble eating foods so I have to be picky snd eat super slow since I have trouble swallowing now 🙁

[@primalpem]

will this help grow the pallet down . for those with a high vaulted pallet?

[@daniellekleeslp4625]

Hi Primal Pem, as I've noted to patients in the past, structure impacts function and function impacts structure. A high narrow palate can be (but is not always) correlated with early oral habits such as habitual mouth breathing, low tongue posture, finger sucking, prolonged pacifier use, item sucking and limited chewing. While Myofunctional Therapy has the potential to significantly impact the dental, facial and airway development of youngsters, changes too these structures in adult patients is more limited. For an adult patient with a high and narrow palate, it can be helpful to work with an orthodontist and a Myofuncitonal Therapist simultaneously. The orthodontist can address structural anomalies and the Myofunctional Therapist can address neuromuscular re-education. Typical tongue posture, functional nasal breathing, and typical swallowing posture/function are behaviors of benefit to patients across the lifespan. I recommend reading "Breath: The New Science of a Lost Art" and "Jaws: A Hidden Epidemic" for a more thorough overview of these nuanced topics.

[@iamz__42]

i can't breathe in that position

[@capcats]

Hi. I would like to know what is a reasonable fee for myofunctional therapy. My son’s dentist is recommending this. He’s 18, has a narrow palate and small airway and is a mouth breather. This is all new to me and i want to make sure I’m not getting over charged. Is it possible to get same results by watching KZbin videos and following instructions? Thank you.

[@daniellekleeslp4625]

There is significant and expansive peer-reviewed research to support the efficacy of Myofunctional Therapy. Consider exploring the Clinical Topics tab on my website or visiting PubMed and searching “Myofunctional Therapy.” While online exercises can provide some insight, a speech pathologist provides extensive training in feeding and swallowing physiology and important feedback/scaffolding to ensure that drill-based exercises carryover into functional tasks and daily life.

[@lexhuggins7348]

I just found out I need therapy for this no ortho will fix my teeth until I get therapy I’m 30 years old I just hope it’s not too late

[@daniellekleeslp4625]

Learning new and healthy oral posture and swallowing habits can be beneficial for patients across the lifespan.

[@cindyfriedberg5003]

Daniel, I have a bad habit of sucking the left side of my upper teeth in my mouth during the day and I do grind my teeth while sleeping and wear a mouth guard,it was recommended by my dentist to see a myofunctional therapist to help stop this habit. Do you have an email I can send a note to? Thanks as it is hard to find someone who does myofunctional therapy. Cindy

[@daniellekleeslp4625]

I am currently on maternity leave but you can use the IAOM or AOMT websites to find a database of providers listed by state!

[@ursistersaccount5734]

hi i'm 15 years old. my face is really long and i always thought it was just me, but over the years I've had people point out how long my face is. I'm worried that my face is forever changed because of my bad tongue posture. If i start these exercises now and continue into adulthood, will my face not be as round? please i'm desperate for some advice, i hate the way that i look. i also notice that my chin protrudes from a side view, and is pretty large. should i seek cosmetic surgery in the future? will this therapy make my face shorter or wider, and get rid of it's longness? edit: i'm turning 16 in 3 months btw

[@JohnBillow]

Its good that you're young. Just mew and your face will change to your liking

[@JohnBillow]

I'm 16 btw

[@joes6178]

I wish I would've caught this when I was a child and still growing. I'm afraid my face will unfortunately be elongated forever even with tongue thrust treatment. How long does it take to see improvement in your teeth?

[@daniellekleeslp4625]

Every patient's body is different and, as a result, patients' aesthetic outcomes can be different. While it is not uncommon to observe significant changes in the teeth and faces of young pediatric patients, it is less common in adult patients. For adult patients, it's important to assemble a multidisciplinary team to address all of your needs. For adult patients who have mouth breathed and exhibited low tongue posture their entire lives, it can be helpful to involve an ENT who can further assess airway structure and function. (This is not medical advice but for education purposes only.)

[@editsbyt7296]

@@daniellekleeslp4625 hi I’m 18 how would my results look?

[@amberjohnson1336]

I am so pissed I have to pay out of pocket for braces, tongue tie release and this therapy all cause my raggedy parents did not take me to the dentist as they should have as a child.

[@waynaofficialchannel605]

I think my tongue is to big. It hard to keep it at the top

[@daniellekleeslp4625]

Hi Tadwayna, a high and narrow palate (i.e. V-shaped) palate can create the sensation of the tongue being "too big for the mouth." Typical oral rest tongue posture (i.e. the tongue resting with the tip right behind the front teeth, lightly suctioned to the roof of the mouth whenever the mouth is at rest), continuous nasal breathing and lots of chewing early in life are all factors that play crucial roles in early palatal and facial development. For more information on these topics consider reading "Breath" by James Nestor and/or "Jaws" by Kahn and Ehrlich.

[@avadheshbhatt1137]

I like to observe people specially after knowing how to mew and just realised that Cristiano Ronaldo is a mouth breather! If you look at his side profile and his body posture you see all the patters of a mouth breath, yet he has a square and symmetrical face!

[@jaspreetsingh8434]

Hey Danielle, so I do understand the correct swallowing with tongue pushing on the roof of the mouth. I can do that, but what do we do when saliva collects on the front bottom of our mouth. How do we collect that saliva first? Is there a correct way to collect that saliva?

[@daniellekleeslp4625]

When the tongue presses against the roof of the mouth during typical swallowing, it creates something called "lingual palatal suction.' This suction helps propel the bolus (whether solid or thin liquid consistency) down the throat. Challenges managing oral secretions and/or the bolus can be related to a variety of factors. It would be helpful to work with a speech therapist who specializes in swallowing to more thoroughly evaluate how you swallow a variety of different textures and consistencies.

[@soheal3674]

I'm a mouth breather how do I fix it?

[@daniellekleeslp4625]

There are a variety of reasons for mouth breathing - sometimes it's the result of an anatomical obstruction to airflow (e.g. enlarged tonsils/adenoids, deviated septum, other structural anomaly etc.). Many times though, mouth breathing is a learned, maladaptive habit. If there is a structural anomaly involved, it's important to follow up with a specialist like an ENT to resolve the structural anomaly. Once the obstructive is addressed/ruled out, it's important to follow up with an Orofacial Myofunctional Therapist to learn effective oral rest posture, proper swallowing and eating skills, and nasal breathing. The reason OMT is so important in retraining the body to nasal breathe is that it strategically reforms ingrained habits (e.g. mouth breathing, tongue thrusting). We swallow 1500 times a day and breathe 27000 times each day. When these repetitive movement patterns are impaired, it's extremely difficult to target them by just "trying to nasal breathe" or "trying not to tongue thrust." These movement patterns are repetitive and nuanced and involve many muscles. I work with many patients who are well educated on these topics (e.g. familiar with John Mew's work, have read "Breath" by James Nestor, have read "Jaws" by Kahn and Elrich) but have had great challenge implementing healthy breathing and swallowing patterns. That's where therapy comes in! We start with drill based exercise related to increasing tongue and orofacial strength and then transition to more complex, functional tasks like eating and drinking roughly 4-5 weeks into therapy. If you have more questions, visit my website daniellekleeslp.com - my email is listed in the contacts section. Feel free to email me!

[@soheal3674]

@@daniellekleeslp4625 thank you for the reply. Just subscribed and will follow along your video

[@martianmerit4285]

Let me show you. Me: 🙄👀🙄.

[@harinarayan8004]

why do people say put the tounge behind the teeth, which one is correct , on the ridge or there

[@daniellekleeslp4625]

The alveolar ridge is behind the front teeth.

[@harinarayan8004]

@@daniellekleeslp4625 you're right , but the instruction is "Just behind the front teeth" meaning the root of the teeth. Which is in front of the ridge. Not question your teaching just trying to understand the correct method.

[@harinarayan8004]

After some research found this (kzbin.infoLu-FHh8d9EU?feature=share) would you say this is right

[@IMMORTAL17BROWNPRIDE]

Where do I place tongue when chewing? It keeps touching front teeth to move food around to chew. Is that normal ?

[@tinguspingus295]

Hello, i am eleven years old and i have been mewing for 3 months but my molars cannot touch when i close my mouth it has a gap of around 3-6mm what can i do?

[@daniellekleeslp4625]

Thanks for reaching out! I'm not warranted to give medical advice but I can share some general insights. The way that the mid face, teeth, mandible (lower jaw) and airway grow are the result of a variety of potential factors ranging from early oral habits, to prolonged allergen exposure, to genetics etc. As one of my favorite professors used to say, "every impairment/disorder is multi-causal and multi-maintained." Strategies like practicing typical resting tongue posture and functional nasal breathing can be helpful tools but when there is significant malocclusion or misalignment of the bite, it's important to seek out the perspective of an orthodontist. Orthodontists specialize in aligning the teeth. Finding an airway-focused orthodontist, or one who realizes that moving the teeth can change the shape of the airway, can be an important piece of the puzzle. Orthodontists can also observe how you are posturing your tongue during swallowing tasks and if this tongue posture may be contributing to your dental alignment.

[@tinguspingus295]

@@daniellekleeslp4625 oh ok thanks! I am also on EF Brace which is myobrace but its created in france (i think)

[@jodajazzjunky]

I do like this lady but there's just one thing wrong... she's got a big mouth 😂😂😂