Myofunctional Therapy and Tongue Thrust
Q. What is Myofunctional Therapy?
A. Myofunctional therapy is a specifically prescribed regimen of exercises designed to 
correct oral facial muscle imbalance and reverse swallow patterns. It is typically recommended to be used in connection with braces. Myofunctional therapy assists the orthodontist with the correction of various symptoms that interfere with the successful results of their prescribed treatments. As a holistic approach, myofunctional therapy treats oral facial muscle imbalance in such a way that, once corrected, the muscles will function appropriately with all interrelated body systems. It enhances oral awareness, which is the foundation for all oral motor development. Myofunctional therapy has been shown to be effective in correcting oral myofunctional disorders such as tongue thrust swallow, improper tongue and mouth resting posture, improper use of oral musculature for chewing and swallowing, and eliminating finger-sucking habits.
Variables that must be addressed by the team sometimes include: evaluating oral motor structures such as: palatal height, dentition, tongue tie, lip incompetency, and oral behaviors, such as thumb/finger/pacifier sucking, teeth grinding, and mouth breathing. Additional medical conditions, such as obstructions to the nasal airway, due to enlarged tonsils and/or adenoids should also be ruled out.
Q. How will the speech therapist help my child?
A. The normal swallow is habituated by incrementally increasing the difficulty of the task. After the client masters individual swallows and sips of thick liquid, consecutive swallows during continuous drinking with water is worked on. Progress of carryover is monitored. Therapy may include any or all of the following:
- Education regarding appropriate chewing patterns.
- Maintaining correct placement of the tongue when swallowing and at rest.
- Sequential positioning of the tip, mid-portion, and back of the tongue.
- Increasing self-awareness of the masseter (chewing) muscles.
- Correction of frontal lisping of the /s/ and /z/ phonemes.
- Elimination of damaging oral habits (digit sucking, nail biting)
- Reduction of unnecessary tension and pressure in the muscles of the face and mouth.
- Development of normal resting postures of the tongue, jaw, and facial muscles.
- Establishment of normal biting, chewing, and swallowing patterns.
- The ability to suck up, back, and swallow without liquid leakage.
Q. What are the pre-treatment considerations:
A. There are many causes of a tongue thrust. Prolonged pacifier use or digit sucking past 18 months can cause a forward thrusting of the tongue. If a client has an obstructed airway, its cause must be determined. Some causes may be enlarged tonsils and adenoids, or allergies. These problems must be eliminated before treatment of tongue thrust. Correcting these problems eliminate the tongue thrust altogether because when the client can breathe through their nose, there is no need to keep the tongue in a retracted position. Speech treatment can only begin once these problems are corrected.
Q. When should my child start therapy?
A. Evaluation to determine if there are any factors that require early intervention is done at age four. Treatment to help children discontinue finger sucking can start at age 18 months. Elimination of these habits can often result in spontaneous improvement and/or correction of dental, speech, and oral motor dysfunction problems. If the child is presenting with a frontal lisp of the /s/ and /z/ phonemes, therapy should begin at age 4.0.
Q. What is a correct swallow?
A. Correct swallowing depends on a proper relationship between muscles of the face, mouth and throat. The act of swallowing is one function that depends on the structure and function of the oral motor mechanism; specifically the lips, tongue, and jaw. To swallow properly, muscles and nerves in the tongue, cheeks and throat must work together in harmony. When a person swallows normally, the tip of the tongue presses firmly against the roof of the mouth or hard palate, located slightly behind the front teeth. The tongue then pulls back, in concert with all the other muscles involved in swallowing. The hard palate, meanwhile, absorbs the force created by the tongue.
Q. What is a tongue Thrust?
A. A tongue thrust occurs when the tongue pushes forward, against the front teeth, causing a reverse swallow. This habit can cause improper teeth alignment, frontal lisping, mouth breathing, and jaw misalignment. Because a person swallows 500-1000 times a day, it’s easy to see how improper swallowing can cause a variety of problems. But it is actually the resting position of the tongue that does the most damage because it is more constant.
Q: How will a Speech and Language Pathologist evaluate my child?
A. The Oral Sensory Motor Analysis will be performed to assess the structural and functional integrity of your child’s oral motor mechanism. Specifically, a speech pathologist will be examining how well the child’s tongue, lips, and jaw are working in isolation and determine if these primary articulators have good range of motion. The therapist will ask your child to protrude, retract, elevate, lower, and alternate his tongue as well as produce tongue clicks and tongue bowl. A “sip-swallow test” will be elicited with water, to determine if your child can swallow, while maintain a smiling, without any liquid spillage. The pathologist will determine if your child is mouth or nose breathing, and her habitual tongue resting position. Finally, an articulation test will be elicited to determine if the tongue thrust is affecting the production of sounds, most importantly, the /s/ and /z/ phonemes.
Q. My child needs braces. Will that correct the tongue thrust?
A. Unfortunately, braces alone will not correct your child’s tongue thrust. If the child is only fitted with braces without Myofunctional speech therapy, then the constant tongue thrusting will most likely reverse the positive effects of braces, especially after they are removed, wasting time and money. Your orthodontist and speech pathologist must work in unison to reverse the tongue thrust and improper tongue placement while simultaneously improving dentition.
Q. How long will my child need Speech Therapy?
A. The length and timing of therapy vary according to the severity and nature of the oral myofunctional disorder. However, most tongue thrust programs are completed in 6-9 months if the child is seen 3-4 times per week and completes all homework assignments.