state is considered to be the amor-phous or non-ordered state. Mechani-cal stress and strain, such as exercise, drives collagen to the ordered state. Lack of mechanical stress and strain, allows collagen to revert to the amor-phous state, as in lack of exercise. An example of the phase transi-tion of collagen can be found in the kitchen. Both forms of collagen are familiar especially if you have ever made a gelatin dessert. If you add the gelatin to hot water you can watch it dissolve as it swells in the hot water. This is the amorphous state. When cooling the mixture in a refrigerator, you can watch the gelatin become firm or “set up” as the molecules are transformed to the ordered or crys-talline state. Just as cooling drives collagen, or gelatin to the crystalline state, mechanical stress and strain on oral tissues drives collagen to the crys-talline state. This process is known as “stress induced crystallinity” 13 . A differential susceptibility to enzymatic degradation exists for these two states. The crystalline or ordered state is less susceptible to enzymatic reactivity than the amor-phous state due to geometric consid-erations. In other words, in the crys-talline state, collagen molecules are tightly packed making them resistant to degradation. In the amorphous state these restrictions are removed. With the absence of mechanical stress and strain on the collagenous tissue the collagen protein will revert to its amorphous state and degrade this result is due to the differential susceptibility to enzymatic degrada-tion for these two states 14 . How does this mechanism relate to orofacial myofunctional therapy? At the point at which pressure is applied, collagen responds with growth and increased strength. The intervention of the health care professional as it relates to the pressure exerted by the tongue and lips in its proper resting position now becomes instrumental in improving oral anatomy and physi-ology. Proper chewing of unrefined foods can also develop the muscles of mastication and the peri-oral muscles this may have a direct effect on elimi-nating bruxism. “...MANY OF THE MYSTERIES SURROUNDING OUR DAY-TO-DAY ACTIVITIES WITH PATIENTS LEAD-ING TO IMPROVED ORAL FUNC-TIONS CAN BE SHOWN TO BE GROUNDED IN SCIENTIFIC PRINCI-PLES. MORE RESEARCH AND UNIVERSITY PROGRAMS IN OROFACIAL MYOFUNCTIONAL THERAPY IS NEEDED.” IMPORTANCE OF BUTEYKO BREATHING TECHNIQUE For many years, the orofacial myofunctional therapist would fight 12 March/April 2012 JAOS mouth breathing or an open mouth at rest posture. Two important goals of therapy are to develop a palatal tongue rest posture and a lip seal. If the patient mouth breathes chronically, therapy results would be limited or short lived. Now, by incorporating Buteyko breathing exercises with orofacial myofunctional therapy, results have improved. The Buteyko Method was developed in the 1950s by Russian doctor Konstantin Buteyko 15 who recognized the negative effects from chronic over breathing. Breathing through the mouth is a typical characteristic of chronic over breathing, the precursor often being a blocked nose. Habitual mouth breath-ing disturbs blood gases resulting in increased nasal congestion thus completing the vicious circle. The Buteyko Method involves learning to unblock the nose using a simple breath hold exercise, making the switch to nasal breathing on a perma-nent basis and adopting lifestyle guidelines to assist with this. Although the Buteyko Method is rela-tively new to the USA, it has enjoyed considerable awareness in Europe for the treatment of respiratory disorders. It has been featured in television documentaries 16 , the UK parliament House of Commons debate, and inclusion by Health Insurance companies 17 and clinical trials 18, 19, 20, 21 . The link between open mouth breathing and increased risk of obstructive sleep apnea is well docu-mented. 22, 23, 24, 25, 26, 27 Kim et al observes that “the more elongated and narrow an upper airway during open-mouth breathing may aggravate the collapsibility of the upper airway and, thus, negatively affect OSA sever-ity.” 28 Given the available research, learning how to unblock the nose and switch to nasal breathing, may offer therapeutic benefits for sleep apnea. 29 Also, oropharyngeal exercises have been shown to lower AHI numbers by 39%, improve snoring frequency and intensity, daytime sleepiness, and sleep quality score in mild to moderate OSA. 30 Changes in neck circumference correlated inversely with changes in the AHI. Therefore, many of the mysteries surrounding our day-to-day activi-ties with patients leading to improved oral functions can be shown to be grounded in scientific principles. More research and university programs in orofacial myofunctional therapy is needed. Currently, there is a shortage of well-trained orofacial myofunc-tional therapists in our country. For more information, please visit www.myoacademy.com and www.myofunctional-therapy.com. REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9. Smithpeter, Covell, AJODO, May, 2010 De Felicio, de Oliveira, da Silva, Cranio Oct, 2010 Grimaraes, et al, American Journal of Respiratory and Critical Care Medicine, May, 2009 Courtney, R, Cohen, M. J Altern Complement Med, 2008 Van Norman, R., Int J Orofacial Myology,1997 Subtelny, J.D., Angle Orthod, 1970 Jang, S.J., et al, AJODO., 2011 Klein, E.T., Am J Orthod, 1952 Yamaguichi, H, Sueishi K., Bull. Tokyo dent. Coll., 2003 10. Wohlish, E., de Rochemont, R., Biochem Z., 1926 11. Gekko, Koga S., Agri. Biol. Chem., 1983 12. Flory, P., Spur, O.K., J. Amer. Chem. Soc., 1956 13. Flory, P., Spur, O.K., J. Amer. Chem. Soc., 1956 14. Kaplan, D.G., American Chemical Society, 1994 15. McKeown, P., Close Your Mouth, 2004 16. http://news.bbc.co.uk/2/hi/health/153320.stm 17. www.avivahealth.ie/member-info/member-bene-fits/asthma-care-program/ 18. Bowler SD, Green A, Mitchell CA., Med J Aust. 1998 19. McHugh P, Aitcheson F, Duncan B, Houghton F., N Z Med J. 2003 20. Cooper S, Oborne J, Newton S, et al. Thorax, 2003 21. McHugh P, et al, NZMJ, 2006 22. Young, et al, Internal Medicine, 2001 23. Ohki, M., et al, Acta Otolaryngology, 1996 24. Scharf, M.B., Cohen A.P., Allergy, Asthma, and Immunology, 1998 25. Pevernagie, D.A., et al Sleep Medicine Reviews, 2005 26. Storms, W., Prim Care Respir J., 2008 27. Staevska, M.T., Allergy Asthma Report, 2004 28. Kim, E.J., et al, European Otorhinolaryngol., 2010 29. www.publications.parliament.uk/pa/cm200102/ cmhansrd/vo020625/debtext/20625-34.htm 30. Grimaraes, et al, American Journal of Respira-tory and Critical Care Medicine, May, 2009
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