Orofacial Myology b The philosophy of “muscle wins” is fundamental to all phases of mechano-therapies used in orthodontics. b Bio-adaptive theories along with muscle and respiration oriented therapeutics are influencing the long term success and stable outcomes of oral health treatments associated with malocclusions, muscular TMD, periodontics, and cosmetic restorative therapies. orthodontic practitioner’s ability to monitor, treat, successfully complete, and maintain orthodon-tic and TMD cases with less relapse and retreatment. Early recognition of orofacial myofunctional issues and OMT ensures a smoother and more effective mechano-and/or dental therapeutic process while achieving long-term stability goals with greater efficiency. b Oromotor issues, functional dysphagia, rest posturing of tongue, lips and mandible, creation of an appropriate freeway space and elimination of parafunctional habit patters is required for long term stabilization and balanced oromotor and func-tional patterns. Shifting S h i f t i ng P Paradigms arad i gms Many practitioners go through a clinical paradigm shift to include orofacial myofunctional therapeutics into their assessment and treatment planning. It becomes not only a philosophical journey of discovery for some, but also one of how and when to work with an orofacial myologist. This paradigm shift occurs especially if past orthodontic treatment reliance was only on mechanotherapies. Some practitioners have an easier transition incorporating these concepts into their conceptual treatment framework if the concept of ‘muscle and/or behavioral therapy’ was gleaned at some point in their formative educa-tion prior to licensure in their profes-sion. Those individuals more quickly recognize they need to identify and locate a licensed professional trained and certified in Orofacial Myology. Others come to this realization after noting relapses in beautifully finished cases where growth patterns cannot be blamed. In either case, the journey leads to the same end goals: provid-ing comprehensive patient care to establish a healthy and balanced orofacial structure, function, and behaviors with healthy respiration leading to the long term stability of the dento-and orofacial environment while also achieving the desired aesthetic results. practi-form allows the orthodontic practi tioner to take advantage of orofacial myofunctional capacity, especially when included as a consideration in initial treatment planning. One cannot ignore the impact of proper orofacial and oromotor functional processes coupled with proper respi-ration on the dentition and peri-odontium. 33, 54 They are dynamic processes. These bio-physiologic processes continue impacting the on-going and evolving dento-and cranio-facial environment over a lifetime. 6 Delving into recognizing, treating, and harnessing the process’ potential appears more frequently in the scientific literature with messages also being delivered from speaker’s podiums. Dentistry, dental hygiene, and orofacial myol-ogy are each making strides adding ‘Function’ to the body of knowl-edge and transferring of the infor-mation for practitioner’s use. 6, 34, 41-47, 53 Orthodontic practitioners are also improving in their own assess-ment abilities of orofacial myofunc-tional disorders, functional dyspha-gia, oromotor dysfunction, temporomandibular muscular dysfunction, and respiration issues as the scientific evidence supporting orofacial myology increases. Clinicians are increasing their focus on the overall impact on the dentition and the orofacial environ-ment, and how/when to incorpo-rate orofacial myofunctional thera-pies to make cases be more predica-ble. 31, 43-45, 47, 52 This increases the Defining Moments and Creating Parameters Understanding a definition of Orofacial Myology (OM) is essential when conducting a comprehensive orofacial myofunctional and temporomandibular muscular assessment and examination and introducing these concepts to the patient. Defining OM/OMT allows one to label the dysfunction noted more clearly and place it into inter-national coding and nomenclature systems. Benkert defines orofacial myology as: Orofacial Myology/Myofunctional Therapy is the treatment of the orofacial musculature to improve muscle balance and tonicity with establish-ment of correct activities of the tongue, lips, and mandible so that normal growth and development may take place in a homeostatic environment. It includes treatment of parafunctional habits for the elimination of noxious oral habits and behaviors, temporomandibular muscular dysfunction, bruxism, clenching, muscle bracing, and range of motion (ROM) activities of the mandible, and/or postural habits.1, 2, 5, 29, 31 The core of this definition was adopted by the IAOM Board of Directors and Membership in 1992 and supported the development of the American Dental Hygienists’ Association (ADHA) 1992 policy statement under the area of Practice, Patient Care Services 9-92: The ADHA acknowledges that the scope of dental hygiene practice includes the assessment and evaluation of orofa-cial myofunctional disorders; and further advocates that dental hygienists complete advanced clini-cal and didactic continuing educa-tion prior to providing treatment. Conceding Means Increased Success Conceding that function has the potential to positively impact the 30 May/June 2012 JAOS
Journal of the American Orthodontic Society May-June 2012: Page 30
