In 1993 the American Association of Orthodontics adopted a policy statement indicating the benefits of OMT treatment, but acknowledging the need for more research. The parameter of treatment provided by the orofacial myologist depends on their formative core professional accredited education and licensure, and the extent of their post-licensure didactic and clinical training in areas of orofacial myol-ogy, dentistry, dental hygiene, speech function, and other areas of medicine. However, in general treat-ment may include: eliminating deviated range of motion muscular and func-tional deviations of the mandible, especially those related to resting postures, chewing, open/closure patterns, speech functional movements/patterning of the tongue, lips and mandible, and orofacial/oromotor func-tions of related activities of daily living. 1, 2, 5, 6, 7, 11, 12, 16, 20, 24, 42, 45, 47, 57-59 Assessment & Examination Structural Anatomical: airway/head, neck, face, dentition Muscular: capacity/tonicity Neurological response: motor/sensory Functional Resting postures/ Mastication, Deglutition, ROM/ Speech patterning Behavioral Habit patterns – present or past Parafunctional habits/patterns clinician/practitioner begins in a similar manner. It happens through experience gained by treating cases utilizing orofacial myofunctional therapy while a pre-licensed profes-sional student, or figuring it out by oneself once in clinical practice through trial and error. Best prac-tice, regardless of when one begins this journey, requires each case considered for treatment utilize a process of care. Best practice process of care includes: b Correction of resting postures of the tongue, lips, and mandible; b Establishing a consistent oral (dental) freeway space; b Balancing and equalizing the muscle function and tonicity of the tongue, lips, muscles of mastication and deglutition and including muscles of the face, head and neck; b Encouraging nasal breathing and normalized respiration; b Eliminating oral habits/behaviors and oromo-tor/orofacial functional behaviors negatively affecting muscle tone and/or impacting the growth and development of the face and dentition (non-nutritive sucking and noxious oral habits, dual bite patterns, establishing oromo-tor consistencies); b Correcting abnormal chewing and deviated swallowing patterns; correcting muscular deficiencies of resting postures of the tongue, lips, mandible, head and neck; correcting ‘tongue thrusting’ swallowing (preparatory and oral phases); eliminating parafunctional habit patterns that may cause destruction of the dentition (especially bruxism, muscle bracing, and/or clenching); providing neuromuscular reeducation and retraining to eliminate impairment in muscle tone and function; OM concepts and principles are rooted between professional domains in dentistry, dental hygiene, physical medicine, and speech pathology. Many professionals still refer to orofa-cial myology as ‘tongue thrust ther-apy’. Most call it ‘myofunctional ther-apy’. Others call it ‘myofascial ther-apy’. Some even report it as ‘oral physical therapy, oral physiotherapy, or oral posturology’ for the face, head and neck. References to treating orofacial myofunctional disorders (OMD) appearing in the literature also reference many names. The best name determined by the IAOM to offer and promote to a patient is: orofacial myology or orofacial myofunctional therapy. It seems to say it all. Nomenclature consistency facilitates communication and research across professional domains. It also allows consistency for interna-tional coding and insurance submis-sions. Professionals including dentists and most of the dental specialties, dental hygienists, physicians, otolaryngologists, speech patholo-gists, along with physicians, ENTs, osteopaths, physical therapists, occu-pational therapists, massage thera-pists, chiropractors, and naturopaths are increasing their awareness and understanding of orofacial myofunc-tional and functional oromotor issues, TMD, respiration, and sleep apnea’s impact on the orofacial envi-ronment and total health. b Completing a comprehensive assessment and examination. b Developing a differential diag-nosis. b Incorporating both function and form into the treatment planning process. Best Practice -Incorporating a Process of Care Behavioral studies add to the evidence that function can impact form across categories of age, race, culture, and pre-/post-orthodontics in a similar manner. 6, 16, 31, 44, 53 The challenge of discovery for each b Implementing an inter-disci-plinary therapeutic approach. b Continuing an on-going evaluation process through the habituation/rehabilita-tion phases. www.orthodontics.com May/June 2012 31
Journal of the American Orthodontic Society May-June 2012: Page 31
