mastication, and neck muscles with hyoid elevation are exercised as needed to achieve treatment goals. As needed, chewing and swallowing exercises are incorporated, along with noxious oral habits and para-functional habits addressed. Many articulation errors (lisping patterns) improve significantly once the tongue, lips, and mandibular patterns function correctly. If speech articulation is an issue, a RDH orofacial myologist will coor-dinate treatment with a speech pathologist to address non-self-correcting errors. The appointment schedule decreases as habituation increases and exercises are weaned while maintaining corrected func-tion. Appointments decrease to an annual re-evaluation for 1-5 years following the completion of a comprehensive therapeutic program to monitor long-term stability. Digit sucking habits eliminate completely or significantly come under control on their way to extinction within the first 24-72 hours of the therapy program. It is literally a ‘Quit in A Day’ behavior modification program for 80-90% of the individuals, however, continued monitoring for 30-60 days with a 3 or 6 month recheck insures full extinction of the behavioral habit, allows monitoring of natural changes to the form, and follows best practice of behavior modifica-tion principles and theories. A TMD patient with pain symptoms or a patient with special needs treatment program may take less/more time than other OMD patients to complete, based on treatment goals and case complexity. 2, 6, 9-12, 16, 31, 34, 45, 46, 53 complexity of the orofacial myofunctional disorders. As a best practice, orthodontists should also include the orofacial myologist in the re-evaluation of the patient for 1-3 years following the completion of an orthodontics and orofacial myofunctional therapy program. 2, 6, 53 On the longer term of 4-6 or more years following completion of an OMT program (in the US) the general dentist and dental hygienist continue monitoring the long-term stabilization. 6, 20, 24 Orofacial Myology Policy Statements American Association of Orthodontics (AAO) – Policy State-ment adopted 1993 American Dental Hygienists’ Associa-tion (ADHA) – Policy Statement 9-92 adopted 1992 American Speech, Hearing-Language Association (ASHA) – Policy and Position Statement adopted 1991 balanced equilibrium and harmony in the functional resting posture, chewing patterns, swallowing pattern, and functional speaking patterning utilizing the tongue, lips, mandible, perioral musculature, cheeks, and head/neck orofacial environment in a correct bio-physi-ologic manner as they relate to maintaining a dental freeway space, neuro-muscular stimulus/responses, activities of daily living involving sitting at rest, mastication (chew-ing) and deglutition (swallowing) issues, eliminating functional dysphagia (preparatory, oral, and in some cases the pharyngeal phase), functional eating and feeding, size of food bites and bolus formation, saliva/food/liquid transfers, elimina-tion of digit (thumb/finger) and other non-nutritive (pacifier, sippy-cup) sucking habits, and additional related noxious oral habits (nail biting/object chewing), along with addressing the parafunctional oral habits/behaviors of bruxism, muscle bracing, clenching, and inappropri-ate ROM patterning (range of motion) of the mandible. Therapy incorporates appropri-ate use of a patent nasal breathing pattern and patent airway mainte-nance; works well with the orthodontic practitioner to elimi-nate muscular and functional Moving Forward Orthodontic practitioners are increasingly aware of negative changes created in the dento-facial environment due to inter-ferences, destruction, damage, and unwanted change in the dentition, dental arches, TMJ functional patterning, and pres-ence of parafunctional habits and patterns. These orofacial myofunctional behaviors make orthodontic treatment more diffi-cult, delay the normal progression of treatment, and leave beauti-fully completed cases at risk in an unstable neuro-muscular environ-ment. Tongue and orofacial muscular ‘issues’ can occur in any area of the face/head/neck. OMD and muscular TMD can impact the mouth and face in an ante-rior, lateral, and/or posterior pattern on a unilateral or bi-lateral basis. Dysfunction is recog-nized as abnormal movements and functional patterning of the tongue, lips, and mandible occur-ring during resting postures; chewing; swallowing of liquids and foods; during speaking; sleep-ing; abnormal jaw muscular and postural patterning, noxious oral related behaviors, or parafunc-tional habit patterns. Orofacial myofunctional thera-pies (OMT) can positively impact and/or eliminate these disorders and dysfunction. OMT was most commonly called ‘tongue thrust-ing’, however orofacial myofunc-tional therapy more completely encompasses the issues. Therapy involves establishing correct orofa-cial muscle tone, creating a Most parafunctional patterns are addressed during the course of an orofacial myofunctional therapeutic program. The background and train-ing of the orofacial myologist will determine the extent and ability to address the orofacial myofunctional disorders and parafunctional habits present. Not all orofacial myologists are trained to address muscular TMD and parafunctional habits/patterns. As with any case assessment, the time and intensity of treatment is determined by the severity and 38 May/June 2012 JAOS
Journal of the American Orthodontic Society May-June 2012: Page 38
