Orofacial Myology

Thanks to a new field of dentistry called orofacial myology, Dr. Roca has begun scheduling patients to learn this new way of preventing malocclusion (bad bite) from the beginning.

What is myofunctional therapy?

Orofacial myology, myofunctional therapy, and oral myofunctional therapy are all terms used to describe a program of exercises that helps you stop oral and facial habits that can change your appearance and affect your health. It retrains the muscles of your mouth, jaw and face, bringing them into harmony and instilling new and positive habits to make sure those changes last.

What are the four goals of myofunctional therapy?

  1. Nasal breathing — Breathing through the nose is the way we are supposed to breathe. It filters, warms and adds moisture to air. Healthy nitric oxide is also released when you breathe through your nose.
  2. Lip seal — Our lips should rest naturally and comfortably together. When your mouth is closed, you sleep better at night and have a lower risk of getting tooth decay and gum disease.
  3. Proper tongue posture — The tongue is supposed to fill up the entire roof of the mouth. When it does, it provides an internal support structure for the upper jaw. If your tongue is in the right place, your teeth will grow in straighter and your face will develop properly. The tongue plays an amazing role in our facial appearance.
  4. Correct swallowing pattern — If your tongue pushes forward when you swallow, you have a tongue thrust swallowing pattern. This makes you more likely to swallow small amounts of air when you eat or drink, and you may experience digestive issues such as acid reflux, stomach pain, gas and bloating.

What is orofacial myofunctional disorder (OMD)?

Orofacial Myofunctional Disorders (OMDs) are disorders of the muscles and functions of the face and mouth. Examples of OMDs are abnormal chewing and swallowing patterns (tongue thrust) and improper tongue position. OMDs may affect, directly and/or indirectly, breastfeeding, facial skeletal growth and development, chewing, swallowing, speech, occlusion, temporomandibular joint movement, oral hygiene, stability of orthodontic treatment, facial aesthetics and more.

What causes orofacial myofunctional disorder?

While it is difficult to pinpoint a single cause of OMD, it can often result from one or more of the following problems:

  • Improper oral habits, including thumb, finger or long-term pacifier sucking
  • Restricted airway due to enlarged tonsils or adenoids, allergies, or chronic nasal obstruction
  • Genetics
  • Structural or physiological abnormalities such as a short lingual frenum (tongue-tie) or abnormally large tongue (macroglossia)
  • Chronic open mouth posture
  • Neurological or developmental abnormalities

How might orofacial myofunctional disorders (OMD) affect everyday life?

An OMD may lead to an abnormal bite — the improper alignment between the upper and lower teeth — known as malocclusion. This problem may lead to difficulties in biting, chewing, swallowing or digesting food. If you want more information about tongue thrusts, please contact us today.

What are some symptoms of OMD?

  • Your lips usually rest apart.
  • Your tongue routinely rests against your teeth or pokes out between them.
  • You have trouble breathing through your nose.
  • You routinely have headaches, or jaw, face or neck pain.
  • You habitually bite, suck or chew on your lips, nails, hair or other objects.
  • You snore, sleep restlessly or sometimes stop breathing while asleep.
  • You find it hard to eat neatly and quietly.
  • You have trouble swallowing pills.
  • You have speech issues.
  • Your face is elongated.

At what age do you start to offer myofunctional therapy?

Myofunctional therapy is suitable for everyone from age 4 years and up. Treatment by 7 or 8 years old is ideal, as oral habits are less ingrained at this stage and easier to change, encouraging healthy dental growth. However, it’s never too early to have your baby do simple exercise for their jaw muscles to help them be stronger, such as giving them appropriate food and chew toys to develop their jaws and facial muscles.

What is a tongue thrust?

Tongue thrust (also called reverse swallow or immature swallow) is the common name of orofacial muscular imbalance, a human behavioral pattern in which the tongue protrudes through the anterior incisors during swallowing, speech and while the tongue is at rest. The tip and/or sides of the tongue may also press against or spread between the teeth.

Why might a tongue thrust happen?

Constant pressure from resting or incorrectly thrusting the tongue away from the hard palate may push teeth out of place. That pressure may later prevent teeth from erupting (breaking through the gum). Correct swallowing depends on a proper relationship between muscles of the face, tongue, and throat.

What is lip incompetence?

Lip incompetence is an inability to keep the lips together, or closed mouth posture at rest, and showing strain in the muscles around the face when a lip seal is attempted. Lip incompetence can result in changes in facial development, tooth eruption and alignment, breathing, swallowing, and jaw joint function.

Myofunctional therapy can help:

  • STOP a tongue thrust habit.
  • START breathing through your nose instead of your mouth.
  • QUIT thumb-sucking, nail-biting, lip and cheek-chewing, or other poor habits.
  • RE-TRAIN facial and tongue muscles to recover physiological function.
  • SUPPORT head-neck-body posture.
  • PREVENT or correct Long Face Syndrome.
  • ESTABLISH a harmonious oral environment.
  • ADDRESS issues such as speech problems, sleep apnea, snoring, digestion, clenching or grinding habits, and TMJ disorders.
One major recommendation is to avoid putting anything between the child’s palate and tongue, like the older sippy cups that have been used for years. This way the tongue can then learn to live in the palate where it belongs. We also talk about helping babies exercise their jaw muscles to help them be stronger.

We also recommend use of the Myochew™ chewing brush (available for sale in our office) for babies to chew on when they are young and teething to help clean the teeth and stimulate jaw growth. We need our children to start at a very young age, as soon as it is allowed by your pediatrician, to chew hard foods and chomp on hard toys that can work out their facial muscles.

What kind of oral myology do we have for the very young?

The integration of oral reflexes begins around the 4 month window. Remember, most of these babies tend to have other existing deficits related to these patterns, and many of them are developmentally delayed in those milestones. So please do not feel your baby is behind, they are just trying to catch up. If they had a tongue tie release, they spent 9 months in utero learning how to swallow with compensations.

With orofacial myofunctional disorders, it’s way more than tongue elevation that is compromised. As such, we would not expect these babies to operate on the same schedule as an infant who had no such problems. Often, these babies will need feeding therapies and body work to continue to relax their reflexes. We do not do myofunctional therapy with babies until they turn 4 years old.

Myochew, Myo Munchee, and Infant Trainer™

So many appliances! How in the world do I pick the best one for my child?

Myo Munchee is an Australian-based company and is an excellent product, depending on the needs of your child. The Myo Munchee is used to work out your child’s mouth and promote nasal breathing.

The smallest size available is BEBE for infants 9 months to 18 months and is only sold through practitioners. The next size, Mini Munchee, is for toddlers ages 18 months to 4 years and so forth. You can purchase these directly from their website, and we stock the BEBE Munchee for infants struggling with mouth breathing and swallowing.

The BEBE Munchee is for the babies in your family and features a sturdy handle that provides comfort and security to the most mini members of the team.

It is great for:

  • Pacifier replacement
  • Oral hygiene
  • Saliva control
  • Occlusal health
  • Weaning aid

BEBE Munchee is safe, non-toxic and comfortable. It is made of medical-grade silicone with a handle that makes it easy and stable for very small children to use.

Soft and snug, Bebe gives the little ones a head start on healthy habits through the natural action of chewing.

Babies in this age range can use Munchee passively or chew it actively. Munchee was envisioned to be chewed while being read to, incorporating its use into a fun and relaxing pastime.

The Munchee is an oral orthotic device that’s easy to use. It is as effective as it is elegant in its simplicity: just chew! We recommend using it actively throughout the day for up to 10 minutes or in conjunction with other myofunctional therapies.

What’s included?

  • Medical-grade silicone BEBE Munchee sized for babies.
  • Multiple small interior prongs to stimulate the gums. BEBE Munchee comes with a handle that can be removed with scissors.
We do not sell the Mini Munchee or any of the bigger sizes because we prefer the Myoresearch (Myobrace®) line of appliances. For example, the Mini Munchee (x-small) is bulkier than the full quadrant Myochew and we like the tongue tag and how much room for the tongue is available in the Myochew.


As far as other myofunctional therapy options for our toddlers go, at Arlington Smile Center, Dr. Roca prefers to use the Myochew and Infant Trainer, sold to us through the Myoresearch company.

We have chosen this line of appliances because we feel it covers many more myofunctional orthodontics needs for all ages.

We love the tongue tag and specifically designed space for the tongue to park when the appliance is in the mouth. It also comes with a removable strap that you can use to attach the Myochew or Infant Trainer to clothing when it falls out of the mouth, just as you would do for a pacifier. You can also use this strap for myofunctional lip activities.

What about the Infant Trainer?

Whereas the Myochew is used for chewing, the Infant Trainer encourages your child to breathe through their nose while simultaneously training them to swallow and position their tongue correctly. Research clearly illustrates that correct facial, jaw and dental growth depends strongly on all of these factors. Although chewing is very important to develop the jaw muscles, we find that the Myochew distracts the children from learning to swallow correctly, so we introduce the Infant Trainer when the child is still sucking their thumb or fingers and not quite ready to begin the full Myobrace interceptive program with Myobrace Class I, Class II, and Class III.

Don’t delay! Call Arlington Smile Center at 703-237-7622 to schedule your next preventative visit, or to ask us any questions about your routine care.