Topics on this page:
	Myofunctional Disorders - Definition
	The Function of the Tongue is the Most Important One
	Typical Situation when Maintaning the Infantile Swallowing Pattern
	The Optimal Food Intake for the Baby is Breast Feeding
	Which Malpositioning of the Teeth are there Due to Myofunctional Problems?

Myofunctional Disorders (myo = muscle):
It refers to the muscles of the mouth and face, especially the tongue and the lips in connection with swallowing

A collection of terms concerning myofunctional problems::

• tongue thrust
  
• tongue thrust swallow
  
• infantile swallow
  
• wrong infantile swallowing
• tongue- and lip habits
• tongue habit
  
• lip habit

The Function of the Tongue is the Most Important One

A baby puts the tongue between the toothless jaws to suck the milk.

A sensory interaction between lips and tongue makes the baby swallow, with the peristalses beginning in the mouth.

The tongue lies deep and shows a longitudinal furrow (Fig.1a,1b).

Fig. 1a: The tongus lies between upper and lower jaw to suckle the breast (see additionally Fig.4b)	Fig. 1b: Cross-section. You see the longitudinal furrow of the tongue ready for the intake of the nipple

This primary (infantile) forward positioning of the tongue to suckle the nipples is changed into a movement against the palate (Fig.1b ,1c).

Fig. 1c: Tongue in contact with the palate	Fig. 1d: Cross-section. Tongue is against the palate

In doing so the lips are closed loosely. The chewing muscles close the jaws. The middle part of the tongue is pressed high against the hard palate and the posterior part of the tongue is pressed against the soft palate to seal off the throat. Thereby the swallowing reflex is activated The chin muscle is relaxed (Fig.2a, 2b, 2c)

Fig. 2a: Food is transported by the tongue	Fig. 2b: Food is transported by the tongue

Fig. 2c: Food is transported by the tongue

If the tongue is not able to press against the hard palate at the beginning of swallowing, the neighbouring muscles ( lips, cheeks) have to assist to make swallowing possible.

Typical Situation when Maintaning the Infantile Swallowing Pattern

Fig. 3: The tongue is positioned between upper and lower teeth

• Open mouthposture


• The tongue is positioned between upper and lower teeth(Abb 3)


• The teeth at the beginning of swallowing are not in contact.

• The tongue is permanently positioned between upper and lower front teeth causing an open bite.


• Only the posterior teeth are in contact


• The tongue moves the teeth - functioning like an incorrect orthodontic appliance.

How can you explain it?

• Within 24 hour you swallow up to 3000 times. While swallowing the tongue exerts a force of 1 - 2 kp.


• This adds up to 3 - 6 tons of unfavourable force impact on the dentition.


• This makes you understand that the tongue is capable to impair or prevent orthodontic treatment.

Myofunctional treatment is mainly a treatment of the tongue

• Still valid: Better prevention than cure!

The Optimal Food Intake for the Baby is Breast Feeding

Breast feeding is crucial for the development of the jaws.

• The tongue-, lip- and facial muscles are trained, which is important for a correct speech pattern later on.


• It has a positive influence on the development of the palate, dentition and face
.

• It is good for the correct resting position of the tongue, leading to the correct swallowing pattern.

	Further Reading:
	Knowledge - Jaw Development and Breast Feeding

It is best to breast feed for at least six months. After six months additional feeding with a spoon and a cup is recommended. We advise not o use baby feeding cups.

If breast feeding is not possible, the hole in the teat must not be too big; only big enough so that the liquid can drop in one second intervalls (Abb 5).

Fig. 5a:Lip shield with a large diameter	Fig. 5b: Lip shield with a small diameter

From the age of six months on offer solid food in a variety of tastes, but be careful not to offer sweet tastes only.

If your child has a tendency to thumb sucking it is advised to give him or her a pacifier. In the case of thumb sucking the tongue is pushed against the floor of the mouth and this leads to the habit to swallow in this position, causing an open bite (Fig.6).

Statistically 70 % of the children need "something" in order to satisfy their natural suction-need. Thumbs, fingers etc. are "dangerous" because these habits are difficult to break.

It is easy to discontinue the pacifier later on. After the age of 2 - 3 years the pacifier should be discontinued. You can for example dig a hole in a beautiful meadow and plant the pacifier, then you water it and wait for the pacifier tree.

The orthodontist Dr. Pick (www.pickmed.com) developed a special pacifier to prevent malpositioning of teeth and jaws (Abb. 5c):

Abb. 5c: Pacifier by Dr. Pick

Which Malpositioning of the Teeth are there Due to Myofunctional Problems?

Fig. 6: open bite

As mentioned before the interpositioning of the tongue between the teeth can cause an open bite
(Fig. 6).
The deviating tongue function has an impact on the soundformation.

• 50 percent of the children with a deviating swallowing pattern have additionally articulation defects.
  
• Especially the "S" and "Sh" soundformation is impaired.

Additional symptoms are:

• The posture of the body is unfavourable.


• The neck is not streched, the head rests on the neck.


• When sitting the back is round.


• Posture and facial muscles appear flabby.


• Most of the time the mouth is open: mouth breathing instead of nose breathing.

A lip habit - a bad habit of the lip with the lower lip under the upper front teeth - can lead to a big overjet, sometimes up to more than 10mm.

Protruding upper incisors can be severely damaged - from a fractured tooth to tooth loss - when a trauma happens to the face.

Fig. 7a:Example of a malocclusion with the lower jaw too far back
Fig. 7b:Pressure from the lower lip to the upper front teeth can lead to a malocclusion

These are only a few typical examples to show us the effects of deviating muscle functions (Fig.7a, 7b).