Breathing Better: An Introduction to Myofunctional Therapy and Airway Health

Recently, I’ve been learning more about airways and breathing, and the health benefits (or consequences) that come with breathing correctly (or incorrectly). What does breathing “correctly” look like? How do we change how we breathe? Is it all mental? What parts are functional or structural? These questions are leading me down a path of exploration and education. The first step of which is learning more about myofunctional therapy. 

So, what is myofunctional therapy? Myofunctional therapy is a non-invasive treatment, using exercises to retrain the muscles of the face, mouth and throat, to improve muscle strength and coordination to correct conditions such as low tongue posture, tongue thrusting, and mouth breathing. These conditions can lead to narrow arches, orthodontic relapse, disordered breathing, and sleep apnea. 

During oral myofunctional therapy (OMT), there are four main goals: nasal breathing all the time (except when eating, drinking or speaking), lip seal, high tongue posture, and correct swallowing. The symptoms seen prior to therapy that often spark a conversation are mouth breathing, open mouth posture, low tongue posture, and a tongue thrust swallowing pattern. 

Nasal breathing is natural; mouth breathing is compensatory. Nasal breathing activates the “rest and digest” parasympathetic nervous system, the diaphragm and deeper breathing. Mouth breathing activates the “fight of flight” sympathetic nervous system, our emergency response system. It also activates the upper chest, shallow breathing, involves larger breaths and leads to over breathing (read The Oxygen Advantage by Patrick McKeown, or Breath by James Nestor to learn more about over breathing). An important aspect of nasal breathing is nitric oxide (NO). NO is an important signaling molecule in the cardiovascular system, has anti-inflammatory properties that aid in reducing inflammation in our nasal passages, tonsils and adenoids, and it is released through our body when we inhale through the nose. Mouth breathing bypasses this system.  

Open mouth posture (a lack of lip seal) is a learned habit, typically leftover from mouth breathing in the past. It can be outgrown but becomes more difficult after 5 years of age. It can be an indication that a tongue-tie is present and can lead to changes in facial structure and appearance. Some cosmetics and health complaints that are common in patients with open mouth posture include a long face, smaller lower jaw or “no chin”, droopy eyes, short upper lip, dark circles under the eyes, and crooked nose. 

Tongue posture… In an ideal world, at rest, our tongue fills the entire space inside our teeth, which includes resting along the palate on top. When the tongue has low posture, the tip of the tongue may rest against (or between) the anterior teeth, instead of at “the spot” — right behind the incisive papilla on your palate. The low contact at the tip of the tongue, often leads to the back of the tongue also being low — not contacting the palate. When the tongue is in the bottom of the mouth, it is more likely to block the airway and cause breathing problems at night/while sleeping. Low tongue posture can also lead to orthodontic relapse, because without the tongue to add stability to the dental arch from the inside, the palate can eventually collapse inward. 

Swallowing … Newer education has come out suggesting that a tongue thrust is a symptom, not a diagnosis. A tongue thrust is a dysfunctional swallowing pattern where the chin and/or cheek muscles contract when swallowing to aid in moving food and lead to the tongue pushing (aka “thrusting”) against the teeth. The muscles pitch in to help the tongue due to low tongue tone or structural limitations due to a tongue tie. This thrust can lead to open bites, both lateral and anterior; orthodontic relapse is often seen in cases where patients have open bites treated, but the tongue thrust pattern remains. 

Four goals:

1. Nasal breathing

• All day, every day; except when eating/drinking/speaking
• Nasal breathing is natural, mouth breathing is compensatory

2. Lip seal

• Lips closed at rest

3. High tongue posture

• Ideally, the tongue rests in the palate, filling the entire space of the oral cavity. The tip of the tongue rests on “the spot” right behind the incisive papilla.
• Tongue position can be influenced by a nose problem (i.e. allergies, deviated septum) or a tongue problem (tongue tie)

4. Correct swallowing

Four symptoms (opposite of goals):

1. Mouth breathing

• When a child (or adult) can’t breathe well, they can’t sleep well, which decreases quality of life.

2. Open mouth posture

• Can be outgrown, but more difficult after 5 years old

3. Low tongue posture

4. Tongue thrust swallowing

Four common compensation patterns (non-exhaustive list):

1. Facial grimace
2. Jaw lateralization/protrusion
3. Neck engagement
4. Floor of mouth

If you’re a provider in the area and do treatments in this realm (most commonly speech therapists, hygienists, body workers, but not exhaustive!), reach out to me! I would love to talk more and work together to take care of our community. If you’re curious about getting myofunctional therapy, contact Health Centered Dentistry, let’s set up a time to chat and figure out if pursuing therapy could be a solution for you! Regardless, I hope you’re taking advantage of the longer days by getting outside and breathing fresh air. Cheers to healthy breathing and healthy living!