Myofunctional Soft Tissue Therapy

Soft Tissue Dysfunction can cause poor facial growth, unstable orthodontics and TMJ Disorder.

The influence of myofunctional habits on cranio-facial development and orthodontic problems has regularly been reported in publications since the era of Edward Angle. More recent studies show that crowded teeth and jaw discrepancies are not always hereditary, but can be caused by the way a child swallows and breathes. Orthodontic treatment rarely includes therapy for these myofunctional problems. The soft tissues control dental position and should be treated in conjunction with any orthodontic appliance therapy.

Research shows the position of the teeth is determined by the lips and tongue.

"More often than recognized, the peculiarities of lip function may have been the cause of forcing the teeth into the malpositions they occupy."

The power of the forces of the tongue, lower lip and peri-oral muscles is sufficient to move the teeth into any position. Soft tissue dysfunction, once recognized, can be treated which will improve the result of any orthodontic treatment, particularly stability. If corrected early, in the mixed dentition an improvement in facial development invariably occurs, and the need for extracting teeth for orthodontic purposes is minimized.

Previously little attention was paid to diagnosis of soft tissue dysfunction, as the problems were difficult to recognise and very time consuming to treat.

The MRC (Myofunctional Research Company) TRAINER System™

was developed to incorporate the philosophy of myofunctional therapy (see myofunctional effect) into a single size, easy to use appliance. Added to this, the use of slow motion digital video allows better understanding and diagnosis of the significance of these problems. The soft tissue dysfunction video, illustrates the effect on tooth and jaw development, plus the detrimental effect on the TMJ Joints.

Treatment of soft tissue dysfunction is therefore essential for long term success of any orthodontic and TMJ treatment.

Myofunctional Effect

The myofunctional effect is built into all the TRAINER System™ and the TMJ Appliances.

Myofunctional therapists, after diagnosing a soft tissue dysfunction, start with treatment involving correct placement of the tongue tip at rest. Correct swallowing starts from this “tongue on the spot” exercise. The TRAINER tongue tag mimics this exercise as, when in place, the tongue is trained to this position, automatically going to the raised part on the tongue tag. The TRAINER’s tongue guard stops the tongue from thrusting between the teeth. This, combined with the lip bumper, prevents contact between tongue and lower lip during swallowing, breaking the hyperactive mentalis activity of the incorrect (reverse) swallowing pattern.

Added to this, the patient is forced to breathe through the nose, further reinforcing the tongue into its correct upward positioning in the maxilla and moving the mandible into the correct class I position. The head tends to be more upright and other changes to normal posture are observed.

This effect also prevents distal movement of the TMJ condyles during swallowing, which decreases compression of the TMJ only (along with the aerofoil base), quickly relieving TMJ symptoms.

Health benefits, from the myofunctional effect from changing to nose breathing and to a more correct posture, are seen in most cases.

As with any repetitive exercise, the daily use of the TRAINER over 12 months or more will change the tongue posture, function and mode of breathing to normal. This is a permanent change in most cases. Of course, most often the dental and skeletal structures need to change also, to accommodate the tongue in a wider upper arch. In younger children, who are still growing (early mixed dentition), this happens with the TRAINER alone.

Design Features of MRC Trainers for Myofunctional Effect

1. Tongue Tag actively trains the positioning of the tongue tip as in myofunctional and speech therapies. It is for proprioceptive location of the tongue tip. The raised section on the tag trains the child to place the tongue in the correct resting "position" with the TRAINER in place. This also acts as a "reminder" to place the tongue tip correctly without the TRAINER. Myofunctional therapists use this tongue positioning as a basis of their retraining of the oral musculature.
2. Tongue Guard stops tongue thrusting when in place and force the child to breathe through the nose. The Tongue guard prevents a tongue thrust swallow when in place, which is a position "training" process for the tongue. This eliminates detrimental forces on the dentition which can slow treatment progress.
3. Lip Bumpers to discourage over-active mentalis muscle activity. Lip bumpers or mentalis stretchers are incorporated to stretch and deactivate overactive mentalis contraction, associated with a tongue thrust swallow. Lip bumpers have been shown to gain arch length in mild to moderately crowded cases. It stretches the mentalis muscle area to break the reverse swallow habit that is responsible for lower anterior crowding and mandibular underdevelopment.
4. Edge to Edge Class I Jaw Position is produced when in place (same as most functional appliances). Combined with prevention of tongue thrusting and forcing the child to nose breathe.

Changing mode of breathing and posture

The MRC TRAINERS stop mouth breathing when in place. The double mouthguard design forces the child to breathe through the nose. Most children who exhibit open mouth posture can nose breathe. They are habitual mouth breathers and can be trained to breathe correctly. "It was observed that children with open-mouth posture displayed a significantly slower pattern of maxillary growth compared with children who display anterior lip seal posture."

Particularly when worn overnight, the TRAINER helps to prevent maxillary arch loss and slowed growth so common in mouth breathers. Woodside and Linder-Aronsen showed "a change from mouth-open to mouth-closed breathing was associated with greater mandibular growth expressed in the chin and greater facial growth expressed in the midface." Passive arch expansion and mandibular growth is achieved by changing mode of breathing.

A Functional Appliance

The MRC TRAINERS act like a functional appliance, (Activator and derivatives) being premoulded into a class I (edge to edge position). It does not need to be specially fitted, and the flexible material used prevents breakage.

A combination of forces

The MRC TRAINERS have been shown to be effective in treating malocclusion in children 6-11 years. As only very light forces are required to move anterior teeth (about 1.7gm), the use of the combination of light aligning forces, removal of aberrant myofunctional forces from the tongue, the lower lip and correcting mode of breathing, plus the features of a functional appliance is the mechanism that makes the MRC TRAINERS so effective.

The labial bows combined with anterior tooth channels afford a constant force on misaligned anterior teeth to assist in the correction of their position. Its soft and very flexible material allows a maximum compliance even to the most severely misaligned teeth.