Orofacial Myofunctional Therapy (OMT)

Please note: The following text cannot and should not replace advice from the patient's healthcare professional(s). Any person who experiences symptoms or feels that something may be wrong should seek individual, professional help for evaluation and/or treatment. This information is for guidance only and is not intended to provide individual medical advice.

TMJ therapy with Anna van Piggelen

Anna van Piggelen M.Ost is the owner of Key Osteopaths in Surrey. Having started a career in osteopathy fifteen years ago, she moved to specialising in head, neck and jaw problems. She has combined her experience in treating EDS and hypermobility with additional training in myofunctional and hands-on temporomandibular joint (TMJ) t

herapy to create a gentle approach to relieve pain in the jaw and surrounding areas, while working to stabilise the jaw for the longer term with myofunctional therapy.

@key_osteopaths

www.keyosteopaths.com

Orofacial Myofunctional Therapy (OMT)

Orofacial Myofunctional Therapy (OMT) is a lesser-known modality that focuses on how you breathe and swallow, as well as your tongue and lip strength and position. These key areas have been shown to aid Orofacial Myofunctional Disorders (OMDs), which include ear fullness, tinnitus, clenching, grinding and jaw dysfunction, as well as supporting the neck and jaw, which are often linked to headaches and migraines. These are common problems experienced by some people with EDS and hEDS, many of whom will have exhausted visits to dentists, GPs or ENT (Ear, nose and throat) specialists without finding answers or relief. This is often the path to people finding myofunctional therapy.

The therapy dates to 15th century, gaining more interest in the 1900s from orthodontists but then falling out of fashion again due to the use of fixed orthodontic appliances.  Recently, however, there has been increased interest in OMT again, due to the growing awareness and research that the oral tissues, good muscles and tongue strength all have an influence on breathing, temporomandibular dysfunction (TMD), jaw development, otitis media (glue ear), snoring and sleep apnoea, among other things. Also, exercises for the oesophageal area have been shown to help symptoms such as gastrointestinal reflux.

Myofunctional therapist numbers have increased significantly in the UK, though they remain relatively small. This is likely to change, and we may see OMT become a common practice in dental surgeries as in Brazil and America. In fact, Brazil has been in the lead, becoming the first country to have a governing body for OMT, with speech pathologists conducting most of the recent research.

What does myofunctional therapy look like?

OMT involves a series of exercises, often using small tools, that target the orofacial area – namely the tongue, cheeks, lips, muscles of mastication (chewing) and swallowing.

Key points

• The tongue should rest at the roof of our mouth – not just the tip, but around two thirds of it, with a light press. This opens the airway, promotes better neck posture, and reduces strain on the TMJ from the over-worked muscles of a constant open mouth position. Multiple studies have shown other benefits to nasal breathing, such as the regulation of the sympathetic nervous system, which is crucial in chronic illness. Check yourself at you read this, where does your tongue naturally sit in the mouth – top, middle or bottom?
• To achieve nasal breathing, we need a strong lip seal. The orbicularis oris, a muscle running around the lips, can often be weak, making it difficult to keep the lips together, which makes mouth breathing more likely, especially at night. Strengthening this muscle helps prevent mouth breathing.
• Swallowing – here’s a test: take a sip of water and watch your lips as you swallow. Do they squeeze together or purse? If so, you’re likely compensating for a lack of strength and function in your tongue by using your facial muscles. Ideally, there should be no visible facial activity when swallowing. Instead, the tongue should work in a wave to press against the roof of the mouth.

Why Is this important?

Imagine how many times we swallow each day. Overusing other muscles will cause fatigue and potentially strain the TMJ. If the tongue isn’t used enough, it weakens and fails to provide the ‘scaffolding’ needed to support the TMJ.

A poor swallow action may also contribute to ear problems. An incorrect swallow action can limit the eustachian tube’s opening ability. If the tongue does not reach the soft palate (the soft bit right at the back of the mouth) when swallowing, the Eustachian tube may not fully open, potentially leading to fluid build-up and otitis media (a blocked ear). Other issues, such as nerve irritation or spasms of the tiny muscles in the ears, are also associated with TMJ.

Nasal breathing has been linked to regulating the nervous system, better oxygen uptake and particle filtration, but keeping a lip seal also prevents us from overworking facial muscles that can start to ache.

The role of OMT in Ehlers-Danlos Syndrome

Many people diagnosed with Ehlers-Danlos Syndrome (EDS) or hypermobility experience chronic pain or discomfort around their jaw or temporomandibular joint (TMJ), as well as headaches, neck pain, ear problems like tinnitus or fullness, clicking, popping, and general instability in the TMJ. The ligaments around the joint are crucial for providing support and function, and when compromised, they can lead to a variety of symptoms.

Myofunctional therapy is a way to rehabilitate the area to reduce stress on certain areas by making others work harder and more efficiently. Imagine your knee joint being a problem – you would train the muscles around it. The jaw joint (TMJ) is the same, except the muscles are your tongue, lips and cheeks.

Finding a therapist

Unfortunately, OMT is not offered through the NHS in the UK, and most patients will find therapists by doing their own research. Most therapists will be able to conduct online sessions if a patient lives further away, but attending the initial appointment is helpful to be able to fully assess the function and demonstrate the correct way to conduct the exercises. Finding a therapist who can explain things clearly is important, as it is likely that several sessions would be required. They also need to understand the concept of pacing – important even with these small exercises. In an ideal world, a therapist that can use hands-on therapy to relax tight muscles in the jaw and/or use acupuncture, which can be useful and normally works well with hEDS and EDS patients.