Impact of Oral Myofunctional Therapy on Orofacial Myofunctional Status and Tongue Strength in Patients with Tongue Thrust

Abstract

<b><i>Introduction:</i></b> Tongue thrust is a frequent clinical condition characterized by abnormal patterns of movements and altered tongue posture on the mouth floor. It might contribute to determining alterations in the maxillofacial morphology and in the development of malocclusion. Several therapeutic options are available for treatment. In particular, the orofacial myofunctional therapy (OMT) is frequently adopted even if only few studies have analyzed its efficacy using validated instruments and no information is available regarding the effect of dentition on the results obtained with OMT. <b><i>Objective:</i></b> To evaluate the effect of OMT through a validated instrument and explore the role of dentition on its efficacy. <b><i>Methods:</i></b> A total of 22 consecutive patients with tongue thrust were enrolled. According to the presence of mixed or complete dentition, the cohort of patients was divided into 2 groups. Each patient underwent OMT according to the Garliner method (10 weekly sessions of 45 min each in hospital and daily exercises at home). The efficacy of OMT was evaluated using the Orofacial Myofunctional Evaluation with Scores (OMES), a validated protocol developed for the assessment of orofacial myofunctional disorders, and the Iowa Oral Performance Instrument (IOPI) to measure the peak isometric pressure exerted by the anterior and posterior part of the tongue. Both OMES and IOPI were administered before and at the end of the treatment. <b><i>Results:</i></b> A significant improvement in the OMES scores was demonstrated after OMT. No significant differences between the patients with intermediate and mixed dentition obtained in both the pre- and post-treatment conditions were demonstrated in the OMES scores. Similarly, a significant increase in the peak isometric tongue pressure in both the anterior and posterior parts of the tongue was demonstrated after OMT in the groups. No differences between the two groups in both the pre- and post-treatment conditions were demonstrated in the IOPI scores. <b><i>Conclusions:</i></b> OMT improves orofacial motricity and tongue strength in patients with tongue thrust regardless of the type of dentition.

Quantitative Measurement of Swallowing Performance Using Iowa Oral Performance Instrument: A Systematic Review and Meta-Analysis

“…An initial screening of the titles and abstracts identified 47 studies. After reading the full texts, 33 studies [ 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ] were included, thus eliminating 14 studies [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 78 ] that did not meet the inclusion/exclusion criteria. The summary of the search strategy is depicted in Figure 2 .…”

“…Among the 14 intervention studies [ 44 , 45 , 46 , 47 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ], participants included dysphagic post-stroke subjects in 3 studies (21.4%) [ 45 , 46 , 60 ], older adults in 4 studies (28.6%) [ 47 , 61 , 62 , 63 ], and subjects with sleep breathing disorders in 4 studies (28.6%) [ 64 , 65 , 66 , 67 ]. Subjects with tongue thrust [ 68 ], as well as patients with Parkinson’s disease [ 69 ], were included in only 1 study (7.1%). Moreover, the sample in 1 out of 14 intervention studies (7.1%) was totally composed of HC without any reported pathologies [ 44 ].…”

“…In 1 study (7.1%) [ 65 ], the experimental group performed myofunctional therapy, consisting of isometric and isotonic oropharyngeal exercises divided into three categories: (1) nasal breathing rehabilitation, (2) labial seal and lip tone exercises, and (3) tongue posture exercises; in 1 study (7.1%) [ 45 ], the experimental group performed conventional dysphagia therapy and effortful swallowing training (EST), consisting of pushing the tongue onto the palate, while squeezing the neck muscles, and swallow as forcefully as possible, whereas the control group performed saliva swallowing without intentional force from the tongue and the neck muscles, and conventional dysphagia therapy, including orofacial muscle exercises, thermal tactile stimulation, expiratory training. In 2 studies (14.2%) [ 44 , 61 ], the experimental exercise was divided into isotonic and isometric types; in 1 study (7.1%) [ 62 ], participants performed a home-based mHealth app therapy program based on three therapy maneuvers: (1) effortful prolonged swallowing, (2) effortful pitch glide, and (3) effortful tongue rotation; in 1 (7.1%) study [ 68 ], participants underwent orofacial myofunctional therapy (OMT), consisting of isotonic and isometric exercises involving the tongue, soft palate, and lateral pharyngeal wall; in 3 studies (21.4%) [ 64 , 66 , 67 ], participants performed an AirwayGym app myofunctional therapy, based on exercises that are aimed at improving the tonicity of the various muscles involved in the pathogenesis of OSAHS; in 1 study (7.1%) [ 47 ], one group performed a tongue progressive resistance exercise (effortful water swallow) whereas the comparative group performed an instrumental tongue isometric exercise (lingual pressing tasks) using IOPI; in 1 study (7.1%) [ 69 ], participants in the experimental group performed traditional tongue exercises (tongue presses against the palate and lateral lingual movements) and instrumental tongue pressure exercises using the IOPI, whereas the comparative group performed only traditional tongue exercises.…”

Speech Disorders in Dysgnathic Adult Patients in the Field of Severity of Primary Dysfunction

“…Kojima et al [21] suggested that orthognathic surgery can improve the malocclusion and skeletal jaw relationship and tongue-palate position during post-operative articulation. Considering tongue thrust, Mozzanica et al [22] also stated that patients with tongue thrust perform forward movements and interpose the tongue between their teeth while speaking and swallowing with consecutive pressure against the lingual surfaces of the anterior teeth and altered tongue position in the oral cavity. As in the present study, incorrect swallowing is related to the bone morphology named as the high palate; it may be possible that abnormal tongue activity is associated with some reduced contraction of the lower jaw elevator and by this, somewhat compensation mechanism activates the perioral muscles.…”

Validation of the translated and cross-culturally adapted Malocclusion Impact Questionnaire in young people seeking orthodontic treatment in Serbia

“…Most patients with malocclusion seek treatment to improve aesthetics, psychosocial relationships, and quality of life (QOL) [1]. However, orthodontic treatment could also improve oral functions [2] and oral health [3]. Demand for orthodontic treatment and treatment outcome satisfaction is not necessarily in correlation with the objective malocclusion records and the clinician's opinion [4].…”