What is Orofacial Myofunctional Pre-orthodontics?
Orofacial means of the mouth and face.
Myo means muscles, and functional means the way things work.
Preorthodontics means jaw development before needing to straighten the adult teeth.
Orofacial Myofunctional Preorthodontics relate to the early evaluation and intervention of the growth of the jaws by correcting the way the muscles of the mouth and face are used during functions, including feeding, chewing, swallowing, drinking, speaking, and breathing. If the muscles of the mouth and face are functioning optimally, then the jaws would develop and form favourably.
The tongue plays a very important role in this entire paradigm, because it is one strong muscular organ that needs to exert pressure against the jaw and the palate (roof of the mouth) from the inside out. If the tongue is dysfunctional (for example if it is low toned, low posture, or restricted by a tongue tie), then the facial muscles usually would exert more pressure against the jaws from the outside in, leading to narrowed dental arches, dental crowding, dental malocclusion (bite issues), and high palate.
Before and after photos of a case example of Myofocus Orofacial Myofunctional Preorthodontic treatment. Results vary between individuals, and each case needs thorough evaluation and records to diagnose and formulate suitable treatment options and recommendations accordingly.
There are also associated functional issues that may be causative to and/or consequence of having narrowed jaws. These may include:
- Mouth breathing
- Narrowed upper airway
- Narrowed nasal airway
- Sleep disordered breathing
- Obstructive sleep apnea
- Behavioural problems
- Nutritional factors
According to growth studies, the natural growth of the bones of the head are:
- 50-60% complete by the age of 4 years old
- 80% complete by the age of 6 years old
- 90% complete by the age of 9 to 11 years old
It is, therefore, preferable, to evaluate and manage jaw development concerns through Orofacial Myofunctional Preorthodontics as early as possible, while the child still has higher potential of natural growth. We recommend to have your children assessed by the age of 3 to 4 years old.
Additionally, as dental practitioners, our scope of practice is of the mouth and face. However, these areas are connected with all the functional systems of the entire body. For this reason, addressing only one part of the body is insufficient to achieve optimal functional health.
We believe the team approach is ideal, in which our patients are being collaboratively managed, as required, by multidisciplinary health providers, consisting of neurodevelopmental chiropractors, paediatric cranial osteopaths, breathing educators, allergists, Ear Nose Throat (ENT) specialists, naturopaths, nutritionists, paediatricians, integrative medical general practitioners, sleep physicians, Temporomandibular Joint (TMJ) dentists, specialist orthodontists, oral surgeons, oral health therapists, orofacial myologists, general dentists, and others.
The goals of Orofacial Myofunctional Preorthodontics are to:
- Unlock each individual’s natural genetic potential
- Widen the jaws and correct the bite
- Avoid the need for extraction/retraction/surgical orthodontics at a later age
- Achieve optimal functional health (breathing, sleeping, swallowing, eating)
At The Myofunctional Centre, we follow the Myofocus Protocols of early intervention orthodontics. Our principal dentist is the co-creator of the Myofocus Take Off Orofacial Myofunctional Algorithm and educates internationally to health practitioners from various disciplines on the concept of Orofacial Myofunctional Preorthodontics and tethered oral tissues.
Is my child suitable to have preorthodontics?
Most children, who still have natural growth potential of the jaws, are usually suitable to have preorthodontic treatment. Because of the rate of natural jaw growth is faster earlier in life, usually the earlier the better to have the functions of the orofacial muscles corrected. Nevertheless, each patient requires an initial consultation with one of our dentists, to evaluate their presenting conditions. Then records are needed to analyze each case individually, and be able to formulate a treatment plan for each patient.
Records consist of:
- Photos of teeth, bite, tongue, lips, tonsils (if possible), and the range of tongue mobility
- Photos of smile, face, posture
- Videos of the patient speaking, chewing, swallowing, breathing, and functioning
- 3D digital study models of the teeth and bite
- Radiographs (x-rays) of the head to assess the jaws, the teeth, the airway, the nasal passages, the neck posture, the jaw growth direction and the jaw growth potential.
Once formulated, a case presentation appointment is then scheduled to discuss the plan in detail with the patient and the parents, and a written proposal will be provided, to assist in making an informed decision.
If your child is unsuitable, then referrals to other health practitioners and/or specialists will be advised and prepared.
How much commitment is required from the patient and/or the parents, with preorthodontic treatment?
Usually the therapy is very intensive at the beginning, because the muscles would require more exercises to improve their functions. According to research, it takes at least 2 months to change a habit, and so we do prefer to see the patient to prescribe the exercises weekly for about 8 weeks, or more, initially. Then, once the muscles are improving, usually then appointments reduce to once a month, on average.
In between each visit to see us, the patient needs to practice the exercises in their own time, properly, about 2 to 3 times per day. It takes around 5 to 10 minutes to complete each set of exercises. Having excellent compliance, establishing a daily routine and having supervision from the parents are crucial factors in the outcome of the therapy.
Do you use jaw expansion plate?
In some cases, we do use jaw expansion plates. The purpose of these plates is to widen the jaws to dimensions that they are supposed to be, for that patient at that particular stage of their jaw growth. Hence, if the jaws are too narrow and the orofacial myofunctional exercises alone are not helping, then the jaw expansion plate may be indicated.
There are also jaws that are significantly too narrow that the tongue does not fit to rest and function ideally in the mouth. These jaws may need to be expanded first, before the functions of the orofacial muscles can be retrained with exercises.
Our preference is also to use removable jaw expansion plates, as these can be taken out for toothbrushing and flossing, and also for the plates themselves to be cleaned, leading to better oral hygiene.
What is the cost of preorthodontics?
We do not have set fees for preorthodontic treatment, because every patient is different, in regards to what they need and how they respond. Patients needing more work and/or taking longer to complete the active phases of treatment, will end up costing more . The length of the treatment is unpredictable for the same reasons. Hence, it is only fair for the patient, parents and the treating team that the fees are not set, but are structured according to how long the treatment takes and what the treatment involves, for each individual.
The payment structure will always be discussed and provided in writing, before the commencement of the treatment.
After the completion of the preorthodontic treatment, will the orofacial functions remain stable?
The stability of the result depends on how well the patient is able to maintain the optimal functional health of the orofacial muscles. If these muscles healthy functions become habitual then the long term stability is more likely to persist. However, if not, then periodic maintenance exercises may be indicated.
It is similar to going to the gym. Muscles have higher chance of weakening, changing, regressing, and becoming dysfunctional, in the absence of regular exercises.
By doing preorthodontics, does that mean my child will avoid braces?
The goals of preorthodontic treatment are to improve the functions of the orofacial muscles and widen the jaws while they still have natural potential to grow. The treatment has better outcomes when patient is younger and also with excellent maintenance of these improved functions as they continue to naturally grow.
Braces are basically used to straighten adult teeth. They do not address orofacial functions, nor do they widen jaws. Hence, sometimes braces are still required when the patient has adult teeth, even after having preorthodontic treatment, if these teeth are not straight. The alternative to braces is using clear aligners (most common brand is Invisalign) to straighten adult teeth.
Our aims of intervening early with preorthodontics are to avoid needing extractions of adult teeth due to dental crowding (excluding wisdom teeth), and to avoid jaw surgery due to having no natural growth potential for narrow jaws to widen.