Over the past few hundred years, industrialized countries have seen a drastic change in the way people’s faces, mouths, and airways develop. Many diets have become soft and processed and require little chewing, mothers often breastfeed for less time than mothers, parents allow their children to use pacifiers and cups for extended periods, and mouth breathing and sleeping problems can to be overlooked.
All of this has led many people to experience underdeveloped craniofacial structures. When this happens, their airway and respiratory performance is drastically affected. Our society has many drugs, machines, and “aid kits” to mask people’s symptoms. We need to look for the root causes of many of our society’s health problems. Who better to start with than children? There should be much more early intervention so that children are not as affected physically, mentally and emotionally as past generations.
If you’ve worked in dentistry for any length of time, you’ll have heard the word dental professionals use to explain or justify the hows and whys of a particular sign or symptom. This can be sensitive during discussions with parents and carers of young patients. “Some guys just do that.” “It’s very common.” “They’ll grow out of it.” “It’s not a problem unless it affects speech or eating.” These are just some of the phrases we use. It is the way we are taught and the way some of our peers and superiors have shaped us. But now we know better, so we must do better.
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How orofacial musculofunctional therapy fits into dental hygiene
The myofunctional therapeutic lens
Being able to look at patients through a myofunctional therapy lens now, I’m not just looking at their teeth and tissues, but the whole person. I know the warning signs that were slipping through the cracks. Even with so much research and emerging science, some providers are out of step with the basics of the overall health and well-being of the people they treat.
Every patient, regardless of age, should be screened for airway problems. The airway affects the ability to get a good night’s sleep, and good sleep affects every aspect of mental, emotional and physical well-being. There is a change in the world of dentistry and as dental hygienists we play a key role in facilitating that change.
Here are five aspects of a pediatric evaluation in dentistry that are either commonly overlooked or described as “normal” or “common.” These should be taken seriously to avoid ongoing and potentially life-long problems.
1. Signs of bruxism and wear on primary teeth
Some parents tell you they can hear theirs child grinding his teeth during sleep while other parents ignore the issue. Wear and tear is an early sign of an airway problem and should never be ignored. This is the brain telling the jaw to move in an attempt to open the airway during sleep to get more oxygen. These children may also have enlarged tonsils.
2. Lack of primary tooth spacing
All primary teeth should be nicely spaced. If they begin to press together or have already done so, craniofacial development has lagged behind. You should see a dentist or orthodontist with airway knowledge for early intervention or a musculoskeletal therapist who can guide parents to the right providers. This can be done from the age of three.
3. Open mouth breathing, snoring and heavy breathing
No amount of snoring is normal for any person and is a red flag indicating a restricted airway and lack of oxygen to the brain. Open-mouth breathing is also considered sleep-disordered breathing and should be taken seriously. Many parents are unaware that their child has sleep-disordered breathing because they sleep in separate rooms, so encourage them to check on their children periodically after they go to sleep. If snoring or mouth breathing is observed, they should seek guidance from a musculoskeletal therapist or airway provider.
4. Tongue-tie
This can be tricky and hard to spot without training and knowledge. A musculoskeletal therapist can review and then guide a family through this process. But if tongue-tie has been diagnosed, it should not be ignored. The effect of a tongue tie goes far beyond breastfeeding and speaking and can have a cascading effect on a person throughout their life.
Tongue-tie release/frenectomies should only be performed by providers who have advanced training and significant experience performing these procedures. A good rule of thumb is that if a provider doesn’t recommend myofunctional therapy before and after a frenectomy, they probably haven’t had advanced training. More research should be done to find the right person. Also note that a good frenectomy provider may not be available in your area, so it may be necessary to travel.
5. Enlarged tonsils
This is often a sign of mouth breathing, but can also be caused by food, household or environmental allergens. Tonsils are scored 1-4 and scores 3 and 4 put patients at high risk for airway obstruction. These children often breathe loudly, snore, or have already developed sleep apnea. If you notice enlarged tonsils, encourage parents or caregivers to ask the child’s doctor for an ENT referral. If the doctor doesn’t think there’s a problem, a second opinion is a good idea. An airway provider or musculoskeletal therapist can help direct families to airway-focused ENT providers.
Quality sleep is a key aspect of health. If children don’t sleep well, their brains and overall development are compromised. All dental practices should screen for airway and sleep problems with a questionnaire or at least ask parents how their children sleep.
Other questions you can ask are “Are they having nightmares or sleepwalking?” “Are there problems with urination?” (This can be sensitive, so never ask in front of the child.) “Are they restless sleepers?” “Is it hard for them to wake up in the morning?” “Do they get up to use the bathroom at night?” “Are they showing signs of behavioral problems such as ADHD/ADHD?” These are all signs of poor sleep and airway problems, which again, are referred to an airway provider or musculoskeletal therapist.
The effects of poor sleep quality are a multi-billion dollar industry, and dentistry has a significant part of the responsibility to help address the sleep crisis. By committing to something as simple as screening new patients and early intervention, we can change the course of the health and well-being of future generations for the better!
After years in oral hygiene, Kelsey Fenner, BSDH, RDH, became interested in a “whole person” approach to treating patients and developed a passion for addressing orofacial dysfunction and imbalance. She is inspired by the transformative power of OMT and the impact this non-invasive and natural treatment can have on overall health, wellness and quality of life. He owns Flow Myofunctional Therapy, a fully virtual OMT practice serving ages 4+. She calls Colorado home with her husband and two sons.
