Disclaimer:
Any medical/health information in this course is provided for general informational and educational purposes only and does not substitute for professional advice. Accordingly, before taking any actions based on such information, I encourage you to consult with the appropriate professionals. The use or reliance of any information contained in this course is solely at your own risk.
I first heard the phrase, “myofunctional therapy” early in 2024.
“Myo-what??” I thought.
A colleague explained, “It’s mouth and throat exercise to allow proper breathing, chewing, swallowing, and facial bone growth.”
“If people don’t have good mouth and throat muscle function” she digressed, “they may end up in your office for TMJ problems.”
Well, my interest was certainly piqued.
Over the next several months, I observed my TMD clients. Sure enough, many of them had problems with their tongue strength, control, and mobility, and many had breathing problems like sleep apnea.
So, later that year, I began training in myofunctional therapy. I did this partially to see what myofunctional therapy was all about, and partially to learn whether there was anything in it that could help my patients with TMJ problems or - even better - prevent these problems from happening in the first place.
Now that I’ve finished training, I’ve started using the therapy in my own practice. And I’ve been reading a LOT of research.
In this post, I want to share with you my current perspective on myofunctional therapy to help you make an informed decision about whether it’s the right fit for you or your child.
What is myofunctional therapy?
Myofunctional therapy consists of face, mouth, and tongue exercises. The goals of this therapy are to:
Breathe properly, using the nose instead of the mouth (assuming no blockages)
Develop proper tongue and lip rest posture
Chew and swallow correctly
Myofunctional therapy typically lasts several months to a year, and consists of 10-15 minutes of exercises at home per day, with regular progressions of exercises by the therapist.
What we know about myofunctional therapy
This is a new-ish field. The evidence is growing. There are some things researchers feel confident about, and some things (a lot, actually) we simply don’t know yet.
Myofunctional therapy is also getting more press. This popularity can lead to claims that may be inaccurate but are easy to spread because it grabs people’s attention.
As I read the research that has been published about myofunctional therapy, I think there’s certainly more here than just a “fad.” However, it’s important to have an accurate understanding of what we know and don’t know about myofunctional therapy.
In this article, I’m going share what I understand myofunctional therapy to be from the research, and how it might help you or your child. Of course, this post will be somewhat biased: I have learned this therapy from passionate instructors, and I make a living by offering services that include it!
Here’s what we know about myofunctional therapy for kids with sleep apnea:
When researchers assess whether a treatment is helpful for sleep apnea, they often use a measurement called AHI (Apnea-Hypopnea Index) to understand the severity of someone’s sleep apnea. Higher AHI = worse. Lower AHI = better.
We have a few studies researching myofunctional therapy with kids who have sleep apnea.
In one study, AHI reduced by 62% in a group of kids compared to a group who didn’t receive myofunctional therapy. This means that they had fewer apnea events during their sleep.(1)
In another study, kids were cured of sleep apnea by having their tonsils/adenoids removed and their palates expanded. Researchers looked at their records for the following four years after surgery and expansion. Those who also received myofunctional therapy remained cured (AHI 0.5 ± 0.4/h), compared to children did not receive myofunctional therapy, whose sleep apnea returned (AHI 5.3 ± 1.5/h).(1)
In another study, no improvements were noted in AHI or in oxygen saturation after myofunctional thearpy. The researchers noted that the commitment of the kids to the therapy in this study was low - only 10 out of the 23 kids completed more than 80% of the exercises.(2)
Ultimately, we need more research with more kiddos to have more confidence about the effect of myofunctional therapy to help sleep apnea symptoms.
For kids with breathing problems during sleep, myofunctional therapy may be helpful, but it’s important to have a proper assessment by an ENT who can assess the severity of the condition and help determine if exercise therapy is appropriate. And, if myofunctional therapy is a treatment that is utilized, compliance is probably important.
Here’s what we know about myofunctional therapy for adults with sleep apnea:
We have a little more research studying the impact of myofunctional therapy on sleep apnea in adults.
In two review articles(1,2), which summarize several studies, researchers found that in adults receiving myofunctional therapy:
AHI reduced by 8.29-14.26
Snoring frequency decreased by 25%
Snoring intensity decreased by 66%
The percent of total sleep time spent snoring decreased from 14.05% to 4.12%
The lowest oxygen saturation improved from 83% to 86% (more oxygen)
The Epworth Sleepiness Scale decreased by 5.7-6.6 points
People were more likely to use their CPAP consistently
These results are promising!
Some Limitations to Note:
We only have studies with small groups of participants. Typically, studies with large numbers of participants are helpful. For example, if I wanted to know whether chocolate or vanilla ice cream is more popular in the world, you would probably be more impressed if I had surveyed everyone in the world rather than everyone in my neighborhood.
We don’t have very many studies. Typically, more studies showing the same results are helpful to confirm the results.
We don’t have much information on how long these benefits last. One study looked at treatment outcomes at four years, but most of the others are studying the effects of a few months.
Overall, we have some studies that suggest that myofunctional therapy might be a helpful adjunct to treatments for sleep apnea. However, each person should be individually assessed.
If you’d like to read more, there’s a Cochrane Review on the topic. You can find it here.(3)
Here’s what we know about myofunctional therapy for dental development and orthodontics in kids:
Some dental research suggests that oral habits might be associated with problems with dental and facial development. These habits include pacifier use, thumb or finger sucking, and the resting position of the tongue.(4)
Myofunctional therapy assesses and may help kids change these habits.
Additionally, there is some correlation between the strength of the muscles of the mouth and how the teeth develop into the proper bite.(5) Stronger tongue/oral muscles were associated with more “normal” occlusion.
Finally, one study suggests that when orthodontics are attempting to correct an anterior open bite (an open space between the front teeth when the teeth are together), undergoing myofunctional therapy may help the orthodontics treatment be more effective. In this study, one group of kids received orthodontics AND myofunctional therapy, while the other group received only orthodontics. After the orthodontic treatment ended, the “ortho-only” group regressed by 3.4 mm, while the group who received myofunctional therapy only regressed by 0.5 mm.(6)
In a study that looked at what may help orthodontic treatment continue to be successful, the authors suggest that myofunctional therapy may play a role, but may not be as effective as orthodontic appliances or surgery.(7)
Overall, several authors conclude that there are some situations when myofunctional therapy may be helpful in supporting orthodontic treatment. And, we need more research to be able to speak more broadly to its impact.(8)
Here’s what we know about myofunctional therapy with tongue-tie release:
When a tongue-tie release is needed, some research suggests that the procedure is more effective when paired with myofunctional therapy.
For example, in one study, those in a group who had myofunctional therapy along with their tongue-tie release had better opening and better tongue mobility compared to those without myofunctional therapy.(9)
One systematic review concludes that the combination of treatments may be better than tongue-tie release alone.(10)
Some studies research the combination of treatment (11,12), but don’t necessarily compare tongue-tie release with vs without myofunctional therapy.
In summary
There are a lot of questions still to answer about myofunctional therapy. Relative to some other types of treatments, we simply don’t have much research.
However, a lack of research doesn’t necessarily mean that a treatment isn’t effective, it simply means we don’t know if it is consistently effective for broad groups of people. So, it's likely best prescribed on a case-by-case basis.
Myofunctional therapy is probably best used in conjunction with other treatments, and will likely consist of collaborating with a team of professionals such as a dentist, orthodontist, physical therapist, and ENT.
Lastly, it’s probably of value to note that the risk of myofunctional therapy is quite low. I have not come across any reports of adverse events in the research. In general, conservative therapies like myofunctional therapy tend to come with less risk and/or expense than surgical or pharmaceutical treatments. Of course, most treatments have a place for the right patient at the right time, and should be applied in a manner that’s unique to you or your child.
Are you connected to a treatment team who can help you decide if myofunctional therapy is right for you? If not, reach out for an evaluation! We’d love to help, and have a network of the best providers in town to make sure you’re on the best treatment plan possible.
Cheers,
Dr. Rebecca Salstrand, PT, DPT
References:
Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA. Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Sleep. 2015 May 1;38(5):669-75. doi: 10.5665/sleep.4652. PMID: 25348130; PMCID: PMC4402674.
Saba ES, Kim H, Huynh P, Jiang N. Orofacial Myofunctional Therapy for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. Laryngoscope. 2024 Jan;134(1):480-495. doi: 10.1002/lary.30974. Epub 2023 Aug 22. PMID: 37606313.
Rueda JR, Mugueta-Aguinaga I, Vilaró J, Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev. 2020 Nov 3;11(11):CD013449. doi: 10.1002/14651858.CD013449.pub2. PMID: 33141943; PMCID: PMC8094400.
American Academy of Pediatric Dentistry. Management of the developing dentition and occlusion in pediatric dentistry. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2024:475-93
Declercq L, Vichos S, Rajbhoj AA, Begnoni G, Willems G, Verdonck A, de Llano-Pérula MC. Correlation between oral muscle pressure and malocclusion in mixed dentition: a cross-sectional study. Clin Oral Investig. 2024 Jul 4;28(7):412. doi: 10.1007/s00784-024-05807-y. PMID: 38963565.
Smithpeter J, Covell D Jr. Relapse of anterior open bites treated with orthodontic appliances with and without orofacial myofunctional therapy. Am J Orthod Dentofacial Orthop. 2010 May;137(5):605-14. doi: 10.1016/j.ajodo.2008.07.016. PMID: 20451779.
Alam MK, Alayyash A. Management Strategies for Open Bite Relapse: A Systematic Review and Meta-Analysis. Cureus. 2024 Mar 16;16(3):e56285. doi: 10.7759/cureus.56285. PMID: 38623106; PMCID: PMC11018291.
Homem MA, Vieira-Andrade RG, Falci SG, Ramos-Jorge ML, Marques LS. Effectiveness of orofacial myofunctional therapy in orthodontic patients: a systematic review. Dental Press J Orthod. 2014 Jul-Aug;19(4):94-9. doi: 10.1590/2176-9451.19.4.094-099.oar. PMID: 25279527; PMCID: PMC4296637.
Carminatti M, Nicoloso GF, Miranda PP, Gomes E, de Araujo FB. The Effectiveness of Lingual Frenectomy and Myofunctional Therapy for Children: A Randomized Controlled Clinical Trial. J Dent Child (Chic). 2022 Jan 15;89(1):3-10. PMID: 35337393.
González Garrido MDP, Garcia-Munoz C, Rodríguez-Huguet M, Martin-Vega FJ, Gonzalez-Medina G, Vinolo-Gil MJ. Effectiveness of Myofunctional Therapy in Ankyloglossia: A Systematic Review. Int J Environ Res Public Health. 2022 Sep 28;19(19):12347. doi: 10.3390/ijerph191912347. PMID: 36231647; PMCID: PMC9566693.
Zaghi S, Valcu-Pinkerton S, Jabara M, Norouz-Knutsen L, Govardhan C, Moeller J, Sinkus V, Thorsen RS, Downing V, Camacho M, Yoon A, Hang WM, Hockel B, Guilleminault C, Liu SY. Lingual frenuloplasty with myofunctional therapy: Exploring safety and efficacy in 348 cases. Laryngoscope Investig Otolaryngol. 2019 Aug 26;4(5):489-496. doi: 10.1002/lio2.297. PMID: 31637291; PMCID: PMC6793603.
Baxter R, Merkel-Walsh R, Baxter BS, Lashley A, Rendell NR. Functional Improvements of Speech, Feeding, and Sleep After Lingual Frenectomy Tongue-Tie Release: A Prospective Cohort Study. Clin Pediatr (Phila). 2020 Sep;59(9-10):885-892. doi: 10.1177/0009922820928055. Epub 2020 May 28. PMID: 32462918.