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Patient Overview
Male, age 40
The patient had an airway screening during a routine preventative dental cleaning, which indicated symptoms of mouth breathing, acid reflux, teeth clenching, and enlarged tonsils. He had a strong desire to eliminate the need to take Omeprazole daily for acid reflux.
Clinical Presentation
Myofunctional Examination
Symptoms
Acid reflux
Asthma
ADD/ADHD
Fatigue
Hyperactive gag reflex
Nasal congestion
Restless sleep
Tinnitus
GI issues
Clenching
Neck tension
No snoring
SupplementalTreatments
No history of a sleep test
No history of a tongue release
Physical therapy as needed for previous injuries
Clinical Exam
Palatal tori
Slight sigmoid arch - mandible
Lingual inclination of posterior teeth
Occlusal wear
Mild crowding on lower anteriors
Venous pooling
Missing upper right 1st molar (#3)
Class I permanent dentition
Tonsils - grade 2
Mallampati - class III
5mm overjet
Mild to moderate overbite
No crossbite
No open bite
No temperomandibular joint (TMJ) click/pop
Functional Evaluation
Combination of nasal and mouth breathing
Competent lip closure upon behavior modification
Floor of mouth compensation
Clavicular, thoracic, and accesory muscle activation with breathing
Grade 2 anterior and posterior tongue tie.
Low resting tongue posture.
Poor tongue awareness and tone.
Therapies Provided
The patient went through 4 sessions of orofacial myofunctional therapy from July 2023 to September 2023. No release of tethered oral tissues (TOTs) such as tongue, lip, or buccal ties was completed.
The patient is using a REMplenish straw and doing a few myofunctional exercises as needed to help maintain muscle tone long term.
Functional Improvements
The patient noted an increase in tongue awareness after his preventative hygiene appointment where myofunctional therapy (MFT) was initially discussed.
With each session of MFT, he noted a significant increase in tongue awareness and improved resting tongue posture with his tongue against his palate more and more.
Throughout his MFT sessions, his tongue tone also increased significantly as noted by the images below.
Poor, uneven lingual palatal suction (LPS) was present during his initial evaluation
Upon completion of MFT, and without a tongue release, most occlusal overflow was reduced
Significant improvement in LPS
Full elimination of floor-of-mouth (FOM) compensation
The patient also noted more awareness of his breathing habits and improvements in his ability to nasal breathe. The patient is now falling asleep while nasal breathing instead of mouth breathing!
Narrow dental arches are contributing to bilateral tongue folding while in LPS due to limited tongue space. Orthodontic treatment was discussed, but the patient has chosen to forego any additional treatment at this time.
Outcome
Functional Range of Motion
Initial
Comfortable mouth opening (CMO) - 47mm
TRMR-TIP - 35.5mm (75.5%)
TRMR-LPS - 21mm (44.7%)
Final
CMO - 53mm - +6mm
TRMR-TIP - 45mm (84.9%) - +9.4% increase in range of motion
TRMR-LPS - 37mm (69.8%) - +25.1% increase in range of motion
After completing four sessions of MFT, the patient removed all floor of mouth compensation and noted almost complete elimination of acid reflux symptoms, which allowed him to stop taking his daily prescription of proton pump inhibitors (Omeprazole)!
He also reported decreased nasal congestion and has an easier time maintaining nasal breathing as an everyday habit! Additionally, he noted overall improvements in resting tongue posture.
Due to prior injuries and military service, the patient continues to have neck tension, which he treats with physical therapy.
Overall, the patient reached his goal of therapy - to reduce his need for taking medication for acid reflux - and is so far maintaining this success!
Options for further treatment
Orthodontic treatment to align and upright teeth to increase tongue space
Tongue release to help alleviate continued neck tension
Due to limited tongue space (noted due to a narrow palate and lateral tongue 'folds' while holding lingual palatal suction), orthodontic treatment would likely be needed before a tongue release could be done to ensure patent airway space after the release.
Because the patient was able to reduce/eliminate his symptoms so well through MFT, no release of tethered oral tissues is planned at this time. A reevaluation for maintenance of symptom improvements and compensation eliminations will be completed in early 2024, and any further treatment, if needed and/or wanted by the patient, will be discussed at that time.
Talk soon,
Liz Laney, Myofunctional Therapist
*None of the information included in this post is intended to be medical advice. Please talk with your healthcare provider(s) before making lifestyle changes or starting/stopping any medications and/or diets.
Case report last updated 12/2023
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