Orofacial Myofunctional Therapy before and after Laser Frenectomy

What is orofacial myofunctional therapy (OMT)?

·       Orofacial myofunctional therapy (OMT) is a program of specific exercises that target the facial muscles for chewing and swallowing.  These exercises help to strengthen the tongue muscles after the frenectomy procedure. 

Why is orofacial myofunctional therapy necessary before & after laser frenectomy?

·       Karen Wuertz, D.D.S. and Brooke Pettus, COMS are authors of the article published in Laser focus in DSP, fall 2018 wrote, “The removal of oral restrictions is necessary to attain optimal orofacial function and must be combined with regular pre- and post-frenectomy orofacial myofunctional therapy (OMT).”

·       OMT helps re-educate the tongue and orofacial muscles during movement and at rest to create new neuromuscular patterns for proper oral function, including chewing, swallowing, speaking, and breathing. 5,6

5. Guilleminault C. Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH.  Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med. 2013 Jun; 14(6): 518-25.  Doi: 10,1016/j.sleep.2013.01.013.

6. Guimaraes KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009 May 15;179 (10):962-6. Doi:10.1164/rccm.200806-981OC.

*Case example by Karen Wuertz, D.D.S. & Brooke Pettus, COMS

Patient: 29 year old female

Clinical exam & symptoms:

·       Temporomandibular Disorder (TMD) symptoms with jaw deviation, clicking/popping on the right side

·       Neck pain and frequent headaches

·       Low facial muscle tone, a short upper lip

·       Mouth breathing all night, regular night time drooling, restless sleep

·       Complained of daytime fatigue & never waking well rested

·       Frequent congestion

·       Forward head/neck and forward rolled shoulder posture

·       Tension in the neck and shoulders

·       Tongue thrust during swallowing

·       Dry, chapped lips and the habits of lip licking, cheek biting and clenching

Intraoral examination:

·       Narrow, high palate

·       Tight upper labial frenum and attached gingiva

·       Tongue is short and wide with a tight, restrictive lingual frenum

·       Range of Motion (ROM) was 28mm from tongue tip to incisive papilla

Laser Surgery:

·       CO2 laser frenectomy was performed to release lip and tongue restrictions

·       Patient was asked to lift, extend, and lateralize the tongue

·       ROM was measured at 47mm.  Patient gained 19mm in the ROM with tongue tip to incisive papilla (gum tissue between upper 2 front teeth).

Postoperative care and healing:

·       Almost immediately, patient reported less neck and shoulder tension

·       Could stand up straighter

·       Her airway felt more open when breathing

·       Able to close her mouth without straining on her upper lip

·       Able to elevate the middle and posterior portions of the tongue to the palate

·       800mg ibuprofen was taken twice the day of and once the day after

·       Soft, bland diet for 48 hours

·       Continue orofacial myofunctional therapy (OMT) regimen after the revisions

-OMT helped the patient retrain and re-pattern neuromuscular movements that had been foreign to her and helped her integrate them into her everyday life

Results:

·       Proper oral posture (tongue to palate)

·       Lip (no open mouth posture at rest)

·       Nasal breathing got increasingly easier

·       Better posture, more energy, eats less, feels rested in the morning

·       Sleeps through the night

·       Tongue thrust eliminated

·       No more night time drooling

·       Decreased in clenching and biting the sides of her tongue at night

Summary:

Optimal orofacial functions in adult patients can be achieved through laser lip and tongue frenectomy procedures and regular pre- and post-frenectomy orofacial myofunctional therapy.

*“The Importanace of Orofacial Myfunctional Therapy Before and After CO2 Laser Frenectomy in Achieving Optimal Orofacial Function” by Karen M. Wuertz, DDS, ABCDSM, ABLS, FOM, and Brooke Pettus, RDH, BSDH, COMS

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  Dr. Anna Lee is an experienced provider for laser frenectomy.  If you have any questions about lip and tongue ties, please visit us at www.annaleedds.com or call for a consultation at 626-335-5114.

Adult Lip and Tongue Ties

     

What is lip tie?

Lip tie is a band of thick tissue that connects the underside of the lip to the gums and restricts the normal movements of the lip.

What is tongue tie?

Tongue tie is a band of thick tissue that connects the bottom of the tongue’s tip to the floor of the mouth and restricts the normal movement of the tongue.

What are some of the problems may be caused by tongue and/lip ties?

1.      Airway obstruction

·       In his book, “Tongue Tie,” pediatric dentist, Richard Baxter, D.D.S., discusses that the tongue is held down by a tongue-tie, the tongue often falls backward during sleep and blocks the airway.

·       When the airway is blocked, the body tries to open up the airway by protruding the lower jaw and grinding teeth.  It is a body’s defense mechanism of arousing the person to breathe when the airway is obstructed. (88, 89)

88.  Kostrzewa-Janicka J, Jurkowski P, Zycinska K, Przybylowska D, Mierzwinska-Nastalska E. Sleep-Related Breathing Disorders and Buxism. Adv Exp Med Biol 2015; 873:9-14.

89.  Jokubauskas L, Baltrusaityte  A.  Relationship between obstructive sleep apnoea syndrome and sleep bruxism:  a systematic review. J  Oral Rahabil 2017; 44(2): 144-53

2.      Chewing

·       Tongue tied restricts movement and function of the tongue.

·       Tongue cannot move food from side to side for sufficient chewing, swallowing and complete digestion.

3.      Swallowing

·       The tongue assists in swallowing 1200-2000 times per day.  Tongue tied restricts swallowing which prevents saliva/food to be swallowed normally and may lead to digestive problems.

4.      Cleaning of the Mouth

·       Tongue tied restricts the tongue from lifting and sweeping the food stuck between the cheeks and teeth.  Tongue is restricted and unable to clean the back teeth and the palate.

·       Lip tied can trap food between the lip and the teeth and make it difficult to brush.

5.      Facial development

·       Tongue tied keeps the tongue in a low position, so the palate does not receive its natural resting pressure from the tongue to form a broad and flat palate. Mal-alignment and mal-occlusion of the teeth may occur and affect the facial development of the person

6.      Obstructive Sleep Apnea (OSA)

·       Dr. Baxter’s article, Tongue-Ties and Sleep Issues, published from Dental Sleep Practice in winter 2018 discusses the following:

“A tongue that is held down by a tie is unable to rest in the palate.  The only place left for the tongue to go is backward, which closes off part of the airway.”  Snoring from upper airway resistance can be a warning sign of obstructive sleep apnea (OSA) or sleep disordered breathing.

7.      Speech

·       Movement of the tongue is important for pronunciation of words and linking the words into sentences.

·       Tongue tied restricts the tongue to move freely and reach the palate to sound out letters, words, and phrases

8.      Problems with posture, neck and back pain

Tongue tied may cause the head to tilt low and forward. The poor posture affects the sternocleidomastoid muscle, trapezius muscle and surround muscles and may cause the following problems:

·       Neck and back pain

·       Headaches and migraines

·       Shoulder pain

Note: dental problems caused by lip and tongue ties are discussed in the 2-24-2019 blog

What is frenectomy?

To remove the thick band of tissues that connects to the lip or tongue.

·       Labial frenectomy (aka frenectomy of lip)

·       Lingual frenectomy (aka frenectomy of tongue)

Indications of adult frenectomy

When the lip and/tongue tied is overlooked in an infant, future health problems can occur as an adult.  Lip and/tongue tied may be the cause of one or more of the problems discussed in this blog.  Consult with your dentist or general surgeon (ENT specialist) for evaluation and diagnosis.

How is frenectomy surgical procedure performed?

·       Scissors-bleeding

·       Scalpel or sharp surgical knife-bleeding

·       Laser-minimal bleeding, faster surgical time, decreased postoperative pain, quick healing

How long will the procedure take?

·       The amount of time needed for the frenectomy procedure depends on the technique used.  The entire procedure may be 30 to 60 minutes; includes pre-treatment preparation, post treatment instructions and the actual surgical (incision) procedure may take only a few minutes.

Post treatment care after the frenectomy procedure

·       Pain-relief medication may be needed

·       Salt water rinses for the next 5 days, 2-3 times per day

·       Soft food diets for 3-5 days; avoid hard, crunchy and spicy foods

·       Gentle tooth brushing

·       Follow-up visit

Orofacial Myofunctional Therapy before and after frenectomy

·       Pre- and post-frenectomy orofacial myofunctional therapy (OMT) helps re-educate the tongue and orofacial muscles during movement and at rest to create new neuromuscular patterns for proper oral function, including chewing, swallowing, speaking, and breathing.7

7 Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Cappasso 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

If you are suffering from any problems related to lip and/tongue ties.  Dr. Anna Lee is here to help you with the diagnosis and treatment. Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  Dr. Anna Lee is an experienced provider for Laser lip and tongue tied frenectomy.  If you have any question about lip and tongue tied frenectomy, please visit us at www.annaleedds.com or call for a consultation at 626-335-5114.

Bedwetting is a common finding in children.  A child drinks fluids before bedtime, constipation, or an episode of emotional stress can cause a nighttime bedwetting accident.  For most children, nighttime bedwetting does resolve itself over time.  If nighttime bedwetting accidents become frequent; the child should be checked and evaluated for possible sleep-disordered breathing.

What is sleep-disordered breathing?

According to the American Academy of Otolaryngology (ENT), sleep-disordered breathing (SDB) is a general term for breathing difficulties during sleep.  It is a medical condition where part, or all, of the airway is blocked repeatedly during sleep. These are some of the symptoms of pediatric SDB:

·            Snoring

·       Irritability

·       Bedwetting-SDB can cause increased urine production at night, which may lead to bedwetting

·       Learning difficulties

What does a tongue tie have to do with sleep?

Dr. Richard Baxter’s article, Tongue-Ties and Sleep Issues, published from Dental Sleep Practice in winter 2018 discusses the following:

·        “A tongue that is held down by a tie is unable to rest in the palate.  The only place left for the tongue to go is backward, which closes off part of the airway.”  Snoring from upper airway resistance can be a warning sign of obstructive sleep apnea (OSA) or sleep disordered breathing.

·       “After tongue tie release, patient notices a deeper quality of sleep and the parents notice less snoring, less waking, and better mood in their child.”

Tongue Tie and Bedwetting 

Dr. Richard Baxter’s book, Tongue-Tied, discusses the association between tongue tie and bedwetting.

·       Sleep-disordered breathing causes lack of deep sleep in children and adults

·       Lack of deep sleep can cause bedwetting

·       Sleep-disordered breathing causes frequent arousals (interruptions), which can cause the child to have the urge to urinate

·       Recent systematic review of removing tonsils and adenoids showed that bedwetting improved in more than 60% of the patients and 50% had a complete resolution of symptoms.

·       Tongue tie release can allow the child to achieve deeper sleep levels and stop bedwetting

·       Removal of tonsils and adenoids, the application of maxillary expander (orthodontic treatment), and tongue tie release can all work together to improve sleep quality.

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  Dr. Anna Lee is an experienced provider for Laser lip and tongue tied frenectomy (releases) for infants, children and adults.  If you have any questions about lip and tongue tied frenectomy, please visit us at www.annaleedds.com or call for a consultation at 626-335-5114.

 

Periodontal Disease = Gum Disease

Periodontal disease is also known as gum disease is a bacterial infection of the gum tissues and bone that hold the teeth in place.  It is caused by the bacteria in plaque, a sticky and colorless film that forms on the teeth. The early stages of gum disease can often be reversed and maintained with proper brushing, flossing and regular dental cleaning & check up with the dentist.  Gum disease that is left untreated would lead to tooth loss and other periodontal complications and problems.

This is the American Academy of Periodontology (AAP) classification of Periodontal Disease:

Type I  Gingivitis

·       Earliest stage of gum disease

·       No loss of attachment, no bone loss

·       Bleeding on probing may be present

·       At this early stage in gum disease, damage can be reversible since there is no bone loss.

·       Proper brushing, floss and regular dental cleaning help to remove plaque

Type II  Early Periodontitis

·       Pocket depths or attachment loss: 3-4mm.  Bone loss is present.

·       Periodontal pockets are formed as the dental tissues (gums and supportive ligaments) begin to pull away from the tooth.  These pockets trap bacteria and causes gum infection

·       Localized area of gingival recession; gums pull away and exposes the root

·       Bleeding on probing may be present

·       Damages caused by gum disease is irreversible

Type III  Moderate Periodontitis

·       Pocket depths or attachment loss: 4-6mm.   Bone loss is present.

·       Bleeding on probing

·       Furcation involvement

·       Teeth show mobility (loose)

·       Damages cause by gum disease is irreversible

Type IV  Advanced Periodontitis

·       Pocket depths or attachment loss: greater than 6mm.   Bone loss is present.

·       Supporting tissues and bone are destroyed. 

·       Bleeding on probing

·       Furcation involvement

·       Teeth show increased mobility (loose).  Some teeth are so loose that they may need to be extracted.

·       Damages caused by gum disease is irreversible

Signs of Periodontal Disease

·       Gums are red, swollen or tender

·       Gums that bleed during brushing or flossing

·       Teeth that look longer due to gum recessions

·       Formation of deep pockets between teeth and gums

·       Loose or shifting teeth

·       Persistent  bad breath or bad taste in the mouth

·       Changes of the teeth fit together when biting (occlusion)

·       Changes of the fit of the partial denture

Gum disease can occur at any age.  If gum disease is detected and treated at early stages, it can be reversed and maintained.  Currently, there is no cure for gum disease. 

If you notice any signs of periodontal disease, please contact Glendora Dentist, Dr. Anna Lee for a dental checkup.  You don’t have to lose teeth to periodontal disease.  Dr. Anna Lee can help to save your teeth. Call and schedule a free consultation at 626-335-5114 or visit us at www.annaleedds.com