Modern myofunctional therapy in the scientific content of developmental biology.

It is not immediately comprehensible to the adult TMJ patient community why it is necessary to go into such depth and to somewhat “overload” the reader with this flood of text. The issues, however, are complex and should be sought out in very early development. Carry out this work not just to benefit for yourself; use the information to spare your children from unnecessary suffering. Unfortunately, it must be assumed that your children’s development will take a similar course if no action is taken. It becomes clear when reading the text that you will have to take the initiative yourself as not much can be expected from “normal” conventional medicine.

If treatment is supported by an automatic appliance (Relaktor), treatment successes are much more likely, which are vitally necessary for speech therapy to be taken into account by the academic community. See the opinion of the DGKFO (German Jaw Orthopedics Society) regarding MF therapy. This has no bearing on developmental biology and its principles; they are not accepted in the field of jaw orthopedics.

Opinion of the DGKFO on diagnosis and treatment of orofacial dysfunctions

Speech therapy is a very young discipline undergoing rapid development. To a large extent, it is subject to major influences by the anthropological aspects of dentistry. Its methods are based too little on the principles of developmental biology and as a result are flawed. Unfortunately, modern MFT is developed outside of training for speech therapy. To this day, it has not been reflected in the curriculum. This makes it very difficult to find qualified therapists.

Modern MFT thinks in terms of orthopedics and considers the whole body. It begins with the infant and develops its methods on the basis of developmental biology.

Prof. Fränkel and later Prof. Grabowski (Uni-Rostock) have compiled a very precise chronological description of the biological developmental steps. In other words, it’s the influences of the tonic pattern in the spaciotemporal developmental paradigm that significantly determine development. As early as at the prenatal stage one can speak of movements that are necessary for growth.

Restorative therapy, i.e. early treatment starting in the infant years, is not only preferable but rather a necessary prerequisite in order to gain diagnostic insights, compensating without being able to treat major errors. For MF therapists and orthodontists:

Myofunctional disorders: Expert opinions & evidence
(Karola Tenhündfeld 10th Jan. 2015)

This carefully-compiled work includes very clear description of the fact that there are more ques-tions than answers for speech therapists when dealing with the basics, i.e. oral functions (myofunc-tions), which are present in cases of all types of disorder that fall under the spectrum of treatments to be provided by speech therapists. Above all, it becomes clear how great the harmful influence of literature by Anita Kittel is for the speech therapist. In Kittel’s case, proceedings were started too late and the focus has been on re-training the tongue (in both diagnostic and therapeutic respects). That corresponds to the requirements of dental medicine and ignores biological principles. The core task is to heal; it must not be the case that speech therapy too is limited to compensatory treatments. Children do not need to be of schooling age to provide extra support to the necessary supporting functions in the perioral region.

It is absurd to treat incorrect positioning only once they have already become established.

These findings go beyond the scope of an MAP patient and the information is intended more as an aid for the therapist to properly meet the needs of this group of patients. The patients have no other choice than to themselves provide their therapist with the findings. Many therapists are very open-minded in this regard as they themselves realize how limited their options are and treatments prove unsuccessful. Modern MF therapists are much more successful in this. For example, this article is a recommendation that describes the “correctly” understood MF therapy at its best, transforming it onto a scientific format that is not contradicted by the field of biology.

Furtenbach M, Adamer I: Myofunctional therapy compact II – diagnosis and treatment. Präsens Publisher, Vienna 2016.

Even at a very young age (at around 8 months old), children should already be developing support-ing functions in the lip (perioral) region. The child switches back and forth for a long time between a suction reflex and an adult swallowing pattern, with these functioning / developing in parallel. The child needs this in order to be able to process solid food too.

Solid food is an independent growth stimulus: it is necessary in order for the oral functions to be stressed with sufficient forces from the hard structures to bring about their development. Systemi-cally there is a need for a balance of forces, and the rest of the body should also have sufficient tone (movement/posture weaknesses).

THE MOUTH: A MULTIFUNCTIONAL SPACE

Insights into the development of oral functions and possible disrupting factors
(Mathilde Furtenbach 03/2017)

At as early as around 18 months of age, the adult swallowing pattern should already be established.
If the necessary developmental step for sufficient supporting functions in the lip area does not oc-cur, switching will occur for the subject’s entire life. This leads to limitations in breathing function through the nose, with serious consequences for the development of functional respiratory spaces. They need to be able to close their mouth for their development.
The changing pressure conditions (underpressure / overpressure) in the respiratory tract induce de-velopment.
This makes diagnosis of the patient difficult as they can do both. Misdiagnoses are par for the course here.
I consider it to be more reliable to derive diagnosis from the hard structures.

“Any tooth abnormality can be attributed to a corresponding tonic pattern”

In the oral functional space, the causality is abundantly clear that incorrect tongue behaviors find their root causes in lacking supporting functions in the perioral region (mouth closure). Only compe-tent lip closure can create the pressure conditions (underpressure) that allow for correct positioning of the tongue (function) that the oral functional space requires for its development. Impeded bite devel-opment is a mere expression of defects in the spaces that find their root cause in the absence of nec-essary developmental steps relating to muscle tone (mouth closure / too little muscle tone). Congeni-tal causes (passed down in the family) here include a tendency towards developing a malposition, leading to similarities.

Myofunctional therapy also possible in small children
(Sabine Fuhlbrück, Special edition of the journal ZWP Zahnarzt-Wirtschaft-Praxis [Dentist-Management-Practice] June 2015)

In the case of compensatory treatments (growth already completed), if the damage has already been done, the functional spaces are only developed to a limited extent and incorrect positions have be-come established, then the therapist needs a chronologically precise knowledge of biological devel-opmental steps to ensure that no errors are made methodologically. That determines the sequence: first working on the lip closure (i.e. support function) of the circular lip musculature. The functional respiratory airways must be used to ensure that inflammation (swelling) does not make breathing more difficult or even impossible. This generally occurs due to lip closure: an ENT doctor is only rarely necessary. With this, tongue behavior (development) improves spontaneously. Only in this way will the therapist be successful in developing a viable swallowing pattern. The degree of severity of the incorrect development (of spaces) does, however, set limits on treatment. The bite development gives very accurate information in this regard on incorrect muscular inductions.

If this is carried out in the reverse order (Kittel), both treatment failure and a real circus per-formance can be guaranteed. If there is an underpressure failure (lip closure), the tongue be-comes burdened by gravity and will not let itself be trained into an upper position. An even worse case still is where breathing function is limited and mouth closure is made more difficult.

For this, it is often necessary to resolve blockages in adjacent structures (body posture), which is what makes osteopathically trained MF therapists so successful. How complicated the problem is can be illustrated by the following text:

The main problem for almost all therapists (physical and psychological) is: “Why do patients hold so tightly onto their habitual patterns and behaviors?”. Answers to this can be provided by brain research (development of patterns in the brain) and motivation research. It is clear here that the more established a development has become (which has a large deal to do with the factor of time), the more difficult it is to train subjects in new patterns, i.e. the demands in terms of patient motivation then often outweigh their capabilities. Exceptions to this often con-firm the rule.

Mrs. Furtenback with her hobbyhorse “pacifier” makes everything right by using this point, as even at this age development traits are established that can make later treatments / therapies extremely difficult.

Too little attention means that myofunctions end up being considered as higher-tier functions in terms of neurology, which also has an impact on the development of adjacent structures. Only con-sidering the skull is to not go far enough, also, and above all else, when considering hard structures. That leads inevitably to incorrect assessments in diagnosis of soft and hard structures in cases of compensatory treatments / therapy.

“An undisrupted sequence of vital functions is only possible if they can help shape skeletal devel-opment (evolution).”

It is this aspect that I attach great importance to and which allows for me to be considered as standing apart from “modern” MF therapists.

No school engaging in physical work with the body has focused on this context (vital func-tions): not even osteopaths. The frequent resistance of MAP patients encountered when they are faced with bodywork which does not relate to myofunctions is more than just an indication that this approach is correct.

TMD / TMJ  patients should not swallow when in maximum intercuspation position, despite this being taught in dental medicine.
I’ve expressed this in somewhat grandiose terms, as it is something that I have been dealing with for a long time and is considered to be very controversial.

Occlusion (dentistry) – Wikipedia
(This link will take you to an understandable explanation of what is meant by maximal intercus-pation, habitual bite position and centricity.)

The tongue is key: it is used to support and control the resting position. Only the tongue is in the position to control the vitally important minimum distance to the teeth. This is something the facial muscles cannot achieve. Here it should also be remembered that the tongue function is of secondary importance. Without a viable supporting function in the lip area, it will too often take up its backup function that it had during the toddler years, and with this the resting position will immediately become instable.

In the resting position (teeth not touching, their distance is minimal / the tongue is flat and held at the level of the upper gums, and the lips are closed), the lower jaw in healthy patients is found to be in centric position (myocentric), a position which may be significantly different from the habitual position. A centric difference is virtually always the case for healthy subjects too, and is compen-sated via neuromuscular processes.

In TMD / TMJ patients, this compensation capability has been lost or is restricted. Is it grossly incor-rect to describe physiologically correct swallowing in the context of maximal intercuspation? In the case of TMD / TMJ patients, doing so would aggravate symptoms. It is, on the other hand, correct to allow for minimal tooth contact (first initial contact) when swallowing when it is needed for orienta-tion. It is not, however, absolutely necessary.

Since dental medicine simplifies things too far, this is something that should be considered on a more differentiated basis. In essence, the Mühlstein principle means there is not even any contact of the teeth during eating; it prevents any premature wear of the teeth. Physiological stresses that re-quire healthy bone structures (density) and healthy parodontium are also obtained by this means with no contact of the teeth.

The situation is different for the milk-teeth bite. In that case, abrasion of the teeth is necessary for the child’s jaw to become aligned and for a stasis to be found. Whether this functions through eat-ing, as is also accepted by Mrs. Prof. Grabowski, it would see involvement of swallowing functions in maximum intercuspation or through physiological bruxism, which would be logical. If the swal-lowing process is involved in maximum intercuspation, it would have to become adapted (modified) to the permanent bite for the Mühlstein principle to come into play.

Mrs. Sabine Codoni and the
body-oriented speech therapy k-o-s-t® by S. Codoni developed by her is an example of this.
MF-therapists that think along these lines and dare to treat adult MAP patients should get a link set up here. We have patients from all over Germany that have problems finding suitable therapists.

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A treasure trove of information on myofunctional therapy and very good therapists are set out be-low. The one thing they all have in common is that they are based on biological principles (Frankel / Grabowski).

Mrs. Ulrike Miehlke, Schwäbisch Hall
http://logopaedie-latzel.de/

Mrs. Sabine Fuhlbrück, Leipzig
http://www.mft-leipzig.de/

Mrs. Sabine Codoni, Basel
http://www.scodoni.ch/

Mrs. Ruth Bernard-Leick, Trier
http://www.logoteam-trier.de/