We all know that mouth-breathing is bad. But do we truly know the importance of nasal breathing? It all starts with myofunctional therapy, and Kirk Behrendt brings in Brittny Sciarra-Murphy, owner of CT Orofacial Myology, to explain what it is and how it will help you re-educate patients on breathing properly through the nose. Stop the negative domino effect! To correct dysfunction early and help change your patients’ lives, listen to Episode 639 of The Best Practices Show!
Episode Resources:
Links Mentioned in This Episode:
Register for Brittny’s and Karese Laguerre’s course at Airway Health Solutions
Listen to I Spy with My Myo Eye podcast
Learn more about CT Orofacial Myology on YouTube
Main Takeaways:
There is a place for myofunctional therapy in every dental treatment plan.
Know how to properly screen for airway and myofunctional disorders.
Educate patients about the importance of nasal breathing.
Start using the BROOMS screener in your practice.
Collaborate with other clinicians.
Quotes:
“The technical term for [myofunctional therapy] is the neuromuscular re-education of the oral and facial muscles. It’s essentially like having a personal trainer for the muscles of the oral facial complex. We have common goals that we work on with our patients. Essentially, it’s to restore proper oral rest posture, which, you might not know what that is. So, as you’re listening to me, I want you to breathe, and I want you to think about where you feel your tongue inside your mouth. Weird question. All my patients, when they come in, they’re like, ‘Well, I don’t know. Nobody has ever asked me that before. My tongue is moving everywhere now that you brought so much attention to my tongue.’ But if you’re having correct tongue posture, if you think about where you say the letter “N”, where the tip of your tongue hits up behind your upper front teeth, essentially, right on your incisive papilla, that is where the tip of your tongue should rest. That whole tongue should actually be resting up in the roof of the mouth. The lips should be closed, and we should be breathing through our nose. This is really what our goal is as a myofunctional therapist, is to restore this posture.” (4:00—5:07)
“Whoever you are listening, whether you’re a pediatric dentist, general dentist, orthodontist, cosmetic dentist, sleep dentist, there’s a place for myofunctional therapy in literally every single dental treatment plan.” (6:35—6:48)
“One of the things that I like to explain, whether it’s other professionals that I’m lecturing to about myofunctional therapy or patients when they come in, it’s really important to understand that structure and function go hand in hand. You can’t really have one without the other. You can slap braces on somebody. You can get those teeth to move while they’re actually physically in the braces. But what about when you take those braces off? What’s going to happen if that soft tissue dysfunction was not corrected? We see a lot of patients with orthodontic relapse. So, patients that have tongue thrust — that can even impact cosmetic dentistry. I mean, how good is doing cosmetic dentistry on somebody that’s always thrusting their tongue? What good is that cosmetic dentistry if we can’t keep those teeth inside our mouth? Periodontal disease, there’s a link between that. Think about the forces of clenching and grinding, bruxism, what that does to the periodontium. Mouth-breathing, we already know what that does to the health of our gums. So, there’s a place for myofunctional therapy everywhere.” (6:54—7:56)
“I think one of the most important things is we want to understand, truly, the importance of nasal breathing and that it’s not okay to breathe through our mouth. Yes, maybe when you’re doing some high-intensity workouts, that’s fine. Otherwise, those lips should always, always, always be closed during the day and at night. You hear patients come in and they’re talking about maybe their children, and they might snore. They might snore a little bit. Or, ‘My husband is snoring. I have to sleep in the other room.’ Snoring is not okay no matter who you are, what age you are. We should be sleeping in our rooms, nice and quiet. I always tell my parents, ‘You want to go in your child’s room and put your finger underneath their nose to make sure that they’re breathing. That’s how quiet we want our children to be when they’re sleeping.’” (7:56—8:45)
“You could be the best myofunctional therapist in America, or to ever exist. But if your patient cannot breathe through their nose, it is very hard for us to be successful. So, we have to see, what is that root cause of mouth-breathing? Are there enlarged tonsils, enlarged adenoids, turbinates? Do they have a tongue-tie that’s impacting their ability to get their tongue up in the roof of their mouth? There are so many things that we want to look at.” (9:45—10:08)
“There are so many kids out there that are truly suffering and that are getting mislabeled as ADHD, getting mislabeled with behavioral issues. Kids respond differently to not getting enough sleep than we do as adults. As adults, we’re lethargic. We want to sit there, and we want to watch Netflix. Kids become hyperactive. They are trying to do everything they can to possibly keep themselves awake. And there’s a big correlation — I want to say it’s like 75% of patients — children that are diagnosed with ADHD actually have an underlying sleep-disordered breathing issue going on. That’s the other thing I feel like in dentistry — there are not enough practices that are focusing on sleep, even though we should, because every dentist should be screening for sleep-disordered breathing. But we think about sleep apnea, and that’s really all that anybody thinks about. But sleep apnea is that final destination we don’t want to get to. Sleep-disordered breathing is really an umbrella term — mouth-breathing, snoring, upper airway resistance. Then, we get to full-blown sleep apnea. So, again, it’s not normal to have any kind of snoring, no matter how old you are.” (11:45—12:57)
“[There are] simple questions that can be asked about sleep, sleep patterns, and behavior. I teach a course to other dental hygienists to become myofunctional therapists. I co-teach with my partner, Karese Laguerre. We came up with a screening that you can do in the op. The acronym is BROOMS . . . It’s very quick to do in your intraoral and extraoral exam as a registered dental hygienist. You’re not taking all this crazy time aside to do this. So, the “B” in BROOMS stands for bruxism. So, any signs of wear going on, any signs of clenching and grinding going on. Maybe your patient has massive tori in their mouth. Well, those grew from somewhere.” (13:45—14:35)
“The “R” [in BROOMS] stands for respiration. How are they breathing? Are they breathing through their mouth? When you’re looking at your patients, even before you call your patient from the waiting room, observe them in their natural habitat. How are they sitting? Are they super slumped over? Is their mouth slumped over, open? When you watch them breathe, are you seeing a lot of chest movement, or are you seeing the movement come from their diaphragm? Because that’s really that primary muscle that we want to be breathing from.” (14:37—15:06)
“The first “O” [in BROOMS stands for] open mouth. I think the first one is open mouth posture, technically. So, again, monitoring them. Is it typical that they have those lips apart, or are they together? And very simple, you can obviously see their teeth if their lips are apart. So, when parents are like, ‘Oh, I don’t know if their lips are together or open,’ well, do you see their teeth? That’s a big tail sign. Patients that have to use ChapStick. They might whip out the ChapStick while they’re in your chair. There is a reason why your lips are chronically chapped. Aside from the fact that, yes, ChapSticks smell fabulous, and lipsticks and glosses, and things like that, if your lips are chronically chapped, that’s a sure sign that you’re probably doing some mouth-breathing and have your mouth slumped open.” (15:08—15:56)
“The “M” [in BROOMS] stands for maxillary transverse width. This is something that should be taken, I think, on every single patient and that can be easily done. Take a cotton roll. A cotton roll measures about 37 millimeters. I don’t know if it differs from company to company, but generally it’s about 37 millimeters. Stick that cotton roll up between three and 14, or the baby second molars, and see if it fits. If we’re talking about an adult and you’re squishing that cotton roll up between three and 14, they are deficient. There’s probably some crowding going on, or they probably have that high narrow palate. For our children, depending on the age, of course, 37 millimeters might be a little bit too big. But by age five, we want to have a 30-millimeter transverse width. And there are not, unfortunately, a lot of five-year-olds walking out there with 30 millimeters. Think about your pediatric patients. We would love to see so much spacing between those primary teeth that you can take a nickel and slide it up there. We don’t see that a lot. A lot of parents think, ‘Oh, their teeth are close together. This is great. They’re not going to need braces.’ But we know that that’s not true. What’s going to happen when those exfoliate, and those adult teeth come in? So, it’s a very simple thing you can do.” (15:58—17:20)
“The “S” [in BROOMS stands for] strained mentalis. So, when you’re looking at a patient and you ask them to close their lips, you might see some strain going on in this chin area, in that mentalis, having some activation. Even sometimes without them actually closing their lips, you end up seeing some strain here. That can be a sign of a vertical overgrowth. So, maybe that jaw is really growing down versus forward, like we want. A lot of those patients will have longer faces and gummier smiles. It’s a lot more difficult for them to actually get that true lip competence. And how simple is that? That’s something that can be done in a jiffy as an RDH. That’s a good screener for if this patient needs a myofunctional referral.” (17:22—18:10)
“The second “O” [in BROOMS stands for] orally defensive. That’s a big one because we see this a lot in the dental world. So, think about, for my hygienists that are listening, you’re trying to scale those lower anteriors, and that lower lip is hooked so far over that you’re almost standing up to fulcrum to be able to scale down there. There’s a reason. Those patients that have severe gag reflex that you’re dreading when you, unfortunately, see their name in the schedule and they’re due for a full set of X-rays — there’s a reason for that. They’re trying to protect their airway. That tongue that constantly follows you around, everywhere your mirror goes, that tongue follows. Difficulty retracting the cheek — any kind of oral defensive sign, there’s probably some kind of dysfunction going on there.” (18:22—19:05)
“A lot of us myofunctional therapists also do breathing re-education. The type of breathing re-education that I’m trained in is called Buteyko breathing . . . I’m going to give you guys a challenge. I would like for you to try to suction your tongue up to the roof of your mouth like this. And then, I want you to try to breathe through your mouth. Tell me, can you breathe through your mouth if your tongue is up like that? You physically can’t, right? So, it’s when that tongue posture drops that we become mouth-breathers. That tongue has to be sitting up in the roof of the mouth in order for us to be good nasal breathers.” (19:28—20:07)
“We talked about tongue posture, but sometimes what people don’t understand is we need that whole tongue up there. You’ll hear myofunctional therapists talk about “the spot” a lot, and we say bring your tongue to “the spot”. “The spot” is essentially that incisive papilla. But if you just have the tip of your tongue up there and the rest of your tongue is hanging down, and you’re going to go to sleep and you’re lying in a supine position, and that tongue is not up and gravity takes over because, again, you’re laying down, that tongue is going to fall into the airway and block your airway. So, we have to ensure that we’re able to get that tongue up there. Now, we do that through myofunctional therapy and through neuromuscular education. But we also have to remember, sometimes there are limitations. And those limitations, one of them can be a tethered oral tissue. So, a tongue-tie. This is a topic that needs to be discussed more in dentistry because in school we don’t get enough training.” (20:09—21:05)
“I think us, as hygienists, and you guys as dentists, we get very, very limited — I mean, we see the picture of true ankyloglossia where the tip of the tongue is completely tethered. That frenum is attached right to the tip of the tongue. Those patients typically can’t stick their tongue out past their lower lip. There are other types of tongue-ties. It could be a more posterior tongue-tie where this patient might still be able to stick their tongue down to their chin, curl their tongue up to the nose. But it’s impacting more of the function of that posterior part of the tongue. And it’s that posterior part of the tongue that has to be elevated for good nasal breathing, that has to elevate to have a good swallowing pattern. So, we can’t just ask a patient to protrude their tongue because that is literally one function of the tongue. The tongue has to do a lot more than just stick the tongue out.” (21:05—21:56)
“When you think about nasal breathing versus mouth-breathing, when you’re mouth-breathing, you’re in sympathetic overdrive. We know sympathetic is fight-or-flight, parasympathetic is our rest and digest. How do you think you’ll feel when you’re in sympathetic overdrive all the time? That’s why we see a lot of these patients that are mouth-breathers have a lot of added stress, anxiety, sometimes depression. There’s a lot that goes into it outside of just what’s going on in this mouth area. It can truly impact your entire body, your digestion. That’s another big one. Digestion starts in your mouth. So, if you have dysfunction all the way up here, it makes sense how it’s going to impact your digestion. Also, your overall body posture. I have some really cool, great before-and-after pictures of our tongue-tie patients before and after release. Patients that have asymmetry in their shoulders, those rolled shoulders, forward-head posture — there’s a piece of fascia that connects from the tip of your tongue all the way down to your toes. So, if you’re presenting with this restriction all the way up in that chain, it makes sense how it’s going to present itself in different ways throughout your body.” (22:15—23:29)
“So many of our patients come in that say, ‘My tongue is too big.’ And you have to look at it the other way. Macroglossia does exist, but it typically exists more in patients with down syndrome. Your tongue being too big, is it really that, or is it that your mouth is too small, your palate is too narrow, your palate is vaulted? So, it’s not that your tongue is big. It’s that your mouth is too small. From birth, we are born obligate nasal breathers. Our tongue should be resting up in the roof of the mouth. From the pressures of the tongue, laterally and anteriorly, it will help to develop that nice U-shaped dental arch that we want. When that tongue isn’t resting up there from a tongue-tie or some kind of nasal obstruction, and that tongue — or thumb suckers, pacifiers, whatever reason that that tongue learns to sit in the floor of the mouth — the upper jaw now has nothing to support its growth. And typically, that’s where we see things cave in.” (23:52—24:51)
“The roof of your mouth is also the floor of your nose and the lateral chambers of your nasal cavity. So, if we do not have that correct oral rest posture, this growth and development is going to be impacted, and that is where we’re going to mouth-breathe. That is where things are going to grow wrong. And typically, then we can talk about all the other — it’s like a domino effect. It really can impact overall health so dramatically.” (26:11—26:38)
“I just had a patient finish her myofunctional therapy program. I don’t know how old she is. I want to say she’s somewhere in her forties. I don’t know where in the forties. I can’t think off the top of my head. She came to us because she wasn’t sleeping for more than four hours at a time. She was mouth-breathing. She was getting winded. We finished her myo program, and I actually just posted her before-and-after pictures on my Instagram page today. Her postural changes were dramatic. Her facial profile change is dramatic — and she just did myofunctional therapy. She does have a tongue-tie that needs to be addressed, but she’s not ready to address that. And the biggest, coolest thing was she said that when she goes for her daily walks, she does not get winded anymore. She doesn’t have to take a break. We did a lot of breathing re-education with her and taught her how to breathe correctly. It’s a big thing. You can tell somebody to be a nasal breather, but if those muscles aren’t strong enough to support how we’re actually supposed to nasal breathe, it’s going to be very hard for them.” (26:38—27:39)
“I think that everybody should check in with themselves. Think about where your tongue is resting. Think about where your lips are and how you’re breathing through your nose. Start doing that BROOMS screener in the op . . . I don’t think that every dental hygienist has to become a myofunctional therapist. Not every dental hygienist wants to, and that is totally fine. However, I do think that every dental hygienist should at least have the knowledge on how to properly screen for airway disorders and myofunctional disorders because the difference that you can make in your patient’s life is astronomical.” (28:02—28:41)
“Collaboration is everything. It is not a one-stop shop. That is something that we take the time to explain to our patients because it can be frustrating. They get a referral to us to fix a tongue thrust, and now we’re telling them that they need to have a sleep study, they need to see an ENT, and that their palate is too small, and we need to have some expansion. It can be really overwhelming. But collaboration — you need to know who you need to have on your team for whatever age or type of patient that you’re working with.” (30:16—30:45)
Snippets:
0:00 Introduction.
1:29 Brittny’s background.
3:56 Myofunctional therapy, explained.
6:25 Why this is important in dentistry.
8:46 Ensure that your patients can breathe through their nose.
12:57 BROOMS, explained.
19:06 Breathing re-education and tongue posture.
21:57 How mouth-breathing affects overall health.
23:30 Changing palates, explained.
25:28 Myofunctional therapy can change lives.
27:54 Last thoughts.
28:42 More about Brittny and Karese Laguerre’s course.
29:39 More about Brittny’s podcast, Facebook group, and YouTube.
Brittny Sciarra-Murphy Bio:
Brittny Murphy is the owner of CT Orofacial Myology. She is a Certified Orofacial Myologist and Buteyko Breathing Educator. Brittny received her degree from the Forsyth School of Dental Hygiene at MCPHS in 2011 and postgraduate training in Myofunctional Therapy through the AOMT and IAOM in 2016 and 2017. Brittny is an educator and mentor for Dental Sleep Toolbox and Airway Health Solutions, training other registered dental hygienists who share the same passion in becoming myofunctional therapists. Brittny is also the face behind the podcast, I Spy with My Myo Eye.
As an orofacial myologist and healthcare professional, Brittny is always looking for ways to improve her patients’ quality of life. She believes myofunctional therapy is a huge aid in attaining those goals. Brittny advocates for her patients every step of the way and will make sure her patients are heard. Brittny is always looking to expand her knowledge and skills by taking courses and keeping up to date on current literature and best industry practices. She works collaboratively with and is well respected by dentists, orthodontists, oral and maxillofacial surgeons (OMFS), otolaryngologists (ENTs), speech language pathologists, and other local health care professionals.
When she’s not wearing her myo hat, you can find her spending time with her husband, Kyle, and her two dogs, KoBe and Beau.
