Impact of Oral Function & Individual Behavior on Facial Structure

Size: px

Start display at page:

Download "Impact of Oral Function & Individual Behavior on Facial Structure"

Marshall Whitehead
6 years ago
Views:

1 Impact of Oral Function & Individual Behavior on Facial Structure Linda D Onofrio, MS, CCC- SLP October 10, Objectives Discuss the scope of structural & sensory- motor based speech disorders and how speech pathology intersects with denjstry, otolaryngology, respiratory therapy, and craniofacial pain. IdenJfy signs/symptoms of an oromyofuncjonal disorder and the potenjal impacts on oral structure. Understand the basics of oromyofuncjonal therapy and how prognosis is determined. Know how to refer and how to find the right resources for your pajent. Know how to get more training in this scope of pracjce. My clinical experience & scope of practice Structural and Sensory- Motor Based Speech Disorders Craniofacial Disorders & CleP Palate Dysarthria childhood & adult Dyspraxia childhood & adult Poor coordinajon & low tone Poor sensory feedback StuTering Social- CogniJve Therapy for AuJsm & Asperge rs Developmental Speech & Language Family CommunicaJon Support 1

2 Discuss the scope of structural & sensory- motor based speech disorders and how speech pathology intersects with other medical professions. Structural & Sensory- Motor Based Speech Disorders Structural CleP palate & craniofacial disorders Asymmetrical & idiosyncrajc facial growth, non- syndromic Post facial trauma Malocclusions Sensory- Motor Dysarthria Dyspraxia Cerebral Palsy AuJsm, Sensory- IntegraJon Oral Aversion, Anxiety OromyofuncJonal Disorders Identify signs/symptoms of an oromyofunctional disorder and the potential impacts on oral structure 2

3 Oromyofunctional Disorders What are orofacial myofunc1onal disorders (OMD)? With OMD, the tongue moves forward in an exaggerated way during speech and/or swallowing. The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing, and at rest. What are some signs or symptoms of OMD? Although a "tongue thrust" swallow is normal in infancy, it usually decreases and disappears as a child grows. If the tongue thrust conjnues, a child may look, speak, and swallow differently than other children of the same age. Older children may become self- conscious about their appearance. What effect does OMD have on speech? Some children produce sounds incorrectly as a result of OMD. OMD most open causes sounds like /s/,/z/, "sh", "zh", "ch" and "j" to sound differently. For example, the child may say "thumb" instead of "some" if they produce an /s/ like a "th". Also, the sounds /t/, /d/, / n/, and /l/ may be produced incorrectly because of weak tongue Jp muscles. SomeJmes speech may not be affected at all. OMD & Feeding Disorders Other dentofacial funcjonal abnormalijes (ICD ) Abnormal swallowing Mouth breathing Sleep postures Thumb sucking Tongue, lip, or finger habits Feeding DifficulJes & Mismanagement (ICD ) Hand- to- mouth experiences External support difficuljes Picky eater Swallowing Disorders Oral PreparaJon Phase Dysphagia (ICD ) Preparing the food or liquid in the oral cavity to form a bolus- including sucking liquids, manipulajng sop boluses, and chewing solid food. Oral Transit/Oral Pharyngeal Dysphagia (ICD ) Moving or propelling the bolus posteriorly through the oral cavity. Pharyngeal Phase Dysphagia (ICD ) IniJaJng the swallow; moving the bolus through the pharynx. 3

4 Diagnosing OMD OMD is open diagnosed by a team of professionals. In addijon to the child and his or her family or caregivers, the team may include: An SLP an orthodonjst a denjst a physician Both denjsts and orthodonjsts may be involved when constant, conjnued tongue pressure against the teeth interferes with normal tooth erupjon and alignment of the teeth and jaws. Physicians rule out the presence of a blocked airway (e.g., from enlarged tonsils or adenoids or from allergies) that may cause forward tongue posture. SLPs assess and treat the effects of OMD on speech, rest postures, and swallowing. Breaking it Down Structure Func1on Behavior Jaw Breathing ATenJon Teeth Muscle tone MoJvaJon Lips Stability Self- awareness Tongue Range of mojon Problem- solving Hard palate Speed & accuracy Parental Support SoP palate & oral pharynx Smooth graded movement Structured & conversajonal speech Pediatric OMD Red Flags History of frequent middle ear infecjons, upper respiratory infecjons, sinus infecjons, allergies Messy eajng & drooling Tongue thrust swallow Low forward lingual rest posture Obvious malocclusions Finger or thumb sucking BoTle or pacifier use past two years old 4

5 Airway obstrucjon Jaw opens to maximize airway Tongue posijon low & forward Hard palate narrows Occlusal changes ArJculaJon DistorJons How Structure & Function InHluence Each Other External Facial Features Breathing Mandible Lip Structure & FuncJon TacJle SensiJvity Occlusion Hard & SoP Palate Lingual Shape & FuncJon ResJng Posture EaJng & Swallowing ParafuncJonal Habits External Facial Features Unusual facial asymmetry, ear posijon, nasal base & eye posijon may be indicajve of a genejc syndrome. Ethnic heritage should be considered when analyzing facial shapes & profiles. 5

6 Chronic Mouth Breathing Jaw Structure & Function Lip Structure & Function 6

Occlusion Maxilla & Hard Palate Lingual Shape & Stability Tongue

A flaccid tongue results in pressure against the lower teeth &

Lingual Stability The tongue Jp should stabilize against the

7 Occlusion Maxilla & Hard Palate Lingual Shape & Stability Tongue shape A large tongue is usually a flaccid tongue. A flaccid tongue results in pressure against the lower teeth & dulls the precision of alveolar sounds. Lingual Stability The tongue Jp should stabilize against the alveolar ridge the N posijon. Lateral margin stability against the top molars improves most speech sounds. 7

Lingual Function Normal range of mojon The tongue should reach behind the molars, into the buccal cavity & extend horizontally Ankyloglossia Tight can be stretched Thick poor lateralizajon and lower

8 Lingual Function Normal range of mojon The tongue should reach behind the molars, into the buccal cavity & extend horizontally Ankyloglossia Tight can be stretched Thick poor lateralizajon and lower jaw explorajon Anteriorly placed ElevaJon requires jaw, poor retracjon, poor molar cleaning Diodochokinesis Alveolar sounds N, T, D, L, S, Z should be made with the tongue Jp & not mid- blade Normal Swallow Tongue Jp stabilizes elevated against the hard palate, molars/masseters compress, face is relaxed It s about stability not strength Eating & Swallowing Parafunctional Oral Habits Sucking Fingers, thumb, tongue BiJng Nails, lips, cheeks Licking Lips Chewing Shirts, pencils, hair 8

9 Articulation & Oral Habits Special Considerations for Teens & Adults Body Posture Clenching & TMJ The S- hole Over weight Bilateral chewers Dentures Implants Understand the basics of oromyofunctional therapy and how prognosis is determined 9

General Oromyofunctional Therapy Targets Encourage & promote nasal breathing. Improve jaw stability & grading. Improve lip funcjon. Improve oral awareness & sensajon.

10 General Oromyofunctional Therapy Targets Encourage & promote nasal breathing. Improve jaw stability & grading. Improve lip funcjon. Improve oral awareness & sensajon. Increase lingual stability, range & mobility, symmetrical movement. Teach correct oral postures for rest, swallows & speech. How to refer & Hind the right resources for your patient When to Refer As early as possible Before braces come off 10

11 What is the Priority Breathing trumps everything Refer to the pediatrician, ENT, allergist, NP, DO Feeding is an indicator of more refined movement MasJcaJon, bolus formajon & stable swallow Variety of textures and flavors, be healthy Oral funcjon should be awesome Normal range of mojon and mobility is the goal ArJculaJon is the culminajon of skill It s the symptom, not the problem Finding the right Resource Private Clinics OromyofuncJonal therapy / Orofacial myology Referral Networks Oregon Speech- Language- Hearing Assoc OSHA Washington Speech- Language- Hearing Assoc- WSHA American Speech- Language- Hearing Assoc ASHA Dental Hygienists trained in OMF therapy through the AOMT & IAOM Local feeding teams OHSU Providence Legacy Kaiser Objectives Discuss the scope of structural & sensory- motor based speech disorders and how speech pathology intersects with denjstry, otolaryngology, respiratory therapy, and craniofacial pain. IdenJfy signs/symptoms of an oromyofuncjonal disorder and the potenjal impacts on oral structure. Understand the basics of oromyofuncjonal therapy and how prognosis is determined. Know how to refer and how to find the right resources for your pajent. Know how to get more training in this scope of pracjce. 11

12 Bibliography Ackerman, RI & Klapper, L (1981). Tongue posijon and open bite: the key roles of growing and the nasopharyngeal airway. Journal of Den,stry for Children, 48, American Speech- Language- Hearing AssociaJon, Ad Hoc Joint CommiTee with the InternaJonal AssociaJon of Orofacial Myology. (1993). Orofacial myofuncjonal disorders: knowledge and skills. American Speech- Language- Hearing Associa,on. ASHA Suppl. 35 (3 Suppl 10), Andrianopoulos, MY & Hanson, ML (1987). Tongue thrust and the stability of overjet correcjon. Angle Orthodon,st. 57 (2), Bailey, LJ, Cevidanes, LH, Proffit, WR (2004). Stability and predictability of orthognathic surgery. American Journal of Orthodon,cs and Dentofacial Orthopedics. 126 (3), Bresolin, D, Shapiro, PA, Shapiro, GG, Chapko, MK, & Dassel, S. (1983). Mouth breathing in allergic children: Its relajonship to dentofacial development. American Journal Orthodon,cs. 83, GarreTo, AL (2001). Orofacial myofuncjonal disorders related to malocclusion. Interna,nal Journal of Orofacial Myology. 27, Hanson, ML & Andrianopoulos, MY (1982). Tongue thrust and malocclusion. Interna,onal Journal of Orthodon,cs. 20, Melsen, B, Aqna, L, Santuari, M, Aqna, A (1987). RelaJonships between swallowing patern, mode of respirajon, and malocclusion. The Angle Orthodon,st. 57 (2), Shapiro, PA (2002). Stability of open bite treatment. American Journal of Orthodon,cs and Dentofacial Orthopedics. 121 (6), Sperry, TP (1989). An evaluajon of the relajonship between rest posijon of the mandible and malocclusion. The Angle Orthodon,st. 59 (3), Smithpeter, J and Covell, D. (2010). Relapse of anterior open bites treated with orthodonjc appliances with and without orofacial myofuncjonal therapy. American Journal of Orthodon,cs and Dentofacial Orthopedics. 137 (5), Ung, N, Koenig, J, Shapiro, PA, Shapiro, G, & Trask, G (1990). A quanjtajve assessment of respiratory paterns and their effects on dentofacial development. American Journal of Orthodon,cs & Dentofacial Orthopedics. 98 (6),

Objectives. Oromyofunction & Oral Health Gum Gardeners April 28, 2014 Linda D Onofrio, MS, CCC-SLP

Objectives. Oromyofunction & Oral Health Gum Gardeners April 28, 2014 Linda D Onofrio, MS, CCC-SLP Oromyofunction & Oral Health Gum Gardeners April 28, 2014 Linda D Onofrio, MS, CCC-SLP 503-808-9919 linda@donofrioslp.com My clinical experience & scope of practice n Be able to conduct an oromyofunctional