ALD 2015 KNOWLEDGE EXPERIENCE APPLICATION ALD 2015 KNOWLEDGE EXPERIENCE APPLICATION ALD 2015 KNOWLEDGE EXPERIENCE APPLICATION.

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1 ALD 2015 KNOWLEDGE EXPERIENCE APPLICATION Moving Tongues Beyond Frenectomy Grace Sun, DDS FAACD MALD MAGD MICOI Los Angeles ALD 2015 KNOWLEDGE EXPERIENCE APPLICATION Accredited Fellow, American Academy of Cosmetic Dentistry Master and Educator, Academy of Laser Dentistry Master, Academy of General Dentistry Master, International Congress of Oral Implantologists Certified Orofacial Myologist Certified Buteyko Practitioner Sitting Member, Board of Directors, ALD Sitting Member, Professional Education Committee, AACD ALD 2015 KNOWLEDGE EXPERIENCE APPLICATION Disclosure: I have no commercial relationships. Learning Objectives Understand the importance of proper tongue posture How to obtain proper tongue posture Moving Tongues Beyond Frenectomy Observe tongue posture, anatomy, movement OMT After Frenuloplasty Facilitation of the tongue assuming proper posture and function. Observe other clues: Phonetic disorders, narrow dental arches, dental crowding, open bite, tongue thrust, orthodontic relapse, scalloped tongue, hypodontia, xerostomia, chapped lips, HFP, TMD, stomatitis, signs of sleep disorders. Assessment and treatment of ankyloglossia (tongue tie) Post-frenuloplasty (frenectomy) healing and rehabilitation of tongue posture OMT = Orofacial Myofunctional Therapy BEFORE FRENECTOMY AFTER FRENECTOMY 1

Indications: Frenuloplasty/ Frenectomy Assessment Tongue tie with impaired function

On-Spot (the tip of the tongue resting on the incisive Papilla/gum ridge behind the

frenum Monitor healing Rehabilitation with OMT (Orofacial Myofunctional Therapy) o

Therapy) Before After A series of exercises to re-pattern and optimize oral and facial

habits Promote stable, proper and healthy oral postures Neuroplasticity Forming a new

pathways being set with respect to increased practice.

Thinking about the new action activates the sensory and motor areas During internal

2 Indications: Frenuloplasty/ Frenectomy Assessment Tongue tie with impaired function Restricted ROM (Range of Motion) Normal ROM: 40-53mm On-Spot ROM: 50-60% of Normal ROM * On-Spot (the tip of the tongue resting on the incisive Papilla/gum ridge behind the upper front teeth) Frenuloplasty/ Frenectomy Treatment Surgically release the restricted frenum Monitor healing Rehabilitation with OMT (Orofacial Myofunctional Therapy) o Re-pattern the habit o Strengthen the oral musculature OMT (Orofacial Myofunctional Therapy) Before After A series of exercises to re-pattern and optimize oral and facial function Neuro-Muscular re-patterning Behavior modification to eliminate unhealthy habits Promote stable, proper and healthy oral postures Neuroplasticity Forming a new N-M pathway The brain s ability to restructure itself after training or practice: Neural pathways being set with respect to increased practice. The more practice you accumulate, the more ingrained or grooved the pathways become. Thinking about the new action activates the sensory and motor areas During internal rehearsal and recall, the supplementary motor area is active Rehearsed activity is stored in the brain Routine action does not require activation of sensory input 2

3 Function of the Tongue Speech (Articulation) Chewing (Mastication) Swallowing (Deglutition) Taste (Gustatory Perception) Facilitate Maxillary Growth -Tongue on palate Oropharyngeal Patency Anatomy of the tongue Embryology: BASE (post. 1/3) 1 st pharyngeal arch Foramen caecum Tied in with development of the thyroid gland BODY (ant. 2/3) 3 rd pharyngeal arch Innervation 3

Tongue Muscular Strength The tongue muscular structure consists of

and generate substantial force Tongue Muscle : 500 g/cm² Cheek &

Physiology of muscles Tongue Musculature Movement Posture

Swallowing Genioglossus Hyoglossus Styloglossus Palatoglossus

Extrinsic Tongue Musculature Genioglossus, which arises from the

hyoid bone and depresses the tongue Styloglossus, which arises from

Palatoglossus, which arises from the palatine aponeurosis, and

4 Tongue Muscular Strength The tongue muscular structure consists of 4 pairs of extrinsic and 4 pairs intrinsic muscles, which can exert and generate substantial force Tongue Muscle : 500 g/cm² Cheek & Lips : g/cm² Orthodontic force: g/cm² Physiology Physiology of muscles Tongue Musculature Movement Posture maintenance Joint stability Heat generation Extrinsic: Chewing & Swallowing Genioglossus Hyoglossus Styloglossus Palatoglossus Geniohyoid Mylohyoid Stylopharangeal Tongue Musculature Function of Extrinsic Tongue Musculature Genioglossus, which arises from the mandibleand protrudes the tongue Hyoglossus, which arises from the hyoid bone and depresses the tongue Styloglossus, which arises from the styloid process and elevates and retracts the tongue Palatoglossus, which arises from the palatine aponeurosis, and depresses the soft palate, moves the palatoglossalfoldtowards the midline, and elevates the back of the tongue 4

Intrinsic - speech Superior longitudinal

(tip down & dorsum up) Transverse (narrow

phases: Oral Pharyngeal Esophageal phase

preventing food from entering the trachea

5 Intrinsic - speech Superior longitudinal (tip + edges up) Inferior longitudinal (tip down & dorsum up) Transverse (narrow & elongated) Vertical (flat & wider) Tongue Musculature Palatine Aponeurosis Swallowing The Action of Swallowing 1. Bolus of food is formed in mouth, while airway remains open 2. Tongue forces bolus into oral pharynx while the soft palette is drawn up closing off the nasal pharynx and blocking the airway Safely transport food from the mouth to the stomach Complex neuromuscular activities consisting 3 phases: Oral Pharyngeal Esophageal phase 3. The epiglottis is tipped downwards preventing food from entering the trachea as the pharyngeal muscles begin a wave of contraction that carries the bolus down into the stomach. 5

OMT after Frenectomy Exercises Immediate post-op

Level 1 = Immediate post-op Level 2 = Long-term

Neuroplasticity Neuromuscular repatterning The Waggle 1.

) Extend tongue to the corners of the mouth.

Tempo: 3 extend-and-holds. Repeat 8x. 3. Tongue Pops (64 sec.

On the 4 th : tongue tip on spot, dorsum on palate.

6 OMT after Frenectomy Exercises Immediate post-op healing, range of motion Swallow pattern establishment Level 1 = Immediate post-op healing, range of motion Swallow pattern establishment Level 2 = Long-term strength building Swallow pattern improvement Neuroplasticity Neuromuscular repatterning The Waggle 1. Horizontal Tongue Waggle (64 sec.) Extend tongue to the corners of the mouth. Tempo is 3 extends and hold, 8 repeats. 2. Vertical Tongue Waggle (64 sec.) Extend tongue to the upper and lower lips. Tempo: 3 extend-and-holds. Repeat 8x. 3. Tongue Pops (64 sec.) Pop 3 times. On the 4 th : tongue tip on spot, dorsum on palate. Resist then release. Repeat 12x. 4. Lizard Extensions (64 sec.) Extend tongue forward 2 times, on the 3rd, extend further. Hold then release. Repeat 12x. 6

) Rotation + Extension: Brush tongue against the inside of the dental arches 360. Trace against cheeks + lips 360. 3. Push-Ups (64 sec.

7 Repatterning the swallow of motion neuroplasticity Neuromuscular benefits Posture improvements 1. Ping-Pong Press (64 sec.) Push tongue against fingers pressed upon cheek (Isometric resistance). Tempo is 3 and hold, 8 repeats. Resistance 2. Double Trace (64 sec.) Rotation + Extension: Brush tongue against the inside of the dental arches 360. Trace against cheeks + lips Push-Ups (64 sec.) Hold a pen or stick across the corners of the mouth. Extend tongue under the stick and push up for 8 pulses. Extend tongue over the stick and press down for 8 pulses. (Isometric pushup extension) 4. Ballistic Tick-Tocks(64 sec.) 5. Clockwork + Center Extensions: Each point tempo is 3 extensions and hold Level 2 2 Exercises

8 Learning Objectives Understand the importance of proper tongue posture How to obtain proper tongue posture Reversing etiology 1. Frenectomy for ankyloglossia 2. OMT: lip seal, proper tongue posture, proper swallow, breaking bad habits 3. ENT eval/ TX, establish nasal breathing 4. Healthy diet, exercise, hypoallergenic environment 5. Facial and jaw development Looking Beyond The big picture Posture, diet, motivation, oral habits, occlusion, dental history, physical health, airway etc. 462 North Doheny Drive Los Angeles, CA Mission: Provide the best training to identify, treat OMDs Educate Healthcare Providers, General Public Facilitate Research 8

9 Thank 9

Oral cavity : consist of two parts: the oral vestibule and the oral cavity proper. Oral vestibule : is slit like space between.

Oral cavity Oral cavity : consist of two parts: the oral vestibule and the oral cavity proper Oral vestibule : is slit like space between the teeth, buccal gingiva, lips, and cheeks 1 Oral cavity Oral