There are good reasons that we, at BreatheWorks, see constant patient referrals from dentists and orthodontists. Functionally speaking, teeth are part of the mandible, and the mandible interacts, directly or indirectly, with the entire head and neck. This integrates dentition with whole-body health.
One common condition we address in collaboration with dental and orthodontic care providers is tongue tie ankyloglossia, which significantly impacts oral functionality. This condition involves restricted tongue movement due to the presence of a short, thick lingual frenulum. Restricted mobility often affects speech, swallowing, and proper tongue positioning, leading to various oromyofunctional challenges.
There is an association between speech1 and swallowing disorders in routine and interventional prosthesis and orthodonty. Aligners can have an impact on the articulation of some phonemes, particularly fricative alveolar consonants. Non-functional oral health and oral sensorimotor alterations go together too, and are associated with a high prevalence of oropharyngeal dysphagia. The dentist and the speech-language pathologist can be a critical team in prevention, early identification, and management of this.
Much is known about the myofunctional dynamics that cause problems in general dentition. One involves differential force from tongue-thrusting, particularly on the maxillary right central incisor, a process that differs during swallowing.
A complicating factor in children is pacifier-sucking, which can affect maxillary and mandibular intercanine widths, as well as breathing and speech functions. Because it interferes with proper tongue position, the duration and frequency of non-nutritive sucking associates very clearly with occlusal and oral myofunctional alterations, notably in anterior open bite, and possibly posterior crossbite.
Mouth breathing is another common deleterious oral habit in children. It often results from an upper airway obstruction, or adenoid or tonsil hypertrophy. Uncorrected, there can arise abnormal dental and maxillofacial development, and an increased risk of caries and periodontal disease. Mouth breathers show narrower hard palate at the level of second premolars and first molars, and deeper palate at the level of second premolars and canines.
In malocclusions the diagnostic and rehabilitation roles of speech-language therapists are vital. There is a link between specific types of malocclusion and OMD and AD, and an association with speech defects. The effect of malocclusion on dyslalia seems to increase proportionally with the severity of the malocclusion. Malocclusions in general cause imbalances in stomatognathic function. Study data show a causal relationship between Class III malocclusions and articulation errors and spectral distortions in consonants. Severity of skeletal AOB is correlated with degree of distortion for consonant sounds.
All of these can lead to articulation disorders. People can adapt their speech to compensate for abnormal tooth position, even across populations. And sometimes the problem is subtler than that, even if it is bound up in apparent primary problems of dentition. People who stutter actually have sensory-motor and tactile-proprioceptive deficits that impede coordination of the mandible, lips, and tongue.
The association between TMD and speech disorders is unclear. Occlusal alterations may influence distortions and frontal lisp in phonemes /s/ and /z/ and inadequate tongue position in phonemes /t/; /d/; /n/; /l/. The same is true with abnormal deglutition. Nevertheless, orofacial myofunctional alterations could be considered influencing factors on TMD. Patients with chronic TMD do show poor tongue strength and masticatory and swallowing functions. It has been suggested that in patients with TMD and clinically diagnosed clenching-type bruxism, TMD diagnoses may be influenced features of slide RCP-MI, laterotrusive interference, and molar asymmetry. Changes in chewing, of interest to speech-language pathologists, has been observed in TMD as well, pointing out the importance of interdisciplinary evaluation when establishing a treatment plan. Finally, there is a clear association between TMD severity, voice-related and oral health-related quality of life.
Speech-language pathologists are natural partners in surgical cleft repair, too, where evaluation encompasses cephalometric analysis, dentoalveolar morphology, dentofacial aesthetics, and speech, concerning articulation and nasality. Long-term, longitudinal speech outcome after surgery, in patients undergoing two-stage primary palatal protocol with early veloplasty and delayed hard palate closure has been evaluated. Results were favorable even before hard palate repair. The typical retracted oral articulation was quite frequent during the early ages, and non-oral misarticulations were almost nonexistent, which implies good velopharyngeal competence. Definite speech improvement occurs in all parameters following late primary palate repair, but residual speech problems do persist in most patients, requiring further evaluation and appropriate treatment.
1 Meira IA, Gama LT, Prado-Tozzi DA, Pinheiro MA, Rodrigues Garcia RCM. Speech in implant-supported and removable complete denture wearers: A systematic review. J Prosthet Dent. 2022 Dec;128(6):1230-1238. doi: 10.1016/j.prosdent.2021.03.006.
2 Mituuti CT, Bianco VC, Bentim CG, de Andrade EC, Rubo JH, Berretin-Felix G. Influence of oral health condition on swallowing and oral intake level for patients affected by chronic stroke. Clin Interv Aging. 2014 Dec 16;10:29-35. doi: 10.2147/CIA.S62314.
3 Pogal-Sussman-Gandia CB, Tabbaa S, Al-Jewair T. Effects of Invisalign® treatment on speech articulation. Int Orthod. 2019 Sep;17(3):513-518. doi: 10.1016/j.ortho.2019.06.011.
4 Rech RS, Baumgarten A, Colvara BC, Brochier CW, de Goulart B, Hugo FN, Hilgert JB. Association between oropharyngeal dysphagia, oral functionality, and oral sensorimotor alteration. Oral Dis. 2018 May;24(4):664-672. doi: 10.1111/odi.12809.
5 Logemann JA, Curro FA, Pauloski B, Gensler G. Aging effects on oropharyngeal swallow and the role of dental care in oropharyngeal dysphagia. Oral Dis. 2013 Nov;19(8):733-7. doi: 10.1111/odi.12104.
6 Valentim AF, Furlan RM, Perilo TV, Berbert MC, Motta AR, de Las Casas EB. Evaluation of the force applied by the tongue and lip on the maxillary central incisor tooth. Codas. 2014 May-Jun;26(3):235-40. doi: 10.1590/2317-1782/201420130077.
7 Valentim AF, Furlan RM, Perilo TV, Motta AR, Casas EB. Relationship between perception of tongue position and measures of tongue force on the teeth. Codas. 2016 9-10;28(5):546-550. Portuguese, English. doi: 10.1590/2317-1782/20162015256.
8 Scudine KGO, de Freitas CN, Nascimento de Moraes KSG, Bommarito S, Possobon RF, Boni RC, Castelo PM. Multidisciplinary Evaluation of Pacifier Removal on Oro-Dentofacial Structures: A Controlled Clinical Trial. Front Pediatr. 2021 Sep 13;9:703695. doi: 10.3389/fped.2021.703695.
9 Nihi VS, Maciel SM, Jarrus ME, Nihi FM, Salles CL, Pascotto RC, Fujimaki M. Pacifier-sucking habit duration and frequency on occlusal and myofunctional alterations in preschool children. Braz Oral Res. 2015;29:1-7. doi: 10.1590/1807-3107bor-2015.vol29.0013.
10 Verrastro AP, Stefani FM, Rodrigues CR, Wanderley MT. Occlusal and orofacial myofunctional evaluation in children with anterior open bite before and after removal of pacifier sucking habit. Int J Orthod Milwaukee. 2007 Fall;18(3):19-25.
11 Schmid KM, Kugler R, Nalabothu P, Bosch C, Verna C. The effect of pacifier sucking on orofacial structures: a systematic literature review. Prog Orthod. 2018 Mar 13;19(1):8. doi: 10.1186/s40510-018-0206-4.
12 Lin L, Zhao T, Qin D, Hua F, He H. The impact of mouth breathing on dentofacial development: A concise review. Front Public Health. 2022 Sep 8;10:929165. doi: 10.3389/fpubh.2022.929165.
13 Berwig LC, Silva AM, Côrrea EC, Moraes AB, Montenegro MM, Ritzel RA. Hard palate dimensions in nasal and mouth breathers from different etiologies. J Soc Bras Fonoaudiol. 2011 Dec;23(4):308-14
14 Maciel CT, Leite IC. Etiological aspects of anterior open bite and its implications to the oral functions. Pro Fono. 2005 Apr-Dec;17(3):293-302.
1 Meira IA, Gama LT, Prado-Tozzi DA, Pinheiro MA, Rodrigues Garcia RCM. Speech in implant-supported and removable complete denture wearers: A systematic review. J Prosthet Dent. 2022 Dec;128(6):1230-1238. doi: 10.1016/j.prosdent.2021.03.006.
2 Mituuti CT, Bianco VC, Bentim CG, de Andrade EC, Rubo JH, Berretin-Felix G. Influence of oral health condition on swallowing and oral intake level for patients affected by chronic stroke. Clin Interv Aging. 2014 Dec 16;10:29-35. doi: 10.2147/CIA.S62314.
3 Pogal-Sussman-Gandia CB, Tabbaa S, Al-Jewair T. Effects of Invisalign® treatment on speech articulation. Int Orthod. 2019 Sep;17(3):513-518. doi: 10.1016/j.ortho.2019.06.011.
4 Rech RS, Baumgarten A, Colvara BC, Brochier CW, de Goulart B, Hugo FN, Hilgert JB. Association between oropharyngeal dysphagia, oral functionality, and oral sensorimotor alteration. Oral Dis. 2018 May;24(4):664-672. doi: 10.1111/odi.12809.
5 Logemann JA, Curro FA, Pauloski B, Gensler G. Aging effects on oropharyngeal swallow and the role of dental care in oropharyngeal dysphagia. Oral Dis. 2013 Nov;19(8):733-7. doi: 10.1111/odi.12104.
6 Valentim AF, Furlan RM, Perilo TV, Berbert MC, Motta AR, de Las Casas EB. Evaluation of the force applied by the tongue and lip on the maxillary central incisor tooth. Codas. 2014 May-Jun;26(3):235-40. doi: 10.1590/2317-1782/201420130077.
7 Valentim AF, Furlan RM, Perilo TV, Motta AR, Casas EB. Relationship between perception of tongue position and measures of tongue force on the teeth. Codas. 2016 9-10;28(5):546-550. Portuguese, English. doi: 10.1590/2317-1782/20162015256.
8 Scudine KGO, de Freitas CN, Nascimento de Moraes KSG, Bommarito S, Possobon RF, Boni RC, Castelo PM. Multidisciplinary Evaluation of Pacifier Removal on Oro-Dentofacial Structures: A Controlled Clinical Trial. Front Pediatr. 2021 Sep 13;9:703695. doi: 10.3389/fped.2021.703695.
9 Nihi VS, Maciel SM, Jarrus ME, Nihi FM, Salles CL, Pascotto RC, Fujimaki M. Pacifier-sucking habit duration and frequency on occlusal and myofunctional alterations in preschool children. Braz Oral Res. 2015;29:1-7. doi: 10.1590/1807-3107bor-2015.vol29.0013.
10 Verrastro AP, Stefani FM, Rodrigues CR, Wanderley MT. Occlusal and orofacial myofunctional evaluation in children with anterior open bite before and after removal of pacifier sucking habit. Int J Orthod Milwaukee. 2007 Fall;18(3):19-25.
11 Schmid KM, Kugler R, Nalabothu P, Bosch C, Verna C. The effect of pacifier sucking on orofacial structures: a systematic literature review. Prog Orthod. 2018 Mar 13;19(1):8. doi: 10.1186/s40510-018-0206-4.
12 Lin L, Zhao T, Qin D, Hua F, He H. The impact of mouth breathing on dentofacial development: A concise review. Front Public Health. 2022 Sep 8;10:929165. doi: 10.3389/fpubh.2022.929165.
13 Berwig LC, Silva AM, Côrrea EC, Moraes AB, Montenegro MM, Ritzel RA. Hard palate dimensions in nasal and mouth breathers from different etiologies. J Soc Bras Fonoaudiol. 2011 Dec;23(4):308-14
14 Maciel CT, Leite IC. Etiological aspects of anterior open bite and its implications to the oral functions. Pro Fono. 2005 Apr-Dec;17(3):293-302.
29 Ferreira CLP, Sforza C, Rusconi FME, Castelo PM, Bommarito S. Masticatory behaviour and chewing difficulties in young adults with temporomandibular disorders. J Oral Rehabil. 2019 Jun;46(6):533-540. doi: 10.1111/joor.12779.
30 Pereira TC, Brasolotto AG, Conti PC, Berretin-Felix G. Temporomandibular disorders, voice and oral quality of life in women. J Appl Oral Sci. 2009;17 Suppl(spe):50-6. doi: 10.1590/s1678-77572009000700009.
31 Tindlund RS, Holmefjord A, Eriksson JC, Johnson GE, Vindenes H. Interdisciplinary evaluation of consecutive patients with unilateral cleft lip and palate at age 6, 15, and 25 years: a concurrent standardized procedure and documentation by plastic surgeon; speech and language pathologist; ear, nose, and throat specialist; and orthodontist. J Craniofac Surg. 2009 Sep;20 Suppl 2:1687-98. doi: 10.1097/SCS.0b013e3181b3edb5.
32 Lohmander A, Friede H, Lilja J. Long-term, longitudinal follow-up of individuals with unilateral cleft lip and palate after the Gothenburg primary early veloplasty and delayed hard palate closure protocol: speech outcome. Cleft Palate Craniofac J. 2012 Nov;49(6):657-71. doi: 10.1597/11-085.
33 Murthy J, Sendhilnathan S, Hussain SA. Speech outcome following late primary palate repair. Cleft Palate Craniofac J. 2010 Mar;47(2):156-61. doi: 10.1597/08-230_1.
MyoNews from BreatheWorksTM is a report on trends and developments in oromyofunctional disorder and therapy. These updates are not intended as diagnosis, treatment, cure or prevention of any disease or syndrome.
