Understanding Myofunctional Therapy

Speaker 1 0:01

Hello , hello everyone and welcome . We are live with Dr Mariana Gajduk for the Breathing , the Beauty of Breathing podcast . Super excited to have everyone here . Write on the comment section if you guys have any questions . But before we start I would love Dr Mariana to introduce herself to everyone .

Speaker 2 0:25

Hello , hello everybody . My name is Mariana . I'm from Ukraine . I'm a dentist Actually , I've been working in a dentist for more than 25 years and I'm very interested in myofunctional therapy . Lately , lately I work like endodontist , but mostly I'm a stomatology therapist . I don't know how to say this in english , correct ? Well ?

Speaker 1 0:56

a somatognathic system . Some people say it a little bit different . Um , it's the study of the function of the muscles of the face right the breathing , chewing , swallowing . The brazilians , when they're talking about myofunctional therapy , they use that term a lot . Yeah , yeah , so you've seen that in the ukraine yeah , I live in ukraine originally .

Speaker 2 1:20

I'm from ukraine and I stay in uk Ukraine nowadays because a lot of people started to leave Ukraine . I didn't do , because I can't imagine my life without Ukraine , and I'm still here .

Speaker 1 1:37

Amazing . Well , we're going to have some questions back and forth . I got some questions from Instagram , so I'm opening my Instagram right now so I can pull those up for us . But let's go ahead and start . When did the interest in myofunctional therapy and all of this airway knowledge come about ?

Speaker 2 2:02

Not so long time , I can see , I can say , um , I started to be interested in my functional therapy when I got my grandson , so you can say , because I started to notice they started to breathe through mouth and it reminded me about myself . I had some problems in my childhood with a mouth breathing and in this way I got many problems with girl , with my health in the end , you know .

Speaker 1 2:42

So , yes , I started to be interested in this because of the health of my grandsons you know , I tell everybody that usually people in this field , they have to have a personal story exactly . It's usually a child or a grandchild , or even ourselves , whenever we start recognizing that , oh my goodness , I know somebody with these issues . So that's why we're so passionate about sharing . We want everybody to to listen , because there's always somebody you're going to be able to help by having this information . If it's , it's going to be somebody else . So stick around and send us your questions that you guys may have . What are you able to do in the Ukraine whenever you see your patients ? Have you changed at all the way that you screen and evaluate these patients ? What are you looking for ?

Speaker 2 3:38

Of course I'm looking first of all for the person . First of all for the person how they speak , in what way they have , what the body position they have , because when they just appear in the room you know and they're going to sit . So I pay attention for everything , of course . And when patient in the chair , I start to ask them how they are feeling , what does it hurt them , how long they've been before in a dentistry chair , what the last visit was and many , many questions I can ask my patients . And of course , about the allergy , because usually we need to do the anesthesia and I'm asking about allergy very often , I can say constantly .

Speaker 1 4:38

That's great . Do you have a screening questionnaire or tool that you use now with your patients ? They didn't use before ?

Speaker 2 4:49

I don't have like list of questions but I can just look at the patients and understand sometimes what they need . You know , if they have pain , I ask them some kind of questions . If they need just some consultation , I can say I can ask something else or can ask more . They then , uh , it needs you know to understand the root of the problem especially for an endodontist .

Speaker 2 5:19

You want to understand the root of the problem exactly exactly because patients in the pain , so we need to help them . How long they have pain what ? How strong this pain , in what period of time they have pain after what ? They have pain from the cold after , after just eating um , what else , whatever you know , so many questions , of course , in my mind when the patient in the dentist's chair Very good .

Speaker 1 5:54

We have a very special person to the myofunctional therapy world listening to us live right now , and it's Sandra Coulson . Thank you , sandra . She said that she lectured in Ukraine in 2022 . Very smart , she's saying so . Every Tuesday , or almost every Tuesday , I am going to be coming live on our Instagram on why your moves and all of these episodes are going to be recorded and added to our new podcast , which is called the Beauty of Breathing . So , if you guys can , after this live , run over to your preferred podcast platform if it's Apple Podcasts or Spotify and please follow the show . Give us some stars , make a comment . That's going to help us keep bringing this information out to the public . I have tons of questions that came in from um , from our listeners . However , we wanted to touch a little bit on what is myofunctional therapy correct ?

Speaker 2 6:59

yes , exactly that's why . Uh , just , I wanted to have a live live on the Instagram because I've got many English-speaking followers . Usually I give the information in Ukrainian , in my native language , but the part , the big part of the audience are English-speaking audience , so they are also interested in dental health and , as much as I can , I try to translate some information to share with them the knowledge , what I have about dental health . So that's why I was interested in this . So I decided to talk a little bit with my English speaking audience about my functional therapy . But like I don't used to work in this specialty , I would like to ask you this question , to tell a little bit my audience what is my functional therapy is ? And I know that you were experienced it in this way and it's changed your life . So I would like you to tell my audience a little bit about your story and about my functional therapy in general . What is this ? What for do we need my functional therapies ? A hundred percent

Functional Therapy in Dentistry and Speech

Speaker 2 8:29

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Speaker 1 8:29

So myofunctional therapy is a therapeutic modality of treatment that most dental hygienists and speech pathologists are getting trained in . Uh , they have to do post um . You know , after they graduate . They have to do post you know , after they graduate . They have to do this training after universities , because it's not really taught in universities and it is not only a list of exercises for us to optimize the function of the orofacial muscles that are responsible for breathing , chewing , swallowing and oral rest posture .

Speaker 1 9:11

A lot of people don't know this , but where you keep your lips and your tongue at rest and how you breathe at rest , that's called your oral rest posture and that's a function , and a very important function . So the simple fact that some people might keep their tongue low , their lips slightly parted or breathing in through their mouth , that is incorrect function . So that's where the myofunctional therapist comes in Myo for muscle functional , for function . That is our main goal . But we start by doing a really good , comprehensive evaluation of the muscles of course , the skeletal structure , the breathing , the airway , and based on all of that we work in conjunction with a dentist or an orthodontist and an ENT who's going to be able to treat the other areas that we cannot , but it's very important for us to be able to recognize when there is an issue with the airway . For example , if a patient has enlarged tonsils or adenoids . We can't see the tonsils . However , there are some signs and symptoms that may tell us that this patient will need to see an ENT to verify if there's , you know , correct airflow whenever they are breathing .

Speaker 1 10:33

So during a myofunctional therapy appointment , after we're done with the initial evaluation , we will meet this patient weekly or biweekly and we give them exercises to do at home , just like physical therapy , just like occupational therapy or even speech pathology , when the practitioners will see these patients and they have to practice at home . So the most important part of this is that adherence . So the patient , understanding how important it is to keep up with these exercises , practice them every day . We also work a lot of on awareness , because this oral rest posture needs awareness . We need to think about where is our tongue , how are we breathing ? These are things that we're not used to thinking about .

Speaker 2 11:23

And you can stack on this idea all the time . It's annoying , quite annoying on the side , to think about it .

Speaker 1 11:30

Yes , it's very important for us to first be aware , then make sure the muscles are moving correctly . Then we start exercising them , so increase tone and then we increase strength and then we work on function . Let's teach these muscles how to work properly , because the function of the orofacial muscles are going to be responsible for keeping your craniofacial structure stable . You know the muscles are so important and they work in conjunction with the bones . You cannot just change the bone shape , like getting expansion or braces , if you're not addressing how the muscle is working . How many of you out there , you guys can tell me on Instagram how many of you have seen several patients relapse right After orthodontics ? How many patients out there have had orthodontics more than once and you guys can tell me in the comments . I can see them . It's very , very common and it's because the muscle is not being addressed . We get used to dysfunctional breathing , we get used to the incorrect position . Even sometimes when a child gets super sick for like a month with an upper respiratory infection , they might , you know , it might become a habit of breathing and a myofunctional therapist is going to try to , you know , correct that habit and you can change the structure . But if you do not change the muscle , these patients are going to relax . You're not going to be able to grow to their full potential .

Speaker 1 12:59

So , first of all , it's collaboration . We need to work with providers . Second , we need more people out there screening . More and more dentists , you know , even if you're an endodontist . Please , we need more people to start looking at this and recognizing when there's an issue . Why am I calling on all the dentists and dental hygienists to start screening ? Because healthy patients come to you and most of these patients don't know they have an issue . You're not going to go to a speech pathologist unless you have a speech issue . You're not going to go to your private doctor unless you're sick or you have a big concern . But so many patients are walking around out there with an airway problem and orophageal muscle dysfunction and they have no idea that it's a problem . They have no idea it's affecting their development . They have no idea that it's impacting their quality of life . So we need more people to be able to recognize , screen and then refer these patients to the right providers yeah , exactly , you know .

Speaker 2 14:03

Just I started to notice , uh , I I didn't use to treat children , I had a private clinic , but uh happened , some problems in my life and this clinic is destroyed because of the situation in my country and I moved to another place and I started to work in the clinic . So I have also children in my dentistry chair . I , of course , I treat the root canals of these patients , little patients and plenty of children's . Plenty of kids are with mouth breathing , you know , and it's like really like a habit , and they breathe . They not only open mouth when they speak , like in normal way , but when they stand up , and I just notice it . They all the time with open mouth , you know , and the face started to change . So I like this expression like function form . Function form , uh , follow form so people say oh sorry function create form .

Speaker 2 15:22

Because it's not my native language , I start to yeah , yeah , function create form . So it's really very important and it's not , and it's visible . Parents doesn't recognize this because they see every single day , every moment , every minute , the children . But when doctors look from the side , they need to pay attention of parents how the children breathe right . So it's very important that's why I started to talk about it and share this with the audience to pay attention of this .

Speaker 1 16:05

So what is your step ? What are some of the things you're looking , uh , whenever you notice a child who is mouth breathing . What are some of your recommendations ? What do you , what are you able to do in ukraine ? Um , you know who do you refer them to ? What do you ? What do you recommend for your patients ?

Speaker 2 16:23

let's just go there uh , of course , I recommend to visit a doctor to look at the mouth deeper and to see what this with tonsils and and adenoids , uh , in the , in kids , with kid . So , um , then I recommend to visit orthodontist because in this way , they can change a little bit the bite right and , of course , we don't have the specialities , like certificate for this in ukraine , but I know some like specialists on Instagram platforms . They started to do my functional therapy . So , yeah , I recommend them to pay attention on this person , on this specialist , and to have consultation , because it's very important for the health and it can impact the health in the future , like I know for of myself . You know how it happened with myself . So I try to to to give them some recommendation to visit the doctor and the sooner the better um , how is it in ukraine working withTs ?

Speaker 1 17:44

Is it easy to create a good relationship with them , and do they often remove tonsils and adenoids ?

Speaker 2 17:54

You know , like I have a grandson and he also has inflammation all the time and sneezing . So when they took antibiotics , two grandsons and they took antibiotics , two grandsons and they have the same diagnosis , and in this way the doctor recommends to remove , to remove the adenoid , I don't know how we will see conservative treatment . I think it will not help because it started to change the habit of the breathing , you know , and it's really I see that it's really day by day it's improving and also it can impact the oroph or facile muscles . So very important to do this . The student is a bad . How old is your grandson ? Uh , the older is five years and the younger two and half oh , very good .

Speaker 1 19:01

And the reason why I ask is because many times , many countries , they will not remove tonsils and adenoids . They're really against it , and then , while in some other countries it's like almost routine , let's just go ahead and get everything out . I have a wonderful friend , dr JJ . He's one of the best ENTs in the world . He's in Malaysia and the first thing that he does when these kids come to him , one is for expansion , palatal expansion , and also they talk about removing sugar , processed foods , dairy gluten .

Speaker 2 19:39

Yeah , I know about it . Yeah , I hear it .

Speaker 1 19:43

We don't really know . You know we get this question all the time , but what causes enlarged adenoids ? I feel like it's a conjunction of things . I don't think it's only one thing . It's not mouth breathing that's going to cause your tonsils or adenoids to be enlarged . I feel like they aggravate them . But your body is fighting something and nowadays we're exposed to so much . You know we're exposed to cleaning products and stuff that we put in our skin and perfume and all of these fragrances , the plug-ins and the sprays and anything they can think of . We're being exposed way more . Our bodies are not used to this . You know , back in the day we didn't have this number of chemicals that our body was getting exposed to . So I do believe that plays a huge part on the reason why we now have way more enlarged tonsils and adenoids . So it's not one thing , but there is the importance of working in conjunction with other professionals , so everybody can take a look and we can find out exactly what could help that patient .

Speaker 1 20:50

We have a question that just came in on Instagram and somebody said are there exercises that you can practice daily to change your bite without the orthodontist ? So a lot of people in this field say follow forms , follow function and function follows form . Meaning form is your skeletal structure , the way that you look is . The form follows function . So depending on the function chewing , breathing , swallowing or rest posture it can change your skeletal structure . I believe that that's true when a child is growing and developing . We do see minimal changes in adults .

Impacts of Myofunctional Therapy and Sugar

Speaker 1 21:38

However , I don't think that you can change the skeletal structure that much by fixing muscle or just by doing muscle exercises .

Speaker 1 21:51

Do I believe that it can improve minimally ? Yes , however , most of these patients don't need just teeth movement . Especially if you have a nasal breathing issue , if it's hard for you to breathe through your nose , you need a skeletal most times . If the soft tissue has , you know , been ruled out a lot of times , you need a skeletal change . So you would need an expander that's a little bit faster , so an rpe or something that's going to move a little bit faster , to open the suture , so the maxillary bone , actually two bones that have a suture in the middle . You need to open that suture to affect the nose , because the maxillary bone is also . Then everything is the same . Right roof of the mouth is the floor of the nose , um , so just exercises won't really change much have I seen teeth move with my functional therapy alone ? A hundred hundred percent . But most of the time , is it enough ? It's usually not enough because most of these patients coming to us need a little extra help .

Speaker 1 22:54

And then there I talked about follow forms function . And then we have function follows form . So , depending on what your skeletal structure looks like , it's how you're going to function . So your breathing has to do with you maybe having a very long face because you develop that way right . Several different reasons . But those people are more likely to be mouth breathers . Or chewing and swallowing is going to look slightly different , depending on what your skeletal structure looks like . So they're very closely related form and function . And it's that question chicken or the egg , which one comes first ? I feel like they both affect each other in different ways . But yes , exercises alone are not enough . We got to work with a team . I always say my functional therapy works because it's not done alone . We have another question Should I go there ?

Speaker 1 23:50

Yeah sure and myofunctional therapy help with mandibular entrapment . Do you want to talk about the mandible being stuck behind the maxilla , or should I ? Okay , I will . So your mandible is your lower jawbone . Maxilla goes supposed to go in front of the mandible slightly . So a lot of times we notice patients with that overbite . An overbite means I know that if this is on the podcast you guys are not going to be able to see it , but if you guys are on Instagram or YouTube you can see it . So if the upper teeth are covering too much of the lower teeth , that's called an overbite , meaning you can barely see the lower teeth . You're supposed to see at least half of the lower teeth . So if you have an overbite , a lot of times that mandible is trapped behind the maxilla . If you look at a lot of kids with an overbite , you look at their side profile . Their mandible is too far back . How do you bring that mandible forward ? A lot of times you just have to open the bite a little bit .

Speaker 1 25:03

Some dentists will do something called planus tracts , where they add this composite material to the occlusal surfaces , the chewing surfaces of the teeth , and it opens up the bite a little bit as soon as you open up that bite , the mandible can come forward and grow forward . Sometimes you need an appliance , you need expansion and whenever they expand they push the teeth out of the way also as they're expanding and the mandible can come forward . So MARPI is transverse expansion mainly , which is lateral sideways . So if somebody's super narrow , a MARPI is going to help open up that suture , expand the maxilla sideways . However , the Marpe does also bring the maxilla forward , but only a couple of millimeters .

Speaker 1 25:50

I noticed that with myself . I feel like I came forward way more than two millimeters , but it will help . I do believe that my lower jaw did come forward after the Marpe . I had a tongue tie release first , which we don't usually recommend , but I knew I was already going to get expansion done . So I decided to go ahead and get my tongue tie release and then I had Marpe . I still have it in my mouth . I'm going to get it taken out , probably in a month . I'm still going through my Invisalign , but I do believe the Marpe . Myofunctional therapy can help slightly with mandibular entrapment , but I would not expect more than one or two millimeters . If this is a person that has a very small airway that we can see on a CBCT . If the CBCT was taken correctly , if this person has sleep apnea , has a very hard time breathing at night , then they are most likely still going to need maxillary and mandibular advancement surgery . We call it MMA .

Speaker 2 26:52

Mm-hmm , amazing . So I had this problem also . I still have . Yes , I changed it a little bit because of the veneers . You know , like this I don't know how to say this in English , so I have protrusia in Latin . Okay .

Speaker 2 27:11

Okay , teeth were sticking out the top ones yes , yes , so a little bit changed with veneers because I had preparation a little bit changed the bite , but my upper jaw is still small .

Speaker 2 27:28

I'm sorry , my upper jaw is still small , you know , it didn't grow with it because I used to breathe in my childhood through the mouth all the time and I had , I was sleeping , you know , like this and my and my upper jaw was all the time like back and it's a period so . But in my 50 I don't want to change it's , it's need to surgical , you know , per operation . Uh , I don't want to change something like uh , it doesn't affect my health now , it doesn't bother me to leave like cosmetic cosmetics , you know problems , but I just wanted to prevent this in my grandson , the same problems . That's why I started to pay attention to this myofunctional therapy to help my grandsons and I wanted to ask you if we are going to avoid the sugar and this man , sugar and gluten . Can it help somehow ? What did you hear about this ? Because I don't know in English , any information .

Speaker 1 28:48

So we just went last weekend to an amazing conference in New York called PENNY . An amazing conference in New York called Penny . It's pediatric , pediatric and adult airway network of New York and it's thrown by Dr Steve Lambert , who is incredible , and the keynote speaker was Dr Robert Lustig . He is a pediatric neuro endocrinologist and all he spoke about guys was sugar . By the way a little plug , if you guys are an Airway Circle member , everything that I recorded is in our Facebook group for members only . So if you're an Airway Circle member , join us over there and you're going to be able to see a little bit about what he spoke . But I do have to share because it just came to my mind now One of the things that he said it's in order for cortical bone to grow , you need pressure and that is the importance of tongue position . So it was really exciting to me . Can you not hear anymore ? It was really exciting to me to see a pediatric endocrinologist talking about tongue position , the importance for craniofacial growth , but he spoke a lot about sugar .

Speaker 1 30:03

I can't hear you . You can't hear me anymore . Nothing changed over here . I keep trying to mess with it over there . You guys , let us know if you can still hear us . Hey , ana , uh-oh , she left . I'll keep talking , you guys . So Dr Lustig kept talking about the different types of sugar out there , right ? So he did say that fructose is the worst . So if you guys see fructose there , she is , is it back ? Can you hear me ? No , I don't hear . Especially corn syrup , take it out , take it out , take your earwax out .

Speaker 1 30:50

Yes , unplug it . Is it going to get better ? Turn the volume on . Yeah , increase your volume . Sorry guys , and yeah , you guys can hear me . Good , I'm not sure where hers is connected . April said so happy to be learning all about this . I don't know . I can hear you fine , do you hear me ? I ?

Speaker 2 31:16

don't know . I can hear you . Fine , do you hear me ? I don't hear you at all . I don't know what happened . I'm sorry . I'm sorry .

Speaker 1 31:31

All right , but you guys , sugar , sugar is the worst . He was connecting it to cancer . He was connecting it to so much , so many other things . Uh , he was such a wonderful lecturer . He's written several books about four books on fat and on sugar . Um , so take a look , uh , to find out a little bit more about his research . Maya levita said so happy that they are bringing more of this knowledge to ukraine . She , take a look to find out a little bit more about his research . Maya Levita said so happy that they're bringing more of this knowledge to Ukraine . She should definitely connect with Dr Marianne Evans . We love Dr Marianne Evans a hundred percent , but that's it .

Speaker 1 32:08

Yes , I have several other questions that you guys sent me , but I think it's more specific to me , so I am going to answer them on my Instagram . If you guys are not following my own moves , please , um , give us a follow . Share with your friends , share these lives with your friends . They are free and they're out there for us to to learn more with each other . And also , if you're looking for a provider and it's any provider in airway , so you may be looking for a provider , and it's any provider in airway , so you may be looking for a dentist , an orthodontist , an ENT , a myofunctional therapist , speech pathologist , occupational therapist , chiropractor ? Go to wwwairwaycirclecom slash directory . You can search by adding your location . Make sure to increase the mileage and it's going to show several professionals , your location , make sure to increase the mileage and it's going to show several professionals around you . Make sure to look for the little extra seal that it shows that they are an Area Circle member , because you know , if they are an Area Circle member , we're an online study club and we meet every Thursday night where we have this incredible lectures from all different world-renowned professionals . So you know they , if they remember , they're learning more and more and more .

Speaker 1 33:24

But anyways , I don't see her coming back . Guys , this has been a wonderful meeting with you . Guys , we're getting a message . He has limited sugar and nervous system regulation 100 . It is crazy . You know how things are changing . We keep getting , uh , you know these questions well , our tongue tie is more of a thing now . Has this always been an issue ? And the truth is that , yes , everything is changing . You know , we're eating differently , we're not exercising much . I mean , everything has changed the way that we , that we live . You know , compared to many years ago , we used to be so much healthier , so we have to learn and keep researching .

Speaker 2 34:24

You know what are other ways for us to live a healthier and better life ? Let's see . Can you hear now ? Yes , I can hear you . I decided to leave and then again to join you . Sorry , sorry , I don't know what happened . You were talking so nice , but I hear nothing .

Speaker 1 34:41

Okay , we'll cut that part off .

Speaker 2 34:45

I will hear it when recording , I think .

Speaker 1 34:48

Alrighty , everybody . Well , we have made our time . I have a meeting right now to go to . I'm running from one thing to another , but thank you so much , dr Mariana , for joining us tonight or today . It's tonight for you , I think it's 8 pm .

Speaker 2 35:05

Thank you so much . Thank you so much for having me . Thank you so much that your time . I had a blast and it was amazing time If I didn't hear something . I would love to hear it in the recording , Okay , so if you will be able to send me the this link , I appreciate this .

Speaker 1 35:33

It's right now on YouTube . It's right now on Facebook on Mayo moves page on Facebook . You guys can look it up . I'll share . On Aerie Circle , we also have a Facebook group that's called Aerie Circle Patients . So if you'd like to ask any questions , we have several parents who are going through the same issues that you might be facing , and adults also over there , and we have several professionals that are all there to just give their time and they kind of help , guide you in the right direction , just give you some light if you're having trouble , you know , finding out exactly what your next step is . So air recycle patients join us over there and it was so wonderful . Can you , before we go really quickly , can you you tell everybody how do they find you , either your website , where you're located in the Ukraine ?

Speaker 2 36:24

my Instagram from what I usually go live and share the information . It's called Mariana Dental and the same I have there on telegram their link and I have a group on telegram where in this group I speak with the audience also when we contact to each other , and where I share also some information and we can chat with each other on the telegram group . So welcome guys .

Speaker 1 37:03

If you send me those links , I'll also put them in the show notes .

Social Media Engagement and Thank You

Speaker 1 37:07

All right , thank you everybody for being here . Thanks for listening to us . Make sure you share , share , share , follow , follow , follow , send it to your friends . So more people .

Speaker 2 37:16

Thank you .

Speaker 1 37:22

Have a nice day , thank you . Thank you for your time . Bye , bye , of course . Bye everybody .