The motor system: a clinical appraisal.

A tongue thrust myofunctional therapy program has been presented which is uniquely successful because of proper timing, patient selection, and conceptual simplicity. A very small percentage of orthodontic patients should undergo myofunctional therapy. Tongue thrusters in the mixed dentition stage are not proper candidates for myofunctional therapy. The incident of tongue thrust in population samples decreases progressively until about the age of 12. Many openbite malocclusions are treatable without myofunctional therapy. Because a large number of tongue thrusters are only adapting to malocclusions, we do not become concerned until the tongue is interfering with mechanics. The percentage is usually quite small. Patients completing orthodontic treatment are easily motivated because they want their bands off. We are changing funcion at a time when mechanical therapy is changing form. There is a synergism between the effects of mechanical and myofunctional treatment. At this stage if the tongue does interfere with mechanics, myofunctional training is essential. Omission of such training will, in all likelihood, lead to partial or complete failure of the treatment program. When myofunctional therapy is necessary, the program should be simple and direct. The importance of bolus control in a peripheral seal during the voluntary movements in preparation for swallowing cannot be overemphasized. The myofunctional program presented teaches the patient the necessary bolus control in peripheral seal swallowing in a very direct manner. Myofunctional training really does not teach correct swallowing but instead teaches the voluntary movements of preswallowing. When the patient learns correct preswallowing, the involuntary movements of deglutition adapt to the new correct preswallowing movements and posture. Myofunctional therapy is essential for the successful treatment of a small percentage of orthodontic patients. If only those patients who really need it are treated, and if this treatment is kept simple and direct, then myofunctional therapy need not place a disproportionate drain on resources.