Myofunctional exercises are most often used to retrain and strengthen the intrinsic and extrinsic muscles of the tongue, the cheek muscles, and the muscles around the lips and mouth. Tongue retraining may include exercises to improve swallowing function, with a goal of training the individual to move the dorsal surface of the tongue upwards to contact the palate, while keeping the tip of the tongue just behind the incisive papilla. The tongue should move in a wave-like motion from the tip to the base, which during mastication, propels the bolus backwards toward the throat.
Many myofunctional therapists have used a variation of an exercise that involves placing a small item at the tip of the tongue and having the patient hold it to the retroinsical spot during swallow. This encourages the use of the body and base of the tongue during the movement, as opposed to a low, forward tongue posture that includes sucking the cheeks and mouth in to create pressure for swallowing, “pursing” the lips, and forcing the tongue against or between the anterior teeth. The retroincisal spot is simply termed “the spot” in myofunctional therapy and is also the ideal place for the anterior tongue during rest.
Tongue strengthening may include exercises to improve range of motion, such as moving the tongue as far as possible out of the mouth in each direction: right and left (tongue lateralization) as well as up and down. These tongue movements and exercises aid in the formation and movement of the bolus and clearing debris within the oral cavity. In order to build strength, patients may also be encouraged to repeatedly hold the tip of the tongue firmly on the palate for a period of time or create resistance against an object (Figure 12).7 Ongoing repetition is crucial to the success of any myofunctional therapy program.
Perioral muscles may be underutilized as in the case of open mouth posture or incompetent lip closure. These are cases where the lip and oral muscles may need to be strengthened. Myofunctional therapy utilized for these muscles include patient education, breathing retraining, chewing and bite exercises, muscle massage, and resistance exercises.34,36