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Question & Answer - Oral Sensory-Motor, Myofunctional, Vocal Tract, & Airway Information

Why haven't the connections between oral, airway, and health problems been put together before now?

Commentary by Linda D'Onofrio, MS, CCC-SLP, Speech-Language Pathologist, Portland, OR, USA

October 2016


2016 seems to be the year Americans discovered their lingual frenums (i.e., the piece of tissue that connects the tongue to the floor of the mouth). But, for those of us who work in the mouths of children and adults, this is old news.

I am a speech-language pathologist (SLP), and my specialty is orofacial myofunctional and structural-based speech disorders in children and adults. Most of my caseload is referred by orthodontists, ENTs (otolaryngologists), and oromaxillofacial surgeons. I am rarely a child’s first SLP, and sometimes I’m the fourth or fifth. Most of my patients have been in speech therapy for years.

This summer parents of my pediatric patients included six women who were SLPs and pediatric dentists. None of them had been trained to screen, treat, or refer out for restricted labial (lip) and/or lingual (tongue) soft tissue. All of them complained about their painful breastfeeding experiences and their children’s early feeding and speech therapy needs because of poor oral function. All of their children were being referred because of orthodontic problems. Half of the children complained of poor sleep and not feeling rested. All six of these children and teens had enlarged soft tissue (tonsils and adenoids) and/or restricted maxillary labial frenulum and/or restricted lingual frenulum.

In the past, mostly adults complained of TMJ (temporomandibular joint) pain and sleep apnea, but now many of my pediatric and adolescent patients are also seeing pain specialists and getting sleep studies before they even meet me. More and more of my families are reporting daytime and nighttime breathing difficulties not yet diagnosed. Unfortunately, their medical providers are not putting the clues together.

When I explain why a child is a poor eater and has distorted speech, when I show them how posterior tongue restrictions encourage forward head posture and open mouth resting posture, when I demonstrate how the hard palate collapses, when I show them how restricted frenula pull on the interior of the gums and cause early recession, when I connect the TMJ pain and headaches to the tongue laying in the mandible (lower jaw), their reactions are very strong to say the least. They all ask the same thing: Why hasn’t this been put together before now?

This is my theory: Most medical and dental care is very Zen and in the moment. Fix the symptom, and make the pain go away. We often miss the underlying cause of the symptom(s), we forget people are creatures moving through time and space, and we rarely follow patients through their whole lives, so we don’t see the consequences of our professional actions or (more importantly) our inactions.

My scope of practice allows me to work with babies and old folks. I follow my patients for many years and always collaborate with their other medical, dental, and professional providers. This has allowed me to see patterns in facial development that not everyone sees. My goal is to open as many eyes as I can. An open mouth is never okay.

All pediatricians, dentists, feeding specialists, lactation consultants, SLPs, nurses, internists, gastroenterologists, otolaryngologists, and orthodontists need to be screening for airway obstruction and restricted soft tissue. Parents need to be educated on the consequences of action and inaction. If parents choose not to intervene at that time, they need to know what signs and symptoms they should look for in the future.

Thanks for letting me get this off my chest. You are welcome to contact me with any questions. – LD’

About the Author

Linda has three diverse areas of specialty.

First, she specializes in normal and disordered language development in children. Her goal is to teach parents and family members to be effective communication partners and teach successful strategies at home.

Second, she specializes in communication therapy for families with children and teens on the autistic spectrum. Linda incorporates the best of current research and techniques to promote social-communication skills and teach cognitive strategies needed to be a successful student.

Finally, Linda specializes in craniofacial disorders and oromyofunctional therapy to correct feeding, swallowing, and speech disorders. Therapy is customized around the needs and abilities of each client and family.

Contact Information

D’Onofrio and Associates

1827 NE 44th Ave STE 120
Portland OR 97213

Linda D'onofrio

Phone: 503-808-9919 
Fax: 503-459-4986