What Is That Open Bite Really Telling You?
A Dental Professional's Guide to Myofunctional Clues
"The child sitting in our chair did not suddenly develop their oral patterns the day before their appointment."
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Unintentional patient reactions, such as lip clenching or gagging, can pose challenges during dental procedures. This course explores how myofunctional issues may contribute to these involuntary behaviors. Orofacial Myofunctional Disorders (OMDs) often originate from patient habits or conditions that manifest during infancy, potentially disrupting healthy function and persisting throughout a person’s lifetime. These disorders can contribute to reactions that complicate...
As dental professionals, we spend a lot of time looking at mouths.
We notice the crowding, the open bite, the narrow palate, the scalloped tongue, the worn teeth and the clenching. We notice when a child is sucking a thumb or using a pacifier longer than expected. We may also notice that a patient seems to be breathing through their mouth while we are talking to them. These are things we see every day, but how often do we stop and ask what those findings might be telling us?
The more I learned about myofunctional disorders, the more I realized that what we see in the mouth is often only one piece of a much bigger picture. Breathing, oral posture, tongue function, swallowing, chewing, habits, muscle function and structure all interact. When one part of the system changes, other parts may adapt. Sometimes the finding we see in the dental chair is the result of a pattern that started much earlier in a patient's development.
This does not mean that every open bite is caused by a tongue thrust or that every patient who mouth breathes has an airway disorder. It means that these findings give us a reason to become curious. Instead of simply identifying what we see, we can start thinking about why we might be seeing it.
The finding is not always the cause
One of the biggest mindset shifts I encourage dental professionals to make when learning about myofunctional disorders is to separate an observation from an assumption. We are very good at identifying what is in front of us. We see an open bite and know it is an open bite. However, this observation does not necessarily tell us why it developed.
An open bite can have several contributing factors. Oral habits, tongue posture, skeletal growth patterns, genetics and other functional or environmental influences may all play a role. The same is true with mouth breathing. A patient may have nasal obstruction, chronic congestion, enlarged tissues, a structural limitation or a habitual breathing pattern. There may be more than one factor involved.
This is why I like to think of these findings as clues rather than answers. A clue tells us that something may be worth investigating. It does not give us a diagnosis. That distinction is important because it allows us to recognize patterns without jumping to conclusions. We do not have to look at one finding and immediately decide what caused it. We can gather more information, ask better questions and determine whether the patient needs additional evaluation.
The mouth is part of a bigger system
Breathing is a good example of how these systems can interact. We breathe all day and all night without consciously thinking about it. When nasal breathing is comfortable, the tongue, lips and jaw can generally establish a functional resting relationship. When nasal breathing is difficult, the body must find another way to get air.
A patient may begin keeping their lips apart. The jaw may drop. The tongue may rest lower in the mouth. Head and neck posture may change. The mouth may become dry. Sleep may be affected. The body is very good at adapting to whatever is necessary to keep us functioning.
The same idea applies to oral habits. A thumb, finger or pacifier habit can influence the developing oral environment, particularly when it is frequent and persistent. At the same time, I think it is important to ask why the habit is there in the first place. Is the child seeking comfort? Is there a sensory component? Is the habit helping them regulate? Could there be something else going on with breathing or oral function?
It is easy to look at the habit and say, "That is the problem." Sometimes it is part of the problem, but it may also be an adaptation to something else. This is where looking at the whole patient becomes so important.
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Development leaves clues
One of the reasons I believe dental professionals have such an important role in identifying myofunctional concerns is that development leaves clues. The child sitting in our chair did not suddenly develop their oral patterns the day before their appointment. There is a history behind what we are seeing.
How did feeding go during infancy? Were there difficulties with breastfeeding or bottle feeding? Did the child have issues transitioning to solid foods? Were there persistent oral habits? Was there chronic congestion? Were there sleep concerns? These questions do not allow us to go backward and prove exactly what caused a particular finding. Development is much more complicated than that. What they can do is give us context.
I have seen this repeatedly in my own work. A child may come into the office with crowding, an open mouth posture and a low tongue position. If we look only at the teeth, we may focus on the orthodontic picture. But when we start talking with the parent, we may learn there was a difficult feeding history, years of oral habits, chronic congestion or significant sleep concerns. Now we have a much better understanding of the child. We still may not know exactly what caused what, but we have more information to work with.
The dental team has a front row seat
Dentists and hygienists are in a unique position because we see patients regularly and often see them over many years. We also have an opportunity to observe how patients use their mouths, not just what their mouths look like. A patient may have never thought about where their tongue rests. These things can be so normal to a person that they do not even consider mentioning them. That is where observation becomes valuable.
Pay attention to the patient's resting posture while you are talking with them. Look at whether the lips are naturally together or apart. Notice how they breathe. Look at the tongue and palate. Ask about oral habits. For children, ask about feeding, sleep, eating and developmental concerns when those questions are appropriate. None of these observations automatically means a patient has a myofunctional disorder. They are simply pieces of information that can help us recognize when a bigger pattern may be present.
This is also why the hygienist can play such an important role. We often have more time with the patient than anyone else in the office. We may be the person who notices that something has changed or who hears a parent mention a concern that never makes it into the dentist's examination.
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Not one more thing!
One of the things I hear from dental professionals when we start talking about airway and myofunctional disorders is, "This is just one more thing I have to add to my appointment." I understand that feeling. Dentistry already asks us to know an incredible amount.
The good news is that recognizing functional concerns does not mean you need to turn every hygiene appointment into a comprehensive myofunctional evaluation. It starts with observation. Look at the lips. Look at the tongue. Look at the palate. Notice how the patient breathes. Ask about oral habits. Ask about sleep when it is appropriate. Ask about feeding and development.
One finding may not mean much by itself. Several findings occurring together may give you a reason to look a little closer. This is where screening can be so useful. Screening helps us identify patients who may benefit from additional evaluation. Dental professionals already understand this concept. We screen for caries risk, periodontal disease and oral cancer. We recognize something that needs further attention and then determine the appropriate next step. Myofunctional concerns can be approached in much the same way.
Start with curiosity
For me, that is what decoding myofunctional disorders is really about. It is not about seeing one finding and immediately attaching a diagnosis to it. It is about learning to recognize patterns and becoming curious about what may be contributing to them. The mouth is connected to breathing, feeding, sleep, swallowing and so many other functions that we often take for granted. As dental professionals, we have a unique opportunity to notice those connections because we see the mouth regularly and we see patients over time.
In my upcoming presentation, Decoding Myofunctional Disorders: Causes and Effects, we will take this conversation a step further. We will look at common patterns dental professionals encounter, explore some of the factors that may contribute to those patterns and discuss the relationship between structure and function. Most importantly, we will talk about what this looks like in the real world of dentistry. What should you notice? What questions are worth asking? And when does it make sense to bring another professional into the conversation?
My goal is to make this topic feel practical rather than overwhelming. You do not need to become a different kind of dental professional. You simply need to become a little more comfortable recognizing when something does not quite fit the picture. Sometimes, that one observation is the beginning of a much bigger conversation. ◼
104750 Decoding Myofunctional Disorders: Causes and Effect
Unintentional patient reactions, such as lip clenching or gagging, can pose challenges during dental procedures. This course explores how myofunctional issues may contribute to these involuntary behaviors. Orofacial Myofunctional Disorders (OMDs) often originate from patient habits or conditions that manifest during infancy, potentially disrupting healthy function and persisting throughout a person’s lifetime. These disorders can contribute to reactions that complicate...
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Opinions and viewpoints expressed in this article are the author's, and do not necessarily reflect those of CE Learning Systems.
