By Pam Marshalla
Q: Why does an oral habit like thumb sucking effect the oral structures in some children but not others? I have seen kids who suck their thumbs who have no dental problems, and I have seen kids who suck their thumbs who have terrible open bites. As I understand things, any oral habit can affect oral structures depending upon the following three factors–– Frequency –– How often the client engages in the habit. Once per day? Ten times per day?…
By Pam Marshalla
Q: Is four years old too early to address a tongue thrust? The term “tongue thrust” has had many meanings through the years. It can mean: A strong forward thrusting of the tongue following the swallow. A reverse swallow pattern. An infantile suckle-swallow pattern. An interdental tongue protrusion on all lingua phonemes.. An interdental tongue protrusion on all the lingua-alveolar phonemes. An interdental tongue protrusion on the all the sibilants. An interdental tongue protrusion on only S and Z. To…
By Pam Marshalla
Q: You mentioned orthodontic referral in one of your lectures on the lisps and R. I am wondering if you also refer to ENTs for issues relating to and resulting from mouth breathing. I follow standard practices in SLP. Therefore I refer clients to orthodontics when there are indications that a dental malocclusion may exist, and when it seems to be interfering with sound production. I refer clients to an ENT when there are indications that there may be upper…
By Pam Marshalla
Q: I have a teenage client with a reverse swallow pattern and related anterior open bite. I plan to teach him correct oral rest, to swallow in an anterior-to-posterior direction, and to increase his tongue strength. Does this sound right? Is there something I am missing? Training correct oral rest position and correct swallow movements are the right basic ingredients of this therapy. But remember that oral swallowing entails two types of tongue movements: The tongue movements needed for food…
By Pam Marshalla
Q: Do you have any thoughts on thumb sucking as a way to move facial bones? One of my four-year-old clients is a frequent thumb sucker. A professional on my team wants to encourage the habit to move this child’s facial bones as part of her craniosacral therapy. The therapist says that the child’s thumbsucking is “a pathological compensation for a structural anomaly.” Now the staff thinks that this child’s thumb sucking is okay. What do you have to say about…
By Pam Marshalla
Q: I am going to evaluate a 15-year-old male with an orofacial-myofunctional disorder. He will get braces soon. What general oromotor exercises do you recommend to get us jump-started? What materials should I order? Your question is far too general for me to answer. There are no “oral-motor exercises” I can give you to get you “jump-started.” The study of oral motor is deep and complex, and it contains many levels of understanding and direction. Your questions suggest that you…
By Pam Marshalla
Q: I have heard that we should avoid the topic of tongue-thrust therapy (orofacial myofunctional therapy). I’d like to hear your thoughts on this. In my experience, problems in articulation, orofacial myology, feeding, dysphagia, and motor speech disorders are all the same thing manifested in somewhat different ways and to various degrees. All of these therapies are about facilitating new oral movements and/or fixing incorrect oral movements. I have spent my entire career (since 1975) studying the research, clinical practices,…
By Pam Marshalla
Q: I have a 5-year-old client who has a tongue thrust on all the sibilants. She also has ankyloglossia, and is low in tone around her mouth and lips. She has a tonic bite reflex and holds her cheeks very tightly when I brush her teeth. She has sensory issues and is very uncomfortable (although cooperative) during teeth brushing. She tends to have an open mouth position and her lips are oftentimes wet. None of this affects her speech intelligibility….
By Pam Marshalla
Q: Is it efficacious to work on a frontal lisp when a child has a reverse swallow, or does the swallow have to be addressed first or concurrently? In the ideal situation, the speech problem, the reverse swallow, the dentition problem (if any), and the oral habit (if any) are address all together in one plan or action. In the orofacial myofunctional literature, the recommendation generally is to work in the following order: Eliminate oral habits Establish correct oral rest…
By Pam Marshalla
Q: I have a student with a restricting lingua frenulum that limits his tongue mobility and impacts his speech intelligibility. What do you write in the referral letter to the physician? Write a letter that explains how the restricting lingua frenulum is impacting as many of the following six areas as you can: speech, oral rest, preparation for swallow, the swallow, health, and social appearance. The letter is sent in the hopes that the primary physician will refer the client…
