Orthodontic perspectives on orofacial myofunctional therapy.

Uke most other specialty areas, orthodontics has a rich professional literature containing disagreement and debate on a number of topics. One area of controversy since the inception of orthodontics in the late 1800s is the relationship between tongue functions and the development of malocclusions. Many orthodontists continue to believe strongly that tongue functions cause certain types of malocclusions and lead to altered patterns of facial development. Others implicate the tongue as the cause of negative tooth position changes (or "relapse") sometimes seen following the completion of orthodontic treatment. On the other hand, many orthodontists express no concern that tongue functions contribute importantly to the problems seen in their clinical practices. Orofacial myofunctional therapy is a treatment regimen that developed in response to the expressed concerns of orthodontists. For the most part, orthodontic problems created the need for the specialty area of orofacial myofunctional therapy (Straub, 1951). The cyclic controversy in orthodontics about the role of the tongue in contributing to orthodontic problems reached a peak in the 1970s. Following the adoption of a Position Statement on tongue thrust by the American Speech and Hearing Association, (ASHA), the House of Delegates of the American Association of Orthodontists adopted ASHA's policy statement in 1977. It is somewhat ironic that orthodontics, which previously encouraged the development of orofacial myofunctional therapy, adopted a position that doubted the efficacy of treatment. Despite the Position Statement, many orthodontists continued to refer patients considered to have myofunctionally related problems. Referrals have continued-where the stability of treatment is questionable with regard to a variety of oral functional or postural variations of concern to the orthodontist. The purpose of this article is to consider some selected aspects of current orthodontic theory and practice that relate to tongue thrusting and to examine the need for orofacial myofunctional therapy for a myriad of orofacial and pharyngeal variations. An attempt will be made to characterize current thinking and offer recommendations for clinical research in selected areas.