What Happens During a Myofunctional Assessment?
So you've booked a myofunctional assessment. Now what?
Are you going to spend two hours sticking your tongue out, making funny faces, and swallowing water while someone watches? (Well, there might be a little of that.)
But a comprehensive orofacial myofunctional assessment involves quite a bit more than looking at your tongue.
Whether you're coming in because of a tongue-tie, mouth breathing, teeth grinding, sleep apnea, or concerns about your child's oral development, my goal is to figure out what's actually happening and, more importantly, WHY.
Because sometimes the problem you think you have is only one small piece of a much bigger puzzle.
1. First, let's talk about YOU.
Before I start examining your mouth, I want to know your history. And yes, I ask a LOT of questions. We'll talk about things like:
Birth history and any early feeding difficulties.
Breastfeeding, bottle-feeding, chewing, and swallowing.
Thumb sucking, pacifier use, nail biting, and other oral habits.
Speech difficulties, past or present.
Mouth breathing, snoring, sleep quality, and sleep apnea.
Allergies, nasal congestion, and previous tonsil or adenoid removal.
Dental history, orthodontics, and previous tongue-tie releases.
Teeth grinding, clenching, jaw tension, headaches, and migraines.
Relevant family history.
Why do I want to know about your childhood feeding history when you're coming in because of headaches?
Because your mouth, tongue, breathing, and swallowing don't operate independently of the rest of your body.
Sometimes the answers to today's problems are hiding in things that happened years ago.
2. Let's take a closer look at your mouth.
Next, I examine the structures involved in breathing, chewing, swallowing, and speech.
This includes your:
Lips and ability to maintain a comfortable lip seal.
Tongue, including its appearance, resting position, and range of motion.
Jaw position and movement.
Teeth, bite, and dental alignment.
Palate (the roof of your mouth), including its shape, height, and width.
Tonsils, uvula, and soft palate.
Nose and nasal breathing capabilities.
Why does all this matter?
Imagine trying to park a large truck in a tiny garage. It doesn't matter how good the driver is if there's simply not enough room.
The same general concept applies to oral function. The shape and development of the oral structures can influence how much space the tongue has and how easily it can move and rest in the mouth.
A high, narrow palate, for example, may be associated with reduced tongue space. Restricted tongue mobility may also make certain movements more difficult.
We're looking at how the structures are built AND how well they work together.
3. What is your tongue actually doing all day?
This is where things get interesting.
Your tongue has a job even when you're not talking, eating, or swallowing. It's supposed to have a comfortable resting position against the roof of your mouth.
But many people have a tongue that spends most of the day hanging out on the floor of the mouth.
I evaluate:
Where your tongue rests naturally.
Whether your lips are comfortably closed.
Whether you're breathing through your nose.
Whether your tongue can elevate, move side to side, and create suction.
Whether your jaw and tongue can move independently.
Whether your lips, jaw, and tongue are coordinating efficiently.
Sometimes someone CAN perform a particular movement, but only by recruiting other muscles or moving their entire jaw to compensate.
That's an important difference.
Being able to stick your tongue out doesn't necessarily mean your tongue is functioning efficiently.
I also examine soft palate and uvula movement and assess nasal breathing capabilities.
4. Time to put those muscles to work.
Looking at your mouth is one thing. Watching it function is another. I include several functional screenings:
Speech sounds: I screen speech sounds to identify difficulties that may be associated with oral structural or functional concerns.
Oral motor coordination: I use oral diadochokinetic (DDK) tasks, which involve repeating specific sequences of speech movements to assess timing, coordination, and accuracy.
Swallowing: I observe how your lips, tongue, and jaw coordinate during swallowing using at least two different consistencies.
I'm looking at tongue placement, movement, jaw stability, and whether other muscles are working harder than they need to.
These are screenings, not comprehensive speech or instrumental swallowing assessments, but they provide valuable information about oral function.
5. What about tongue-ties?
This is an important distinction.
I don't provide standalone tongue-tie assessments or diagnose tongue-ties.
What I DO assess is how your tongue functions.
I look at its range of motion, elevation, lateralization, coordination, suction, and movement during speech and swallowing.
If I identify restricted tongue mobility or suspect that a restrictive lingual frenulum may be contributing to functional difficulties, I'll explain my findings and recommend further assessment by an appropriately qualified healthcare provider who can evaluate and diagnose a tongue-tie.
And here's something worth remembering: everyone has a lingual frenulum (the little piece of tissue connecting the underside of the tongue to the floor of the mouth).
Having a visible frenulum doesn't automatically mean you have a tongue-tie that needs releasing.
Function matters. A lot.
6. Why I don't just hand you a list of tongue exercises.
This might be the most important part of the entire assessment.
People often come to me thinking they have a problem in just one area.
They want help with sleep apnea. Or headaches. Or a tongue-tie. Or teeth grinding.
But during the assessment, we sometimes uncover a much bigger picture involving oral structure, tongue mobility, breathing, resting posture, and compensatory muscle patterns.
For example, I assessed an adult who initially came to me because of sleep apnea and difficulty with CPAP compliance.
During the assessment, we identified restricted tongue mobility alongside concerns with nasal breathing and compensatory muscle patterns. She also reported tension headaches and neck pain.
Suddenly, there were additional pieces of the puzzle worth investigating.
This is why I believe it's important to understand the structures AND function before jumping into exercises.
Sometimes structural concerns need to be investigated first. This might mean seeing an orthodontist, dentist, ENT, or another healthcare provider before starting therapy.
Other times, we can begin working on function while other concerns are being investigated.
The point is that I don't want you spending time and money doing exercises that aren't addressing the factors limiting your progress.
7. So, what do you actually leave with?
You're not going to spend two hours with me and then walk away wondering what just happened.
We review the findings together during the assessment, and afterward, I provide a written summary report that includes:
Assessment findings and identified concerns.
Recommendations for further assessment or consultations with other healthcare providers, when appropriate.
A list of individualized exercises to get started.
Recommendations for where to begin and what future treatment might look like.
We discuss what makes the most sense for YOUR situation.
Sometimes that's starting myofunctional therapy. Sometimes it's addressing structural concerns first.
And sometimes, simply understanding what's happening gives you a completely different perspective on the symptoms you've been trying to manage for years.
An assessment doesn't automatically mean committing to months of therapy. It gives you information, a starting point, and a plan.
8. Can you do this virtually?
Absolutely!
I offer both virtual and in-person assessments for children, teenagers, and adults throughout British Columbia.
Virtual assessments: Before we meet, I'll ask you to provide specific photographs and videos so I can review your oral structures and observe certain movements. We'll go through these together during our appointment, discuss your history, and complete the functional portions that can be assessed virtually.
In-person assessments: These allow me to examine oral structures and observe functional movements directly.
Both options can provide valuable information. We'll determine which format makes the most sense for your situation.
Who should consider a myofunctional assessment?
You don't need to have a diagnosed tongue-tie to benefit from an assessment.
It may be worth taking a closer look if you or your child experience:
Mouth breathing, snoring, or sleep-disordered breathing.
Sleep apnea or difficulty tolerating CPAP.
Teeth grinding, clenching, jaw tension, or headaches.
A high or narrow palate, dental crowding, or orthodontic concerns.
Feeding, chewing, or swallowing difficulties.
Speech sound difficulties potentially associated with oral dysfunction.
Low tongue resting posture or difficulty keeping the lips comfortably closed.
A diagnosed tongue-tie or history of tongue-tie release.
These symptoms don't automatically mean you have an orofacial myofunctional disorder, but they may be clues that deserve a closer look.
Before You Go...
Here's something to think about:
Have you ever considered that your headaches, poor sleep, teeth grinding, or difficulty breathing through your nose might be connected to how your mouth and tongue are functioning?
Most people haven't.
And that's exactly why I believe a thorough assessment matters.
Sometimes we spend years treating individual symptoms without ever looking at how everything fits together.
Start with an assessment. Understand the findings. Then make a plan that makes sense for you.
— Kaylene
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