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Welcome to dentistry’s largest dental hygiene practice management resource center! We are the leading dental hygiene consultant/coaching business.

We will increase your TOTAL dental practice profitability without working more hours or days each year.

- Debbie Seidel-Bittke, RDH, BS, Speaker, Author. Dental Hygiene Coach & Consultant

Dental Practice Solutions - Debbie Bittke

HOW TO SPOT AN OROFACIAL MYOFUNCTIONAL DISORDER | 5 Sign to Look for that Could Change a Life

By: Debbie Seidel-Bittke, RDH, BS

December 13, 2017

Have you noticed that some patients tend to have more lunch stuck on their teeth then others?

You know the patient that comes in and apologizes for eating on the way to her appointment. You tell her that it is fine, that you are just glad she had lunch. When she opens her mouth, you are shocked.  It appears that the entire bagel is still in her mouth, smashed up against her teeth.  How is that possible?

Then there is the 60-year old man that instantly falls asleep when you lean the chair back and starts snoring just as you are going to give him an injection. How about the cute little six-year old girl that has a speech impediment, or the five-year old boy with an overjet and long skinny face with dark circles under his eyes.

You may have thought that the lady with the bagel mouth was just not kind enough to clean up before her appointment, and left you to do it for her.  Well, it is very likely that she has an ankylosed tongue that does not allow her tongue to reach up high enough to clean food debris off of her teeth.

It may be obvious to you right away that the 60-year old man is suffering from sleep apnea, but did you know that is could be due to his tongue not being able to reach up to the roof of his mouth. It is literally blocking his airway at night because it rests on the floor of this mouth.

That cute little six-year old girl hasn’t been able to develop proper speech patterns due to a tongue thrust.  And you got it, the five-year old boy is a thumb sucker. These are all signs of an Orofacial Myofunctional Disorder (OMD).

HOW TO SCREEN FOR OROFACIAL MYOFUNCTIONAL DISORDERS

Dentists and hygienists are in a prime position to screen for Orofacial Myofunctional Disorders. There are several signs we can screen for to determine if the patient may have a disorder and benefit from seeing a trained therapist. The following are some of the most commons signs:

Upper or Lower Lip Frenum Restriction

Jaw Pain or Clicking/Popping

Mouth Breathing

Sleep Apnea

Snoring

Ankyloglossia (tongue tie)

Forward Head Posture

Neck Pain

Enlarged Tonsils/Adenoids

Acid Reflex

Narrow Palate or Crooked Teeth

ADHD

If you are new to learning about OMT, keep it simple by starting with these five signs and symptoms:

Ankyloglossia

Commonly referred to as “tongue-tie” occurs when the lingual frenulum is too short to allow for normal tongue movements. Best if done with the patient in an upright position. Have the patient open wide and lift his tongue to the roof of his mouth.  Determine is he is able to reach his tongue up to his incisive papilla easily or if he struggles.  Then have him stick his tongue straight out, if the tip appears heart shaped, this is a sign that he is tongue tied. The heart shape apex happens when the frenum is short and pulls down the center of the tongue.

Low tongue rest posture

Think mouth breather.  When nasal breathing is impaired, the jaw drops and the tongue rests low and forward in the mouth in order to open the airway for breathing. It may be that nasal breathing is not impaired, but mouth breathing has become a habit. Watch for your patients resting position. Is the mouth open? Is he breathing out of his mouth or nose?

Tongue Thrust

Tongue thrust is in which the anterior surface of the tongue makes repeated contact with any of the anterior teeth, or protrudes between the arches. Have the patient swallow for you while you are holding his bottom lip. If he has a tongue thrust he may have a very hard time swallowing. He may need to pull the lower lip out of your hand in order to complete the swallow. In a healthy swallow, the tongue rests in the palate, the teeth come together, and then the person swallows. The facial muscle should not move, so any lip puckering or licking of the lips before swallowing should be warning signs of tongue thrust. Another sign will be an anterior open bite.

Sleep Apnea

When you place a patient in the supine position and he immediately falls asleep and starts to snore, this is a sign that he may have sleep apnea or other conditions keeping him up at night. Luckily for us trying to get work done, this does not happen very often. In most cases you will need to question the patient. You will often get the response of “my wife tells me I snore, but I don’t know”.  If nothing else, this is an opportunity for them to become mindful of possible snoring and to question their spouse or use a sleeping app to record their sleeping patterns and sounds. Referring the patient to have a sleep study or consult with his medical doctor is a good place to start.

Digit Sucking

Although there are adults that suck their thumb, odds are that most of your thumb sucking patients will be children. It may be an easy screening if you see the child suck his thumb, but often they will not do it in public and you will have to look for signs and question the parents.  Look for an anterior open bite and a swollen nub on the patients thumb or fingers.  One reason a child may suck his thumb at night is to help open his airway so he can breathe. If he has a tongue tie he may be using a digit to press the tongue down out of the way. Resting the tongue on the incisive papilla area is also soothing and if his habit is hold the tongue down, he is missing out on this natural soothing technique. OMT specialists have ways to help break the child of this habit and can help with underlying causes.

WHAT IS OROFACIAL MYOFUNCTIONAL THERAPY

Orofacial Myofunctional Therapy (OMT) is the neuromuscular re-education or re-patterning of the oral and facial muscles. It is the establishment of correct functional activities of the tongue, lips and jaw, so that normal growth and development may progress in a stable, homeostatic environment. OMT specialists obtain training in this field in order to work with patients to correct disorders that are affecting their well-being. Think physical therapy for the mouth.

HOW TO BECOME A TRAINED OROLFACIAL MYOFUNCTIONAL THERAPIST

Orofacial Myofunctional Therapists include dentists, dental hygienists, speech pathologists and occupational therapists. Although OMT may be in the scope of our license, further training is required in order to properly treat patients. Training opportunities for those interested in learning more about Myofunctional Therapy include private mentoring from a current Myofunctional Therapist, courses through academies or associations, or information learned within the educational curriculum.

CONCLUSION

Proper treatment of OMD’s require a collaboration of dental and medical professionals. By being aware of the signs for these disorders, you are able to provide a screening for potential issues and refer them to seek treatment with a trained OMT. When you become aware of OMD’s you will start to see them everywhere- maybe even in the mirror.

 

References:

International Association of Orofacial Myology- www.iaom.com

Academy of Orofacial Myofunctional Therapy- www.aomtinfo.org

Academy of Applied Myofunctional Sciences- www.aamsinfo.org

American Speech-Language-Hearing Association- www.asha.org

Cindy Rogers, RDH, BS, OMT is the lead hygiene advisor for Dental Practice Solutions. She started in dentistry as the front desk girl in 1998, and has since been a business leader, dental hygienist, writer and untiring advocate of Orofacial Myofunctional Therapy.

Dental Consultant | The Dental Hygienists Role in Keeping Doctor’s Schedule Full

By: Debbie Seidel-Bittke, RDH, BS

December 6, 2017

Every success schedule in the dental office begins with a strategy. Without a strategic plan, you are not able to meet the financial goals to keep your dental practice surviving.

The best plan is to not survive, but thrive.

What is the dental hygienist’s role in keeping doctor’s schedule full?

1st Step to Doctor’s Success Schedule

The first step for hygienists to help keep doctors schedule full is to have a mindset that they are like an associate to doctor; helping the practice to grow.

2nd Step to Successful Scheduling

The next step is actually two-pronged. The hygienist needs to audit all patient records before their day at the office begins. This audit serves many purposes but for this blog we will stick to the topic of what a hygienist’s role is for successful scheduling and helping doctor’s schedule stay full all day.

When auditing the patient’s records look to see what outstanding treatment is necessary. Why does the patient need to schedule this? What is the urgency the hygienist and all the clinicians will speak to this patient about?

For example: Does the patient have a dark spot on their bite-wing x-ray and when you audit the patients record you feel concerned they may very soon have a toothache.

Why did this patient not want to schedule this appointment? It is important to understand the patient’s objection so that when the hygienist has the patient in their chair they can immediately address the patient’s previous objection.

Example: Without even saying; “I know money is a concern,” what you can say is (Have the patient seated upright in the chair with x-rays, and/or intra-oral photos there in front of the patient), “Mrs. Jones, doctor and I are both concerned about this black spot on your x-ray. Let me show you this area. Do you see this black spot? Here is the nerve of your tooth and as you can see this black spot is very close to the nerve which means that once it reaches the nerve it will cause a toothache and also means we probably need to do a root canal and a tooth with a root canal needs a tooth. This means spending a lot more money to keep this tooth.”

Notice how the hygienist in this example address the patients concern before they could even give their objection which they stated at their last appointment and this is the reason the treatment is unscheduled.

It is also very important that hygienists not only think about the gum health of their patients but provide a visual exam.

After the hygienist completes all of their screenings, it is a great time to sit the patient upright in the chair and show them what you see. Look together with the patient. Make the patient part of this process. This means that you look together and ask the patient if they see what you see.

Use words that the patient understands. Saying words like “periodontal disease,” and “tooth decay” probably don’t mean as much to your patient as if the words: gum infection, inflammation, active disease, cavity, black soft spot, etc.”

When you see holes in doctor’s schedule it’s time to take a look at the hygiene patient exam process. It’s a great time to look at patient records who have not scheduled their appointment and discuss as a team what you can do differently so these patients will schedule and pay.

The best way to get patients scheduled and paying for the care you offer is to communicate (your words and actions) in a way that helps the patient to feel and believe they want what they need.

Many of your patients have left your office without committing to schedule and pay for your care. Many of these patients also took very nice vacations this summer, they already plan to buy that new iPhone X, some have spent a lot of money on a really nice car and many have spent thousands of dollars on a sleeve of body of tattoo’s.

Our job? We have a responsibility to help our patients want what they need. Don’t most people want to live a longer and healthier life? This is our overarching message, “Optimal oral health will help you live a longer and healthier life!”

Still have holes in your schedule? Please feel free to reach out to an expert. This is one area that we have created a success strategy around. Our client offices have many patients who now schedule and pay for treatment AND many of their patients pay before their treatment is complete.

Our client offices have a system in place for big cases where patients are currently paying in advance for doctor and hygienist’s services.

Most of the medical cosmetic offices have patients pay in advance and why can’t your patients feel urgency to pay for keeping a healthy mouth?!

It’s all in how you are delivering your message to the patient in your chair.

Debbie Seidel-Bittke, RDH, BS is a dental consultant, coach, speaker and author. She is also CEO of Dental Hygiene Solutions, powered by Dental Practice Solutions. Debbie is a world-class leader in creating profitable hygiene departments. She is well-known as a former clinical assistant professor at USC in Los Angeles and a former hygiene department program director. Dentistry Today recognizes Debbie as a Leader in Dental Consulting.

DENTISTRY TODAY considers her a top dental consultant for the past 16 yrs.

The focus of Dental Practice Solutions is to create healthier, longer lives for your patients while supporting the practice to optimize their hygiene department. The team at Dental Practice Solutions, takes an integrative approach with your team to create an increase in your production and collections without working harder. When you continue to use the systems implemented, you will benefit from production that creates dividends year after year, for the life of your dental practice.

Debbie is also a former Hygiene Program Director and clinical assistant professor for the dental hygiene program at USC in Los Angeles.

Debbie is passionate about supporting dental teams to provide a profitable, patient-centered dental practice through improving systems and efficiencies in the dental hygiene department