Unlock Your DSO’s Full Potential: The Game-Changing Role of Myofunctional Therapy

Karese is a registered dental hygienist, myofunctional therapist, and leading innovator in integrative dental care, transforming the way dental service organizations (DSOs) approach growth and patient care. She founded The Myo Spot, a practice aimed at amplifying oral wellness to whole-body wellness. Through tele-therapy, she helps clients of all ages overcome tongue ties, TMJ disorders, sleep apnea, grinding, anxiety, and various breathing and orofacial dysfunctions. Passionate about education and self-help, she published Accomplished: How to Sleep Better, Eliminate Burnout and Execute Goals. When not working with clients globally, she spends time with her husband and four kids. 

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Transcript

I'd like to welcome Karese to the show. Thanks so much for coming on today.

Thank you so much for having me. I'm grateful to be here. Awesome.

And I'm very excited to talk about your topic because I think this is just so beneficial and could be so awesome for DSOs. So let's get started.  So tell us a little bit about what exactly myofunctional therapy is and how does that benefit hygienists? 

So myofunctional therapy, you'd be surprised to know is a century old practice. Now it's a modality that originated in dentistry. So you may have heard of, One of the people who were involved, Edward Engel,  Engel's classification system, he was very involved in malocclusion and gave it a classification, but he was also very interested and invested in why was that even occurring?

Like, how does malocclusion occur? Is it genetic? Is it diet? Is it like, what happens that throws people off and what creates these different malocclusions? He had a student, Alfred Rogers, who really took that education, that study, that mastery to the next level, and really discovered that it's the soft tissue pressures, both internally with the tongue and externally with the lips and the cheeks, that really do create a persistent influence in how the occlusion really lines up.

And so from that muscular training, somebody termed it myofunctional therapy and boom, by 1918, there were over 50. 50 articles on the topic and how muscular training and soft tissue influence have such an impact on orthodontics and where everything stands. So myofunctional therapy is really  in the simplest way possible.

It's like, Having a personal trainer for all the muscles below the eyes, but above the shoulders, because we're really just strengthening and engaging and really helping to enrich the function of oral facial musculature.  And so that's myofunctional therapy, but how does it benefit hygienists? Because it's primarily hygienists and speech language pathologists that practice myofunctional therapy.

So hygienists are really key for this because We are so in tune already with oral function, whether we know it or not, like when you're in there and you're feeling the pressures of the tongue or you're doing an extra oral or intraoral exam and you're feeling around, you're feeling muscles, you know what tough tissue feels like we are the specialist in oral function.

And so I think it's a really, really important thing. Great lateral move for a lot of hygienists to kind of take the next step into mastering oral facial function in addition to what we already know and how we're already using it. But just in a more You know, in tune way. 

Yeah. Yeah. And I know as a professional, I have heard of that. But what about the general public? Are people aware that this is a thing? Or it a good, just a kept secret between us professionals?

great question. Sometimes it feels like on both ends, it's a secret to the public and the secret to some professionals. I run into some dental people who are like my, Oh, what?  And so it's a great question. I think my functional therapy is. on the rise. So a lot of people have heard of a lot of different things such as mewing.

Mewing is really like a dialed back version of myofunctional therapy. When you think of people who are doing these jaw exercises or face yoga, which some people may have seen on the Kardashians, all of that is a derivative of myofunctional therapy. So a lot of people have heard of  Some of the concepts of myofunctional therapy, but they're not exactly aware that it is myofunctional therapy.

However, I think with this wonderful movement we have with Gen Z and all of social media and how everybody is into holistic alternative outcomes, I think that's the way that everybody's going. I'm starting to see more and more people just.  Spontaneously find me as opposed to what used to be primarily referrals from dental and medical providers.

So public awareness is on the rise. 

Yeah. And I've heard you talk about airway in the past. And, um,  you said that  ideal for the dental clinician Because of our workspace. And what do you mean by that? Like, because of what we know about the mouth or explain that just a little

Yeah, that's perfect. I say that a lot. This is our workspace. Airway is dental. So when I say that, I'm really speaking about anytime you've ever asked a patient. So if you are a dental provider, you've ever asked a patient to open their mouth, uh, you are looking right into their airway and you're getting so many signs and symptoms and you have maybe no idea that really you're looking at all you're looking at.

So if we think about just our workspace.  Think of maxilla. So you look at someone's palate. If you see a palate that is narrow, that's vaulted, you're really looking at our palate is actually the floor of the nose. So while it's the roof of the mouth, it's the floor of the nose. So you have to imagine that if they don't have that big, broad,  what we can call normal arch, what they have is narrow and vaulted.

What do you think that nasal space looks like?  It's probably really narrow up there too, and that creates difficulty for them. So you're already looking at the nasal part of the airway. Then if you go and you look into the back of their throat, so you're trying to look behind their tongue, and sometimes you can't see in their throat, you can't visualize the tonsils, you don't see the uvula, it just looks like one long continuous soft palate and then just tongue, that has to give you a good insight as well too, because that's the oropharynx, and that is our throat.

oral airway. If you're having a difficulty in trying to visualize and see that, they're having difficulty trying to move air between that. And so that's a great indicator. If you're looking at their mandible, and you notice that their mandible is recessed or retreated, mandibles. You have to look at the mandible as the anterior and the lateral borders of the upper respiratory tract.

If that mandible is pushed back into that,  you're already seeing an impingement on the airway. So in three spaces that all dental providers are always looking at, we're always maxilla, the oral pharynx, and the mandible. We are key for all of the airway space and for identifying these things for patients.

So that's what I mean when I say that this is our domain. 

Yeah, airway is just huge right now. And I think they're finding out so much more about breathing in general. I've heard so much about breathing recently that it's amazing. It's just what you're doing. So that's so, so inspiring.  So, um, what are some of the common oral health or systemic issues that MIO addresses? And how does this align with the goals of a 

So oral health wise, it's always going to align with CSOs when you're looking at periodontal  health. I know we talk a lot in dentistry about how there's a high prevalence of periodontal disease. Periodontal disease we talk about as an industry. from a biochemical component. We talk about oral hygiene, we talk about salivary component, we talk about all of the biochemistry that's involved that can help to break down the periodontium.

But periodontal disease also has a biomechanical  component as well. Your patients who brox, who grinds, who, you know, have chewing habits that they really need to stop because they're over chewing, they're creating excess occlusal forces that are really degrading down our periodontium and create vertical bony defects.

Now you pair that with the biochemical component and those vertical bony defects, the gum irritation and the inflammation that's present there that creates a wonderful opportunistic space for anaerobic bacteria. And then now, yes, we have it. We have periodontal disease there, right? So if we get that patient back on track with oral hygiene, we do what we do, whether we're doing SRP or sending them to a periodontal specialist, if we've never addressed the biomechanical component, and so that's All of their function or dysfunction with those parafunctional habits that contribute to the breakdown of the periodontium.

That is now going to leave us with a person who's in our chair telling us they're using their brush, they're brushing correctly, they're doing the flossing, they're doing all the things. But you have persistent  periodontal degradation. We don't want that. So we have to start addressing that biomechanical component.

That's a big, big thing. So periodontal disease is my, my biggest one. But on top of that, those parafunctional habits, that's a part of oral health as well. carries, that's a part of oral health. We have the mouth breathers who are more prone to having higher incidence of parafunctional habits. And so these mouth breathers are losing their saliva, that's creating a more opportunistic environment as well for a lot of bacteria. 

Helping to contribute to caries and so forth dry mouth, and we don't want any of that So it's really important on that end from oral health that we start to address the dysfunction That's present in so many people that we see but on top of that systemic wise we know that there is a oral systemic connection.

And I know a lot of people get tired of talking about the oral systemic connection, but it's incredibly important because the body's all connected, right? I know our insurance is like to tell us that our body, our mouth and our eyes are entirely different places, but  it's all connected. And so everything that digestion starts in the mouth, everything that happens in the mouth is going downward.

So we have a lot of people who have incidents of, uh, acid reflux, GERD, um, indigestion, irritable bowel syndrome, very much connected to mouth breathing, oral dysfunction. We can help that. Um, anxiety, the biggest thing with anxiety, I don't think a lot of people think enough about this connection, but when you have somebody who is experiencing anxiety, the very first thing that a therapist will do is we'll teach them Breathing exercises, breathing and anxiety have always been linked for a long time.

Mouth breathers have a higher incidence of having diagnosed anxiety. So dealing with a lot of these things that we see in our chairs every day, we see on our patient forms all the time. It's so far beyond just the them breathing and the sleep. And I think that's where everybody likes to focus on. It can deal a good bit with their cardiac health, their digestion, their mental health, their periodontal health and their overall, you know, carries and wellness.

And so there's a lot of good focus there that DSOs should be really involved in because we're seeing these people. every single day. 

Yeah, and there's a lot of anxiety in, in, in the general population now. Mental health is such a thing. I never even thought about that. That is really, that's really great. I, I, I think that's really amazing. Thank you for bringing that up.  So what makes the DSO environment suitable? or challenging for implementing a MIO program.

How could, how can they do that?

So the D. S. O. Environment is really suitable for myofunctional therapy because we've just talked about how we're seeing all these people all the time. But the D. S. O. Space is actually growing and leaps and bounds. And the A. D. A. Last year said that there's about 15 percent of dentists who are involved with a D.

S. O. That's a good portion of people who were in our workspace. We need to be looking at this space. stuff. It has to be something that we're targeting and working towards. Um, I think what makes DSOs really suitable is that if you have an appropriate system and workflow, you can really get Myo done on a mass scale.

And so that's what makes it really suitable is that it's wonderful to replicate and to scale. And then it can really help to establish that competitive advantage because there aren't a lot of DSOs or transcript. You know, different practices that are doing myofunctional therapy that are implementing it well.

And a lot of people are asking for this. So in the last National Health Institute survey in 2022,  1 in 3 people are looking for their medical and dental providers to have more integrative health services. And so we want more of these natural. solutions to these common problems that people are having, and that really differentiates it.

What makes it more challenging is that there are multiple offices, multiple practices, different personalities. And so it's always important that, you know, we're able to segment it, to split it. start. And then from there we can kind of scale it up. And I'm sure we'll talk about that in a little bit. But that way we can keep that same high quality standard of care and make sure that everybody is achieving the results that they want and the profitability that they're looking for to. 

Yeah, so what kind of steps would you take in introducing the MIO into a practice and ensuring that it's successful?

Yeah. Okay. So we started to chat about this just a little bit. segmentation is incredibly important. And so that's my first step. I always want to start small. And so you want to take your most likely your most urban, your most forward thinking your best demographic that you can assess, and you want to start there.

So whether that's one office in a smaller DSO or it's a region in a larger DSO, you're gonna start small. small, and you're going to have two leads that are going to implement the myofunctional therapy. One from like a clinical standpoint, who's going to be your main point person who is actually doing the myofunctional therapy, and to somebody who's going to be on the team and and who's really going to make sure that everybody's able to talk about it to assess and to adequately point people to where they need to go and where they need to be.

And so we educate and we definitely try to get both of those people on board. And then we start to establish these really good focal points. So my second step is to really establish those points of Where we're going to narrow into Myofunctional therapy can do a lot of different things. We can focus in on sleep.

We can focus on digestion We can focus on mental health. We can focus on periodontal disease. You got to pick a couple. Okay, just pick two So if you want to focus let's say on tmd And sleep then you can focus on tmd and sleep and you'll roll out a sleep Small case program where now we're assessing for exactly that TMD or sleep for Mayo.

Not that you're going to disregard all the other stuff, but that can come in later. Once we have our program refined, you want to optimize, which is going to be the third step. And so as you start to roll out, you're going to review, you're going to revise, and the workflow is going to change. Your system is going to change and you're really going to get it to be fine tuned.

And then you're going to. You can transfer all of that out so you'll be able to transfer that out over multiple locations and start to slowly implement and get it all in. That way we're creating that consistent environment so that if somebody moves, so let's say they move from one side of town to the other side of town and now they have an entirely different practice within your, your group, they get the same consistent quality of care in each office. 

Yeah, I love that. So do you have any training or resources that you can offer to DSOs to get them started in this process?

Absolutely. So with my company, MyoMerge, I do consulting and coaching and help to get it into practices. On our website, myomerge. com, I've got a wonderful resource. It's the DSO guide to the three P's, people, patients, profits, where it really talks about how myofunctional therapy can be leveraged to help solve issues that are typically present in a lot of those three P's, and how you can solve them. 

out and implement now. It's always challenging. And so that's why I'm there with the consulting and the coaching. And so reaching out to me through the website to is always an option so that we can get everything planned out custom to that specific off. 

And so what are the key trends or the innovations that you're seeing in MILE that are going to be coming out that DSOs should probably prepare for?

Ooh, there's so much coming along the horizon. I think a lot of segmentation. So how I just explained us segmenting to like reach a specific target. Myofunctional therapy has always been a very broad scale where it would be like, okay, we just do the bio and it can cover all these various spaces. But from what the research is pointing to having more targeted programs and segmentation is really going to be what's coming up in the future.

Also the ability to do a lot more remotely. And so you can have maybe one point person. for multiple practices. That way, everybody is able to be seen. And so there's a lot going on in my own with technology. And I think with a I can only get better and better. But that segmentation and tele health services are definitely the way to go. 

Well, Karese, this is so exciting and you are amazing today and I'm so glad you're getting this information out there because I think it's so important and we all need to get on this with the airway and the breathing. So, um,  If our audience would like to get a hold of you,  do they do that?

Yeah, so I am always available online. Feel free to reach out at any point in time on social media. I am on Instagram, Facebook, and TikTok  at themyospot, T H E M Y O S P O T. Or you could also reach me online, myomerge.  com. I'm always available for free meetings, and then we can chat from there. 

Well, thank you so much for coming on today. This has been great.

Thank you for having me!