MEMORANDUM (very important)To: Physicians, Dentists, Specialists and Staff
Specialized speech therapy addressing oral motor skills (OMT) can be provided for patient problems of tongue and lip rest postures, speech disorders and digit habits, and also as an ideal alternate treatment for appliance therapy. However, oral conditions that crowd the tongue, prevent adequate nasal respiration or prohibit a closed lip posture can prevent successful therapy or appliance use.
The guidelines below are intended to aid you in instances where a patient referral for a Speech-Language and Oral Muscle evaluation and services should be deferred to a later time. I would be happy to provide consultation for any patient where you would wish my opinion for a specific condition or problem.
SUGGESTED GUIDELINES FOR DEFERRING REFERRALS FOR
SPECIALIZED SPEECH & ORAL MOTOR SERVICES
- Patient cannot achieve lip closure without effort due to severe open bite, maxillary protrusion or unresolved nasal airway obstruction.
- Patient has severe posterior crossbite, deep anterior overbite or underbite, or lingually-tipped anterior teeth. Stable molar contacts are preferred for the initiation of myofunctional services.
- Patient is missing maxillary incisors.
- Patient has had recent oral/nasal surgery, e.g. T&A, maxillary impaction for vertical maxillary excess, frenectomy, mandibular repositioning. I prefer to wait for 3-6 months for healing and to allow for spontaneous adjustments.
- Patient has recently eliminated an adverse oral habit. I prefer to wait for 6 months to determine whether additional treatment is indicated.
- Patient has an exceptionally high, narrow palate where rapid palatal expansion (RPE) is involved. Prior to RPE treatment, I can work on tongue placement and lip closure to facilitate the patient’s adaptation to RPE treatment.
- Patient has true macroglossia i.e., due to a space-occupying mass in the tongue; however, forward tongue rest postures with no tongue pathology or airway interference are appropriate referral situations.
- Patient has a short lingual frenum that distorts the dental arch and will require surgery. However, many patients with a restricted lingual frenum can respond to the adaptation program I provide.
- Patient with a skeletal jaw deformity and growth pattern.
- Patient who cannot or will not cooperate in treatment and follow directions and assignments; lack of motivation or low mental ability.
- Patient with neuromuscular disorder that interferes with speech production.
- Patient who is a candidate for dental/orthodontic procedure involving appliance which will extend across the palate and can interfere with tongue functions. The exception is an appliance that can be constructed with a reminder groove for the tongue at the incisal papilla area. (I am available for consultation with such patients on a case-by-case basis.)