EP #162 What Orofacial Myofunctional Therapy Does For Breathing Sleep And Teeth

Mouth breathing can look harmless until you connect it to snoring, restless sleep, orthodontic relapse, and the daily grind of never feeling fully rested. We sit down with Angela Richwine from Renew Myo (formerly Central Virginia OMT) in Fredericksburg, VA to talk about orofacial myofunctional therapy and why the tongue, lips, and facial muscles can shape far more than a smile. If you’ve ever wondered why braces “don’t stick,” why a child sleeps like they’re fighting the sheets, or why snoring shows up out of nowhere, this conversation gives you a new lens.

Angela breaks down the basics in plain language: the goal is training and retraining the muscles of the mouth and face so the tongue can rest on the palate, the lips can stay closed at rest, and nasal breathing can become the default. We talk through the signs parents and caregivers can spot without any equipment, including open-mouth posture, picky or noisy chewing, frequent burping from swallowing air, attention issues, bedwetting, and speech clues that may signal tongue function problems. She also explains tethered oral tissues like tongue ties and why “they can stick their tongue out” is not a real assessment.

One of the most powerful moments is a child case story where sleep and bedwetting improve within months through myofunctional therapy combined with the right referrals, including ENT evaluation and orthodontic palatal expansion. We also dig into common misconceptions, what a thorough evaluation looks like, and how Renew Myo coordinates care with dentists, orthodontists, speech-language pathologists, and other providers, sometimes using CBCT imaging to better understand airway and jaw health.

Follow Renew Myo on Instagram and Facebook (search Renew Myo or Central Virginia OMT), check out the self-quiz at www.centralvirginiaomt.com, or call 540-369-6044. If this helped you connect the dots, subscribe, share this with a friend, and leave a review so more families can find the support they need.

Angela Richwine

Renew Myo 

centralvirginiaomt.com

connect@centralvirginiaomt.com

540-369-6044

Transcript

Welcome And Meet Angela

Speaker 0:01

This is the Fredericksburg Neighbors Podcast, the place where local businesses and neighbors come together. Here's your host, Dori Stewart.

Speaker 2 0:13

Welcome back to another episode of the FXBG Neighbors Podcast, where we share the stories of our favorite local bird. We've got Angela Richwine. She is with Renew Myo, formerly Central Virginia OMT. Angela, welcome to the podcast.

Speaker 1 0:34

Thank you so much, Dory, for having me here today. I feel honored to be able to represent Fredericksburg and share what we have to offer to our community and our families.

Speaker 2 0:46

Amazing. Well, I'm looking forward to learning all about

What Myofunctional Therapy Really Is

Speaker 2 0:49

it. So let's start there. Share with us what is Renew Myo.

Speaker 1 0:53

Renew Myo, also known as formerly known as Central Virginia OMT. But you know, what's the OMT? What's this myo word that some people are hearing and reading about on social media pages? Myo is muscle, means muscle. And the the words right above my head that say orofacial, myo functional therapy. We kind of all know what therapy is. It's just the process of improvements of bodily functions. You know, we have movements, we have a physical therapist, occupational therapist, we have other therapy that can improve the overall health of an individual. Orofacial is the face right here, the whole head and neck, mostly starting in the mouth. So the oral cavity. Myo is muscle, and functional, of course, is the function of the muscle. So what I do is I train and retrain the facial muscles that help contribute to airway, breathing, orthodontic care, dental care, and really overall health. Because if you think about it, the mouth, it's the gateway to the body. And the tongue is made up of 16 muscles, believe it or not, it's an organ. Wow.

Speaker 2 2:10

Interesting.

Speaker 1 2:11

Right, right. So we have because of the tongue being able to help us eat, speak, chew, swallow, it's a very important uh contributing factor to our body.

Speaker 2 2:25

Interesting. Thank you for simplifying that for me and um putting that in very easy to understand terms. And so it

Her Story And The Aha Moment

Speaker 2 2:35

seems like such a um a very specialized uh area. I want to know what is your background and how did you get into this?

Speaker 1 2:46

My background is I have been a dental hygienist for over 30 years and I started off in orthodontics. Um it's been a wonderful, a wonderful journey that has brought me here today. What's interesting is I have a little bit of a lisp, a little bit, because I'm wearing a palatal expansion device right now that is fixed into my mouth. I'll keep it for in there for maybe a year, a year and a half. But getting to where I am now, fifth round of orthodontics. We shouldn't have to go through that many rounds of orthodontics, and we see a lot of relapse. So getting to where I am now, I've also had children who have had orthodontic relapse, who have had breathing problems. I was a mouth breather for so, so long. I was a thumbsucker. My teeth would connect in the back, but I had what was called an open bite. So my teeth wouldn't come together all the way, but yet they closed together in the back. This open bite was created by myofunctional disorders. And these disorders, there's just so many signs and symptoms to list all of them. But getting to this point was my my aha moment was in dental hygiene. We have to take in the healthcare curriculum or in health with healthcare licensure, we have to take continuing education units annually. And one of the courses that I took, uh, the presenter was a myofunctional therapist. I had never heard of this term before, and this was 20 years ago. And um, she was naming off these myofunctional disorders, and I had just had my second child. Everything, I thought I was the only person in the room. She was talking directly to me. She was listing all sorts of the simp the symptomatology to where my child checked every single thing that she was talking about. So, of course, I had to dive deeper and deeper. And marry being married into the military, we continued to move. The internet was just not great with information. So little by little I was just reading about it, reading about it until I was able to really dive deep into myofunctional therapy. And since, let's see, six years ago, I stepped out of hygiene, dental hygiene, and opened up my practice to be able to help moms and adult parents and adults help their children and themselves and other family members with maybe say mouth breathing, nasal congestion, orthodontic relapse, snoring, sleep apnea. We have children and adults who still suck their thumbs. We have uh children who are bed wetting, but the biggest thing that parents can really look for is mouth breathing, snoring, um, attention issues. Um, and that's really where I kind of skipped over a little bit, and I'll go back to your question. But what got me here is really my family history, myself and then my own children. And I just wanted to dive in deeper. Sadly, it's not taught in healthcare curriculum until recently. We have so many more volunteers like myself who go into the university setting. I go down to VCU and virtually for maybe an hour to two hours on Zoom teaching dental hygiene students and dentists on recognizing all of these signs and symptoms that can be found in the dental office because we see our patients at least twice per year. So dentists have and dental hygienists and assistants have this front door access of helping these individuals, but what is it that they're looking for?

Speaker 2 6:42

Yeah, so it's so interesting and fascinating that all of the things that you can help. So walk me through a little bit deeper

Signs Parents Can Spot Early

Speaker 2 6:53

there. So if if someone uh has their child at an orthodontist, a dentist, and maybe they are still having some issues, what are some signs that that a parent could um could tell, okay, maybe I need to go see a myofunctional therapist, maybe I need to take it a step further.

Speaker 1 7:17

Great question. Gosh, there's so many. And I I think a big takeaway for parents listening today, um, or friends who may have seen other children, maybe teachers even, is mouth breathing. Really just a lot of the open mouth posture, you know. Um, bed wedding, I had mentioned that. Let's think about eating. What about eating? We have to watch to see if there's open mouth posture. And you know how some people don't like listening to others chewing with their mouth open? That's a red flag. So anything that you see or hear, those are red flags when it comes to eating, or maybe gulping, or maybe a lot of burping. If there's a lot of gas in the body, they're probably swallowing a lot of air. And that's a disorder, that's part of the disorders as well. Now, let's get into a little bit of that speech. I am not a speech and language pathologist, however, what we look for during our assessments is the movement and the function of the tongue. The movement and the function of the tongue also includes speech. So is that tongue able to articulate and say all of the sounds in the American alphabet uh the way that they should, and maybe not sound like you know, somebody who's British? Or maybe we have someone who has a Boston accent and they want to pack the ka. However, in the you know, English language, the American English language, we enunciate the R. And so if you hear somebody who just cannot say that R sound, then that could be some sort of disorder as well. So, because of that, myofunctional therapy can help with the function of the tongue in the movement and placement. Um, but there could also be other factors, like there could be a tethered oral tissue, also known as a tongue tie. So we do check for tongue ties. There are also lip ties and also buckle ties, which are your cheek ties. So we do check for those. I check for those. Myofunctional therapy is part of checking the entire oral cavity, the mouth, for anything that could be tethered or causing this malfunction of the tongue.

Speaker 2 9:48

So interesting.

A Child’s Sleep Turnaround

Speaker 2 9:49

Do you have a case study that you can share with us of you know a transformation that you have witnessed?

Speaker 1 9:58

I've seen so many. Um, so I I did think about this and I really wanted to share my screen. However, um, I know that our time is limited, so I'll tell you about a case instead of showing you one. How's that? Is that okay? Yeah.

unknown 10:12

Okay.

Speaker 1 10:13

Alrighty. So I am going to use a four-year-old girl, and let's just call her Angela, just because that's my name, and we'll just call her Angela. So mom brings Angela in and uh presents to us that she is not sleeping at night. She has tossing and turning, the sheets are all over the place. They're snoring. She wakes up multiple times, goes in to wake up. Mom and dad, I have to use the bathroom. Can I crawl in bed with you? I'm thirsty. Um, I had a nightmare. Or maybe the sibling is sharing the bedroom with Angela and um is being woken up because they're screaming or they're talking in their sleep, or there's just unsettled sleep. So mom wants to know, Angela, can you, or you know, therapist, can you please help? Yes. Let me do an assessment. Let me check the mouth, let me check the tissues. I also look at the posture because the ankles, the shoulders, the hips, the head turn, the head shape, the face shape, the eye set, the way that the muscles work in the whole face. These are the things that I assess during my two-hour evaluation that these the assessment that these parents and children receive when they come in to see me. I look at the whole body. From there, I like to see do they have a bite that's just not right? Is the tongue not resting in the palate? Which here we all are gonna hear this today. The tongue should comfortably rest in the palate at rest, not in the floor of the mouth, not low, not forward. The entire tongue should be resting in and against the palate with your lips closed, nasal breathing. Those are the goals of myofunctional therapy. But back to the case. So, mom started myofunctional therapy with her daughter with me, and within three months, there was no more bed wetting. She was sleeping through the night. We had her checked um at the ENT for tons and large tonsils and adenoids. And then I also had the recommendation for her to go see an orthodontist for palatal expansion because her baby teeth were all touching. Typically, what we'd like to see in a mouthful of baby teeth is spacing. We want to be able to spit it, excuse me, I can't speak with my expander in. We want to be able to fit between the spaces, a nickel or a dime between each and every baby tooth. Because think about it, the baby tooth is so teeny tiny, it's so small. Now think about your adult tooth. Try fitting all of those adult teeth where those little baby teeth are fitting. If there's no space between those baby teeth, there's really no room for those adult teeth to grow in. So that's also a big sign that we can notice in the dental chair, but parents can also notice these things. So this little patient came in and we were able to get her into orthodontics. We were able to put a palatal expander in her mouth, which is what I have in my mouth right now. And we were able to get her breathing again. And that's just an incredible journey for this little girl, for the moms. It's life-changing, completely life-changing. She's now seven and a half years old, and I see her on every six to 12 month recall appointments. And uh, by the time she's an adult and out of college, I better get an invitation to her wedding. Such a great family. That's that's that's kind of what we see. That is what we see a lot of in the practice, but also with adults snoring. Um, it's a really, really big deal. But why? Why are we snoring? It's that airway collapse. So I'm able to assess what's happening inside of the airway with a collaborative team who of dentists, myofunctional therapists, speech and language pathologists, physical therapists, occupational therapists, orthodontists, ENTs, physical therapists. The list goes on, but we really need collaboration from providers, healthcare providers who are fully aware of what airway is, means, does. And it's not just straightening teeth. It's about expanding and changing that skeletal position in order for the entire body to just settle right into place. That's it's pretty incredible that the transformations that we see every day.

Speaker 2 14:45

I bet you just lie out of bed in the morning, and your job is so exciting. You're you're changing lives, but you're also solving mysteries that people probably have been so frustrated, and they're probably just so grateful to meet you that you're able to help them. So I just love what you do, and I can tell that you love what you do.

Speaker 1 15:10

I do, I really do. I'm so thrilled that I was able to have this journey and to be where I am now and to be able to share this with our community and just to be able to change lives for the better.

Myths About Tongue Ties

Speaker 2 15:25

What are some myths or misconceptions that you hear about myofunctional therapy? Probably a lot.

Speaker 1 15:33

Yes, I'll touch on, I'll touch on um one in particular that tethered oral tissues are a fad. I hear that a lot. A fad. Um, really what it comes down to is social media. Social media. We have such great access to care, to knowledge. Dr. Google is just incredible to so many families. And you know, we call it Dr. Google because that's where it's not easy to get an appointment with a physician. It's just not easy. And then what's their education on airway? And what's their education to be able to help you? I have been told as a mom multiple times with all three of my children, let's wait and see, let's wait and see. Well, by the time it was the time to get braces on my children, they were teenagers, young teenagers. And by that time, the structure has already grown and settled into place. Seven to 11 years old, depending on the growth of the individual, that's considered geriatrics and orthodontics. Why? Because of the bony growth and the cranial sutures and where everything settles into place. So traditional orthodontics were straightening teeth. And I mean, I know I had it. I also had relapse. And because of that, that's why middle-aged woman, I'm now in a palatal, an adult palatal expander. Should this have been taken care of as when I was younger? Yes, but the knowledge just wasn't there. The knowledge is here now. So the myth about tethered oral tissues, tongue ties, it's inaccurate. It's just really what social media is able to provide in research, clinical data, everything that's being presented from professionals in the field, experts in the field. And it's not just within the United States. Brazil is the only country now, currently, that checks for tethered oral tissues, a full assessment at birth. Really? So we do have providers here in the United States, and we do have some local providers as well who will check and assess for tethered oral tissues at a young age, but it's really not at birth. So the misconception that we have in the birthing centers, um, i.e., the hospital setting, is if a baby can stick their tongue out of the mouth, then they don't have any tethered oral tissue. They don't have a tongue tie. Well, that's incorrect because I will share with you that my middle child can stick his tongue all the way out of his mouth up to his nose on both sides of his nostrils and touch it. However, when I do one of my assessments to check for a tethered oral tissue or also a tongue tie, he is tethered. He cannot lift his tongue up and he cannot stick it out of his mouth. So, providers today, unless you are taking continuing education courses that show and teach these method, the methodology behind checking and assessing the airway and these tethered oral tissues, then we may miss it. And that's just that's just common. The myth is that tethered oral tissues are not a fad. It's just that the information is now becoming more readily available for for everybody to just, if you have a laptop or a computer or a cell phone, you have access to the internet, you have access to information. And these social media pages, moms, crunchy mom groups, local mom groups, and all of these other um tethered or world tissue or airway groups, they're open for the public. And this the public wants to know they're hungry for why their health is just not optimal. Why can't I sleep? Why can't I eat? Why is my kid spitting out their food when they're chewing their food? Why are they pouching the foods in their cheek like a little chipmunk? Why are they mouth breathing? Why are they burping? So that's a very big misconception is that tethered oral tissues are a fad.

Speaker 2 19:49

Yeah. Thank you for clearing that up for us. So interesting.

How Renew Myo Advocates For Patients

Speaker 2 19:52

What is something that you wish the listeners knew about Renew Myo?

Speaker 1 20:00

That I am your advocate. I am going to reach out to as many providers as I need to get you into the right hands. And it might not be a local provider. I do refer out of our area, depending on the case. Everything is just case dependent, and it also depends on the expertise of the provider that I would like for you to be in the hands of. So it's very important to me to be able to give every provider, every person who walks through my door, every family member that opportunity to be able to achieve optimal health. Now, I will say that with myofunctional therapy, we may not start it right away. We may need to get you a consult for um what's called a CBCT scan. Not it's an x-ray, it's a type of x-ray, and it circles around your head. And we're able to see your nasal cavity, we're able to see where the teeth rest in the mouth, we're able to see your TMJ, which is your jaw joint. The J stands for joint. So if you ever have pain or discomfort, you don't have TMJ. What you have is TMJ D. So it's temporomandibular joint disorder. So that is the J stands for joint, but the D is the disorder. Anyhow, um, we may need to send you for a consultation for expansion. We may need to send you for a consultation to check the tonsils and adenous or something else. Uh so myofunctional therapy, you come in for your assessment, and I'm kind of in the center of all the healthcare providers because then I'll be able to refer you out to the right person. If I don't see you or the patient for six months, that's okay because I asked them to send me updates on their treatment, and that way I am fully aware, I can. remain up to date that way I can also be in touch with their provider, which I am on text message basis with all of my referring providers because it's that important to me to know that I have communication with them so that we can collaborate on the cases. It's funny because my uh friends tell me that I have no social life. And I will say that I don't have a social life because I'm always working. I'm always on the phone. I'm always texting and communicating with providers and my patients that it's that important to me. So it's um it is busy. I do have a family life and I do turn off my phone and I do step away. But it's also important to me to be able to check in to my devices and just make sure that you know some patients have six children and a husband on deployment. So they don't have time until after all the kids go to bed. And that's the only time that they can communicate with me. So I alternate um evenings early early mornings and I do check my messages and I am able to respond to them as needed. But um I really really like to say that at Renew Myo formerly Central Virginia OMT that you're you're you're gonna get a real a real person. Jen is going to answer your calls and talk to you and listen to you. And she relays all of your information to me before you even come to see me. Jen and I talk about all of our patients she she speaks with on the phone and um we have meetings often very very frequently during the day because it's important to her as well which I'm so glad that she's on my team. And we also have uh three other myofunctional therapists on our team as well. One is a speech and language pathologist uh who will be right I'm excited um and she's gonna be starting in June and then we have a hygienist who is going to be working up in the northern Virginia area and then we have another hygienist who is in Alabama. She sees the majority of our virtual clients um however I see virtual and in person.

Speaker 2 24:11

Nice nice well I just love the care and the thought that you have put into your patient experience and I can tell that even though uh you say you don't have a social life you love what you do and so it it it shows when you're talking about it.

How To Connect And Closing

Speaker 2 24:29

For sure.

Speaker 1 24:30

Thank you.

Speaker 2 24:31

Yeah so if the listeners want to connect with you if they want to learn more from you where can they find you?

Speaker 1 24:37

Oh thank you for asking I'll go ahead and just say my phone number here um if anybody is able to write it down great otherwise you can find me on social media but my phone number is 5403696044. Social media you can find me at Renew Myo I am on Instagram and on Facebook I'm also on LinkedIn but I find that you can receive so much education so much more information on the Instagram and the Facebook page now I will also say that my um my journey with this Marpe device this palatal expander in my mouth I am recording every week or maybe every couple of days my journey so if somebody has interest in learning more about palatal expansion and creating more space in the mouth then you can follow along on my short videos that I have on social media on Instagram under the reels part. So it's uh renew myo but if you type in central virginia omt because that's still my I'm still going by that name as well but renew myo um then you'll find me on there as well my website uh we are in the process of changing it over that's how new this transition is so it's www.central virginiaomt.com and we also have a self quiz on the website so if anybody wants to take a self quiz on there have fun with it has some great questions on there for self-awareness nice I love that Angela thank you so much for joining me on the podcast today and sharing Renew Myo with us thank you so much Dori for having me I enjoyed this thank you thank you for listening to the Fredericksburg Neighbors podcast to nominate your favorite local businesses to be featured on the show go to fxbg neighborspodcast dot com