| 1. To rearrange overall body posture |
Carrying out an exercise to stretch the cervical muscles*. |
- Instruct patients to perform pendulum movements with their head four times, starting twice from right to left, and twice from left to right. |
| Exercise to stretch the lateral spine muscles * |
- Instruct patients to stretch the arms up and lower the trunk towards the feet. Perform three times, keeping their arms extended for 15 seconds. |
| Awareness and modification of body posture**. |
- Ask patients to, with their eyes closed, perceive their body in relation to the posture. |
| - Ask patients to sit in front of a mirror and perform self-monitoring to modify and maintain their posture with the shoulders and head aligned, forming 90º angles between the trunk and hips, knees and feet. |
| 2. To raise awareness of respiratory function. |
Perception of the performed breathing pattern*
|
- Ask patients to perform self-monitoring in relation to their breathing pattern, perceiving the use or not of the mouth as a way of breathing, as well as the movement of the diaphragm and thoracic regions during function. |
| Awareness of normal/adequate physiological pattern**. |
- Show patients, through videos and images, the ideal breathing pattern. |
| 3. To perform nasal cleaning. |
Application of saline solution in the nostrils**. |
- Insert 5 ml of saline into the patients’ nostrils, with the help of a syringe. Patients should have their head flexed backwards. Ask them to force the introduction of the liquid into their nasal cavity. After cleaning, ask them to blow their nose, alternating nostrils. |
| - Perform only one cleaning in each nostril, as well as the process of blowing their nose. |
| 4. To promote use of the nasal airway. |
Performing nasal inhalation and exhalation exercises**. |
- Ask patients to inhale air only through one nostril (occluding the other with a finger) and exhale the air through the previously occluded nostril, closing, with the finger, the nostril that was used to inhale the air. Perform it five times. |
| 5. To strengthen the muscles: orbicularis oris, buccinator, jaw elevators, intrinsic and extrinsic of the tongue. |
Performing orofacial myofunctional exercises**. |
- Perform counter-resistance exercises with a spatula in the three regions of the orbicularis oris of the lower and upper lips. Hold the spatula making a movement contrary to the muscle for 10 seconds, for three series. |
| - Perform counter-resistance exercises with a spatula in the middle bundle of the buccinator muscle, for 10 seconds, for three series. |
| - Carry out resistance exercises of the tongue against the palate, for 10 seconds, for three series. |
| - Perform mouth opening and closing exercises keeping the apex of the tongue in the region of the incisive papilla (three series of 10 movements). Then, perform digital counter-resistance against the lower premolars for 10 seconds, for three sets. |
| 6. To establish the nasal airway at rest. |
Nasal airway training**. |
- Ask patients to breathe only through the nose, initially, for 2 minutes, keeping the mandible elevated and anterior oral sealing (through lip occlusion or contact of some region of the tongue against the palate). During this time, patients read a text silently or watch a video. One minute per session should be added to the nasal breathing maintenance time, until reaching 5 minutes. |
| 7. To promote lower middle respiratory type. |
Respiratory and pneumophonoarticulatory training involving the emission of phones*. |
- Request inspiration and expiration while counting numbers, performed by the therapist in a rhythmic way. Each number counted corresponds to one second. |
| Training starts inspiration (nasal mode and lower middle type) at 4 seconds and expiration at 6; increasing in the next session by 6 seconds to the inhalation and exhalation by 9. The goal of this workout is to inhale in 7 seconds and exhale in 14 seconds. |
| - Ask patients to breathe in air (nasal mode and lower middle type) and perform oral expiration, without using reserve air. Perform it three times. |
| - Ask patients to breathe in air (nasal mode and lower middle type) and perform the sustained emission of the phoneme [s], without using reserve air. Perform it three times |
| - Ask patients to breathe in air (nasal mode and lower middle type) and perform the sustained emission of the phoneme [z], without using reserve air. Perform it three times. |
| - Ask patients to breathe in air (nasal mode and lower middle type) and perform the emission with the passage of loudness from the phone [s] and to the phone [z], without using reserve air. Perform it three times. |
| To monitor the increase in maximum phonation time, a stopwatch is used. As a goal, the normality time for adults is taken into account. For /s/, 15 to 25 seconds. For the other phonemes, 16 to 18 seconds. |
| 8. To promote pneumophonoarticulatory coordination. |
Training of pneumophonoarticulatory coordination involving the reading of sentences and texts*. |
- Ask patients to read short, medium and long sentences. |
| Ex.: Inhale- THIS IS JOHN- Exhale. |
| Ex.: Inhale- THIS IS JOÃO'S HOUSE- Exhale. |
| Ex.: Inspire - THIS IS THE GRAIN THAT WAS IN JOÃO'S HOUSE - Exhale. (PICOLOTTO, 1996). |
| - Ask patients to read a text, making the necessary pauses for inspiration, taking care not to use reserve air to avoid hyperfunction of the vocal muscles. Every time this exercise is carried out, a text different from the one proposed in another session is selected. |
| 9. To promote nasal breathing during masticatory function. |
Respiratory training during chewing**. |
- Offer patients their favorite cookie and request that chewing be performed using only the nasal cavity for breathing. Three portions of 2 cm each are offered. |
| 10. To promote coordination between breathing and swallowing functions. |
Respiratory training during the swallowing of solid and liquid foods**. |
- Ask patients to place a portion of food in their mouth while breathing through their nose, prepare the food for swallowing, pause in breathing, swallow the food and exhale after swallowing. Three portions of cookies, 2 cm each, are offered; 10 portions of 15 ml of water, fractionated into 5 ml by swallowing. |
Effectiveness of a myofunctional therapy program in the treatment of mouth breathing in patients with dental malocclusion: a pilot clinical trial
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