# Episode 1 — Myofunctional Therapy and the View from the Hygiene Chair **Length target:** 12–14 minutes (~2,300 words) **Publish date:** Launch day **Keywords (show notes / SEO):** myofunctional therapy, dental hygienist, airway, tongue posture, mouth breathing, RDH career --- ## Show notes (copy/paste into Buzzsprout) In the very first episode of Optimized Airway, Kirsten shares the view from the hygiene chair — one seat among many on a dental and airway team — and why the time, frequency, and trust built into that seat make it such a useful place to notice early airway and myofunctional signs. You'll learn what myofunctional therapy actually is (and what it isn't), how it fits alongside the work of dentists, orthodontists, ENTs, and SLPs, and three patient signs worth watching for at your very next appointment. **In this episode:** - (00:00) Why I started this podcast - (02:15) What myofunctional therapy actually is - (05:40) What the hygiene chair sees best - (08:20) Three signs you're already seeing every day - (11:30) Your first homework assignment **Resources mentioned:** - 1-Hour CE Course for Hygienists → optimizedairway.com/ce-course (code PODCAST20 for 20% off) - Free airway screening checklist → optimizedairway.com (footer signup) --- ## Script Hi, and welcome to the very first episode of Optimized Airway. I'm Kirsten Trevisonn, your host — a registered dental hygienist (hy-JEE-nist), a certified orofacial myologist, and the founder of Optimized Airway Education. Whoever's listening right now — hygienist, dentist, orthodontist, assistant, speech-language pathologist, ENT, sleep physician, or someone building the products we all use — I'm glad you're here. [BREATH] I want to start this show the way I'd start a conversation with a colleague at a CE event: by telling you why this topic matters to me, and what I've learned from the seat I sit in — the hygiene chair. So let's get into it. [BREATH] A few years into my career, I started noticing a pattern. Patients would come in for their recall — clean home care, decent tissue, nothing flagged on paper — and something would still feel worth a second look. Mouth breathing in the chair. A tongue that scalloped against the lower teeth. Kids with dark circles under their eyes whose parents would mention, almost in passing, "Oh yeah, she snores, but the pediatrician says it's fine." I started wondering who was best placed to say something about that. And then it hit me: I see this patient twice a year, every year, for years. That's a pretty good vantage point. So I decided to start paying closer attention to what mine was showing me. That question is what eventually pulled me into myofunctional (MY-oh-funk-shun-ul) therapy. It's the reason this podcast exists. [BREATH] I want to tell you about the moment it clicked for me — a moment I still think of as my own learning curve, not anyone else's failure. I had a nine-year-old patient — I'll call her Emma — who'd been coming to our office since she was three. Every recall, I noticed the same things: chronic mouth breathing, a narrow palate, chapped lips year-round, and a mom who mentioned, appointment after appointment, that Emma still wasn't sleeping through the night. For six years, I didn't say anything, because I hadn't yet connected those dots myself. Nobody had handed me that framework in school — it's genuinely newer than a lot of our training. So I kept it to myself, not because I didn't care, but because I didn't yet know what I was looking at. The day I finally said to Emma's mom, "I think there might be something going on with the way Emma breathes at night, and I'd like to walk you through what I'm seeing" — she teared up. She'd asked her pediatrician about it more than once. This time, a few more dots got connected, and it happened to start in the hygiene chair. That's when I went and got trained. Not to replace anyone on Emma's care team — to add one more set of eyes to it. [BREATH] So let's define our terms, because "myofunctional therapy" gets used a lot of different ways. Myofunctional therapy is the neuromuscular re-education of the muscles of the face, mouth, and throat. In plain English: it's physical therapy for the tongue, lips, and surrounding muscles, retraining how they rest, how they swallow, and how they function during breathing and speech. It isn't a gadget, and it isn't the tongue exercises you might see on Instagram. It's a structured, evidence-based protocol — usually six to twelve months — addressing things like low tongue posture, open-mouth posture, tongue thrust swallow patterns, and the downstream effects of restricted airways and tongue ties. And it works as part of a team. A myofunctional therapist collaborates with orthodontists, airway-focused dentists, pediatric ENTs, sleep physicians, bodyworkers, and lactation consultants. Every one of those roles brings something the others don't have time or training to catch alone — that's the whole point of a team. There's a growing body of peer-reviewed research supporting myofunctional therapy for conditions like obstructive sleep apnea (AP-nee-uh), tongue thrust, and post-frenectomy (fren-ECK-tuh-mee) rehabilitation. Here's the part I think more hygienists would find exciting if they knew it: myo work is one of the most natural clinical extensions of dental hygiene there is. We already work in this anatomy every day. We already talk with patients about habits. We already build rapport over years of recall visits. It isn't a career pivot so much as a career expansion. [BREATH] So what does the hygiene chair specifically add to this picture? Every seat on a dental and airway team sees a different piece — here's the piece the hygiene chair tends to see well. Three reasons. **Reason one: time.** A hygiene appointment often runs 45 to 60 minutes. That's more uninterrupted time with a patient than most other providers in the chain get in one visit, and it's enough time to actually watch — how a patient breathes when they're not thinking about it, how the tongue rests between rinses, what a parent mentions offhand about snoring. **Reason two: frequency.** Most patients come back twice a year, for years. We watch kids grow up and adults age, which makes it easier to notice a pattern over time rather than in a single visit. Think about how many times you've seen the same patient — ten, fifteen, twenty visits. That's a longitudinal view worth something. **Reason three: trust.** Patients tell hygienists things that don't always come up with their physician. "She's still wetting the bed at nine." "He grinds his teeth so loud I can hear it from the hallway." "My husband snores so badly I sleep in the guest room half the week." Those are airway clues, and the hygiene chair often hears them first — maybe because of the repetition of the visits, or because we're not usually the ones delivering news about a cavity. Time, frequency, and trust. Not a replacement for anyone else's expertise — a genuinely useful complement to it. [BREATH] Alright, let's get practical, because I don't want you just nodding along — I want you to notice something different at your very next appointment. Here are three signs many of us are already seeing every day and might not yet be flagging. **Sign one: mouth breathing in the chair.** Not during rinsing — everyone breathes through their mouth then. I mean at rest, during your assessment or scaling. Habitually parted lips at rest can be worth noting as a possible sign of nasal obstruction or low tongue posture. A related clue: chronically dry or chapped lips, sometimes with a lower lip that looks a little puffy compared to the upper. **Sign two: tongue scalloping** — those small wavy indentations along the lateral borders of the tongue. It can relate to bruxism or clenching, but it's also often a sign of a tongue resting low in the mouth instead of up against the palate. A tongue that rests low isn't helping shape the palate or support the airway, and that pattern is often connected to snoring and disturbed sleep. **Sign three: forward head posture in the chair.** When you recline the patient, do they crane their head forward to swallow comfortably? Forward head posture can be the body's way of compensating for a compromised airway. Paired with rounded shoulders and an open-mouth rest posture, it's a postural pattern worth a second look. Mouth breathing, scalloping, forward head posture. You'll likely see at least one of these on your very next patient. [BREATH] Now, I know what some of you are thinking: "Kirsten, I have twelve minutes to scale, polish, and get this patient out the door — I don't have time to add an airway assessment on top of everything else." I hear you. I've been there. The goal here isn't to add twenty minutes to your appointment. It's to change what you notice in the ten seconds you're already using to greet your patient. This is a lens change, not extra work. Once you have the lens, you'll pick these things up in the time it takes to walk someone to your op. [BREATH] So here's your homework — because I'm a hygienist, and we love a checklist. On your next clinical day, try this: at the start of each appointment, take ten seconds to observe your patient's resting posture before you recline the chair. Lips together or apart? Tongue visible or tucked behind the teeth? Head over shoulders or jutted forward? Don't say anything yet. Don't try to fix anything or refer anyone. Just notice. Building that observation habit comes first — noticing before speaking up is what keeps this useful rather than overwhelming, for you and for the dentist you work alongside. Try that for one full clinical day. I'd love it if you'd DM me on Instagram at optmized_airway — that's optmized, no i after the t — and tell me what you noticed. I read every message, and I'm curious how many of you spot something on day one. Next week, in Episode 2, I'll walk through how to bring this into a real-world practice day — how to open the conversation with your dentist, how to think about the extra time, and how to talk with patients without sounding alarmist. And the week after, in Episode 3, we'll talk about what this work can do for you as a clinician — career growth, income, and feeling like the clinician you trained to be. [BREATH] One more thing before I let you go. If you're feeling that flutter right now — "wait, I've been seeing this for years and didn't have a name for it" — that's not a shortcoming. That's the moment a lot of us started. You're not late. You're right on time. If today's episode was useful, I'd love it if you'd follow the show wherever you're listening — it helps other clinicians find it. Reviews help too, so if you have thirty seconds, I'd be grateful. And if you want to go deeper, my 1-Hour CE Course at optimizedairway.com/ce-course covers a full airway screening framework, parent conversation scripts, and a 90-second screening you can use at any recall. Use code PODCAST20 for 20% off, just for podcast listeners. I'm Kirsten Trevisonn, and this has been Optimized Airway. I'll see you back here next Tuesday. Take care of yourselves out there.