The importance of the dental profession in the uncharted waters of airway health is only now starting to be recognized by dentists and other integrative physicians. This exciting and forward thinking shift in dentistry will go down in history as a major driver for the integration of medical professionals with their dental counterparts. Dentists play a critical role in the diagnosis, treatment planning, and overall supervision of the patient’s oral health journey. Therefore, it makes sense that they have a foundational role in sleep disordered breathing and orofacial myofunctional disorders and therapy. There are many challenges you need to know about when it comes to oral myology as a dental modality.
What do dentists need to do?
Dentists need to build upon their current understanding of orofacial myofunctional disorders and how it correlates to the form and function of the mouth and associated structures. Educational seminars like The Breathe Institute’s Seminar, which is headed by Soroush Zaghi, MD can help the dentist further their education in this area of dentistry.
The dentist will need to then hire and train oral myologists also called myofunctional therapists to aid in the data collection, evaluation, therapy, and re-evaluation of pediatric and adult patients suffering from sleep disordered breathing and orofacial myofunctional disorders. As you may have gathered, this modality is called oral myology and the individual assisting the dentist is called an oral myologist.
Dentistry and dentists at the center of care.
It is critical to understand the role of dentists in this newer modality. The dentist is the sole person responsible for the care of the patient including the diagnosis of any oral disorders or dysfunction, the ordering and interpretation of radiographs, the treatment of those diagnosed disorders/dysfunctions, and the referral for integrative care to optimize overall patient care. Therefore, Oral Myology is best classified as a dental modality under the purview of the practicing dentist. The lack of statutes that explicitly describes oral myology as a modality has raised questions and challenges amongst the governing boards of dentistry and their constituents.
Because an oral myologist is not explicitly defined in Nebraska statutes, the lack of statutes has led to much unnecessary confusion and apprehension. The second issue is the scope of practice for a person that is assisting the dentist in the orofacial myofunctional therapy. Lastly, there is much concern over who can become an oral myologist and whether they can work independent of a supervising dentist.
Oral Myology and Dental Practice Act
Every state has a Dentistry Board Act, which defines the practice of dentistry and acts as a regulatory document to protect citizens from the unlawful practice of dentistry. It is critically important to abide by the Act’s explicit expectations. However, the Dental Board Act leaves sufficient room for interpretation by its constituents to be able to practice dentistry. Even though the oral myology modality is not explicitly defined in many Dental Practice Acts, by the very definition of the modality it falls under the purview of the practicing licensed dentist.
Scope of Practice in a Dental Office Setting
What is the scope of practice for an individual that is assisting the dentist with oral myology in the state of Nebraska? Luckily we already have statutes that describe how an individual may assist the licensed dentist in the practice of dentistry.
First, we must understand what qualifies as practicing dentistry. Section 38-1115 of the Nebraska Dental Act states clearly the definition of practicing dentistry and Section 38-1116 states clearly the exceptions to the previous section. According to the current Dental Practice Act, oral myology or myofunctional therapy is considered to be a dental service and is to be considered practicing dentistry. Furthermore, it requires certain diagnostic capabilities and prescription of treatment for disease, pain, deformity, deficiency, or physical condition of the human teeth, jaws, or adjacent structures.
Second, according to the Dental Practice Act a dentist is allowed to employ an individual not licensed under the Dentistry Practice Act for the purpose of assisting a licensed dentist in the performance of their clinical and clinical-related duties.
For example, a dentist may ask their hygienist to screen for sleep disordered breathing risks during a comprehensive examination to identify orofacial dysfunction. During the dentists examination, the dentist may decide it is appropriate to further analyze the dysfunction by gathering more detailed patient history and measurements of the orofacial complex. This non-invasive gathering of data may be delegated to a highly trained individual under the general supervision of the dentist.
After a thorough review of the clinical findings, the dentist may prescribe certain orofacial exercises. The simple exercises may be delegated by the dentist, to an individual under general supervision, to be explained and taught to a patient. Throughout the patient’s therapy, the dentist will supervise and monitor the patient’s progress. The dentist may recommend certain radiographic imaging or prescribe further treatment to achieve the desired oral health outcome.
A Simple Path for Independent Oral Myology Practitioners
Lastly, it is my humble opinion that an addition to section 38-1116 will simplify and clarify the scope of practice for individuals performing oral myofunctional or oral myology therapy outside of a dental office setting. It is vital to not hinder the growth and development of this fairly novel modality by allowing qualified individuals to independently set up a business outside of a dental office.
Of course, this should be highly scrutinized and new statutes should be added to the section mentioned above to allow for this possibility. As a baseline requirement, independent individuals should have some form of licensed training such as RDH, SLP, RN, OT, PT, DC, and potentially others.
As a second requirement these individuals should attain a certification such as COM ® by The International Association of Orofacial Myology or COMT ® by The Academy of Orofacial Myofunctional Therapy. These individuals must also have a dentist or medical doctor provide collaboration or general supervision to ensure a licensed primary care professional is overseeing the overall care of the patient.
In summary, oral myology describes a dental modality where orofacial myofunctional therapy is prescribed by dentists and/or physicians for the treatment or adjunctive treatment of orofacial and myofunctional disorders that disrupts normal dental, airway, and occlusal development. This critically important modality will help many patients with oral health and the reduction of co-morbidity risks associated with dysfunction of the orofacial complex. A dentist may train an individual to assist in the assessment, data collection, and oral exercise instruction under their general supervision. Many dental boards will need to decide if they will allow independent oral myology practitioners to provide evidence-based dental services outside of the dental office and in collaboration with or supervision of a licensed dentist or physician.
