A wrong tongue function (low tongue position at rest and incorrect swallowing) can lead to abnormal growth of the jaws and incorrrect positions of the teeth. At a later age, jaw joint complaints can even arise. The FroggyMouth corrects a wrong tongue function; at children and adults. It is important to use the FroggyMouth properly and to monitor progress. This article lists a number of important backgrounds and tips. Supplemented with personal experiences of Liset Maas, OMFT speech therapist and OMFT teacher.
From protral to alveolar swallow
A baby swallows with a protral swallow. Between the 12th and 18th months the transition to a posterior alveolar swallow starts; that is the right swallow for children and adults. The trigeminal nerve takes over tasks from the facial nerve during this transition. A two to three year old child should be able to swallow correctly. By the age of four at the latest, the posterior alveolar swallow must be present. Sometimes this is not possible due to abnormal oral habits, such as sucking habits, open mouth behavior (with a low tongue position) and/or mouth breathing. Abnormal oral habits hinder the transition from a protral to an alveolar swallow.
Starting with the FroggyMouth
The FroggyMouth can be used from the age of three to automate the right swallow. An incorrect swallow is accompanied by:
- Compression of the lips.
- Mentalis activity.
- Forward displacement of the tongue and/or lateral widening of the tongue.
- Molars that do not touch each other during the swallowing moment.
Instead of working with the FroggyMouth, you can also start with a preliminary OMFT from the age of three (working on the mouth closure, making the lips stronger and using a mouth trainer). From the age of six, you can start with the full OMFT protocol.
Functioning of the FroggyMouth
When the FroggyMouth is used, the upper and lower lips curl outwards, so to speak. During swallowing, the lips no longer close together and no negative pressure (suction) is built up in the oral cavity. Swallowing in the usual (incorrect) way is no longer possible. This produces ‘stress’, which causes a reaction in the brain stem. In order to be able to swallow with the lips open, the brain searches for another way of swallowing. When the focus is not on swallowing but on a fascinating TV program while using the FroggyMouth, the other way of swallowing will be integrated into the motor memory. It happens automatically (subconscious-cognitive automatism).
When wearing the FroggyMouth, the activity of the facial nerve is replaced by activity of the trigeminal nerve. The third branch of the trigeminal nerve, the mandibular nerve, is responsible for feeling in the lower jaw, lower teeth, chin, and tongue. When wearing the FroggyMouth, the rear part of the tongue is raised both at rest and during swallowing. The molars are also closed briefly during the swallowing moment, which is part of a good swallow. When the back of the tongue rises, an inhalation and exhalation through the nose naturally occurs.
A stable anatomical environment is the only condition to use the FroggyMouth. So not with a very narrow upper jaw, because the tongue then cannot take a comfortable position against the palate. The tongue will then not find its physiological references because there is not enough space. Orthodontic work will first have to be done to widen the jaw.
If the palate is not too narrow, the FroggyMouth can be used by someone with a crossbite. Furthermore, it can be used in combination with a block brace, removable braces, invisalign braces, etc.
The first weeks
When you start wearing the FroggyMouth, things don’t immediately get better. When the FroggyMouth is in the mouth, it is visible that:
- The lips move regularly.
- There is slurping.
- There is drooling (this often stops after one week, without intervention).
- The tongue at rest comes forward occasionally.
- There is still mouth breathing.
Visible changes after some weeks
After a few weeks of wearing, changes can be seen. When the FroggyMouth is in the mouth, it is visible that:
- The lips move minimally or not at all.
- The slurping is almost over.
- The drooling has stopped.
- There is already more control over the tongue.
- There is dental occlusion during swallowing.
- There is breathing through the nose (because the back of the tongue rises).
Observate if it’s going right
How long the FroggyMouth has to be worn, depends on the person. During a therapy session, observe the mouth behavior when wearing the FroggyMouth while the client watches a movie. When there are no more conspicuous things to observe, things are moving in the right direction. Also observe the mouth behavior without the FroggyMouth in the mouth. Check that the lower part of the face is relaxed during the swallowing moment and at rest. How does the tongue move when speaking? Is it still coming up? Let the client count aloud from 1 to 60 (without the FroggyMouth in the mouth). Observe speaking and swallowing while the client is counting:
- Does the tongue no longer come forward during swallowing?
- Do the molars close when the client has to swallow?
- Are the lips relaxed during swallowing?
- Is the mentalis inactive during swallowing?
- Does the tongue remain within the dental arch above and below during speech?
If that is all the case, the client is now using the new motor program. The use of the FroggyMouth can be reduced (see below: ‘Phasing out the use of the FroggyMouth’).
During observation it may also become apparent that the old motor program is still being used. Warning signs for this are:
- Lip licking/lip biting (lip licking once during a session is too much).
- Contraction of muscles that lift the upper lip.
- Mentalis activity during swallowing.
- Abnormal pronunciation (addental and/or interdental).
Continue to use the FroggyMouth unabated.
3-3 Froggy Swallow Feedback
For parents of a child using the FroggyMouth (or the partner of an adult client), it is easier to watch the lips while swallowing than to judge the way of swallowing. The 3-3 Froggy Swallow Feedback means that a parent (or partner) is allowed to say, ‘That’s going well!’ or ‘Wow, you swallow with relaxed lips’ three times a day during a swallowing moment. In addition, the parent or partner may say, “Be careful, your lips are pressed together” three times a day during a swallowing moment, when lip compression and/or mentalis activity is visible.
Setup for treatments with the FroggyMouth
For the use of the FroggyMouth, OMFT speech therapist Liset Maas-Houtekamer has drawn up a standard that can serve as an example for treatments.
Week 1:
– Discuss the folder of the FroggyMouth.
– Determine the size of the FroggyMouth.
– Give the instructions:
- Use continuously for 15 minutes every day. If the FroggyMouth is removed from the mouth once during those 15 minutes, start again.
- Use the FroggyMouth while watching a television at eye level, because the head is not bent.
- Keep watching attentively, so that the head moves as little as possible and the correct swallowing can be activated in the same way
- during this 15 minutes.
- Don’t talk with the FroggyMouth in the mouth.
- Give little to no instructions on how to swallow; the correct swallowing process must come about subconsciously.
Week 2:
– Was the FroggyMouth used according the instructions?
– Discuss any details.
– Drool yes/no? (See below: ‘What to do if drooling persists?’).
– Observation wearing the FroggyMouth for 10 minutes (while the client is watching a movie).
– Explain the 3-3 Froggy swallow feedback.
– Apply the 3-3 Froggy swallow feedback daily.
– Schedule an appointment for in two weeks.
– Continue to wear the FroggyMouth as instructed.
Week 3: no appointment.
Week 4:
– Was the FroggyMouth used according the instructions?
– Discuss any details.
– Drool yes/no? (See below: ‘What to do if drooling persists?’).
– Observation wearing the FroggyMouth for 10 minutes (while the client is watching a movie).
– Discuss the 3-3 Froggy swallow feedback. Does this work or is additional explanation needed?
– Let the client eat something to further explain the 3-3 Froggy swallow feedback.
– Schedule an appointment for in 2 weeks.
– Continue to wear the FroggyMouth as instructed.
Week 5: no appointment.
Week 6:
– Was the FroggyMouth used according the instructions?
– Discuss any details.
– Observation wearing the FroggyMouth for 10 minutes (while the client is watching a movie).
– Was the parent (or partner) able to properly apply the 3-3 Froggy swallow feedback?
– Let the client eat something to discuss the 3-3 Froggy swallow feedback;
– Schedule an appointment for in 4 weeks.
– Continue to wear the FroggyMouth as instructed.
Check after 4 weeks (earlier if necessary):
– Was the FroggyMouth used according the instructions?
– Discuss any details.
– Observation wearing the FroggyMouth for 10 minutes (while the client is watching a movie);
– Was the 3-3 Froggy swallow feedback correctly applied? Are the changes visible?
– Let the client eat something to judge the swallow (lower half of the face relaxed / no lip and mentalis activity during swallowing?).
– Observate spontaneous speaking or counting (exercise: counting from 1 to 60).
– Schedule an appointment for in 4 weeks (if necessary sooner).
– Continue to wear the FroggyMouth as instructed.
Phasing out the use of the FroggyMouth
Is the new motor program being used and are there no longer wrong functions to be seen during swallowing and speaking? Then wearing the FroggyMouth can be phased out with the following phases:
- Use the FroggyMouth every other day (4 days on, 3 days off) and do this for two weeks.
- Use the FroggyMouth every other day (3 days on, 4 days off) and do this for two weeks.
- Use the FroggyMouth 2 days a week and do this for one to two months.
- Use the FroggyMouth 1 day a week and do this for one to two months.
What to do if drooling persists?
Explain to the client that saliva flows forward through the tongue into the mouth when drooling. Closing the lips prevents that. If the saliva is in the front of the mouth, it takes a lot of strength and effort to swallow it (compression lips and negative pressure in the oral cavity). If the saliva is on the middle part of the tongue, it will be easier to swallow the saliva. The styloglossus muscle is essential for swallowing. The styloglossus muscle is a small, short muscle. There is one on each side of the tongue. The muscles connect the sides of the tongue to the base of the skull through a bony protrusion (the styloid process) and run down from the temporal bones. Contraction of these two muscles pulls the tongue back and upward and narrows the tongue.
Activate the styloglossus muscle by pushing with a closed mouth mirror on the middle part of the tongue for 10 seconds (while the client gives counter pressure with the tongue). Do this three times every day before using the FroggyMouth. This makes swallowing easier and reduces drooling when wearing the FroggyMouth. Usually, the drooling disappears within a week in this way. If that is not the case, it is advisable to continue doing the above pushing exercise for another week.
Guideline for size selection
The FroggyMouth comes in three sizes: small, medium and large. The width of the client’s mouth determines the required version. When using the FroggyMouth, the corners of the mouth should remain relaxed. Therefore: rather a little too small FroggyMouth, than one that is too big.
Small:
– For boys up to 10 years old.
– For girls up to 13 years old.
Medium:
-For boys from 10 years old and therefore also for adult men.
– For girls from the age of 13 and therefore also for adult women.
Large:
For adult men with a large mouth size.
Results
Clinical studies indicate that approximately 60% of FroggyMouth users automate correct swallowing. The following classification has been published in the book ‘Neurciences and swallowing rehabilitation’:
- ± 20% have no progress;
- ± 20% has progress but no automaticity yet;
- ± 60% have a good swallow that is automatic.
Book Neuroscience and Swallowing Rehabilitation
The book ‘Neuroscience and Swallowing Rehabilitation’ presents scientific studies and insights that provide the background for using the FroggyMouth. It neatly summarizes thousands of pages published by hundreds of researchers. In this sense, the book is a collection of reflections from forty years of clinical experience, providing a better understanding of functional rehabilitation. Part of the above article is based on parts of the book and is therefore recommended for anyone who wants to work professionally with the FroggyMouth.
Both the book and the FroggyMouths can only be ordered in the Dutch section of the OMFT.info webshop, because each country has its own supplier. In any case, the book and FroggyMouths are available from the producer in France. The video below provides an explanation for users of the FroggyMouth.
