COM Treatment Planning & Intervention Strategies 2 — Questions and Answers
Question 1: When establishing treatment frequency for an adult patient with a chronic tongue thrust, which scheduling approach is most appropriate during the initial active phase?
- Daily sessions for the first two weeks
- Weekly sessions for 6–12 months
- Bi-weekly sessions for 4–6 weeks, then monthly (Correct answer)
- Monthly sessions throughout the entire program
Correct answer: Bi-weekly sessions for 4–6 weeks, then monthly
Bi-weekly sessions during the active phase allow sufficient practice time between appointments while maintaining therapeutic momentum, transitioning to monthly visits as habits stabilize.
Question 2: A patient presents with a unilateral posterior crossbite and associated lateral tongue posture deviation. What is the correct sequence of intervention?
- Begin myofunctional therapy immediately to correct tongue posture
- Refer to orthodontist first to expand the arch, then initiate myofunctional therapy (Correct answer)
- Extract teeth to create space before therapy
- Begin lip exercises prior to any dental referral
Correct answer: Refer to orthodontist first to expand the arch, then initiate myofunctional therapy
Arch expansion by the orthodontist must precede myofunctional therapy so the tongue has adequate arch width to achieve correct resting posture.
Question 3: Which of the following best describes the 'maintenance phase' in an orofacial myofunctional treatment plan?
- A period of daily intensive exercises to solidify gains
- Infrequent check-ins to monitor carryover of correct patterns into function (Correct answer)
- The phase where the clinician introduces new muscle groups to train
- Re-evaluation with the referring dentist only, without myologist involvement
Correct answer: Infrequent check-ins to monitor carryover of correct patterns into function
The maintenance phase consists of periodic monitoring visits to confirm that newly learned orofacial patterns are being maintained across daily functions.
Question 4: A 7-year-old child cannot achieve nasal breathing during sleep due to enlarged adenoids. What is the orofacial myologist's appropriate first action?
- Begin nasal breathing exercises and monitor for six months
- Refer to an ENT physician for evaluation before initiating therapy (Correct answer)
- Fit the child with a tongue crib appliance
- Begin oral motor exercises focused on lip seal
Correct answer: Refer to an ENT physician for evaluation before initiating therapy
Obstructive adenoids are a medical issue that must be assessed and treated by an ENT before myofunctional therapy for nasal breathing can be effective.
Question 5: In a COM treatment plan, what is the PRIMARY purpose of including 'awareness exercises' in the early stages?
- To strengthen the orbicularis oris muscle rapidly
- To help the patient consciously recognize incorrect muscle patterns they were previously unaware of (Correct answer)
- To prepare the patient for orthodontic appliance placement
- To test whether the patient can follow home program instructions
Correct answer: To help the patient consciously recognize incorrect muscle patterns they were previously unaware of
Awareness exercises help patients recognize existing dysfunctional patterns so that conscious correction and eventual automaticity of new patterns can occur.
Question 6: A patient's treatment progress has plateaued after three months with no improvement in resting tongue posture. Which intervention adjustment is most appropriate?
- Discharge the patient as non-compliant
- Re-evaluate for underlying structural, physiological, or psychological barriers and modify the plan accordingly (Correct answer)
- Double the number of exercises in the home program
- Refer immediately back to the dentist without further assessment
Correct answer: Re-evaluate for underlying structural, physiological, or psychological barriers and modify the plan accordingly
A plateau signals the need to reassess for unresolved contributing factors such as airway obstruction, anatomical restriction, or compliance issues before modifying the exercise program.
Question 7: When coordinating care with an orthodontist, at what point in orthodontic treatment should active myofunctional therapy ideally be COMPLETED?
- Six months after orthodontic appliances are removed
- Before orthodontic retention is discontinued (Correct answer)
- Only after the patient has been in retention for five years
- Concurrent with initial bracket placement
Correct answer: Before orthodontic retention is discontinued
Active myofunctional therapy should be completed before retention ends so that correct neuromuscular patterns support long-term orthodontic stability.
COM Treatment Planning & Intervention Strategies 2
When establishing treatment frequency for an adult patient with a chronic tongue thrust, which scheduling approach is most appropriate during the initial active phase?