Tagged "jaw grading bite blocks"

Ask A Therapist: Jaw Grading Bite Blocks and Dissociation

Posted by Deborah Grauzam on

Hello TalkTools,


I am Speech and Language Therapist working with an 11 year old with autism. He has a TalkTools® Program Plan, but I would value the opinion/support of one of your Instructors.


A significant priority at present is supporting him with dissociation of his jaw movements and then with grading. However, we have not been able to get a reliable bite on the Jaw Grading Bite Blocks. Interestingly, after about a month, he has achieved a bite/hold on the DnZ-vibe (not what I had initially planned that we would work on) with the vibration turned on. When the vibration is turned off, his bite is not so reliable. We are working at present on transferring the bite/hold to the #5 Jaw Grading Bite Block.


Do your instructors have any thoughts or experience with this? He does have complex sensory needs that are clearly factors in his eating, speech and other motor skills. I will certainly seek out advice from his Occupational Therapist once he has settled into a new school placement soon.


Many thanks,




Hi Sally,

I'm Robyn, a TalkTools® Instructor, and I've received your inquiry.

You are actually answering your own question, so great observation! This client needs more input to understand what's expected.

Hold the Bite Block in your right hand. With your left hand, hold a Jiggler in place on the top of the Bite Block and place at the correct spot as directed. I usually grab both tools with one hand and apply upward pressure on the mandible and say " bite and hold".

If this doesn't work, try reversing the hierarchy and working from 7 to 2 on the Bite Blocks, because the weakness may be in the high position. If there is a low jaw posture, sometimes reversing the order of the hierarchy is required.

I hope this helps!


Robyn Merkel-Walsh, MA, CCC-SLP

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Ask a Therapist: Teeth Grinding

Posted by Deborah Grauzam on



My 7 year old son with Down Syndrome used to grind his teeth and had grown out of it (we thought). He recently had surgery and the grinding has returned with ferocity. It’s only during the day and is worse than before. His teeth have been ground down to next to nothing. I’m at a loss as to what to do and try, but I would really like to nip this in the bud before his permanent teeth come in – he as 2 bottom ones so far.


Do you have any suggestions of strategies I could try?


It is not uncommon for children with jaw weakness or jaw instability to teeth grind, stop and then renew the habit when they are under stress.  Surgery can certainly be considered a stressful situation.  As I had mentioned above and reiterate in my book, Assessment and Treatment of the Jaw: Sensory, Feeding and Speech, the TMJ (temporomandibular joint) is the site of organization within the human body.  What your son is telling you, without using the words, is that he wants stimulation in that joint to calm himself down (to satisfy a need).  Once teeth grinding begins and the dentition becomes uneven the habit may continue after the stress has left.  The grinding continues to even out the biting surface of the teeth for chewing or may continue just because the child learns the grinding "feels good."  In either case, we know the grinding is detrimental to your son's teeth and we need to find a way to help him to stop doing it.


You asked for specific suggestions and here is what I would like you to do.  Since your son has the diagnosis of Down syndrome it is likely that he also has jaw weakness.  The activities taught in the book Assessment and Treatment of the Jaw: Sensory, Feeding and Speech are used as an alternative to the teeth grinding while addressing the root cause.  The activities will improve jaw symmetry, stability and grading.  Each of these jaw goals will also improve his feeding skills and his speech clarity.  If possible I would ask you to find a Speech-Language Pathologist in your area who has been trained in the TalkTools approach to muscle-based feeding and speech deficits.  She or he would be able to direct you through the two primary activities: "Jaw Grading Bite Blocks" and the "Bite Tube Hierarchy."  Used together these should reduce and hopefully eliminate the teeth grinding.  Additional activities in the book include: teaching him to chew gum without swallowing the gum, chewing on his back molars and a variety of other activities to address the identified jaw muscle needs.  

As in all cases it is best to read the entire book first to identify your son's specific needs and then to choose the activities that he enjoys.  An ideal time to practice each activity would be when he is teeth grinding.  In this way you will give him an alternative that will help him while acknowledging the fact that he needs stimulation to the TMJ. 

I hope this helps.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Jaw Instability and Parent "Homework"?

Posted by Deborah Grauzam on

Hi TalkTools,


I recently completed the self-study course "A Three Part Plan for Oral Placement Therapy." Really enjoyed the course and hoping to use the knowledge with patients. I have 2 questions to start:


1) I see that the jaw assessment is done with bite blocks and then the bite blocks are used for therapy as well, if jaw instability exists. I am confused as to when the bite tube hierarchy is used. I see that the bite tube hierarchy (hierarchy for strength and compression) is used for ages birth to 3, but I believe bite tubes can be used for adults as well. So, when do you recommend the use of bite blocks versus bite tubes?

We do use the Bite Tube Hierarchy for the birth to 3 population. Not only is this hierarchy developing jaw grading (the up and down jaw movement we are looking for in speech), it also facilitates the chewing movement we need for feeding. Since it does not require the same cognitive skills that the TalkTools Jaw Grading Bite Blocks requires for teaching bite and hold, our young clients can do this activity. You are correct that we can use this tool at any age both for feeding, if we are working on teaching chewing skills or for speech, or if we want to reinforce the jaw grading necessary for syllables.

The Bite Blocks have been one of our best tools for developing jaw grading (because it isolates the jaw in multiple positions and works to increase skill at the position) as well as teaching a client the motor plan for the specific positions needed for speech. We often use them in conjunction with the Bite Tube Hierarchy because each gives the client a different sensory-motor experience, working both in movement and in isolation. So it is not always an either/or choice. If appropriate, I always assess in both hierarchies, analyze the results and then determine my goals. If both tools can provide input and skill the client is missing, I may do both with a client.

2) Sara says on DVD that parents need to do homework 3x per week and that if parent is only going to do it 2x per week, child is not likely to progress. The homework manual mentions that if parents don't return the folder, homework will not be sent home and child will progress at slower rate. I see patients once weekly. If parents don't wish to be involved in homework, can the child progress? What has your experience been with this?

This can be tricky as we as therapists try to make decisions on the best therapies to use. Sara is referring to the literature stated in exercise physiology. If a muscle is not worked regularly then we cannot change the function of the muscle. In our experience we've seen this and often with children who have special needs and sensory-motor based speech and feeding deficits more frequent exercise is necessary to change muscle function. If a family is not involved and working at home, you are more than likely not going to see changes in their muscle function.

Remember that this program as a whole allows multiple opportunities to practice the same functions. For example, we may target jaw grading through the TalkTools Bite Tube Hierarchy, TalkTools Jaw Grading Bite Blocks, chewing solids on the back molars, gum chewing or the slow feed technique. I might be able to encourage a family to practice gum chewing and chewing on the back molars at meals 2-3X during the week while I focus on the Bite Blocks and Bite Tubes in therapy. Even though we are performing different activities we are targeting the same muscles and therefore they are getting practice throughout the week. Although the ideal is always that the client practices daily in all areas of the desired home program, in reality we know this may be difficult. The best way to determine if the therapy is making a change in function is to take good data. If you are seeing progress, you are more than likely on track! If I don't see progress over a months time, my tendency is to look at why and change my approach or my goals.

My experience has been that if I can give a family just one activity to work on, then point out the successes we see in that technique, I can often get them on board for supporting this program. The most important piece of information parents need is understanding what it is they are doing, why they are doing that activity, and how it is going to impact their goals. I have to question why a family is seeking speech and language services if they do not want to participate in assisting me in working toward their goals. The more I can reinforce their successes, however small, the more involved they may become! I hope this helps!

Renee Roy Hill, MS, CCC-SLP

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Ask a Therapist: Bite Block Hierarchy Application

Posted by Deborah Grauzam on

I bought the OPT Program, but am struggling with one part of it. I have a child who can hold the bite block #2 between her teeth on the L and R sides for 15 seconds with isometric pull. She can't hold both of the bite blocks between her teeth at the same time with isometric pull (Exercise B) for even one second, though, without demonstrating compensatory strategies (moving head or body forward or pulling up on the chair). I have read and reread the OPT for Speech Clarity and Feeding book looking for what to do next. Page 94 says to make a note of the failure and then proceed to 'Using the Correct Diagnostic Term.' But, in that section, it doesn't tell me what to do. If she fails at having both bite blocks in her mouth with isometric pull, what can I do to strengthen her jaw so that I can then move to bite block #3 for the Bite Block Exercise section?

Without actually seeing the child it is hard to figure out the problem so I will give you some options as any of these can explain the problem:

1. Look at her bite on both sides of her mouth. If she is grinding her teeth or has dental alignment problems that may be the reason she cannot maintain a hold on both bite blocks at the same time. If that is the case then go on to Exercise C - using Bite Block #2.

2. Repeat Exercise A using Bite Block #2. While you are pulling make sure a) you are pulling hard enough, b) she is not tightening her body (even slightly) in any way, as that can also be a compensatory strategy and c) her jaw is not sliding out of alignment (even a little bit). If none of these compensatory behaviors are present, go onto Exercise C - using Bite Block #2.

3. Remember to use the Bite-Tube Hierarchy in conjunction with the Bite Blocks as this activity will also address her jaw instability.


Sara Rosenfeld-Johnson

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Ask a Therapist: Tongue Thrust

Posted by Deborah Grauzam on

I have been working with a 2, almost 3, year old patient for 10 months. He initially came to me with delayed speech -- one-syllable words with limited vocabulary and reduced intelligibility. He now uses 5-6 word sentences spontaneously, intelligibility has increased, he has added new speech sounds and errors are primarily /th/ and blends. We did a lot of oral strengthening as he was a drooler and that has improved. He had a very restricted lingual frenum, corrected in December. He also has an inferiorly attached upper labial frenum, which limits some range of motion in upper lip movement. My concern:   he continues to exhibit a suckle drinking pattern. We have introduced the straw program, but I can’t get past the first one because of the suckle. Is he too young? Should that improve with the increased range of motion now that he's had the lingual frenectomy? He is at a good point with language and articulation, so I was wondering if there is something I can do to make a difference?

Tongue thrusting should be fully remediated by 24 to 36 months, so suckling at this age is atypical. I would refer the patient to an oral surgeon or ENT to seek medical advice on the frenums. It sounds to me like there may be a structural issue.

Sara Rosenfeld-Johnson wrote an article titled, “Effective Exercises for a Short Frenum,” on how to stretch the frenum (sublingual) with the use of bite blocks which I would recommend you read. See if you can get the client to touch the upper back molar with the tongue tip. If not, you can try Sara's exercises. I do this often to prove that therapy alone may not work. Sometimes you can stretch it, but it depends on length, color and location.

Robyn Merkel-Walsh

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