Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy.  She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

Hi,

 

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?

Hi,

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

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