Informed Consent For The Myofunctional Patient

You are enrolling in a comprehensive myofunctional therapy program. This program costs a total of $2250 and includes as many sessions as necessary over one year. For patients who are undergoing tongue-tie surgery, this includes 6-8 weeks of pre-frenectomy exercises as well as post-frenectomy healing protocols and exercises.

This comprehensive myofunctional therapy program also includes the management of treatment outside of your scheduled sessions. Coordination with your other doctors and healthcare providers will provide multi-disciplinary support for your myofunctional needs. If you need help, referrals can be made to the best practitioners and doctors in your area who understand myofunctional therapy, and can help you achieve the best health and wellness outcomes to aid in your myofunctional treatment.

Every comprehensive program includes a full treatment kit with the supplies
needed for your therapy program.

Refunds for therapy will be processed strictly on a case-by-case basis and any
refunds issued will be at the full-price per session rate of $150 (based on an average of 12-15 sessions). A $99 non-refundable fee will be assessed to cover the kit plus shipping and handling, associated administrative costs, and payment processing fees.

Results Of Treatment And Commitment To The Program

Myofunctional therapy treatment usually proceeds as planned, and everything possible will be done to help you achieve the best results. However, because this type of treatment involves patient participation and at-home involvement, it is not guaranteed you will be completely satisfied with the results if the assignments and exercises given are not completed outside of your scheduled appointments. The success of your therapy depends on the level of cooperation and involvement you are willing to take at home. To receive optimal results, it is recommended patients practice their exercises for at least five minutes, twice per day.

Any therapy program requires commitment and long-term dedication. If you decide at any point during treatment you would like to stop the program, then you will have the option to take a break and restart at a later stage. However, no refunds will be offered except in special circumstances.

Length Of Treatment

The comprehensive myofunctional therapy program usually consists of 12 sessions. Every patient presents with unique symptoms and circumstances. The goal is to work with you until your treatment is complete. On average, most programs range from 10-18 sessions. It is rarely necessary to need more than 18 sessions to achieve successful outcomes. Instructions and exercises related to tongue posture, lip seal, swallowing pattern, chewing, drinking, and eating will be given throughout this program. In addition, breathing, posture, snoring, sleep apnea, and tongue-tie exercises will be given as needed on a case-by-case basis. Every patient is unique and will require a treatment plan made for their specific symptoms. Outside of the exercises given, developing an awareness of your breathing and oral postures is crucial. All of the necessary tools, tips, and techniques will be provided to help you develop awareness, but ultimately this is a skill you will need to cultivate on your own.

Therapy Sessions

Therapy sessions last about 45-minutes with your myofunctional therapist on an every-other-week basis (once every two weeks). These sessions must remain consistent. However, if you feel you have not been able to practice adequately within the two weeks, it is better to reschedule to a later date than to keep the appointment and not be prepared.

It is also important too much time does not pass between sessions. If more than four weeks pass between sessions, then the outcome of the therapy will be affected and you may not achieve optimal results. If more than six months pass between sessions, and you cannot be reached to schedule a session, then no refund will be available. However, any unused sessions can be completed at any time and will still be available to you for up to two years from the start date of your therapy. After two years your sessions will no longer be useable.

Relapse

Completing myofunctional therapy treatment does not guarantee perfect breathing
or oral and facial musculature for the rest of a person’s life. Therapy will help develop an awareness of correct breathing, swallowing, facial muscle function, resting posture of the lips and tongue, and eliminate habits, but without maintaining this awareness, old habits and muscle patterns can resurface months or years later. As long as an awareness of the myofunctional concern is maintained, relapse should not occur.  After myofunctional therapy is complete, you will not be required to practice regular myofunctional exercises, However, maintaining awareness of your newly learned habits for breathing and muscle function will be vital to prevent relapse.

Allergies

Allergies are a common problem and affect an estimated 10-30% of the
population. In some cases, it may be necessary to work with a specialist to help
manage and control allergy symptoms. Occasionally, patients with chronic
allergy/nasal congestion may require additional medical management. A referral to
an ENT, allergist, or immunologist may be recommended.

Temporomandibular (Jaw) Joint Dysfunction

Many patients find relief from problems in the jaw joints which cause pain, headaches, or ear problems through myofunctional therapy. However, because problems associated with the TMJ are often multi-faceted, and can be rooted in non-muscular causes, myofunctional therapy is not guaranteed to help all patients with TMJ conditions. Outcomes cannot consistently be predicted for every patient undergoing therapy. Treatment by other medical or dental specialists may be necessary, and referrals made accordingly.

Ankyloglossia (Tongue-Tie) And Frenectomy (Release of A Restricted Frenum)

Many patients experience myofunctional disorders caused by a tight or restricted
lingual frenum. This affects an estimated 10% of the general population and occurs
when the tongue is “tied” or anchored to the floor of the mouth, restricting functional movement. In some cases, it is impossible to proceed with myofunctional therapy because the tongue is severely restricted and unable to function or move properly. In this circumstance, a procedure called a frenectomy must be performed to release the tight tissue underneath the tongue. Without a frenectomy, improper resting posture, swallowing patterns, and orofacial musculature cannot be corrected. Treatment by a dentist or oral surgeon may be necessary, which could be determined at any point during therapy. If you choose not to have your frenum released, optimal outcomes for your myofunctional therapy cannot be guaranteed.

Speech Therapy

Myofunctional therapy is not speech therapy; these are two separate and distinct fields. However, myofunctional therapy has been shown to improve speech when muscular concerns are the underlying issue. Myofunctional therapy can have a foundational role in correcting speech problems and work as a “building block” that is part of achieving successful speech changes. Due to the wide variation in causes for speech concerns and disorders, it is impossible to guarantee myofunctional therapy alone will improve speech. Treatment by a licensed speech pathologist may be necessary. If any of the conditions or complications mentioned above do exist or occur, a referral may be necessary to a dental professional or medical specialist for further treatment. Fees for these services are not included in the cost of myofunctional therapy treatment.

Short notice cancellations or missed appointments significantly affect this practice, leaving appointment slots that are unable to be filled. Situations and circumstances can arise unexpectedly, which this practice will try to accommodate when possible. Please provide at least a 48-hour advance notice whenever possible.

For any appointments that are canceled or changed with less than 48 hours of notice, as well as any missed appointments (no-shows), a cancellation fee of $50 will be applied.

I hereby acknowledge I have read and fully understand the treatment considerations and risks presented in this form. I understand problems can occur and actual results may differ from the anticipated results. I also acknowledge I have discussed this form with Abigail Odom, RDH, OMT at Open Mobile Care, LLC and have been given the opportunity to ask any questions.

I hereby consent to the myofunctional therapy treatment proposed and authorize Abigail Odom RDH,OMT at Open Mobile Care, LLC to provide the treatment. I understand my treatment fee covers only treatment provided by Open Mobile Care, LLC. Treatment provided by other dental or medical professionals is not included in the fee for my myofunctional therapy treatment.

I understand my myofunctional therapy sessions may be conducted over Zoom
teleconferencing, if not in person, and those sessions will be automatically recorded for liability purposes.

I also understand my myofunctional treatment records, including photographs and videos, may be used for purposes of research, patient education, or for professional/healthcare providers. No records or images will be used for marketing purposes or on websites.

I hereby consent to the making of diagnostic records (including photos) before, during, and after myofunctional therapy treatment, and to Abigail Odom, RDH, OMT at Open Mobile Care, LLC, providing myofunctional therapy treatment. I fully understand all the risks and guarantees associated with the treatment.

I have the legal authority to sign this on behalf of: