You came in for straighter teeth, and now someone’s telling you that you also need tongue exercises. It’s a fair thing to be suspicious of. Add-on recommendations are exactly the kind of thing a practice could lean on to raise the bill, and you have no way to check that from the chair. So let’s answer it directly: what myofunctional therapy actually does for orthodontic treatment, when it’s needed and when it isn’t, and what the evidence for it actually looks like, warts included.
What tongue thrust and low tongue posture actually do to Invisalign
Invisalign moves teeth. It doesn’t change what your tongue does when you swallow, which is anywhere from several hundred to a couple of thousand times a day. If your tongue pushes forward against your front teeth on every swallow instead of staying up against the palate, that’s a small, constant force working against the exact movement Invisalign is trying to hold. The same habit is why teeth drift back after braces: a retainer holds your teeth for the hours you wear it, but your tongue is working the other hours, whether you’re mid-treatment or years past it.
A tongue thrust isn’t the only version of this. A tongue that simply rests low in the mouth rather than up against the palate, whether or not it thrusts forward on swallow, causes its own version of the same problem, and the two directions feed each other. A low resting tongue tends to go along with breathing through the mouth, and breathing through the mouth tends to pull the tongue down and keep it there. That’s covered in more depth here.
During growth, that matters beyond just the swallow. A tongue that isn’t pushing outward against the palate removes a force that would otherwise widen the upper arch, which is part of why crowded teeth and a narrow, malformed arch so often trace back to years of mouth breathing rather than genetics alone. We go into that mechanism in more depth here. It’s also why an arch narrow enough to leave no room for the tongue, the fourth path below, often has this same history behind it.
Is this just an upsell?
It’s a reasonable question to ask any provider, not just us, and we’d rather answer it than get defensive about it. In our exams, most Invisalign patients who come in with a bite, crowding or spacing problem do show some degree of tongue thrust, a low resting tongue posture, or mouth breathing, and that lines up with what the research finds too. A 2025 study of orthodontic patients ages 6 to 16 found atypical swallowing in all of them, with only 5% resting their tongue correctly against the palate. A broader systematic review pooling several such studies found a real association between atypical swallowing and malocclusion, though it rated the overall certainty of that evidence as low, so treat the exact numbers as suggestive rather than settled. That particular study was done in children rather than adults getting Invisalign specifically, but the direction of the finding, that this is common rather than rare, matches what we see clinically.
Caruso S, Cipriani F, Martino C, Calgani L, Arcangeli M, Gatto R, Caruso S, Mattei A. Cross-sectional study of atypical swallowing and occlusal characteristics in 6-16-year-old patients presenting for orthodontic care. Dent J. 2025;13(12):607. Gonçalves FM, Taveira KVM, Araujo CM, Ravazzi GMNC, Guariza Filho O, Zeigelboim BS, Santos RS, Stechman Neto J. Association between atypical swallowing and malocclusions: a systematic review. Dental Press J Orthod. 2023;27(6):e2221285.
That it’s common isn’t the same as it being automatic, and it isn’t what should convince you either way. What actually distinguishes a legitimate recommendation from a sales pitch is whether you can verify it yourself. Here’s the same four-point check we use: tongue resting broad against the palate, lips closed without effort, teeth slightly apart, breathing through the nose. If a provider tells you they found a tongue thrust or low resting posture, you should be able to see it for yourself with that same check, or have them show you exactly what they saw, not just take a diagnosis on faith.
One of our patients was referred to us just to bond a space between her front teeth. The exam found a tongue thrust that had been pushing the gap open. Bonding it without addressing that would have meant watching the same gap reopen. Retraining the tongue first with myofunctional therapy meant Invisalign could close it for good, with no bonding needed at all: a more polished result than covering it up would have been. See how that case played out.
What the evidence actually shows
We’re not going to tell you this is settled science, because it isn’t, and you’d catch us if we tried.
The most cited study is a retrospective comparison of 76 patients with open bites: one group got orthodontic treatment alone, the other got orthodontic treatment plus myofunctional therapy. Years later, the group without therapy had relapsed by an average of 3.4mm. The group with therapy had relapsed by an average of 0.5mm, a large and statistically significant difference. But it wasn’t a randomized trial. Patients weren’t randomly assigned to each group, which leaves room for the two groups to have differed in other ways going in.
Smithpeter JA, Covell D Jr. Relapse of anterior open bites treated with orthodontic appliances with and without orofacial myofunctional therapy. Am J Orthod Dentofacial Orthop. 2010;137(5):605-614.
Systematic reviews looking across the wider body of research have been more cautious. One found only four studies rigorous enough to include out of 355 screened, all with a high risk of bias, and concluded the evidence is thin, even while noting that combining the two treatments makes sense on paper. A more recent review found a similar pattern: most available studies carried a meaningful risk of bias, and when the two strongest studies were pooled, there wasn’t enough evidence to say one specific appliance approach beat another for closing an open bite.
Homem MA, Vieira-Andrade RG, Moreira Falci SG, Ramos-Jorge ML, Marques LS. Effectiveness of orofacial myofunctional therapy in orthodontic patients: a systematic review. Dental Press J Orthod. 2014;19(4):94-99. Koletsi D, Makou M, Pandis N. Effect of orthodontic management and orofacial muscle training protocols on the correction of myofunctional and myoskeletal problems in developing dentition: a systematic review and meta-analysis. Orthod Craniofac Res. 2018;21(4):202-215.
So here’s where that leaves things: the mechanism makes sense, a well-known habit works against orthodontic movement, and the strongest single study shows a large effect. But the field doesn’t yet have the tightly controlled trials that would let anyone claim certainty. That’s why every recommendation here is tied to what your own exam finds, not applied as a blanket add-on.
Four paths, and who each one actually fits
When a habit shows up on the exam, treating it alongside Invisalign is generally the path we recommend. It aims at a result built to last, not just teeth that look straight on the day treatment ends. Sequencing depends on two different things: how pronounced the habit is, and whether there’s physically enough room for the tongue to hold a corrected position in the first place.
| Path | What it fixes | Best fit | What it takes |
|---|---|---|---|
| Invisalign alone | Tooth alignment and spacing | No tongue thrust or mouth breathing found on exam | Committed, likely lifelong retainer wear. If a tongue habit contributed to the original shift, nothing else is retraining it, so the retainer ends up doing that job alone, indefinitely |
| Invisalign and myofunctional therapy together | Alignment and the habit driving it, addressed at the same time | A tongue thrust or mouth-breathing habit found on exam. This is generally our preferred path when a habit is present, since it aims for a result that holds rather than one that’s corrected today and vulnerable later | A bit more coordination and a modest add-on cost, the investment in an outcome built to last rather than a detour |
| Myofunctional therapy first, then Invisalign | Resolves the habit before any teeth move, so movement happens into an already stable pattern | A pronounced tongue thrust or significant mouth breathing, where moving teeth before the habit is under control would work against the treatment | Adds several weeks before Invisalign starts |
| Invisalign first, then myofunctional therapy | Widens or aligns a narrow, crowded arch to create the physical space the tongue needs, then trains the tongue into that new space | An arch too narrow or crowded for the tongue to rest correctly no matter how well the exercises are done, so training would be practiced against a mouth that has nowhere for it to go yet | Therapy starts once there’s actually room for it to work, rather than training a position the mouth can’t physically hold |
Which of these fits you isn’t a preference call. It comes from what the exam actually finds: whether your tongue thrusts on swallow, where it rests, whether you’re breathing through your nose or your mouth at rest, and whether there’s enough room in the arch for a corrected tongue position to hold. Here’s a four-point check you can try yourself right now.
What to ask for
If a myofunctional therapy recommendation feels like it came out of nowhere, it’s fair to ask what specifically was found on your exam. There should be a specific answer: a swallow pattern observed, a resting tongue position checked, a mouth-breathing sign noted, or a lack of room in the arch, not just “it’s good to add.” If you don’t get a specific answer, that’s worth pushing on.
Call 702-734-0776 or tell us what’s going on, and we’ll walk you through exactly what we found on yours and why.