In this episode, I sit down with Kara Pfister, a speech-language pathologist and certified orofacial myofunctional therapist, to unpack one of the most misunderstood—and underutilized—areas in orthodontics: function. We break down what myofunctional therapy actually is, when you should be referring (and when you shouldn’t), and why working without a team is one of the biggest mistakes you can make in modern orthodontics.

If you’ve ever wondered why some cases relapse, why certain patients struggle with expansion or open bites, or how to actually build a referral network that improves outcomes—not just checkboxes—this episode will give you practical, real-world insight you can apply immediately. More importantly, it might completely change how you view your role as an orthodontist—not just as a tooth mover, but as a gatekeeper for long-term function and health.

Quotes

“We’re not just fixing speech—we’re often preventing bigger problems before they even start.”
— Kara Pfister

“If they release the tongue without addressing function… it’s like doing surgery on a hip and expecting someone to just walk again.”
— Kara Pfister

Key Takeaways

Intro (00:00)
Why orthodontists must act as “gatekeepers” for function (00:30)
What a myofunctional therapist actually does (01:17)
Why most speech issues aren’t being caught early enough (02:46)
The real causes: airway, tongue tie, and oral habits (14:35)
Why school speech screenings often miss these problems (13:04)
How to identify when to refer (31:22)
The truth about tongue ties—when they matter (29:53)
Why releasing a tongue tie without therapy fails (30:58)
Expansion vs. tongue tie timing—what comes first (36:17)
How improper function leads to relapse (34:49)
Building a referral team that actually works (40:51)
Where to find qualified myofunctional therapists (44:11)

Additional Resources

If you’re serious about improving outcomes—not just finishing cases—you need to stop working in isolation.

Start by building your team:

Find a qualified myofunctional therapist through https://iaom.com (International Association of Orofacial Myology)

Connect with specialists (ENTs, oral surgeons, therapists) who share your philosophy

And if you want to reach Kara directly:
👉 https://speech4fun.com
👉 Search Kara Pfister (5.0 Google reviews)

Because at the end of the day, the best orthodontists aren’t just great clinicians—they’re great connectors.

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