The way your tongue, lips and jaw work when you breathe, swallow, chew and rest can be worth a closer look. Anna van Piggelen assesses the patterns behind mouth breathing, tongue thrust and jaw tension, and tells you honestly whether therapy will help.
A specialist in head, neck, and TMJ issues, integrating traditional osteopathy with Orofacial Myofunctional Therapy.
A whole-body practitioner combining manual therapy with Pilates techniques and ultrasound to enhance mobility and manage degenerative pain.
A versatile practitioner for all ages, offering both structural treatment and specialised Cranial Osteopathy for babies and adults.
Anna is a Registered Osteopath and Orofacial Myofunctional Therapist. Her interest is personal as well as professional: she underwent palate expansion and myofunctional therapy herself after problems linked to longstanding childhood oral habits, so she knows what a structured programme asks of you.
Orofacial myofunctional therapy (OMT) is a structured way of assessing and retraining how the muscles of the tongue, lips, jaw and face work together in breathing, swallowing, chewing, speech and rest. It uses targeted exercises and habit retraining where a specific pattern has been found. There is no standard set of exercises, so your programme is built around your assessment.
Your tongue and lips spend far more time resting than working, so resting posture matters. Anna looks at where your tongue rests, whether your lips close comfortably, whether your mouth hangs open, and whether nasal breathing feels easy. The aim is not to force one rigid posture on everyone. It is to find the root causes behind what brought you in.
Oral function patterns can appear at any age, and people arrive by different routes: a dentist or orthodontist referral, advice before or after tongue-tie treatment, or a parent noticing something. The first question is never ‘do you need therapy?’ It is ‘is there a pattern here, and is it worth addressing?’
Longstanding mouth breathing, low tongue posture, tongue thrust, unusual swallowing, trouble keeping a lip seal, jaw tension, clenching or grinding, orthodontic relapse, tongue-tie concerns, or habits carried from childhood. If jaw pain, clicking or locking is your main worry.
Mouth breathing, open-mouth posture, tongue thrust, thumb or finger sucking, dummy use, restricted tongue movement or orthodontic concerns. Therapy is age-appropriate, and parents are part of it.
The evidence base for OMT is still developing, so we assess the individual and never assume therapy is right because one sign is present.
Causes include nasal obstruction, allergies, enlarged tonsils or adenoids and habit.
There are several possible reasons, so Anna checks tongue mobility, oral space, breathing and lip posture before recommending anything.
The tongue moves forwards or between the teeth, sometimes with extra lip or facial effort.
Lips that rest apart, or close only with visible effort.
These can coexist with other patterns but are not automatically caused by tongue position or breathing.
Tooth position is a dental matter, but tongue and lip function can be part of the picture.
Mouth breathing is a breathing pattern, not a diagnosis. If you cannot breathe comfortably through your nose, that needs investigating before any retraining. Persistent blockage, significant snoring, witnessed pauses in breathing, hearing concerns, or enlarged tonsils or adenoids may need a GP, ENT, dentist or sleep specialist first. OMT works best as part of multidisciplinary care, not instead of it.
Oral function patterns can appear at any age, and people arrive by different routes: a dentist or orthodontist referral, advice before or after tongue-tie treatment, or a parent noticing something. The first question is never ‘do you need therapy?’ It is ‘is there a pattern here, and is it worth addressing?’
Your orthodontist diagnoses and manages tooth and jaw position. Where they spot tongue thrust, difficulty with lip closure or an oral habit, Anna assesses the functional side and works alongside them. Relapse has many causes and should not automatically be blamed on the tongue. Research on OMT as an orthodontic adjunct exists but has limits, and your retainer instructions still matter.
How a frenulum looks does not tell us how well the tongue works, so Anna assesses movement and function. Some people are advised to do exercises before or after a release, and a procedure does not by itself create a new resting posture or swallow. Anna does not perform tongue-tie surgery and will refer you to a suitably qualified professional if restriction looks significant.
Anna listens to your concerns, then asks about breathing, oral habits, swallowing, chewing, dental and orthodontic history, jaw symptoms, tongue-tie history, snoring and any previous exercises. She observes where your tongue rests, its mobility, your lip closure and how you swallow, and whether nasal or mouth breathing predominates. She then explains what appears relevant, what is normal variation and whether therapy is appropriate. Not everyone needs a full programme.
Patterns that have lasted years do not change with occasional practice, so consistent home practice is the heart of therapy. Anna gives you guidance on exercises to do at home and shows you how to progress them.
There is no fixed duration. It depends on the pattern, how long it has been there, your age, how consistently you practise, other treatment and any medical or structural factors. Progress is reviewed as you go.
I have seen Anna regularly for a few years and every time I leave the practice I feel relaxed, straighter and pain free. Typically carrying stress in my back, Anna not only treats the area of pain, but has a holistic approach, and gives advice on exercises, stretches, and breathing techniques to take away. She knows just what you need: a specific adjustment after massage to release tension, to a ‘maintenance session’ and five minute relax at the end. Anna has treated the whole family with various injuries and growing pains and I can not recommend her enough!
Rhoda BreakellI contacted Anna at a time of urgent need and she was able to see me very quickly. She is professional and friendly. Not only did she help with the immediate issue, she also gave me a set of preventative exercises to benefit me long term. I highly recommend her.
Julia BeresfordLove Anna, she is really good. Helped me out with mobility issues, muscle and tension release post training. Also now that I’m expecting my baby she’s been fantastic, helping with some discomfort I started having during my third trimestre… 100% recommended!
Maria Alejandra ReisAnna is highly knowledgeable and identifies the source of any pain quickly. She then works with you to resolve any issues and doesn’t rely on session after session but instead provides support activities to shorten recovery times. Highly recommended
Peter HinesMy wife and I – plus my two grown-up daughters – have all seen Anna at one point or another over the last two/three years. She is absolutely fantastic. What you get is what you need – reassurance, matter-of-fact advice and most importantly – pain relief. Anna also gives you some simple stretches and exercises that help mitigate any future problems. Before meeting Anna I had seen a number of other osteos and she is the best by a mile. Highly recommended.
Nick BennettDespite a busy practice, Anna rescued me when I was in agony and unable to move, let alone get out of bed. She quickly got me up on my feet and gave me exercises to keep me mobile until the next visit. I cannot fault her. She’s not just a fantastic practitioner but a lovely person as well. She always puts others before herself. In fact she’s so highly respected that she doesn’t need to scrape around for work and genuinely only treats you when you need it. She is a most professional person and comes very highly recommend from me.
Valerie RichardsonI have been seeing Anna for a few years now after struggling with migraines. She has not only helped me immensely but was the first person I’d seen to get to the root of the problem. Along with being a brilliant therapist, her advice and aftercare is invaluable. I can’t recommend the clinic highly enough
Gemma ShanleyAnna is a delightful and competent professional who gives first rate, comprehensive treatment at every visit. I went in as a “wonky donkey” and walked out feeling six foot tall with a normal gait in my first visit! I have given her practice details out to many of my friends. Also, her new treatment rooms are a relaxing retreat from the hustle and bustle – an excellent place for monthly maintenance.
Julia WishartI had a fantastic treatment from Anna. She really got to the root of problem and gave me great advice to improve my form and help me to prevent further injury.
James MartinOMT does not replace dental, orthodontic, medical, ENT or speech and language care. Sometimes the best outcome of an assessment is a referral, and Anna will refer you to a different practitioner where necessary.
OMT does not replace dental, orthodontic, medical, ENT or speech and language care. Sometimes the best outcome of an assessment is a referral, and Anna will refer you to a different practitioner where necessary.
Research covers atypical swallowing, mouth breathing, lip function, tongue posture, oral habits and tongue-tie, and its quality varies. A 2025 scoping review identified 58 studies but concluded there was not yet enough high-level evidence to confirm effectiveness across every condition studied, so our claims stay specific and proportionate.
Book an orofacial myofunctional assessment with Anna at Key Osteopaths. She will explain her findings and whether therapy, osteopathic input, home exercises or referral is the right next step. We start with the function, then decide what, if anything, needs to change.
Key Osteopaths is in West Byfleet and regularly sees patients from Woking, Weybridge, Guildford, Pyrford, Cobham and across Surrey. Find us at Ground Floor, 3 Park Court, Pyrford Road, West Byfleet KT14 6SD, or call 01932 640322.