Health Wanted: Mosquitos, Round Two

The Episode

Itchy, itchy, scratchy, scratchy, ooh I got one down my back-y. Nothing takes the fun out of a lovely day outside like being eaten alive. This week on the Health Wanted, we’ve got the buzz on summer’s greatest pest: mosquitos.

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The Listener Questions

Does orofacial myofunctional therapy really work?

There are a class of recognized disorders called orofacial myofunctional disorders that are caused by musculature issues in the mouth and surrounding facial muscles. They can result in issues with tongue position, leading to problems with breathing, swallowing, and speech production.

A good example of this is something like a tongue thrust, where the tongue is pressed too far forward, impacting the ability to keep the mouth closed. It also includes speech issues that could result from genetics or environment (like excessive thumb sucking that changes the shape of the front of the mouth).

To address these issues, one approach is orofacial myofunctional therapy to improve muscle tone and tongue position. It has its benefits in certain contexts, but like a lot of things it tends to get overhyped or sold as a cure-all for things it's not really appropriate for.  

It’s also largely a complimentary practice that should be used with an interdisciplinary team to address certain issues. These would be things like swallowing issues, excessive mouth breathing, drooling, tongue thrusts, or even recovery from jaw surgery.

The evidence for benefit when it comes to physiological issues that result from orofacial myofunctional disorders varies, depending on what issue you're trying to improve. There’s pretty good evidence for it improving swallowing or drooling issues, and some plausible evidence for improving mouth breathing.

But while certain orofacial myofunctional therapy exercises that target muscle tone can be part of an approach that will ultimately improve speech (which usually includes other things like articulation therapy or phonological therapy), the evidence for these interventions to improve speech disorders is pretty limited.

Why isn't the shingles vaccine recommended for people under 50?

There are a couple of reasons that we don’t recommend the shingles vaccine to people under 50.

As background, chickenpox is caused by a virus called herpes zoster. After you have a chickenpox infection, the virus can lie dormant in your body and then years later be reactivated into shingles.

So the first reason we don’t recommend the shingles vaccine to people under 50 is that their likelihood of getting shingles is much lower. One of the greatest risk factors for progression is a weakened immune system, which happens with age.

While it’s not unheard of to get shingles under 50, it is rarer. And there currently is no booster for the shingles vaccine, so we don’t want to give it too early and have immunity wane when you’re at greatest risk for developing shingles and having particularly bad outcomes later in life.

Why are there no boosters? Because we haven’t invested in creating one.

The Shingrix vaccine protects for at least 7 years, and we just don’t have the data to support giving another dose later on. This is an example of the cost-benefit trade off in public health decisions. The vaccine was tested in people over 50, because that’s who is at greater risk, so that’s who gets recommended.

We don’t really have information about efficacy in people younger than that, and the risks are smaller so the overall benefit is smaller as well.

It might seem nice to just offer everyone anything they might want but there is actually a lot of calculation that goes into making recommendations on a population level.

Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:

• Streaming at wabe.org or the WABE app
• Subscribing on Apple or Spotify
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