Specialist article Classifying treatments
IQoro alternativePull alone or pull within the pattern
Are you looking for an alternative to IQoro, or do you want to know what a mouth trainer can actually do? Here you will find out how IQoro works, what the studies on it show and where their limits lie. And why we do not practise the lip pull on its own, but embedded in breathing, swallowing and head balance.
Does this sound familiar?
Mouth trainers in everyday life: What applies to you?
What applies to you?
Tap whatever applies to you.
If two or more points apply, it is worth looking at the whole pattern. Lip closure, tongue reference position, swallowing, nasal breathing and head balance are connected. How much of this a mouth trainer addresses depends on how the training is structured.
What happens in the mouth during the pullHow we structure the trainingThe key points at a glance
- IQoro is a mouth trainer from Sweden: you pull a screen behind the lips forward for ten seconds three times, three times a day. Studies, mainly from the developer’s research group, report improvements in swallowing and in reflux complaints, mostly without a comparison group.
- An independent measurement in healthy people with a similar oral screen shows that during the pull it is mainly the lips that work; the base of the tongue, throat and larynx hardly move. A swallow is a different sequence.
- The FaceFormer is built differently: lip wedge, flexible membrane and a sealed oral cavity in which negative pressure develops when you swallow. The pull exercise is one of several exercises there, embedded in swallowing, tongue reference position, nasal breathing, head balance and the night with the ZERO.
Video
Why we treat basic functions instead of symptoms
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The device
What is IQoro?
IQoro is a training device from Sweden: a flat screen that lies behind the lips in front of the teeth, with a handle that protrudes from the mouth. It was developed by the Swedish dentist and swallowing researcher Mary Hägg1. The manufacturer is MYoroface AB in Hudiksvall, and IQoro® is a trademark of this manufacturer. We mention the name only for classification and have no connection with the manufacturer.
according to the manufacturer, you pull the screen forward while holding your breath2
a day: three pulls per session, three sessions at least two hours apart2
of training time a day, according to the manufacturer. Once the goal is reached, one to two sessions are said to be enough2
The manufacturer names swallowing difficulties, reflux and heartburn, a lump-in-the-throat feeling, coughing and hoarseness, snoring and sleep apnoea as areas of use. IQoro is said to stimulate the swallowing function via nerves in the mouth and to train muscles from the lips to the diaphragm3. We show further below which of these claims have been studied.
Mouth trainers
What mouth trainers can do in principle
Oral screens have long been used in orthodontics, speech therapy and rehabilitation. The principle is similar: the lips work against a resistance in the oral vestibule. The differences lie in shape, material and exercise sequence.
Passive oral screen
It is worn without actively exercising, for example at night, so that the lips stay on the screen.
Pull trainer
The screen is pulled forward briefly and forcefully, and the lips hold against it. IQoro belongs to this group.
Training device with a programme
The device is part of a sequence in which lip closure, tongue, swallowing, breathing and head balance are practised together, as with the FaceFormer.
For all oral screens, what is measured depends heavily on shape and instructions. A research group in Gothenburg showed in 29 healthy people that the measured lip strength increases with the surface area of the screen and that sucking, that is, negative pressure in the mouth, raises the values further4. A higher reading therefore does not automatically mean that the lips have become stronger.
What do you think: which muscles do most of the work when pulling on an oral screen?
Research
What the studies on IQoro show
There are more published studies on IQoro than on most mouth trainers. That deserves a fair look.
The manufacturer lists just under twenty publications5, most of them from the research group around Mary Hägg in Hudiksvall. The main topics studied were swallowing disorders after stroke and in old age, as well as complaints with hiatus hernia, that is, a diaphragmatic hernia.
Swallowing in old age
In Swedish care homes, 49 older people trained with IQoro for five weeks, and 67 received usual care. Swallowing speed in the water test improved considerably more with IQoro, and signs of choking decreased. Quality of life related to swallowing did not differ1.
Oesophagus and reflux
43 adults with long-standing swallowing complaints of the oesophagus trained for six to eight months. Almost all reported fewer complaints afterwards, and reflux complaints also decreased6. In 28 people with hiatus hernia, less choking, coughing and hoarseness were reported7. Neither study had a comparison group.
Face after stroke
18 people with facial and swallowing disorders after stroke trained with IQoro for three months, and 13 former patients with a palatal plate. Both groups clearly improved facial mobility and swallowing ability, and no difference between the devices was found8.
That is more than many mouth trainers can show, but it has limits. Most are before-and-after observations without a comparison group. The developer was involved in the largest controlled study, the examiners knew who had trained, and the authors themselves write that the clinical benefit has not yet been established and that further studies are needed1.
were included in the largest controlled study on IQoro, 49 of whom trained with the device1
in an independent pilot study from Denmark: no benefit compared with the usual therapy9
The first independent randomised study we could find comes from a Danish rehabilitation centre. In 22 people with a tracheostomy tube after severe brain injury, IQoro brought no benefit in addition to the usual therapy. Residues in the throat even decreased less in the IQoro group9. The authors emphasise that this patient group is different from those in earlier studies.
Context
“IQoro fake”? A factual answer
Anyone searching for “IQoro fake” or “IQoro experiences” usually wants to know whether the device delivers what the advertising promises. IQoro is not a fake. It is a real, CE-marked product on which published studies exist1. The legitimate question is a different one: how robust are these studies, and who do they apply to? Four questions help with any study, including ours.
Is there a comparison group?
Without one, it is impossible to separate what the training achieves from what time, recovery or other therapy contribute.
Who carried out the study?
Studies involving developers are not worthless, but they need independent confirmation.
What was measured?
Lip strength or a symptom questionnaire is something different from an X-ray of swallowing.
For how long?
A pattern changes over months. Short studies do not show what lasts.
A device is not good because it has studies. What matters is what was tested.We apply the same standards to FaceFormer therapy.
The only randomised study on the FaceFormer comes from Hamburg. 45 children aged between three and sixteen were treated for six months either with the FaceFormer or with conventional myofunctional therapy. In the FaceFormer group, the tongue rested against the palate more often during swallowing, and mouth closure was achieved more quickly. At the end, there was no difference in lip strength10.
Limitations: Sabine Berndsen was a co-author, the groups were small, and basic functions were measured. More under Studies and science.
The mechanism
What happens in the mouth during the pull
What an oral screen moves in the body was investigated independently by a research group at Sahlgrenska University Hospital in Gothenburg. Ten healthy adults pulled on a semi-soft oral screen, a different model from IQoro, while X-ray film and surface EMG were recorded. A dry swallow, that is, a swallow of saliva only, served as the comparison11. This cannot be transferred one-to-one to IQoro, but the principle is the same.
of the muscle work during the pull was done by the lips, the muscles under the chin 17 to 19 %, the masseter muscle 8 to 11 %11
was how far the larynx rose during the dry swallow, measured as the middle value (median)11
did it move upwards during the pull on the oral screen; at the median, it stayed still or even dropped slightly11
So during the pull, it is mainly the lips that work. The base of the tongue, the back wall of the throat and the larynx moved considerably less than during swallowing. The authors therefore consider the influence of the exercise on swallowing to be small and ask how an exercise without a swallow is supposed to improve swallowing11.
As early as 2008, Mary Hägg and her co-author wrote that their patients’ progress could be explained by sensorimotor stimulation and the brain’s capacity to learn rather than by strength training of the lips12. So even from the developer’s point of view, lip strength alone did not explain the progress.
Thinking model
Weak muscles or a missing pattern?
The manufacturer explains reflux, snoring and sleep apnoea by weakened muscles that need to be strengthened3. We do not dispute that slack tissue plays a role. But we see the order differently. In our view, the loss of tension is usually not the beginning but a consequence: muscles that are not integrated into their function are not used and lose tension.
The pattern deviates
Mouth breathing, a low-lying tongue or a forward head position replace the reference order.
The body compensates
Other muscles take over the work. The nervous system stores the compensation as the preferred pattern.
Muscles are not used
Whatever is not integrated into the function loses tension. Tissue in the mouth and throat becomes slack.
Symptoms become noticeable
Complaints only appear at the end of many such chains. When they appear and how pronounced they are depends on extent, duration and age.
When a function is needed again in everyday life, the tension comes with it.That is why we train the function and not the strength. In our view, tension is the result, not the goal.
Where strength is lacking, for example after a stroke, gaining strength can make sense. In our view, however, an isolated pull or strength exercise is not simply too little, but a different stimulus. If a signal arrives outside the natural swallowing sequence, the nervous system places it in the pattern most familiar to it. That can be a compensatory pattern.
Like one chord from a piece of music
If you play a single chord from a piece over and over again, louder and louder, the ear learns this chord. It does not learn the piece. Within the piece, the chord has its place, its tension and its resolution. It is similar with the lip pull: in the swallow, it belongs in a sequence of lip closure, tongue pressure on the palate, elevation of the larynx and a short pause in breathing.
For the tongue, too, strength is only one partial ability: in seven studies on resistance training of the tongue, it remained inconsistent whether swallowing itself benefited13. How swallowing runs as a pattern is explained in the articles Swallowing and swallowing disorders and Reflux and heartburn.
The key difference
Stimulus architecture: why the shape matters
A mouth trainer is more than a resistance. Its shape determines which stimuli the lips, tongue and oral cavity receive, and therefore which pattern the nervous system can learn.
We call this stimulus architecture. For this purpose, the FaceFormer is built from three elements that work together: lip wedge, membrane and the sealing of the oral cavity14. They give the nervous system a clear starting impulse: where the movement begins, where it goes and over which surfaces the forces are distributed15.
Lip wedge
Oval and bevelled all round. The bevel acts like a guide track along which the lips align towards the centre of the mouth. It guides without forcing the movement and gives noticeable feedback.
Flexible membrane
Highly elastic silicone that nestles against the oral vestibule, into the vestibular folds and laterally as far as the back molars. This way it adapts to different jaw shapes and distributes the pressure over a wide area.
Sealed oral cavity
The lip wedge and membrane are joined without an opening to the oral cavity. That is why a stable negative pressure develops when you swallow, which draws the tongue to the palate.
Drag to rotateLip wedge Oval and bevelled all round. It guides the lips to the centre of the mouth.
Flexible membrane It nestles against the oral vestibule and distributes the pressure over a wide area.
Sealed oral cavity Joined without an opening to the oral cavity, which is why negative pressure develops when you swallow.
In our view, it takes exactly this shape to address breathing, swallowing and head balance at the same time. The lips work on the lip wedge, the sealed mouth lets the air flow through the nose, and the negative pressure lifts the tongue to the palate and takes the soft palate with it. Because breathing, swallowing and tongue movement are controlled together in the brainstem, lip closure has further effects as far as the nasal passage and head balance15.
The manufacturer describes IQoro as a screen made of medical plastic that combines hardness and flexibility, with a flat handle. The shape is intended to reach a large area on the inside of the lips16. According to the instructions, no negative pressure should develop in the mouth; the lips are supposed to provide the resistance5. Two design principles, then, for two different exercises.
Our approach
Pull within the pattern: how the training is structured
FaceFormer training also involves pulling. There, the pull exercise is one of several exercises: forwards as the pull exercise (module 2), upwards, downwards or in changing directions in modules 4 to 6. It is embedded in the basic exercise with swallowing, in tongue reference position and nasal breathing, in head balance rotation and night-time use. The film shows the basic sequence.
Pull according to the manufacturer (IQoro)
- Three pulls of 10 seconds each, three times a day
- You hold your breath during the pull
- No swallow to build up negative pressure; the lips are supposed to provide the resistance
- According to the manufacturer, the tongue finds its place by itself
Pull exercise in FaceFormer training
- Pressing and pull for 6 seconds, up to 20 repetitions, three times a day
- Breathing through the nose the whole time
- In every repetition, bite down once and swallow; negative pressure is intended
- Tip of the tongue at the reference point, head upright, the ZERO at night
Both approaches use the lip pull against resistance. They differ in whether the pull stands on its own or is embedded in swallowing, breathing and head balance. The information on IQoro comes from the manufacturer’s website, as of 30 September 20262.
Why the swallow in every repetition? We swallow many hundreds to a thousand times a day17. Each of these swallows reinforces a pattern, the old one or the new one. If you swallow while practising, you are practising exactly the sequence that the body is meant to repeat afterwards without thinking.
The triad
Breathing and head balance are part of it
Lips and swallowing are two parts. The pattern we train is based on three basic functions: breathing, swallowing and head balance.
If breathing runs through the mouth out of habit, the mouth opens again, no matter how strong the lips are. That is why you breathe through your nose throughout the training. From about the sixth week, the breathing exercise is added: calmly through the nose into the belly, with a swallow in the breathing pause.
Why mouth breathing is not a matter of indifference is explained in the articles Mouth breathing and Deviated septum.
Head balance helps determine how freely the tongue and hyoid bone work. If the head drifts forward, the floor of the mouth and the neck take over holding work. In head balance rotation, you slowly turn your head to the side while your lips hold the FaceFormer.
At night, habitual patterns assert themselves most easily. That is why, from about the third week, you wear the FaceFormer ZERO while you sleep. It supports mouth closure and nasal breathing while you are not thinking about it, and complements the training during the day.
In our view, a taped mouth does not achieve this. The reason is explained in the article Mouth taping.
Orientation
What you can look for in a mouth trainer
Whether FaceFormer, IQoro or another device: these questions show how much of the pattern an exercise addresses.
Is there a swallow?
A swallow in the exercise connects the lips, tongue, throat and breathing. Without a swallow, you are training one partial ability.
How do you breathe?
Nasal breathing during the exercise also turns the training into breathing practice. This way you practise the route that the air is meant to take in everyday life too.
Where is the tongue?
Clear instructions on the tongue reference position are part of it. In our view, a low-lying tongue tends to find its way back into its habitual pattern on its own.
How is the device shaped?
The shape determines the stimulus. Pay attention to what the lips work on and whether the oral cavity is sealed during swallowing.
How is the head positioned?
Upright and balanced, not pushed forward. Otherwise the neck and floor of the mouth join in.
What is the device made of?
Look for a CE-marked medical device made of tested material. The FaceFormer is made of medical-grade silicone (ISO 10993, USP Class VI), without BPA, plasticisers and latex. More under Materials and manufacturing.
If you are training because of a swallowing disorder after a stroke, a hiatus hernia or severe reflux, coordinate the training with your treatment team. Do not stop treatments prescribed by your doctor, such as medication for reflux, on your own.
Switching
From pull trainer to FaceFormer
If you have been practising with IQoro or another pull trainer, your lips already know the resistance. What is new is the sequence: pressing, biting down, swallowing and relaxing in every repetition, plus nasal breathing and head balance. In our view, it makes sense to decide on one programme, because a pattern is learned through frequent, identical repetition. An overview is given in Course and duration of the therapy.
- From day 1
Basic exercise with the ZERO
Three times a day: 8 repetitions in the first week, 14 in the second, and 20 from the third. The free app sets the pace.
- From week 3
Pull exercise and night
The pull exercise is added to the basic exercise. At night, you wear the ZERO.
- After a few weeks
Switching to the ONE
During the day, you train with the FaceFormer ONE. It is the same size and shape as the ZERO, just made of firmer material.
- From around week 6
Breathing and head balance
The breathing exercise and head balance rotation extend the training, ideally in consultation with a practice.
- Over 6 to 12 months
The pattern runs by itself
An old pattern is not given up through insight, but displaced through frequent, precise repetition. This is followed by maintenance training.
At the beginning, tired lips, pressure on the teeth or irritated mucous membranes are common. In that case, pause briefly and continue with fewer repetitions. If you have acute inflammation in the mouth, a completely blocked nose, recent surgery in the mouth or an acute jaw joint lock with severe pain, talk to your doctor first. If you train with a practice, coordinate the plan there.
Questions
Frequently asked
What is a good IQoro alternative?
That depends on what you want to train. If you are only interested in the lip pull, many oral screens are built in a similar way. If you want to practise mouth closure in combination with swallowing, tongue reference position, nasal breathing and head balance, a training device with an exercise programme is a better fit. This is how FaceFormer training is structured.
Is IQoro fake?
No. IQoro is a real, CE-marked product of MYoroface AB, and published studies on it exist. Most of them come from the developer’s research group and have no comparison group. An independent pilot study in people with a tracheostomy tube found no benefit. How robust the results are therefore depends on the question being asked.
What is the difference between IQoro and FaceFormer?
With IQoro, according to the manufacturer, you pull on a plastic screen with a handle three times for ten seconds, holding your breath and not swallowing. The FaceFormer has a lip wedge and a flexible membrane that seal the oral cavity. The lips press the lip wedge, in every repetition you bite down and swallow, you breathe through your nose, and the tip of the tongue lies at the reference point. In addition, there is the breathing exercise, head balance rotation and the night with the ZERO.
What do studies and experiences with IQoro show?
A controlled study in care homes found a greater improvement in swallowing speed than with usual care. Studies without a comparison group report fewer complaints with hiatus hernia and after stroke, while an independent pilot study found no benefit. Individual experience reports are not evidence.
Can I combine IQoro and FaceFormer?
In our view, it makes more sense to decide on one programme. The nervous system learns a pattern through frequent, identical repetition. Two different sequences set two different stimuli, for example a pull while holding your breath without swallowing and a pull with nasal breathing and swallowing. FaceFormer training also includes pull exercises, there with swallowing and nasal breathing.
How can I encourage mouth closure?
A mouth closure that holds by itself does not come from holding on, but when the lips, tongue reference position, nasal breathing and swallowing work together. Mouth closure exercises with the FaceFormer combine these parts: press the lips, bite down, swallow, relax, and breathe through the nose while doing so.
What is an orofacial trainer?
An orofacial trainer, also called a mouth trainer or face trainer, is a device for the muscles of the mouth and face, often a screen in the oral vestibule. The devices differ in whether you only hold against a pull or practise a whole functional sequence. The FaceFormer is a Class I medical device made of medical-grade silicone.
More articles from the knowledge section
Where to go next
Sources
- Hägglund P, Hägg M, Wester P, Levring Jäghagen E (2019). Effects of oral neuromuscular training on swallowing dysfunction among older people in intermediate care: a cluster randomised, controlled trial. Age and Ageing 48(4):533-540. PMID 31062842. Source
- MYoroface AB. How to use IQoro (Trainingsanleitung und Training FAQ des Herstellers). Abgerufen am 30.09.2026. Source
- MYoroface AB. IQoro, Startseite (Einsatzgebiete und Wirkprinzip laut Hersteller). Abgerufen am 30.09.2026. Source
- Wertsén M, Stenberg M (2017). Measuring lip force by oral screens Part 2: The importance of screen design, instruction and suction. Clinical and Experimental Dental Research 3(5):191-197. PMID 29744200. Source
- MYoroface AB. Scientific articles (Studienliste des Herstellers für Fachleute). Abgerufen am 30.09.2026. Source
- Hägg M, Tibbling L, Franzén T (2015). Esophageal dysphagia and reflux symptoms before and after oral IQoro training. World Journal of Gastroenterology 21(24):7558-7562. PMID 26140003. Source
- Hägg M, Tibbling L, Franzén T (2015). Effect of IQoro training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms. Acta Oto-Laryngologica 135(7):635-639. PMID 25963055. Source
- Hägg M, Tibbling L (2015). Effect of oral IQoro and palatal plate training in post-stroke, four-quadrant facial dysfunction and dysphagia: A comparison study. Acta Oto-Laryngologica 135(9):962-968. PMID 25947252. Source
- Blichfeldt M, Kothari M, Fabricius J (2025). Effect of Oral Neuromuscular Training on Tracheostomy Decannulation and Swallowing Function in Patients with Severe Acquired Brain Injury: A Pilot Randomized Controlled Trial. Dysphagia 40(6):1405-1413. PMID 40387911. Source
- Korbmacher HM, Schwan M, Berndsen S, Bull J, Kahl-Nieke B (2004). Evaluation of a new concept of myofunctional therapy in children. International Journal of Orofacial Myology 30:39-52. PMID 15832861. Source
- Bengtsson L, Dotevall H, Sjögreen L, Ragnemalm L, Tuomi L (2022). Effects of oral screen exercise on orofacial and pharyngeal activity: An exploratory study using videofluoroscopy and surface electromyography in healthy adults. Clinical and Experimental Dental Research 8(2):519-528. PMID 35106972. Source
- Hägg M, Anniko M (2008). Lip muscle training in stroke patients with dysphagia. Acta Oto-Laryngologica 128(9):1027-1033. PMID 19086198. Source
- Smaoui S, Langridge A, Steele CM (2020). The Effect of Lingual Resistance Training Interventions on Adult Swallow Function: A Systematic Review. Dysphagia 35(5):745-761. PMID 31612288. Source
- Dr. Berndsen GmbH. Material und Herstellung des FaceFormers (Membran, Lippenkeil, Silikon). Source
- Dr. Berndsen GmbH. Wie wirkt die FaceFormer-Therapie? (Reizarchitektur, Unterdruck im Mund). Source
- MYoroface AB. Why IQoro works (Wirkprinzip, Material und Form laut Hersteller) und Produktseite IQoro. Abgerufen am 30.09.2026. Source
- Lear CS, Flanagan JB, Moorrees CF (1965). The frequency of deglutition in man. Archives of Oral Biology 10:83-100. PMID 14262163. Source
Get started
Ready for the training?
The free FaceFormer app guides you through the basic exercises, counts along and reminds you of your sessions. If you wish, a practice from the practitioner directory can support you.
FaceFormer ZERO + ONE
Both material hardnesses for getting started, day and night. The set for adults.
FaceFormer ZERO
The softer FaceFormer for getting started, for children and for the night.
FaceFormer ZERO Children’s Set
ZERO with hygiene box, plush bag and success book with stamp.
FaceFormer training aims to restore the physiological setting of the basic functions of breathing, swallowing and head balance, with lip closure and the tongue reference position, thereby creating the conditions under which symptoms can improve. It does not replace a medical assessment. You can find practitioners near you in the practitioner directory.
