Orofacial myofunctional therapy refers to the oral cavity (oro-) and face (facial) muscles (myo) and how they work together to influence how your head, jaws, and teeth develop primarily during your childhood, however they can be identified at all ages of life. Together, these structures will influence how well you breathe, eat, speak, and sleep, which in turn impacts your medical and dental health. Healthy function contributes to healthy bodies with great cosmetic effects!
How common are Orofacial Myofunctional Disorders (OMDs)?
Estimates vary according to the definition and criteria used to identify OMDs, as well as the age and characteristics of the population (e.g., orthodontic problems, speech disorders, breastfeeding problems, etc.).
- Tongue thrusting (protrusion of the tongue between the teeth) during swallowing is estimated to range between 33% and 50.5% of the general population of school-aged children (Fletcher, Casteel, & Bradley, 1961; Gross et al., 1990; Hale, Kellum, Nason, & Johnson, 1988; Hanson & Cohen, 1973; Wadsworth, Maul, & Stevens, 1998).
- The presence of tongue thrusting (the protrusion of the tongue between the teeth) during swallowing is significantly related to age. Prevalence estimates are highest in preschool- and young school-aged children and lowest in adolescents (Fletcher, et al., 1961; Wadsworth, et al., 1998).
- Children with articulation disorders are more likely to exhibit a tongue thrust swallow (55.3%; Wadsworth, et al., 1998).
- Approximately 31% of children diagnosed with chronic mouth breathing (a common symptom of OMD) exhibit an articulation disorder (Hitos, Arakaki, Sole, & Weckx, 2013).
- Higher estimates are reported for individuals receiving orthodontic treatment (62% to 73.3%) or with dental malocclusions (Hale, Kellum, & Bishop, 1988; Stahl, Grabowski, Gaebel, & Kundt, 2007).
- In individuals with a temporomandibular disorder (TMD), the percentage of those with orofacial myofunctional variables is estimated to be 97.92% (Ferreira, Da Silva, & de Felicio, 2009).
Tongue thrusting is the most common OMD
Healthy tongue, lip, and teeth rest postures can make enhance one’s appearance
Malocclusions can limit patients from biting and chewing food efficiently
Correcting the OMD can help prevent orthodontic relapse
Oral habits (sucking, chewing, pacifiers) push the lower jaw forward, which opens the patient’s airway; it can be very difficult for the patient to discontinue the habit without an assessment to address the root problem
Patients of all ages can benefit from therapy!
Therapy works to reshape the appropriate muscles, develop normal neuromusculature (“brain-mouth”) functions, and establish new, healthy habits
Early identification and treatment can correct abnormal muscle function while the child’s head and mouth are still growing, which can help the orthodontist bring teeth and occlusion into a more desirable relationship
Therapy can improve the clarity of speech, stabilize dental/orthodontic treatment, enhance one’s appearance, and help maintain optimal oral and medical health for a lifetime of benefits!
Signs and Symptoms
Signs and symptoms of orofacial myofunctional disorders may include:
- Open mouth resting posture (in children, adolescents, and adults)
- Structural abnormalities
- Restricted lingual frenulum (“tongue tie”)
- Dental abnormalities, such as excessive anterior overjet, anterior, bilateral, unilateral, or posterior open bite, and under bite
- Abnormal tongue rest posture (Mason, 2011)
- Interdental or lateral lisp (“s, z, sh, ch, j” sounds) or difficulty elevating the tongue for “t, d, n, l, s, z” behind the upper teeth
- Drooling and poor oral control, specifically past the age of 2 years
- Nonnutritive sucking habits, including pacifier use after age of 12 months, as well as finger, thumb, or tongue sucking (Warren & Bishara, 2002; Warren, et al., 2005; Zardetto, Rodrigues & Stefani, 2002)
- Lack of tongue-palate suction during liquid, solid, and saliva swallows; atypical swallows may have the tongue push against or protrude between the teeth
Causes
There are often several factors contributing to an OMD. Anything that causes the tongue to have an atypical rest posture (ie: not resting up, suctioned on your palate) makes it difficult to achieve natural lip closure, and reduces or impedes the ability to obtain and maintain correct oral rest postures leading to an OMD. The following factors may coexist and play a role in OMDs:
- Airway restrictions, such as obstructed nasal passages, enlarged tonsils, adenoids, hypertrophied turbinates, and/or allergies) (Bueno, Grechi, Trawitzki, Anselmo-Lima, Felicio & Valera, 2015). These may result in upper airway obstruction and open mouth posture (Abreu, Rocha, Lamounier, & Guerra, 2008; Vázquez-Nava, et al., 2006), as well as an incorrect swallow pattern and mouth breathing (Hanson & Mason, 2003).
- Chronic nonnutritive sucking (such as thumb or finger sucking, pacifiers) & chewing habits past the age of 3 years of age (Sousa, et al., 2014; Poyak, 2006; Zardetto, et al., 2002)
- Orofacial muscular/structural differences that encourage tongue fronting could include: delayed neuromotor development, premature exfoliation of maxillary incisors that encourage fronting of the tongue, orofacial anomalies, and ankyloglossia.
Evaluation and Collaborative Care
An OMD evaluation is quite involved as it offers a thorough evaluation of the patient’s medical, dental, and speech-language histories, posture, head and mouth structures, swallowing, and articulation of speech sounds. Evaluations typically result in referral and/or collaboration with a variety of health professionals to determine how to best treat each patient’s needs. The interdisciplinary team may include a/an:
- Allergist
- Dentist
- Oral surgeon
- Orthodontist
- Otolaryngologist (ENT)
- Physician
- Plastic surgeon
- Physical therapist
- Sleep Apnea Specialist
Treatment
The primary purpose of orofacial myofunctional therapy is to create an oral environment in which normal processes of orofacial and dental growth and development can take place, and be maintained (Hanson & Mason, 2003).
- Eliminate non-nutritive sucking
- Establish nasal breathing
- Develop a healthy oral rest posture for teeth, lips, and tongue
- Improve speech sound placement
- Improve handling and swallowing of saliva, solids, and liquids
Our Favorite Research and Websites
- Dr. Baxter at Tongue Tie Alabama has great videos, podcasts, and case studies on his website. He is a huge advocate for tongue and lip releases using the LightScalpal CO2 laser, which our treatment team uses.
- Dr. Zaghi
- FAIREST-6 Pediatric Screening for Sleep Disordered Breathing
- Tongue tie compensations are often associated with body pain and tension
- Orofacial Myofunctional Therapy
- How a functional frenuloplasty is done by Dr. Zaghi and our treatment team
- Impact of rapid palatal expansion on the size of adenoids and tonsils in children
- Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis
- Speech and Feeding Improvements in Children After Posterior Tongue-Tie Release: A Case Series
- Tongue Restriction Questionnaire: A New Screening Tool to Identify Tongue-Tied Patients
American Speech-Language-Hearing Association. (n.d.). Orofacial Myofunctional Disorders. (Practice Portal). Retrieved November 1, 2022, from www.asha.org/Practice-Portal/Clinical-Topics/Orofacial-Myofunctional-Disorders/.