What are Orofacial Myofunctional Disorder?

Orofacial Myofunctional Disorders (OMDs) are maladaptive functional patterns arising from structural and/or muscular based deficits within the orofacial complex  resulting in compensations, undesirable habits and/or further impact to the orofacial structures. OMDs are the nexus of structure and function and therefore in some cases a structural anomaly results in functional challenges and in other cases atypical oral habits and limited functional skills result in undesirable structural changes. For example, ankyloglossia (tongue tie) can cause issues with feeding and swallowing, or a low and forward tongue posture may cause a dental malocclusion such as an open bite. OMDs can occur across the lifespan, but the way the disorder is treated is based on the age and/or cognitive status of the patient (Merkel-Walsh, 2020). 

When an Orofacial Myofunctional Disorder is present, functional symptoms may include one or a combination of the following symptoms:

  • Open mouthed posture (lips apart, tongue low and forward or between the teeth)
  • Tongue Thrusting during speech and/or swallowing
  • Non-nutritive sucking habits (thumb finger sucking, prolonged pacifier use)

  • Noxious oral habits (nail biting, chewing on non-edibles)

  • Reduced speech clarity, especially with /t, d, l, n, s, z, r, ʧ, ʤ, ʃ, ʓ/

  • Sleep Disturbances (sleep apnea, night wakings, bedwetting)

  • Mouth Breathing

  • Chronic Congestion

  • Drooling

What are some of the causes of Orofacial Myofunctional Disorders?

OMDs rarely have a single cause but rather a combination of factors. The most commonly noted etiology of an OMD is an upper airway obstruction (e.g. enlarged adenoids and/or tonsils, chronic congestion, deviated septum, allergies) which impairs nasal breathing. When nasal breathing is impeded, the body naturally accommodates by relying on mouth breathing.

Long-term mouth breathing changes the natural resting position of the jaw, tongue and lips. This change in position can influence growth patterns of the maxilla and mandible often result in the development of significant malocclusion. Furthermore, long term mouth breathing compromises the natural process of breathing which relies on the nasal airway to cleanse and purify air for the pulmonary system and may lead to additional health concerns as well as functional challenges.

Evidence based practice suggests that OMDs may also develop as a result of: 

  • Hypotonia (low tone)

  • Structural or physiological abnormalities such as cleft palate, or maxillary insufficiency

  • Tethered Oral Tissues (lingual, labial, buccal ties)

  • Neurological deficits

  • Developmental delays

  • Genetic predisposition

  • Birth trauma

It is crucial to first address what may be contributing to the persistence of an Orofacial Myofunctional Disorder before beginning treatment, as treatment may not be successful if the etiology persists. A Board-Certified Orofacial Myologist® can help you to determine what may be contributing to its presence and can help refer you to the appropriate medical and/or dental professionals to address these concerns.

The following is a guideline as it relates to orofacial myofunctional disorders (OMDs) and the various age ranges.

Infants and Babies

While orofacial myofunctional disorders (OMDs) may be identified throughout the lifespan, orofacial myofunctional therapy is not applicable to infants or babies, due to the need for active involvement in the therapy process. However, recognizing these issues early and making the appropriate referrals to qualified specialists are preventative for compound problems that may occur later in life. This includes issues such as mouth breathing, tethered oral tissues, and orofacial muscle tone issues. The referral and/or treatment of patients may be provided by an interdisciplinary healthcare team that includes COM®s, Dentists/Orthodontist (DDS), Physical Therapist (PT), Occupational Therapist (OT), Craniosacral Therapist (CST), Otheopathic (DO), Speech Language Pathologist (SLP), Oral surgeons, ENTs, Sleep medicine specialists, and body work professionals, and lactation consultants.

School-aged Children and Adults

This is a large age range, that can present with a myriad of issues including mouth breathing, sleep disturbances, temporomandibular joint disorder, orthodontic problems, tethered oral tissues, poor oral rest posture, difficulty with chewing, challenges with the oral preparatory and transit phases of swallowing, tongue thrusting, reduced speech clarity, feeding disorders (picky eating), voice disturbances (hoarseness and resonance issues) and prolonged noxious habits. The older the child, the more they may have developed physical compensations (i.e. atypical head and neck posture, atypical oral placements for speech).  Over time, if left untreated, symptoms of breathing, sleeping, swallowing, and speech deficits may impact the activities of daily living. 

It is important to note that orofacial myofunctional therapy is an integral part of orthodontics and studies have shown that it may shorten orthodontic treatment time and prevent orthodontic relapse. Those patients experiencing negative craniofacial growth, TMJ pain and dysfunction, obstructive sleep apnea (OSA), or upper airway resistance syndrome (UARS) may also benefit from orofacial myofunctional therapy as part of an interdisciplinary plan of care.  An RDH, COM® , physical therapist, ENT, sleep specialist and/or dentist specializing in TMJD are often needed in these specific cases.

The referral and/or treatment of patients >4 years of age may be provided by an interdisciplinary healthcare team that includes but is not limited to a COM® , dentist/orthodontist (DDS/DMD), registered dental hygienist (RDH), physical therapist (PT), occupational therapist (OT), craniosacral therapist (CST), osteopath/ chiropractor (DO/DC), speech-language pathologist (SLP), oral surgeon, ENT, sleep medicine specialist, and bodywork professionals.

For more information, please visit the American Dental Association (www.ada.org), The American Academy of Pediatric Dentistry (www.aapd.org), The American Dental Hygiene Association (www.adha.org), The American Speech-Language Hearing Association (www.asha.org) or The Oral Motor Institute (www.oralmotorinstitute.org).

Toddlers, Preschoolers, individuals with special needs

Orofacial myofunctional disorders (OMDs) in this age group may include issues with nasal breathing, chewing, the oral preparatory phase of swallowing, speech sound development and oral rest posture. The toddler age range, from 2-3 years old, requires commitment & compliance from both the caregivers and the child. 

This age range benefits with oral motor, feeding and oral placement therapy techniques to remediate the OMD. Young children with OMDs may need the expertise of the pediatric dysphagia specialist (SLP/OT) to select the right feeding utensils, food textures and placement of the food into the mouth to optimize feeding safety and maximize progress in therapy.

For toddlers aged 2-3 years old who have myofunctional disorders without feeding issues, the focus shifts to supporting proper nasal breathing, promoting an ideal oral rest posture, and addressing related concerns such as breathing patterns, airway growth, sleep quality, and the risk of malocclusion. A proper oral rest posture, with lips closed, nasal breathing, the tongue resting on the palate, and teeth slightly apart, helps maintain balance in the oral and facial muscles, reducing the likelihood of malocclusion as the child’s teeth and jaws develop. Therapy may include simple exercises to strengthen orofacial muscles and improve breathing patterns, which can positively impact sleep quality. Caregivers are essential in reinforcing these habits and exercises consistently, fostering optimal orofacial and airway development while promoting better long-term health outcomes for their child.

Some preschoolers may start to develop skills to engage in OMT exercises as they age and improve their ability to follow volitional directions and self-monitor, which usually occurs by the age of 3.5-4.0 years. At this point children need to have some sense of self-monitoring, age-appropriate motor planning skills and the ability to imitate OMT techniques.

At this age, if a child has not already been weaned from sucking habits, such as thumb sucking or pacifier use, then it should be addressed by using habit elimination programs. Therapists use a non-invasive, positive reinforcement program to help eliminate these habits without the use of punitive oral appliances. This age group is also ideal for early myofunctional appliances that may assist in guiding facial growth, supporting the development of the orofacial complex.

Children and adults with special needs also fall into this category.  A Certified Orofacial Myologist® (COM®) may not be dually trained in specific feeding, swallowing and speech techniques which are more passive in nature and designed for individuals who cannot follow volitional directions.

The referral and/or treatment of these patients may be provided by an interdisciplinary healthcare team that includes but is not limited to a COM® (ages 3-4 and up), dentist/orthodontist (DDS/DMD), registered dental hygienist (RDH), physical therapist (PT), occupational therapist (OT), craniosacral therapist (CST), osteopath/ chiropractor (DO/DC), speech-language pathologist (SLP), oral surgeon, ENT, sleep medicine specialist, and bodywork professionals.

Why be concerned about OMDs?

Orofacial Myofunctional Disorders interrupt normalized movement patterns. Orthodontists have documented their concerns about OMD’s since the early 1900’s. Failure to address an OMD can result in one or more of the following

  • Long term mouth-breathing patterns that compromise overall healthy breathing

  • Establish detrimental oral habits that impede further growth and development

  • Establish atypical patterns that impact chewing and swallowing

  • The improper development/alignment of the teeth

  • The improper development of jaw growth and facial structure

  • Slowing the process of orthodontic treatment

  • Undermining the long-term stability of orthodontic treatment, resulting in malocclusion relapse

  • Negatively impacting the stability and function of the temporomandibular joint (TMJ)

  • Speech distortions

  • Negatively affecting social relationships due to open mouth postures or noisy chewing and swallowing patterns

  • Normalized oral and physical movement patterns

A variety of peripheral pain issues like chronic facial, neck and back pain; headaches; tooth grinding and clenching; as well as temperomandibular joint dysfunction (TMJD or TMD) have also been associated with OMD’s, as have episodes of tinnitus and vertigo.
Improper tongue position has also been associated with some sleep disordered breathing patterns.
Many individuals with OMD’s have been reported to have early delays in the area of feeding and swallowing. Picky eating patterns often emerge as a result of the lack of oral coordination needed in the first three years of life. Since OMD’s are typically associated with jaw, tongue and lip movement, speech patterns can also be impacted.

What Can Orofacial Myofunctional Therapy Accomplish?

Orofacial Myofunctional Therapy involves an individualized program to help the patient retrain these adaptive patterns of muscle function, and to create and maintain a healthy orofacial environment. Treatment goals may include the following:

  • Normalize tongue and lip resting postures

  • Establish nasal breathing patterns

  • Establish atypical patterns that impact chewing and swallowing

  • Stabilize the dentition from extraneous orofacial muscle movement

  • Address harmful oral habits including:

    • Prolonged pacifier use
    • Thumb and/or finger sucking
    • Fingernail, cheek, or lip biting
    • Tongue sucking
    • Clenching or grinding of the teeth

Benefits of Orofacial Myofunctional Therapy may include:

  • Correcting and improving tongue and lip postures which can aid in the development of normal patterns of dental eruption and alignment.
  • Assisting in the stabilization of the teeth during and/or after orthodontic treatment or jaw surgery

  • Identifying the need and referring for Speech treatment. Supporting the remediation of speech errors differently than some traditional methods (when working with a speech language pathologist trained in Orofacial Myology).

Treatment is often a collaborative process with a variety of medical and dental specialists. A Certified Orofacial Myologist® can help you determine what may be contributing to the presence of an OMD, and can help refer you to the appropriate clinicians to address these concerns.

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