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MYOFUNCTIONAL DISORDERS

An orofacial myofunctional disorder (OMD) is when there is an abnormal lip, jaw, or tongue position during rest, swallowing or speech. Complications of an orofacial myofunctional disorder include speech disorder, feeding challenges, oral development, and airway health. 

Causes:

Tethered oral tissues 

Enlarged tonsils/adenoids 

Chronic finger or thumb sucking

Extended pacifier use

Low muscle tone

Signs & Symptoms:

Open mouth resting posture with low/forward tongue

Excessive drooling

Dental abnormalities: overbite, crossbite, open bite

Tooth decay

Gummy smile

Teeth grinding

Frequent respiratory infections

Chronic ear infections

Enlarged adenoids/tonsils 

Snoring and OSA

Restless sleep

Bedwetting

Daytime drowsiness 

Hyperactivity or ADHA-like symptoms

Learning difficulties

Tongue thrust swallow

Speech errors, particularly s, z, sh, ch, j, t, d, n, l, r

Allergic shiners (ie, under-eye circles)

Difficulty chewing and swallowing (ie, picky eating)

Noxious oral habits (eg, thumb sucking, nail biting, prolonged pacifier use)

Poor posture

Tongue tie
Oral Habits
Extended Pacifier Use
Myofunctional Disorders: About

GOALS OF MYOFUNCTIONAL THERAPY

The goal of myofunctional therapy is to strengthen the orofacial muscles and achieve optimal function for speech, feeding, oral development, and airway health. This is done by targeting:

  • Correct oral rest posture (ie, mouth closed, tongue up)

  • Nasal/diaphragmatic breathing

  • Correct chewing and swallowing


Oral Rest Posture:
The tongue is nature's palate expander. Without this constant suction, the palate forms high and narrow. A high, narrow palate distorts development of dental arches, and restricts airway space. Oral rest posture is also foundational for correct speech. The tongue obtains stability from bracing between the upper molars, which puts the tongue in the "ready" position.

Nasal Breathing:
A closed mouth encourages nasal breathing. The nose filters, warms, and humidifies air. Nasal breathing supports immune function, and maximizes circulation and oxygen uptake. In regards to sleep, a tongue that does not suction to the palate at rest, falls back in the mouth. This restricts the airway space and can be associated with snoring.

Correct Chewing and Swallowing:
A myofunctional disorder is associated with a tongue thrust, where the tongue pushes against the front teeth rather than up against the palate during swallowing. This has consequences for speech, associated with a frontal lisp. It also contributes to difficulty eating and swallowing, and is responsible for orthodontic relapse.

Treatment for Myofunctional Disorders
For infants and children birth to 4, the ideal treatment is myo-informed feeding therapy with either a speech-language pathologist or occupational therapist trained in tethered oral tissues (TOTs) and orofacial myofunctional disorders (OMDs). Feeding therapy is play-based, and does not require a child to be able to follow directions to achieve results. As the child demonstrates the cognitive capacity to imitate and self-monitor, they may be more appropriate for integrating myofunctional therapy techniques.


For ages 4- adults, myofunctional therapy with a speech-language pathologist or registered dental hygienist with advanced training in this specialized area of practice. For speech and feeding challenges, a speech-language pathologist will also be incorporating other treatment modalities to meet the needs of each individual.


Schedule a free phone consultation if you have concerns for a myofunctional disorder.

Photo Cedit: Billings, D’Onofrio, Gatto, and MerkelWalsh, 2017

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Myofunctional Disorders: About

REFERENCES

Hoang, et al. 2023. Orofacial dysfunction screening examinations in children with sleep-disordered breathing symptoms. Journal of Clinical Pediatric Dentistry, 47(4):25-34 

Archambault, N. (2018). Healthy breathing round the clock. The ASHA Leader, 23: 48-54.

Alves Jr., M., et al. (2011). Three dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children. International Journal of Pediatric Otorhinolaryngology, 75, 1195–1199.

Bueno D.A., et al. (2015) Muscular and functional changes following adenotonsillectomy in children. International Journal of Pediatric Otorhinolaryngology Apr; 79(4): 537-40.

de Castro Rodrigues, R.L.,et al. (2014). Characteristics of altered human frenulum. International Journal of Pediatrics and Child Health Care, 2, 5-9.

Camacho, M., et al (2015). Myofunctional therapy to treat obstructive sleep apnea: A systematic review and meta-analysis. SLEEP, 38(5), 669-675

Ferrés-Amat, E., et al. (2016). Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol. Medicina Oral Patologia Oral Cirugia Bucal, 21(1), e39-47.

Gulmaraes, et al. (2009). Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. American Journal of Respiratory and Critical Care Medicine. 179, 962-966

Hsu, H.Y., Yamaguchi, K. (2012). Decreased chewing activity during mouth breathing. Journal of Oral Rehabilitation, Aug; 39(8): 559-67.

Kuroishi, et al. (2015). Deficits in working memory, reading comprehension and arithmetic skills in children with mouth breathing syndrome: analytical cross-sectional study. Sao Paulo Medical Journal, 133(2), 78-83.

Myofunctional Disorders: Text
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