MYOFUNCTIONAL DISORDERS
An orofacial myofunctional disorder (OMD) is when there is an abnormal lip, jaw, and tongue position during rest, and dysfunctional movements during eating, swallowing and/or speech. Complications of an orofacial myofunctional disorder include speech disorder, feeding challenges, oral development, and airway health.
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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
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GOALS OF MYOFUNCTIONAL THERAPY
The goal of myofunctional therapy is to strengthen the orofacial muscles and achieve optimal oral rest posture.
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Correct oral rest posture (ie, mouth closed, tongue up)
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Nasal/diaphragmatic breathing
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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 reduced airflow, poor sleep quality, and 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.
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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
