What are orofacial myofunctional disorders?
An orofacial myofunctional disorder (OMD) is a disorder in the muscle function of the lips, tongue, and/or jaw that negatively affects various aspects of an individual’s health, function and development. The orofacial muscles of the mouth and lower face help us to breathe, chew, swallow and speak.
Source: [5], [6]
OMDs can be found in children, adolescents, and adults. OMDs can co-occur with a variety of speech and swallowing disorders and result from a combination of learned behaviors, physical/structural variables, genetic and environmental factors.
Some potential signs of OMDs:
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Tongue thrust – tongue between the teeth while swallowing
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Abnormal chewing and swallowing and/or
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Breastfeeding difficulties
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Mouth breathing with lips apart/mouth open at rest possibly due to:
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Airway obstructions such as enlarged tonsils or adenoids
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Poor oral resting posture with the tongue resting low in the mouth
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Jaw misalignment such as an overbite, underbite, or open bite
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Tongue tie or any soft tissue restrictions such as lip tie, buccal tie
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Speech sound errors (especially after the age of 7)
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Prolonged pacifier use, thumb or finger sucking
Source – [1], [3]
Frequently Asked Questions
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OMDs are complex and can be caused by anything that impacts correct oral resting posture. The disorder is multifactorial, it can be caused by anything that reduces or impedes correct oral resting posture (explained in the next section):
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Blocked nasal passages, possibly due to enlarged tonsils, adenoids, or allergies
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Muscular/structural differences
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Pacifier and thumb sucking habits past 3 years of age
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Source – [1]
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Your tongue should rest gently and comfortably in your palate (roof of your mouth), NOT touching your teeth in any way or resting on the floor of your mouth
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Your lips should be sealed
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Your teeth should just be slightly apart (about 2-3 mm) AND
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You should be able to easily breathe through your nose day and night
Source: [7], [8]
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Consistent open-mouth breathing
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Mouth breather vs nasal breather
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Incorrect tongue posture where the tongue is resting against or between the front teeth and/or on the floor of the mouth
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Prolonged oral habits:
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Pacifier use after 12 months of age
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Thumb/finger sucking
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Putting shirts or other objects in their mouth
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Chewing habits
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Frequent congestion or colds, likely to have chronic ear infections
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Drooling or poor control of saliva, especially after 2 years of age
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Sleeping difficulties
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Including: snoring, breathing through mouth, frequently waking up, bed-wetting
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Which can lead to poor attention during the day
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Dental decay, cavities, unhealthy gums
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Jaw misalignment such as an overbite, underbite, or open bite
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Tongue tie (posterior and/or anterior)
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Abnormal chewing and swallowing of liquids and solids
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Tongue thrust swallow (tongue moved forward in mouth during swallow)
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Inability to swallow food without lip closure support
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Chewing with mouth open, noisy, slow, and/or messy eating
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Unusually small bites
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Dislike for textures that require more chewing
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Speech sound difficulties
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Especially: Frontal or lateral lisp (s, z, sh, ch, j), persistent errors with /r/
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Source – [1]
It is likely that you came to the clinic to treat speech sound errors. In the case of an orofacial myofunctional disorder, speech sound errors are a symptom. We have to treat the OMD in order to get to the root cause of these errors and not only treat the symptoms.
Speech is connected to the same structures that we use for chewing, swallowing and breathing. We have to support the whole system in order to have a solid foundation to target speech sounds.
Source: [9]
The priorities of treatment are to support nasal breathing, teach proper oral resting posture, to teach chewing and swallowing without compensation strategies, and to correct speech sound errors.
If an OMD goes untreated, over time it is likely to cause:
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Temporomandibular Joint Disorder (TMJ)
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Tension headaches
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Neck and/or upper back tension
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Movement of teeth (possible to need orthodontic work again)
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Small palate which leads to smaller nasal passages which block the airway
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Sleep disorders
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Persistent speech sound errors that don’t resolve in conversation
Source – [3]
The youngest would be four. Each person is different, some are ready to follow the program and some need more time.
Based on previous clients:
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Treatment of a lisp cannot start while a child has a palate expander, or if there are significant jaw corrections or orthodontic work that needs to be done first
Consult with your orthodontist and SLP to determine the best treatment order for your child
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SLPs can help with the following:
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Increasing accuracy and intelligibility of speech sounds
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Bringing awareness to recognize correct movements and placement of the tongue and jaw when they speak, drink, eat, and are at rest
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Teaching proper chewing and swallowing techniques
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To work on minimizing tiring compensation strategies
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Teaching the practice of nasal breathing patterns
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See “what are the differences between nasal breathing and mouth breathing?” below
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Multiple providers typically work together for the treatment of OMDs. An orthodontist is necessary to assess and correct the structure of the mouth.
Discuss with your SLP if an orthodontist is a necessary first step in your child’s treatment.
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Dr. Rix with Rix Orthodontics is who we collaborate with the most often
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Dr. Long Tieu with Deerfoot Meadows Orthodontics has training in orofacial myofunctional disorders
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If you would like to search for providers yourself, here are some key phrases we suggest you look for when searching – “orofacial myofunctional disorders” and “breath based orthodontic work”
Through an examination, the orthodontist should assess
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Teeth – spacing, orientation, missing teeth, excess wear
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Jaw – short, narrow, growth pattern
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Bite – alignment (overbite, overjet, crossbite)
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Sleep/Breathing symptoms – mouth breathing, trouble breathing, trouble sleeping, snoring, attention
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Myofunctional/soft tissue – tongue tie, swallow, tight chin muscle, lip tie (upper and lower), tongue rest posture, poor oral habits, speech issues
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Saliva pooling
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Some orthodontists will complete a 3D scan to observe enlarged tonsils and adenoids
After an examination, the orthodontist will be able to recommend treatment and will discuss any other referrals needed such as an ENT or sleep clinic.
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An ENT (ear, nose, throat) specialist can assess such things as: tonsils, adenoids, sinuses, hearing concerns, sleep and breathing issues.
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Sleep clinics can assess breathing difficulties during sleep and sleep disorders
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Do it! – Don’t delay orthodontic work for speech therapy.
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Discuss your child’s specific speech sound errors as there are some that can be worked on at the same time, and others that have to be done afterwards
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For example, if the child has a palate expander in, we would likely not work on some specific sounds such as: s, z, sh, ch, j
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“s” and “z” frontal lisp (where the tongue comes between the front teeth during these sounds, it almost looks like the TH sound).
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Initial R or vocalic R sounds (ar, air, ear, er, ire, or, rl)
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“l”
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“sh,” “ch,” “j” distortions – could be frontal lisp, lateral lisp, or distorted and “slushy”
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A lateral lisp is a speech sound error where the air comes over the sides of the tongue and over the molars. Airflow for all speech sounds should be over in the middle of the tongue and in a forward direction.
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Other sounds that may be in error: “t,” “d,” “n,” “k,” “g,” “ng”
The benefits of nasal breathing:
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Engagement of the parasympathetic nervous system (this is relaxing for the body)
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Engagement of the diaphragm which leads to a more efficient and full breath
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Lower heart rate
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Lower blood pressure
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Improved sleep
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Decreased anxiety
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Lowered cortisol levels
Research has indicated that OMD’s and mouth breathing correlate with:
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Altered air pathway and reduced nasal respiratory function
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More oxygen intake during exercise (more unnecessary inhales)
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Orofacial deformities and structural changes of the skull with a longer face
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Altered tongue posture (tongue resting low in the mouth)
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Sleep apnea and snoring
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Increased fatigue, headaches and stress
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Tongue thrust swallow
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Increase in halitosis (bad breath) and tooth decay
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Higher rates of cardiovascular disease
Source – [2]
There are varying degrees of tongue tie (mild to severe) and there is a difference between structure and function of the tongue.
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Two types of tongue tie
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Anterior – this is the part of the tongue tie that you can visually see
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Posterior – this is farther back and farther inside of the tongue, an untrained eye may not see it
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Some people have both, some have only a posterior tie
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Structure vs. function
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For example, there are people with moderate tongue ties who have minimal functional impact and people with mild tongue ties with significant functional impact.
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It is important to have the tongue tie evaluated, and do a functional assessment. A orofacial myofunctional assessment will include watching the individual do a variety of movements and swallow food and liquid.
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If function (swallowing food) is impacted, an OMD is likely present
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[1] – American Speech-Language-Hearing Association. (n.d.). Orofacial myofunctional disorders. American Speech-Language-Hearing Association. https://www.asha.org/practice-portal/clinical-topics/orofacial-myofunctional-disorders/
[2] – Lörinczi F., Vanderka M., Lörincziová D., & Kushkestani M. (2024). Nose vs. mouth breathing- acute effect of different breathing regimens on muscular endurance. BMC sports science, medicine & rehabilitation, 16(1), 42. https://doi.org/10.1186/s13102-024-00840-6
[3] – Mohamed M., & Green M., Treatment or Orofacial Myofunctional Disorders – Muscle and Exercise Manual (2021).
[4] – Merriam-Webster. (n.d.). America’s most trusted dictionary. Merriam-Webster. https://www.merriam-webster.com/
[5] – Children’s Therapy Place. (2019, April 9). Orofacial myofunctional disorder. https://childrenstherapyplace.com/orofacial-myofunctional-disorder/
[6] – Rosero Salazar, D. H., Carvajal Monroy, P. L., Wagener, F. A. D. T. G., & Von den Hoff, J. W. (2020, February). Orofacial muscles: Embryonic development and regeneration after injury. Journal of dental research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977159/#:~:text=The%20orofacial%20muscles%20include%20the,of%20cranial%20neural%20crest%20cells.
[7] – Huffman, C. (2023, April 21). Oral rest posture 101. Myofunctional Therapy. https://www.functionalfaceomt.com/blog/oralrestposture#:~:text=your%20tongue%20should%20rest%20gently,your%20nose%20day%20and%20night
[8] – Erickson, E. (2024, March 13). Where should your tongue rest? proper tongue position explained. Mewing Coach. https://mewing.coach/blog/where-should-your-tongue-rest
[9] – McPherson, R. (n.d.). About Orofacial Myology. OM Health. https://www.omhealth.com.au/about-orofacial-myology