Orofacial Myofunctional Therapy
What is an Orofacial Myofunctional Disorder?
Orofacial myofunctional disorders (OMDs) are patterns involving oral and orofacial musculature that interfere with normal growth, development, or function of orofacial structures, or call attention to themselves (Mason, n.d.A). OMDs can be found in children, adolescents, and adults. OMDs can co-occur with a variety of speech and swallowing disorders. OMD may reflect the interplay of learned behaviors, physical/structural variables, genetic and environmental factors (Maspero, Prevedello, Giannini, Galbiati, & Farronato, 2014).
Signs and Symptoms
Articulation problems
Dental abnormalities
Drooling and poor oral control, specifically past the age of 2 years
Mouth breathing
Open mouth posture
Orthodontic issues
Picky eating habits
Problems with chewing and swallowing
Sleep issues (snoring, sleep apnea, fatigue, jaw misalignment, bed wetting, etc.,)
Teeth grinding/TMD
Finger/Thumb/Tongue sucking
Tongue thrust (abnormal tongue rest posture)
Tethered Oral Tissues
Causes of OMDs
No single cause of orofacial myofunctional disorders has been identified. Causes seem to be multifactorial. Anything that causes the tongue to be misplaced at rest limits lingual excursions within the oral cavity, makes it difficult to achieve acceptable lip closure, and reduces or impedes the ability to obtain and maintain correct oral rest postures leading to an OMD. That said, common causes include:
Airway obstructions (deviated septum, large adenoids/tonsils)
Craniofacial abnormalities
Improper/Extended use of pacifiers (past 12 months) and sippy cups
Oral habits such as finger/thumb sucking
Structural anomalies
Neurological deficits
Tongue, lip and/or cheek ties
Myofunctional Therapy:
Exercised based therapy for tongue and face muscles involved in breathing, speaking, chewing and swallowing.
Interdisciplinary Team
Assessment of orofacial myofunctional disorders has many possible aspects, which often require an integrated team approach. The orofacial myologist (SLP, OT, RDH, DDS) should refer and collaborate with other professionals who may include one or more of the following:
Allergist
Dentist
Oral surgeon
Orthodontist
Otolaryngologist
Sleep Doctor
Physician
Physical therapist
Osteopath
Cranial Sacral Therapist
Chiropractor
Incidence
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, 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).
References:
American Speech-Language-Hearing Association. (n.d.). Orofacial Myofunctional Disorders. (Practice Portal). Retrieved 1/15/20 from https://www.asha.org/Practice-Portal/Clinical-Topics/Orofacial-Myofunctional-Disorders/.
American Speech-Language-Hearing Association. (2016b). Scope of practice in speech-language pathology [Scope of Practice]. Available from https://www.asha.org/policy/sp2016-00343/.
Hanson, M. L., & Mason, R.M. (2003). Orofacial myology: International perspectives (2nd ed.) Charles C Thomas.
International Association of Orofacial Myology. (2020, June 16). Orofacial myofunctional disorders. https://www.iaom.com/faq/
Master reference list IAOM: http://oralmotorinstitute.org/resources/Orofacial-Myofunctional-Disorders-RefList.pdf