Orofacial Myofunctional Disorders

What are Orofacial Myofunctional Disorders (OMD)?

An orofacial myofunctional disorder (OMD) is when there is an abnormal lip, jaw, or tongue position during rest, swallowing or speech.

Orofacial myofunctional disorders include one or a combination of the following:

abnormal thumb, finger, lip, and tongue sucking habits
an inappropriate mouth-open lips-open resting posture problem
a forward interdental rest posture of the tongue problem
a forward rest position of the tongue against the maxillary incisors problem
a lateral, posterior interdental tongue rest posture problem
inappropriate thrusting of the tongue in speaking and/or swallowing.

What are some of the causes of Orofacial Myofunctional Disorders?

It is often difficult to isolate a particular source as the sole cause of an orofacial myofunctional disorder and in most cases, it can be result of a combination of factors. Many experts suggest that OMDs may develop as a result from the following:

A restricted nasal airway due to enlarged tonsils/adenoids, deviated septum, and/or allergies.
Improper oral habits such as thumb or finger sucking, cheek/nail/cuticle biting, teeth clenching/grinding, and tongue, lip or cheek sucking
Extended use of a pacifier and/or long-term use of sippy cups
Structural or physiological abnormalities which may include a short lingual frenum (tongue-tie)
Neurological deficits and developmental delays
Hereditary predisposition

The most commonly noted etiology of an OMD is a lack of 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 jaw and maxilla and 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.

What are the long term consequences of an Orofacial Myofunctional Disorder?

OMD can, over time, cause:

Dental malocclusion (teeth not closing properly)
Atypical pattern of swallowing (thrusting of the tongue to swallow)
Difficulty chewing food (“sloppy eaters”)
Mispronunciation of sounds (i.e. lisp)
Cosmetic problems (development of a long face, retruded chin)
Jaw joint pain
Weak lips
Long term mouth-breathing patterns that compromise overall healthy breathing
Establishment of detrimental oral habits that impede further growth and development
Establishment of atypical patterns that impact chewing and swallowing
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)
Negatively affecting social relationships due to open mouth postures or noisy chewing and swallowing patterns

How are Orofacial Myofunctional Disorders treated?

They are treated with myofunctional therapy. Exercises are customized for every patient’s needs. Breaking habits is a difficult task, and success in therapy depends greatly on individual motivation and commitment to the therapy program.

What is Myofunctional Therapy?

Myofunctional Therapy (literally, muscle-function therapy), addresses oral myofunctional disorders (OMD). OMD is an umbrella term that refers to abnormal oral resting postures and oral functions (“tongue thrust”/lingual horizontal swallowing and chewing differences), and oral habits (such as thumb/finger sucking, or tongue sucking). The patient with an OMD systematically moves through a series of exercises and activities that develops oral capability, establishes unharmful oral resting positions, trains new swallowing and chewing skills, and/or extinguishes the oral habit(s).

What can be achieved with Orofacial Myofunctional treatment?

The goals of orofacial myofunctional treatment are to eliminate habits (such as thumb sucking), and establish:

Adequate lip seal at rest
An optimal resting tongue position
A typical pattern of swallowing
Bilateral chewing and correct drinking habits
Nasal breathing, with lips together
Good neck and head posture

Elimination of habits and use of healthy oral behaviors can also decrease periodontal disease, and reduce the risk of orthodontic relapse (your teeth moving after the removal of dental appliances).

Strengthened muscles and correct tongue placement also has a positive effect on your facial appearance.

Can’t orthodontic treatment alone restore the placement of my teeth?

The doctor can realign your teeth and restore your smile, but they do not retrain your tongue to rest in the right spot, or eliminate habits. Over time, it is likely that the habits or behaviors that have disrupted your dental development in the first place will again impact your teeth alignment.

Myofunctional therapy is not directly responsible for moving teeth. Positive dental correction is a nice secondary benefit to myofunctional therapy, but the fact is we move muscles out of the way so teeth move into their desired positions; either on their own or with help.

Signs and Symptoms of Orofacial Myofunctional Disorders

Presence of one or more of the following:

Tongue visibly forward at rest and while swallowing
Lips-apart at rest and during swallowing
Tongue seems to ‘get in the way’ during a dental examination
Anterior or posterior open bite through which a tongue rests
Habitual mouth breathing and opened-mouth posture perhaps with snoring at night
Excessive elongated facial growth called ‘Long Face Syndrome’
Loose, flaccid lip tone – especially seen in the bottom lip
Facial smirk / grimace to seal the lips closed during swallowing
A tongue that comes forward into a cup when taking a drink
Dimpling appearance to the chin when swallowing and / or when lips are together at rest
Teeth that are visible in the presence of an arched upper lip
No masseter involvement during the swallow
Messy eating, excessive drooling, and/or crumbs that lodge in corners of the mouth
Improperly chewed food resulting in frequent stomach pains and gas

The normalized patterns of proper tongue, lips and jaw postures are crucial to facilitating normal growth and the overall development of the orofacial structural and musculature systems.