What are orofacial myofunctional disorders?

Have you taken a look at your young child’s teeth and thought, “Hmm, what’s going on in there? Why are their teeth so crooked already?”

How about if you have an older child or teenager who has already gone through the expensive and difficult process of braces… only to find that their teeth are starting to look crooked again not long after the braces have been removed?

Or, are you an adult working up the nerve to explore the options of braces for yourself (Invisalign, anyone?) … despite having already had them when you were a teenager?

If you’re nodding “yes” to any of these statements, you are not alone! But what’s happening with your teeth is not just because you or your child are “unlucky” or have “bad genes,” as you may be thinking. In fact, the underlying problem is likely an orofacial myofunctional disorder which is contributing to the symptoms you’re seeing in the mouth. Read on for a “Q&A” introduction to orofacial myology!

“An orofacial… what? I’ve never heard of such a thing! What is it?”

Orofacial myofunctional disorders are atypical, adaptive patterns that occur when the muscles of the of the face, neck, and mouth don’t function normally. If these adaptive movements happen regularly, they can have a variety of effects.

“But why hasn’t anyone mentioned this before? My children and I go to the dentist regularly, and they’ve never mentioned it!”

The field of orofacial myology as we know it today is relatively new, although the fundamental concepts of facial and tongue muscle function, breathing patterns, and their effects on the teeth have been around for over a century. Although we are fortunate that more and more dentists, ENTs, and other oral health professionals are now becoming aware of orofacial myofunctional disorders and their dental/health impacts, the fact is that many of these professionals simply have not had the exposure, training, or experience to be able to diagnose or treat these disorders. Instead, crooked teeth are often chalked up to genetics instead of searching for the true, underlying causes.

“Okay, I’m intrigued… What does an orofacial myofunctional disorder actually look like? How do I know if my child or I have one?”

Examples of orofacial myofunctional disorders include (but aren’t limited to) one or a combination of the following:

-A routine habit of resting with the lips apart

-Mouth breathing

-A frontal or lateral lisp

-Improper chewing and swallowing. For example: Only chewing on one side, using a vertical “munch” chewing pattern instead of a rotary chewing pattern, decreased or no tongue side-to-side movement while chewing, not having good control of the food in the mouth while chewing, pushing the tongue against the front teeth while chewing or swallowing, coughing/choking frequently while swallowing, or needing a lot of liquids while eating

-A forward resting posture of the tongue between or against the front teeth

-A low resting posture of the tongue on the floor of the mouth

-Tongue thrusting against the teeth at rest or while swallowing

-Thumb and finger sucking habits

-Other harmful oral habits

“So, what’s the big deal? We might have some of these characteristics, but our teeth don’t look that bad… Why should I care about this?”

Orofacial myofunctional disorders are often caused by, or can contribute to, other medical and dental disorders. Your orofacial myologist will uncover these associated problems and create a personalized treatment plan that will get you on the right pathway for better functioning that will last long after the braces come off. Here are some of the related issues that often co-occur with orofacial myofunctional disorders:

-Malocclusion (improper alignment of the teeth)

-Orthodontic relapse (teeth getting crooked again after braces come off)

-TMJ dysfunction

-Forward head posture; poor body posture (“slumping” or “hunching”)

-Changes associated with abnormal jaw growth and position

-Sleep difficulties (like sleep apnea, bed-wetting, upper airway resistance syndrome, or restless sleep, among others) — In children, these sleep difficulties can lead to challenges with attention, behavior, and development.

-Allergies

-Nasal obstruction (like a deviated septum or enlarged nasal turbinates)

-Upper airway obstruction (like enlarged tonsils and/or adenoids)

-Tethered oral tissue (such as a tongue or lip tie)

“What can orofacial myofunctional therapy accomplish?”

Our orofacial myofunctional therapy program involves a 4-step process to help a person retrain these adaptive patterns of muscle function to create and maintain a healthy and more efficient system.

Treatment goals may include (but are not limited to):

-Establishing nasal breathing

-Normalizing tongue and lip resting postures

-Improving strength and coordination of the oral musculature

-Eliminating improper chewing and swallowing

-Using balanced and efficient chewing and swallowing

Treatment may also address the elimination of oral habits including:

-Prolonged pacifier use

-Thumb and/or finger sucking

-Fingernail, cheek, or lip biting

-Tongue sucking

-Clenching or grinding of the teeth

Your treatment plan may include referrals to other professionals as appropriate depending on your specific case and what is uncovered in your evaluation. Being under the care of a team of professionals who are knowledgeable about muscle function, airway, sleep, and how to look at the “big picture” of all these factors together is often life-changing for our patients!

“When should therapy begin?”

Therapy for orofacial myofunctional disorders can begin at different ages.

-Children as young as 4 years of age can benefit from an evaluation to determine if factors such as an inability to breathe nasally consistently or a tongue tie would require intervention and would allow the clinician to make appropriate referrals to professionals for remediation.

-Children 5 years of age are at an ideal time to begin a program to help eliminate harmful sucking habits.

-Children 6-7 years of age are good candidates to begin a formal orofacial myofunctional therapy program.

-Teens and adults of all ages are also able to achieve successful, long-term results.

“I’m sold! How do I get started with orofacial myofunctional therapy?”

If you suspect you or your child have an orofacial myofunctional disorder, the first step is to call and schedule an evaluation. The evaluation will include a detailed medical history, assessment of orofacial structure and function during speech and feeding tasks, and may include an articulation assessment. Our patients leave their evaluations with a whole new understanding of how their facial structures and muscles work together, and we often hear that it is the most eye-opening, thorough evaluation they have ever had!

“How can I make the most out of my orofacial myofunctional therapy plan?”

Success with an orofacial myofunctional therapy program requires a team approach: the orofacial myofunctional therapist, related professionals (including dentists, ENTs, pediatricians, sleep physicians, etc.), the patient, and the family must all collaborate for the best possible outcome. Following the exercise and referral recommendations of your therapist and related professionals will help ensure that you or your child progress through the program and achieve your goals as efficiently as possible.

Are you ready to get on the Pathway to better breathing, sleeping, eating, and drinking? Give us a call!

The above information was gathered from the website of the International Association of Orofacial Myology (IAOM). For more information regarding OMDs and Orofacial Myofunctional Therapy, please visit their website: https://www.iaom.com/