Orofacial Myofunctional Therapy

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What is an orofacial myofunctional disorder?

An orofacial myofunctional disorder (OMD) is a term to describe the abnormal function of the oral and facial muscles during swallowing and at rest. The term "tongue thrust," a pattern in which the individual pushes the tongue against or between the teeth while swallowing and in rest posture, is often used to describe a common OMD. 

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What is oral rest posture?

Oral rest posture refers to where the tongue, teeth, and jaw are when a person is not talking or eating. A healthy oral rest posture is one in which the tongue tip is slightly elevated and behind the front teeth while the root of the tongue is slightly suctioned to the back palate. 

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How can poor oral rest posture impact dental development?

The tongue may be considered a natural palate expander, so if it is not resting on the top palate, the palate may not expand to provide space for growing dentition. When a person has poor oral rest posture, the lips, tongue, cheeks, and dental structures do not work well together. Orthodontic treatment may be slowed, unstable, or at risk of relapse. 

4

How does poor oral rest posture impact speech articulation?

Oral rest posture is like the base camp for speech production. If oral rest posture is abnormal (e.g., tongue low and forward in the mouth against the lower front teeth), articulators may need to move further to produce clear speech. During the rapid production required for speech conversation, the body may take an easier, more familiar route (i.e., "economic efficiency") to produce speech sounds. This may lead to "mumbled" speech. Without first correcting the oral rest posture, it may be difficult to fully correct sounds with traditional speech therapy. Common speech sound errors include: t, d, n, l, s, z, r, "ch" and "j." 

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What causes poor oral rest posture +/or tongue thrust swallowing?

The cause of poor oral rest posture and tongue thrust swallow is typically multifactorial. Common factors include, but are not limited to: 

1) Restricted nasal airway due to enlarged tonsils/adenoids or allergies.

2) Oral habits such as finger/thumb sucking, cheek/nail biting, tooth clenching/grinding.

3) Habitual mouth breathing and/or open mouth posture.

4) Structural or physiological abnormalities such as tethered oral tissues. (TOTs), ankyloglossia (i.e., tongue-tie), or abnormally large tongue (very rare). 

5) Neurological or developmental abnormalities.

6) Hereditary predisposition to some of the above factors.

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When should therapy begin?

Age, motivation, time commitment, as well as current orthodontic treatment must all be taken into account. The age of the child is not as important as the motivation to succeed. Since the program uses a behavioral approach to therapy, the client's motivation is critical. In addition, the ability to commit to the therapy program is very important in order to establish the new, wanted behavior (i.e., healthy oral rest posture). 

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How long does rest posture (i.e., tongue thrust swallow) therapy take?

There are four phases to the therapy program. The first two, rather intense, phases of therapy lasts approximately 12 weeks. The later phases, essential for habituation, last approximately 6 weeks with retention checks built in thereafter when necessary. 

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What is the role of the parent/practice partner?

Changing a habit, especially one that is persistent throughout the day, requires a lot of work! When a practice partner is informed, interested, and supportive, they will be instrumental in the client's success. Therefore, practice partners are required to be present at every session (preferably the same person every time). 

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Is therapy difficult?

Definitely! Learning a new habit requires commitment, discipline, and effort - for the client as well as the practice partner. We will work as a team to make therapy positive and successful!