Orofacial myofunctional therapy

Orofacial myofunctional therapy (OMT) is used to treat tongue tie, lip tie, tongue thrust, mouth breathing, jaw malocclusions. Speech-language pathologists should be familiar with how to treat these disorders. 

ASHA defines OMDs as “patterns involving oral and orofacial musculature that interfere with normal growth, development, or function of orofacial structures, or call attention to themselves.” OMT has been used since the 1900s. 

Orofacial Myofunctional Disorders (OMDs) are common. Tongue thrusting during swallowing is present in 33% to 50.5% of the population. There’s also a connection between OMDs and other speech disorders or orthodontic issues. According to ASHA, children who have articulation disorders have been found to be more likely to have a tongue thrust swallow.  

A critical component of treatment for OMDs is orofacial myofunctional therapy. Orofacial myofunctional therapy can improve the strength, coordination, and positioning of the muscles of the mouth. The SLP typically treats OMDs through oral muscle exercises, articulation therapy, and techniques or tools to improve swallowing.  

Causes and symptoms 

Orofacial Myofunctional Disorders can be caused by several different factors. This can include anything that causes a misplaced resting tongue posture, difficulty achieving lip closure, or difficulty/inability to maintain a correct oral posture at rest. 

Structural differences and/or certain chronic behaviors may cause OMDs, including:

• Thumb sucking
• Extended use of pacifiers/sippy cups
• Structural abnormalities
• Tethered Oral Tissues (TOTs) (lingual, lip, and buccal ties) 
• Genetics
• Orthodontic problems
• Enlarged tonsils/adenoids that cause nasal passages to become obstructed (leading to improper resting tongue posture) 
• Neurological disorders

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Symptoms of OMDs can include these issues with swallowing, speech, and/or breathing: 

• Drooling
• Sleep apnea, snoring, or other signs of disordered sleep
• Articulation issues (most commonly a lisp)
• Open mouth posture at rest
• Oral dysphagia/difficulty swallowing (due to trouble closing the lips)
• Dental problems (teeth can be pushed out of place from a tongue thrust pattern) 
• Difficulty biting/chewing food (due to malocclusion of teeth) 
• Facial grimace and other cosmetic differences 
• GI issues (due to swallowing air) 

Research states that early signs of OMDs can be seen as early as infancy. Orofacial myofunctional therapy can be initiated as early as 4 years old, according to some sources. This early intervention can lead to improved outcomes. 

Assessment and diagnosis 

A comprehensive assessment should be completed by an interdisciplinary team. This can lead to an accurate and appropriate diagnosis of an OMD. 

In addition to a speech-language pathologist, the team can include:

• Dentist 
• Orthodontist
• Physician 
• Otolaryngologist (ENT) 
• Allergist
• Plastic Surgeon 
• Sleep Apnea Specialist 

These specialists can assess for any structural or biological factors contributing to an OMD. They can also use imaging and other assessment measures to diagnose OMDs. 

The SLP plays an important role in the assessment of OMDs, and should communicate with the rest of the client’s care team. 

The SLP’s assessment may consist of:

• Case history
  • Medical history (any abnormal sleep habits, breathing difficulties, etc.)
  • Oral habits (such as pacifier use, thumb/finger sucking, etc.)
  • Surgical history
  • Previous or current dental problems 
  • Feeding history (difficulty chewing certain textures, trouble closing the lips to swallow) 
  • Speech/articulation difficulties 
• Feeding/swallowing assessment 
• Speech assessment
  • May include Diadochokinetic tasks and a standardized assessment such as the Goldman Fristoe Test of Articulation (GFTA) 
• Oral Motor Examination 
  • Assessment of the structure and function of the lips, tongue, jaw, velum) 
  • Look for abnormalities such as TOTs (Tethered Oral Tissues) or malocclusions

Treatment of OMDs with Orofacial Myofunctional Therapy 

According to ASHA: “The primary purpose of orofacial myofunctional therapy is to create an oral environment in which normal processes of orofacial and dental growth and development can take place, and be maintained.”

The team of specialists may need to first treat the issue(s) contributing to the client’s Orofacial myofunctional therapy, for example through an adenoidectomy, tonsillectomy, or frenectomy. 

The speech-language pathologist can then use specific techniques to encourage an accurate resting posture of the lips and/or tongue, correct an articulation disorder, or improve swallowing abilities. 

Here are some techniques an SLP can use in Orofacial myofunctional therapy: 

#1 Tongue exercises

• Tongue push-up: Pushing the tongue upward on the roof of the mouth, behind the top teeth and holding for 5 seconds at a time. 

• Click the tongue: Make a clicking sound with the tongue by pushing it against the palate. 

#2 Lip exercises for lips-together oral rest posture 

• Lip together posture: Encourage this by having the client hold a tongue depressor vertically between the lips for 5 seconds at a time. 

• Eliminate non-nutritive sucking: Provide recommendations for how to stop thumb/finger sucking or eliminating pacifier use. 

#3 Swallowing techniques 

• Modified food/liquid textures

• Elimination of sippy cups

• Encouraging use of straws 

#4 Breathing exercises

Nasal breathing: Breathing in with the mouth closed, then close one nostril by pushing a finger against it while breathing out. This can encourage nasal breathing over mouth breathing.