WHAT IS AN OROFACIAL MYOFUNCTIONAL DISORDER (OMD)?
Orofacial Myofunctional Disorders (OMDs) occur when there is abnormal development or use of the face, mouth and/or tongue muscles, resulting in dysfunctional lip, jaw or tongue placement and movements during rest, swallowing or speech.
WHAT CAUSES AN OROFACIAL MYOFUNCTIONAL DISORDER?
The causes of orofacial myofunctional disorders (OMDs) are multifactorial. However, they tend to originate from a low resting and functioning tongue due to:
- Genetic defects like tongue ties, cleft palate, craniofacial abnormalities, and syndromes.
- Oral habits like thumb, finger, and object sucking; frequent and extended use of bottle or pacifier.
- Airway issues like congestion caused by allergies or sinusitis, enlarged tonsils or adenoids, deviated septum, polyps, elongated soft palate, or any other obstruction. Orofacial myofunctional disorders can be caused by or contribute to airway issues.
- Diet: there has been research suggesting that refined sugars and the western diet have caused narrowing of the craniofacial structures therefore restricting the space available for muscles such as the tongue.
THE ORIGIN OF OMDS
From the beginning of one’s life, muscle movement and structural growth are dependent upon one another. Correct muscle function of the face, mouth, jaw and tongue at an early age plays an invaluable role in stimulating proper growth and development of the jaws, airway spaces and dentition. Use of these muscles begins with the swallow in utero and their dysfunction may appear once breastfeeding begins. Any abnormality early in life can affect function and habits later on in life. These abnormalities cause orofacial myofunctional disorders (OMDs). As these disorders persist there can be a domino effect of potentially life-long health concerns. Addressing any muscle dysfunction early on in life is key in preventing future symptoms associated with OMDs.
THE OMD-AIRWAY CONNECTION
EFFECTS OF OROFACIAL MYOFUNCTIONAL DISORDERS
The tongue is such a critical component to our overall health. Although it seems like a small thing, its position and function in the mouth can help or hinder us in many ways. Early on in development it can help form and retain the shape of the roof of the mouth, which is also the floor of the sinus. If the tongue is low and can't rest on the roof of the mouth, it effects the swallow, resulting in difficulty with breastfeeding early on. These two factors combined can hinder ideal development of facial structures and airway. As the child grows and develops, their structures become compromised which further compounds the existing habits and problems, causing a trickle effect as shown above.
TONGUE POSTURE (One of the main indicators of OMDs)
A low-resting tongue occurs when the tongue sits low in the mouth, either in the front or back. Three factors typically contribute to a habitual low-resting tongue: genetic abnormalities (tongue-tie), habits (finger/thumb sucking), or airway issues (that prevent nasal breathing). Anything that forces the tongue low can contribute to the following symptoms:
- mouth breathing
- tongue thrust swallowing patterns
- ear infections
- stomach aches
- crowded teeth
- narrow dental arches and facial features
- sinus issues
- speech problems
- orthodontic relapse
- jaw pain
- headaches or migraines
- neck pain
- sleep disordered breathing or sleep apnea
When the tongue is low in the mouth, the head tends to rest in a forward position and the shoulders tend to roll forward affecting the cervical spine and posture. Ideally, the tongue should rest in the roof of the mouth providing support for the upper jaw, which is the floor of the sinus. Because a low resting tongue posture becomes habitual in nature, just removing the source of the problem (fingers, tongue tie or tonsils and adenoids, for example) doesn't solve the problem in entirety. This is the goal of therapy: to eliminate habits and restore proper muscle function so muscles of the lips, tongue and jaws rest and work together correctly.
KEY CONTRIBUTORS OF A LOW RESTING TONGUE
Correct oral resting posture is critical to the function of the tongue and proper development of the sinuses and airway spaces. Therefore, it is important to address any factor that results in mouth breathing. Cold, unfiltered air enters our bodies when we bypass the nose and breathe through the mouth. This can disrupt the homeostasis between oxygen and carbon dioxide, contributing to further health problems. Chronic mouth breathing can contribute to the following:
- development of long and narrow facial features (long face syndrome) in children
- gingival inflammation
- periodontal disease
- bad breath
- dry mouth (which can lead to decay)
- enlarged tonsils and adenoids
- sleep disordered breathing (snoring and sleep apnea)
Nasal breathing is essential. It naturally humidifies, filters and warms the air entering our bodies. Nasal breathing also creates nitric oxide, which is a potent vasodilator, natural antimicrobial, and blood pressure regulator. Other health benefits of nitric oxide include improved oxygen absorption, blood vessel maintenance, reduction in the potential for cardiovascular disease and stroke. If nasal breathing is impossible or reduced, the benefits of nitric oxide can be missed.
A tongue tie (or ankyloglossia) occurs when the small string of tissue under the tongue (frenum) doesn't degrade properly during development and is tighter or shorter than it should be. With this restriction the tongue loses its mobility, is unable to move freely to function properly, and is forced to sit on the bottom of the mouth. The body does its best to compensate for these lingual restrictions in order to chew, swallow and speak as well as possible, despite the reduced mobility. Ultimately, tongue ties will contribute to OMDs and can result in the symptoms listed above.
TETHERED ORAL TISSUES (TOTs)
Lips and cheeks also have frenums that can be tight or short, consequently affecting speech, chewing, and swallowing. If any of the frenula in the lips, cheeks or under the tongue are restricted, they are considered a tethered oral tissue.
WHAT IS THE TREATMENT FOR TETHERED ORAL TISSUES (TOTs)?
Treatment for tethered oral tissues depends on the degree to which functions are restricted and the severity of symptoms. When therapy alone cannot retrain the brain and the tongue so the muscles can function and rest properly, surgery is recommended. Releases of TOTs can be done with a laser or with scissors, and both require exercises before and after surgery so the tissue does not reattach. Wound constriction is a normal process of wound healing, and therapy helps prevent long term constriction.
ORAL HABITS (SUCH AS THUMB/FINGER SUCKING)
Sucking on fingers, thumbs, clothes, or hair and biting on nails, pencils and other items can all either indicate or contribute to an existing OMD (as can extended and frequent use of bottles and pacifiers). These habits force the tongue into a low position, creating a habitually low resting tongue posture, thus contributing to the previously listed symptoms. The goal of therapy is to retrain the tongue to sit on the roof of the mouth and achieve complete closure of the lips so the jaws can form properly. This then allows the teeth to come in properly.
Example of what oral habits can do.
A tongue thrust occurs when the low resting posture and other dysfunctional muscle movements of the lips and cheek cause the tongue to push forward against the teeth during the swallow. A tongue thrust can affect the position of the teeth during development, complicate orthodontic treatment, or cause orthodontic relapse. A tongue thrust can also be a symptom of underlying airway problems. Often times, open mouth resting posture and mouth breathing go hand-in-hand with tongue thrust swallowing patterns. Signs of a tongue thrust include:
- mouth breathing
- forward tongue that is visually resting between the front teeth
- front teeth that do not come together (open bite)
- excessive lip and chin movement or head bobbing during the swallow
- sucking habits (which cause the tongue to rest low in the mouth and subsequently stay low during the swallow)
Orofacial myology is not speech therapy, but it can help improve speech articulation if low tongue posture is present. Certain articulation errors can be caused by tethered oral tissues and may improve with their releases, especially if a child or adult continues to struggle in speech therapy. Orofacial myofunctional disorders affect how the muscles work to produce sounds. Read more on ASHA’s website regarding speech and OMDs.
HEADACHES, MIGRAINES, MYOFASCIAL, JAW, NECK & SHOULDER PAIN
A low resting tongue posture, among other factors, can affect how the jaw sits in the joint. Altered tongue function can lead to TMJ disorders and pain. Therapy can help reduce pain by restoring proper resting posture of the tongue. While jaw pain can be multifaceted, much of the time it is of muscular origin and can be improved with therapy.
SNORING, SLEEP APNEA & SLEEP-DISORDERED BREATHING
A quality night's sleep is critical for optimal health, especially during growth and development. Proper sleep allows for adequate oxygenation of the blood and nourishment of the cells in our bodies. If the tongue sits low in the mouth, it is more likely to fall back and block the airway, reducing oxygenation. Mouth breathing is a risk factor for snoring and sleep apnea which can lead to high blood pressure, diabetes, heart disease and stroke in adults. Poor sleep in children can affect cognition, behavior, academic performance and contribute to hyperactivity. Other signs of sleep disordered breathing are:
- frequent night time arousals to use the restroom (or bedwetting in kids)
- night sweating
- night terrors
- clenching and grinding
- restlessness during sleep
- daytime sleepiness
- insulin resistance or weight gain
Ask your doctor if you experience several of these symptoms, as a sleep study may be needed.
Orofacial myology can addresses issues associated with sleep disordered breathing if habitual mouth breathing is present or if low resting tongue posture is causing the tongue to fall back into the airway. OMT has been shown to reduce snoring and sleep apnea.
The tongue helps to shape the upper jaw during growth and develop. If there is homeostasis between the resting lips, cheeks and tongue, proper development of the jaws and airway occurs allowing for adequate room for the teeth. The tongue acts like the body's natural support for the upper jaw and keeps the teeth in proper alignment within the dental arch. If the tongue does not rest in the top of the mouth during growth and development, the jaw may narrow and teeth may become crooked. Furthermore, if the tongue is not resting and functioning correctly after braces come off, the teeth can move and become crooked again. Therapy prior to or during orthodontic treatment is critical for long term retention, especially if muscle dysfunction is the source of crooked teeth. It is important to look at the root cause of crooked teeth and ensure that any airway issues are addressed prior to straightening the teeth.
BENEFITS OF OROFACIAL MYOLOGY IN KIDS AND ADULTS
Like physical therapy is used to restore function and movement to the body as a whole, orofacial myology does the same by retraining the muscles of the face, neck and mouth (as well as the brain) in order to eliminate incorrect muscle patterns (OMDs) that have developed over time. In addition to muscle retraining, orofacial myology can contribute to healthy breathing patterns by focusing on exercises that enforce slow, nasal diaphragmatic breathing. Muscle retraining, healthy breathing and proper habits can aid in:
- young children's facial, airway and dental development
- proper chewing, swallowing, and digestion
- preventing recurrent ear infections
- speech articulation
- healthier day- and night-time breathing
- improving quality of sleep
- increasing alertness
- orthodontic retention
- reducing TMD pain
- reducing snoring or sleep apnea
All of which can boost self-esteem and improve overall health and quality of life.
Success in therapy is dependent upon consistent daily exercise until proper muscle function is restored and maintained. It takes time, persistence, and commitment from the patient and family members to get optimal results. Complete and optimal treatment often requires a multidisciplinary approach utilizing other healthcare professionals, orofacial myology being just one piece.