Frequently Asked Questions
Orofacial myofunctional therapy is an interdisciplinary practice that works with the muscles of the lips, tongue, cheeks, and face and their related functions. These functions include breathing, sucking, chewing, swallowing, and some aspects of speech. It acts in the prevention, evaluation, diagnosis, and treatment of people who may have these functions compromised or altered. It can also act in improving facial aesthetics. The specialist in orofacial myofunctional therapy can work in partnership with other professionals, such as dentists, orthodontists, doctors, physical therapists, speech therapists, occupational therapists, nutritionists, nurses, and psychologists, among others.
As an emerging field, questions are quite common when we talk about orofacial myofunctional therapy. Below are answers to some frequently asked questions, as initially compiled by the Academy of Orofacial Myofunctional Therapy (AOMT).
Orofacial myofunctional therapy (OMT) consists of strengthening and neurological re-education exercises to assist with the normalization of developing, or developed, craniofacial structures and their functions. It is related to the study, research, prevention, evaluation, diagnosis, and treatment of functional and structural alterations in the region of the mouth (“oro”), face (“facial”), and regions of the neck (oropharyngeal area).
The main problems related to orofacial myofunctional disorders (OMDs) are alterations in breathing, sucking, chewing, swallowing, and speech, as well the position of the lips, tongue (including what is known as oral rest posture), and cheeks.
The stomatognathic system (i.e., teeth, jaws, and associated soft tissues) is supported by an interdisciplinary team including speech language pathologists, otolaryngologists, orthodontists, dentists, dental hygienists, physical therapists, occupational therapists, and others. Each country’s healthcare system is different, with each specialty having differing degrees of leadership roles in providing such care. In some countries, speech pathologists may take a leading role, whereas in others, another profession such as physical therapy or dental hygiene may have a more prominent role. It truly is an interdisciplinary therapy, with several professions contributing, each according to its own scope of practice. It is incumbent upon the professional to complete additional training in orofacial myofunctional therapy, and to abide to local laws in the country in which they reside.
Feeding a child stimulates the orofacial muscles and this promotes the growth of the face. In the same way, proper suction and chewing prevents dental alterations, and difficulties when structures such as the lips and tongue are moving. This is fundamental in the production of speech sounds.
Besides all the nutritional and immunological benefits, the practice of breastfeeding stimulates the proper functioning of the structures of the mouth and face. Breastfeeding strengthens the orofacial muscles of the infant, reducing risk of future problems in important functions such as breathing, chewing, swallowing, and speaking.
Difficulties of sucking in infants may occur due to: lack of sucking reflexes, which decreases the suction force; tongue and/or lip tie restrictions; lack of coordination between the actions of sucking, swallowing, and breathing; improper positioning of the mother and/or the baby; inadequate lip closure around the breast nipple; inadequate movement of tongue and jaw during breastfeeding.
When breastfeeding is not possible, milk may be collected from the mother’s breast, or an alternative milk may be recommended by a pediatrician. Milk may be offered by a bottle, a spoon, or a small cup. A specialist in orofacial myofunctional therapy, in conjunction with the expertise of a lactation consultant, may assist in determining the most appropriate way to breastfeed the infant based upon his/her individualized needs.
For breastfeeding infants with a cleft lip, the guidelines are the same as given to infants without clefts. Many babies with a cleft lip may breastfeed with no alterations. However, in cases with a cleft palate, many children may fail to have an adequate milk intake with breastfeeding alone. In these cases, the milk can be offered using special feeding bottles.
The intensity, frequency, and duration of these oral habits may cause changes in facial growth, alteration of tooth position, difficulty with correct use of orofacial muscles, impairment of breathing functions, chewing, swallowing, and they may also lead to issues with speech, such as slurred speech, or an anterior lisp (i.e., placing the tongue between the teeth). The pacifier soothes the baby because it satisfies the need to suck, but its use ought to be eliminated as soon as possible. Alternative options that support the proper development and function of these structures are available, and can be recommended by orofacial myofunctional therapists when appropriate.
The first step is to understand how these habits began and why they still occur. The child must be understood and not ridiculed; this awareness is crucial to gain the cooperation of the child. Depending on the case, the orofacial myofunctional therapist may indicate exercises for strengthening the orofacial muscles, particularly the lips and tongue, while addressing the balance of the stomatognathic functions (i.e., breathing, chewing and swallowing). An occupational therapy consultation may also be indicated.
The preference for soft foods may be related to a reduction in the strength of the muscles of mastication (i.e., chewing). It may also be related to the presence of enlarged tonsils. Feeding early on with different consistencies may stimulate the strength of the orofacial muscles, and enhance facial development.
A lisp is a distortion of speech, characterized by placing the tongue between the front teeth during the production of the sounds /s/ and /z/.
By chewing only on one side, an imbalance of facial muscle strength is produced because the muscles on that side of the face are emphasized while the other side is neglected. This can lead to facial asymmetry over time. In addition, the bite can be altered and the temporomandibular joint, also known as the “TMJ,” (i.e., the joint that connects the jaw to the skull and allows the mouth to open and close) may suffer undo stress.
An open bite corresponds to a problem of occlusion caused by multiple factors, including habits (e.g., thumb/finger sucking or pacifier use) or the presence of functional disorders (e.g., mouth breathing and inadequate pressure of the tongue at the top of the mouth for an optimal position during swallowing and/or speech).
Orthodontic and orofacial myofunctional therapy can be closely related, with each directly impacting the other. Each case must be analyzed and discussed by the professionals involved. Treatment may be indicated before, during, and/or after orthodontics. Orofacial myofunctional therapy specialists help to improve orofacial stability and diminish orthodontic relapse after removal of braces by promoting a balance of orofacial muscle strength and functions, and improving the oral rest posture of the tongue.
The term temporomandibular dysfunction (TMD) is used to define problems that can affect the temporomandibular joint (TMJ), as well as muscles and structures involved in chewing.
TMD may be related to various factors such as dental changes (e.g., loss or wear of the teeth, poorly fitting dentures), unilateral chewing, mouth breathing, lesions due to trauma or degeneration of the TMJ, muscle strains caused by psychological factors (e.g., stress and anxiety), and oral habits (e.g., nail biting, biting objects or food that is too hard, resting a hand on the chin, grinding or clenching teeth during sleep).
Pain may be present around the TMJ, possibly radiating to the head and neck. It may also involve earache, tinnitus, ear fullness, sounds when opening or closing the mouth (e.g., popping, clicking, grinding in the TMJ), pain or difficulties when opening the mouth, and pain when using muscles involved in chewing.
Most cases of TMD would benefit from treatment by a team of allied health professionals such as an orofacial myofunctional therapy specialist, dentist, psychologist, physical therapist, neurologist, and otolaryngologist. The orofacial myofunctional therapy specialist, after conducting a thorough assessment, may apply techniques to rebalance the muscles of the mouth, face, and neck, and restore the functions of breathing, chewing, and swallowing. With this, there may be attenuation or elimination of the signs and symptoms of TMD. The patient should be educated about any harmful oral habits that might re-exacerbate symptoms.
A specialist in orofacial myofunctional therapy may work, with advanced training and according to their particular specialty’s scope of practice, on the underlying muscles that may be involved. This work should be performed in conjunction with other healthcare team members. The main objective of the orofacial myofunctional therapist is to rehabilitate the functions of chewing, swallowing, sucking, and facial expression, as essential to human communication. The muscles of the face are manipulated so that they can “relearn” the functions that they performed before the injury. The orofacial myofunctional intervention should be initiated as early as possible, in order to prevent muscle atrophy.
Snoring is defined as partial obstruction of the upper airways, causing some muscles of the mouth and throat to produce vibration and noise during sleep.
Obstructive Sleep Apnea (OSA) is defined as an obstruction of the airflow channel during sleep.
Due to constant vibration from snoring, the muscles of the mouth and throat become larger, and this may bring about changes in size, width, and thickness. These changes may contribute to the appearance of total or partial obstruction of breathing during sleep, otherwise known as obstructive sleep apnea.
Patients who snore and/or present with obstructive sleep apnea should be treated by an interdisciplinary team, including a sleep specialist. In this team, the orofacial myofunctional specialist may help by directing in the performance of specific exercises to strengthen the muscles of the mouth and throat, and improve oral rest posture.
Wrinkles may be the result of suboptimal postures, habits, and repetitive movements performed when chewing, swallowing, breathing, and in speaking, particularly in the presence of excess facial muscle strain.
The specialist in orofacial myofunctional therapy trains facial muscles to work properly for the optimization of such functions as chewing, swallowing, and breathing. When these functions are working optimally and noxious habits are eliminated, one may observe an improvement in facial aesthetics, including facial rejuvenation and smoothing of wrinkles.
Facial trauma includes any injury to the face. As such, some degree of damage to the facial muscles, teeth, and bones of the jaw are often involved, contributing to impairments in mouth opening and closing, chewing, swallowing, and speech articulation. The temporomandibular joint and aesthetics of the face may also be affected. Speech is in the domain of a speech-language pathologist, and therefore might warrant such a consult.
Treatment of a patient who has suffered a facial trauma is multidisciplinary and specialized. The goal of the specialist in orofacial myofunctional therapy is to promote the balance of facial muscles, which may help to relieve pain, decrease swelling, improve chewing, speech, and the appearance of scars and facial aesthetics. Patients may also benefit from re-education of chewing, swallowing, and breathing patterns.
Mouth breathing refers to breathing performed predominantly by the mouth. In this way of breathing, the individual uses the nose minimally or not at all to inhale and exhale air.
Common causes of mouth breathing are: issues that compromise the airway and impede effective nasal breathing, such as allergic rhinitis, sinusitis, bronchitis, enlarged adenoids or tonsils, tumors in the region of the nose, enlarged turbinates, nose fractures, etc. Additional causes include weakness or low tone of facial muscles that lead to open mouth rest posture, and habits such as thumb or finger sucking. Diets heavy in processed and acidic foods can also contribute to an increased propensity towards mouth breathing.
When breathing is done through the nose, the air is filtered or cleaned, warmed, and humidified. Thus, the air reaches the lungs with less impurities in it. When you breathe through your mouth, the air does not go through this process, and instead reaches the lungs full of impurities. The oral rest posture of the tongue and jaw when mouth breathing may also alter mandibular (i.e., lower jaw) posture, palatal (i.e., top of mouth) width, and other craniofacial growth patterns, as well as posture of the head, neck, and upper body.
Someone who mouth breathes may have one or more of the following characteristics: nasal congestion and/or chronic rhinitis, with which dennie lines (i.e., small creases) along the lower eyelids are often associated; open mouth posture at rest, contributing to a tendency towards dry, chapped lips and/or lip color changes; long face syndrome (i.e., sagging cheeks, ill-defined and recessed jawline, maloccluded teeth, etc.) resulting from a tongue that sits low and forward in the mouth, in combination with a high-arched and narrow palate, and weakened lip, cheek, tongue, and jaw muscles; forward head and rounded shoulder posture with weakened abdominal muscles; respiratory issues such as a short, fast, and shallow breathing pattern, wheezing, and/or snoring; impaired sleep, often associated with dark circles under the eyes; altered nasal appearance including a crooked nose (indicating a deviated nasal septum), a widened nose (indicating nasal turbinate hypertrophy), and/or narrow nostrils (resulting from nasal valve collapse); etc.
Mouth breathing basically keeps the body physiologically in a “fight or flight” sympathetic functioning, as opposed to a “rest and digest” parasympathetic functioning. Therefore, the deepest, most restful stages of sleep will not be adequately attained, resulting in such things as restless sleep, daytime sleepiness in adults or hyperactivity in children, bedwetting, or frequent awakenings from sleep due to urination. Other signs of mouth breathing during sleep include: snoring, sleep apnea (i.e., breathing interruptions during sleep), drooling on the pillow, thirst upon waking up, headaches, and decreased oxygen saturation in the blood.
Those who mouth breathe may have lower strength for chewing, and swallowing difficulties. Thus, they may prefer softer foods, and the use of liquids to assist in feeding. Mouth breathing leads to chewing food with lips apart, which becomes faster, noisier, and less efficient than with lips closed. Contrary to nasal breathing, is difficult to breathe through the mouth when the mouth is full of food, thus an individual will need to choose whether to chew or to breathe. This can lead to greater digestive problems and the potential for choking due to the poor coordination between breathing and chewing, and an increase in the swallowing of air. In the process of swallowing, one may also notice changes such as: forward projection of the tongue against or between the teeth, noise, tightening of muscles that wrap around the mouth, and extraneous movements of the head and neck. There may also be excessive production of saliva. The feeding of those who mouth breathe may also be impaired because of decreased olfaction (smell) and taste. As a result of changes in chewing, smell, and taste, the individual may have decreased appetite, gastric changes, constant thirst, gagging or choking, pallor (i.e., pale appearance), and weight loss.
Sleep disturbances, as previously listed, can generate agitation, anxiety, impatience, decreased levels of alertness, and impulsiveness. All of these changes can impair attention, concentration, memory, and subsequently contribute to learning difficulties in children.
An individual who breathes through the mouth can seek an orofacial myofunctional therapy specialist to assist in the treatment of mouth breathing, as any such therapist is trained to deal with these cases. However, some orofacial myofunctional therapists seek additional training in respiratory education techniques that may be helpful. Orofacial myofunctional therapy is commenced only after evaluation to determine the cause of mouth breathing. It is therefore advisable to work within an allied team, which would include an otholaryngologyst (ENT) and/or an allergist.
Speech therapy works to prevent, assess, diagnose, and treat specific speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults (American Speech-Language-Hearing Association). Orofacial myofunctional therapy (OMT) involves the study, research, prevention, evaluation, diagnosis, and treatment/neuromuscular re-education of structural and functional impairments in the mouth, face, and neck (Academy of Orofacial Myofunctional Therapy). Speech therapy addresses all of the nuances of articulation, as well as all of the phases of swallowing – oral, pharyngeal, and esophageal. OMT addresses tongue strength, coordination, and positioning to aid in articulation, bolus formation, and the initiation of swallowing. By improving the strength, coordination, and function of orofacial muscles involved in speech and swallowing, OMT complements the efforts of speech therapy.
Tongue-tie is a popular term used to characterize a common condition that often goes undetected. It occurs during pregnancy when a small portion of tissue that should disappear during the infant’s development remains at the bottom of the tongue, restricting its movement. When an infant is born with tongue-tie, it is important to research other family members, since this change has a genetic influence.
A specialist in orofacial myofunctional therapy should be well-suited to detect a tongue-tie. In the case of infants, a pediatrician and a lactation consultant may also be involved.
Many people with tongue-tie suffer long-term consequences without knowing the cause. There are infants who have changes in the feeding
cycle, causing stress for the infant and for the mother. There are also children with difficulties in chewing or with speech development, which can continue into adulthood. With the chronic oral rest posture of the tongue in the floor of the mouth, any of the aforementioned orofacial myofunctional disorders (OMDs) may result.
When the tongue cannot perform all its necessary movements, and thus jeopardizes any of its functions including sucking, swallowing, chewing, or talking, a small surgery or frenotomy in the tongue is indicated. The “cut” of the frenulum in infants is a simple procedure done with scissors, scalpel, or laser and anesthetic gel, and lasts about five minutes. In children and adults, the most common procedure is the frenectomy or frenuloplasty (i.e., partial removal of the lingual frenulum). This is indicated when the tongue is visibly restricted, is unable to adequately reach the palate, or when speech impairments are caused by inadequate elevation of the tongue tip, especially in producing the sounds of “L” and “R,” that cannot be corrected with speech therapy treatment. An interdisciplinary approach is recommended to determine the appropriate timing of such a procedure for children and adults, as tongue space, tongue and orofacial strength and coordination, airway health, the ability to effectively participate in a pre- and post-procedure therapy program, etc. are all important factors that need to be considered.
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