Understanding Orofacial Myofunctional Disorders: What You Need to Know
WHAT DOES OROFACIAL MEAN?
Orofacial refers to the mouth and face, specifically the oral cavity and the surrounding structures, such as the lips, tongue, jaw, and cheeks. It encompasses the functions and movements associated with these areas, including eating, speaking, breathing, and facial expressions.
WHAT IS AN OROFACIAL MYOFUNCTIONAL DISORDER?
An orofacial myofunctional disorder (OMD) is a condition that affects the muscles and functions of the mouth and face. It involves abnormal patterns of muscle use, posture, and coordination that can impact oral health, speech, breathing, and facial development.
COMMON SIGNS OF OMD
Below are some common signs and symptoms of Orofacial Myofunctional Disorders (OMD).
If your child is exhibiting several signs on this list, we would love to have a call with you to discuss how one of our programs may help. Schedule a free consult call today.
Lip-biting or sucking and/or tongue sucking
Facial asymmetry or unevenness.
Chronic nasal congestion or allergies
Difficulty swallowing certain foods
Frequent choking or coughing during meals
Drooling or excessive salivation
Frequent ear infections or ear pain
Difficulty sleeping
Dental problems, such as malocclusion or tooth decay.
Lack of lip seal
Tongue tie or lip tie
Weak or uncoordinated facial muscles
Inability to keep the mouth closed for extended periods of time
Tendency to breathe through the mouth during physical activity or exercise
Open mouth posture
Tongue thrusting
Forward head posture
Speech difficulties or lisping
Difficulty chewing and swallowing
Bruxism (teeth grinding)
Mouth breathing
Snoring or sleep apnea
Crowded or crooked teeth
Narrow dental arches (high narrow palate)
Frequent headaches or jaw pain
Thumb or finger sucking and/or bottle feeding beyond toddler years
Jaw clicking or popping
Misaligned bite
Gagging or choking on certain foods or liquids
Tension or pain in the facial muscles
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CAUSES OF OROFACIAL MYOFUNCTIONAL DISORDERS
Various factors can lead to orofacial myofunctional disorders (OMDs), including genetic predisposition, prolonged use of pacifiers or bottles, improper oral habits (such as thumb sucking or tongue thrusting), nasal congestion/blockage, lack of chewing, structural abnormalities, and neurological conditions. Let's explore each of these factors in more detail.
GENETIC PREDISPOSITION
Genetic predisposition to orofacial myofunctional disorders (OMDs) can occur when certain genes associated with the development and function of the muscles in the orofacial region are inherited from parents. These genes can influence the way the muscles in the mouth, face, and throat develop and function, which can impact speech, breathing, and swallowing.
For example, some individuals may inherit weaker or improperly functioning muscles in the mouth and throat, making it more difficult to properly chew, swallow, or speak. Others may inherit a smaller jaw or other structural abnormalities that can lead to OMDs. It's worth noting that genetic predisposition to OMDs doesn't always guarantee that an individual will develop the disorder, as environmental factors and lifestyle habits can also play a role in its development.
PROLONGED USE OF PACIFIERS OR BOTTLES
Prolonged use of pacifiers or bottles can cause orofacial myofunctional disorders (OMDs) by affecting the development of the oral and facial muscles. Sucking on a pacifier or bottle nipple requires a different tongue and lip position than breastfeeding, which can lead to muscle imbalances and improper swallowing patterns.
When a baby sucks on a pacifier or bottle for an extended period, it can cause the tongue to rest in a low and forward position instead of resting against the roof of the mouth. This can result in an open mouth posture, which can lead to mouth breathing and changes in the position of the teeth and jaws. The constant suction can also cause the cheeks to collapse, which can lead to weak cheek muscles and an underdeveloped midface.
Over time, these muscle imbalances and improper oral habits can contribute to OMDs, such as tongue thrust or a weak tongue posture. Children who use pacifiers or bottles for prolonged periods may also develop a preference for mouth breathing, which can lead to a range of other health issues, such as dry mouth, bad breath, and even sleep apnea. Therefore, it is important to limit the use of pacifiers and bottles and encourage healthy oral habits to prevent the development of OMDs.
IMPROPER ORAL HABITS
Improper oral habits like thumb sucking or tongue thrusting can cause Orofacial Myofunctional Disorders (OMDs) by affecting the muscles and tissues in the mouth and face. When a child persistently sucks their thumb, fingers or pacifier, it can lead to a misalignment of the teeth and jaws, and cause changes to the shape of the roof of the mouth. These changes can result in an abnormal swallowing pattern, where the tongue pushes against the front teeth instead of the palate during swallowing. This pattern can create pressure on the teeth, jaws, and facial bones, leading to OMDs.
Similarly, tongue thrusting, which is the habit of pushing the tongue forward against or between the front teeth during swallowing, can also cause OMDs. The repeated pressure exerted by the tongue can cause the front teeth to protrude and affect the normal growth and development of the jaws. This can result in problems with speech, chewing, and breathing.
NASAL CONGESTION
Nasal congestion, which blocks the nasal passages, can also contribute to OMDs by forcing individuals to breathe through their mouths instead of their noses. This can result in changes in the muscles and structures of the orofacial complex and alter the proper resting position of the tongue and lips.
COMMON CAUSES OF NASAL CONGESTION
Allergies: Exposure to allergens like pollen, dust mites, and animal dander can cause nasal congestion in children.
Upper respiratory infections: Viral infections such as the common cold, flu, and sinus infections can cause inflammation and swelling in the nasal passages.
Environmental irritants: Exposure to irritants such as smoke, air pollution, and strong odors can cause nasal congestion.
Deviated septum: A deviated septum is a condition where the nasal septum (the wall between the nostrils) is crooked or displaced, making it difficult for air to flow freely through the nasal passages.
Enlarged adenoids: Adenoids are small glands located at the back of the throat. When they become enlarged, they can obstruct airflow through the nasal passages, causing congestion (see pg. 7).
Sinusitis: Sinusitis is an inflammation or infection of the sinuses, which can cause congestion, pressure, and pain in the nasal area.
Nasal polyps: Nasal polyps are small growths in the lining of the nasal passages, which can cause congestion and difficulty breathing.
Rhinitis: Rhinitis is an inflammation of the nasal mucous membrane, which can cause congestion, runny nose, and sneezing.
Foreign object in the nose: Young children may insert objects into their nose, causing blockage and congestion.
Structural abnormalities: Structural abnormalities such as cleft palate or craniofacial syndromes can cause nasal congestion and breathing difficulties in children.
ENLARGED ADENOIDS
Enlarged adenoids can also cause nasal congestion by blocking the airways. Adenoids are small glands located at the back of the nose, and when they become enlarged, they can obstruct the flow of air through the nasal passages, leading to congestion.
Effects of enlarged adenoids:
Difficulty breathing: Enlarged adenoids can make it difficult to breathe through the nose, leading to mouth breathing, snoring, and sleep apnea.
Speech problems: Enlarged adenoids can affect the way a person speaks by causing a nasal-sounding voice or speech impediments.
Recurrent ear infections: Enlarged adenoids can block the Eustachian tube, which connects the middle ear to the back of the nose. This can lead to fluid buildup in the middle ear, increasing the risk of ear infections.
Facial structure changes: Chronic mouth breathing due to enlarged adenoids can cause changes in the facial structure, such as a long and narrow face, a high-arched palate, and crowded teeth.
ORAL RESTING POSTURE
Oral resting posture refers to the natural, relaxed position of the tongue, lips, and other oral structures when an individual is not speaking, swallowing, or actively using their mouth. This posture plays a significant role in oral and facial muscle function, as well as overall craniofacial development.
PROPER ORAL RESTING POSTURE
Tongue Position: In proper resting posture, the tongue should gently rest against the roof of the mouth, specifically on the hard palate. This position helps to support the proper development of the upper arch of teeth and provides stability to the upper jaw.
Lip Closure: The lips should be lightly closed but not forcefully sealed. This closed mouth posture ensures that the oral muscles are in balance, promoting proper dental alignment, facial aesthetics, and functional speech patterns.
Nasal Breathing: Breathing should occur through the nose during resting posture. Nasal breathing filters and humidifies the air, and it is associated with better oxygenation of the body and overall health.
IMPROPER ORAL RESTING POSTURE AND OMDS
When the oral structures fail to maintain their natural contraction achieved through proper oral resting posture, it can result in muscle weakness and structural alterations within the craniofacial complex. This misalignment typically manifests when the tongue hangs low, and the mouth remains open. These deviations can have profound implications for the functioning of various oral components, consequently affecting the growth and development of the head and mouth structures.
One prime example of the consequences of improper oral resting posture is observed in individuals with a low-resting tongue. This condition often gives rise to a high and narrow palate, a structural anomaly that can lead to dental and craniofacial issues. The ongoing presence of a low-resting tongue can also contribute to muscle weakness in the oral region, further compounding the problem.
Moreover, improper oral resting posture can lead to a persistent open mouth posture. When an individual habitually maintains an open mouth, it can disrupt the natural process of nasal breathing, causing them to rely more on mouth breathing. Mouth breathing is associated with various adverse effects, such as reduced filtration and humidification of inhaled air. This can exacerbate the symptoms stemming from improper oral posture and potentially lead to additional complications.
LACK OF CHEWING
Lack of chewing hard foods can have negative effects on muscle function and jaw development, leading to an increased risk of orofacial myofunctional disorders. This is because chewing on hard foods helps stimulate the muscles and bones in the jaw, thus promoting proper growth and development.
CHEWING FOR MUSCLE DEVELOPMENT
Chewing is an important function that not only breaks down food for digestion but also helps to stimulate the muscles and nerves in the mouth, jaw, and face. When we chew, we exercise the muscles involved in the orofacial complex, including the tongue, lips, cheeks, and jaw. This exercise helps to maintain muscle strength, tone, and coordination, which are essential for proper orofacial development and function. When a child does not chew adequately, it can lead to an OMD. Inadequate chewing can lead to weak orofacial muscles, which can contribute to the development of OMDs. Children who primarily consume soft and processed foods that require little or no chewing, or who swallow food without proper mastication, may not get the necessary exercise to develop and maintain their orofacial muscles. The use of pacifiers, sippy cups, and bottles beyond appropriate ages can also limit the opportunity for chewing and contribute to orofacial muscle weakness.
CHEWING FOR JAW DEVELOPMENT
Chewing on hard foods can stimulate the growth and development of the bones of the jaw through a process called bone modeling or remodeling. When we chew on hard foods, it creates stress and strain on the bones of the jaw. This stress activates cells called osteoblasts which promote the formation of new bone tissue.
Additionally, when we chew, the muscles that move the jaw are engaged and work to develop strength and tone. This increased muscle activity can further stimulate bone growth by placing tension on the bone and promoting the deposition of new bone tissue.
Over time, this repeated stress and strain on the bones of the jaw can cause them to grow and remodel in response to the demands placed upon them. This is important for the development of a healthy and properly functioning orofacial complex.
Lack of chewing, on the other hand, can lead to underdevelopment of the bones of the jaw and surrounding structures, which can contribute to the development of orofacial myofunctional disorders (OMDs) such as mouth breathing, tongue thrust, and abnormal swallowing patterns.
STRUCTURAL ABNORMALITIES
There are several oral structural abnormalities that can cause OMDs. Some of these include a high or narrow palate, malocclusion, enlarged adenoids, and tethered oral tissue. These abnormalities can affect the way the tongue, lips, and jaw muscles function, leading to improper alignment and coordination of the orofacial muscles. This, in turn, can lead to issues such as speech problems, difficulty chewing or swallowing, and breathing difficulties. Let’s take a closer look at each of these.
HIGH NARROW PALATE
A high narrow palate can cause OMD by reducing the space available for the tongue to rest in a natural position within the oral cavity. This can result in the tongue being forced into a low and forward position or resting against the teeth, causing an imbalance in the orofacial muscles. These imbalances can lead to a range of OMDs, including tongue thrust, open mouth posture, and improper swallowing patterns. Over time, these improper habits can further exacerbate the structural abnormalities, creating a vicious cycle that perpetuates the OMD.
MALOCCLUSION
Malocclusion, which refers to misalignment of the teeth and/or jaws, can cause OMDs in a few different ways. For example, if the upper and lower jaws do not come together properly when biting down, it can lead to compensatory movements of the tongue or lips, which can in turn affect the overall functioning of the orofacial muscles. Malocclusion can also cause abnormal stress on certain teeth, leading to improper force distribution during chewing and swallowing. Over time, this can lead to muscle imbalances and contribute to the development of OMDs. Additionally, malocclusion can affect the position of the tongue and lips at rest, which can impact breathing patterns and contribute to conditions like mouth breathing.
TETHERED ORAL TISSUE
Tethered oral tissue (TOT) refers to a condition where the tongue (tongue-tie), lip (labial tie), or cheek (buccal tie) are restricted in their movement due to an abnormal attachment to the underlying bone or tissue. This can be caused by a congenital abnormality or it may occur as a result of scar tissue formation following an injury or surgery. When the tongue or other oral tissues are tethered, it can affect a person's ability to speak, eat, swallow, or breathe properly, and can also contribute to various orofacial myofunctional disorders (OMDs). Treatment for TOT may involve a procedure known as a frenectomy, which involves releasing the restrictive tissue with a surgical or laser technique.
TONGUE TIE
Tongue tie, also known as ankyloglossia, is a condition in which the thin piece of tissue that connects the underside of the tongue to the floor of the mouth (called the lingual frenulum) is shorter or thicker than usual, which can limit the movement of the tongue.
This can affect facial development, feeding, breathing, and speech in different ways.
Facial Development - Tongue tie can affect facial development by hindering the tongue's ability to rest on the roof of the mouth, leading to a high and narrow palate. The absence of static pressure on the palate can impact jaw and face growth, resulting in airway and dental problems.
Breastfeeding Difficulties - Tongue tie can cause difficulty with breastfeeding because it can interfere with the baby's ability to latch on properly and transfer milk sufficiently, leading to pain and frustration for both the baby and mother. This can result in poor weight gain and inadequate nutrition for the baby. The restricted movement of the tongue due to the tight or restrictive frenulum can prevent the baby from forming a good seal around the nipple and properly stimulating milk production. Tongue tie can also cause the baby to tire easily during feedings and may require frequent feedings to get enough nutrition.
Chewing Difficulties - Tongue tie can cause difficulties with chewing because it can limit the mobility and range of motion of the tongue. The tongue is an important muscle that helps move food around in the mouth, mix it with saliva, and position it for swallowing. When a person has a tongue tie, the frenulum (a piece of tissue that connects the tongue to the floor of the mouth) is too tight or restrictive, which can prevent the tongue from moving freely and fully. This can make it difficult to chew and break down food properly, leading to digestive problems and potentially malnutrition. Additionally, people with tongue tie may compensate by using their cheeks or lips more during chewing, which can cause excessive wear on the teeth and lead to dental problems over time.
Speech Difficulties - The tongue plays a crucial role in speech production by shaping sounds and controlling the flow of air through the mouth. When a person has a tongue tie or other tongue-related issue, it can impact their ability to properly articulate certain sounds, resulting in speech difficulties. For example, a person with a tongue tie may have difficulty producing certain consonant sounds that require the tongue to be raised, such as "t," "d," "n," and "l." This can lead to a lisp or other speech impediment. Additionally, a person with a tongue tie may have difficulty with more complex sounds that require more intricate tongue movements, such as the "r" sound.
TMJ Difficulties - Tongue tie can also have an impact on the temporomandibular joint (TMJ), which is the joint that connects the jawbone to the skull. When a person has a tongue tie, it can cause the tongue to rest in a low position, which can cause the jaw to be held in an incorrect position. This can lead to tension and stress on the TMJ, potentially resulting in pain, clicking, or popping sounds when opening or closing the mouth, and even headaches. Additionally, compensatory movements of the jaw, such as excessive clenching or grinding of the teeth, can also contribute to TMJ issues.
LABIAL TIE
A labial tie is a condition where the tissue connecting the upper lip to the gums is too tight or restrictive, causing limitations in lip mobility. This can have a negative impact on oral resting posture and feeding.
When the labial tie is present, the upper lip may be pulled inwards and downwards, making it difficult to maintain proper oral resting posture with the lips resting together. This can lead to an open mouth posture and cause the tongue to rest in a low and forward position, leading to a cascade of negative effects on the growth and development of the jaw, airway, and face. Inadequate lip closure can also lead to mouth breathing, which can further exacerbate these issues.
Feeding can also be affected by a labial tie. Infants may have difficulty latching onto the breast or bottle, leading to poor weight gain and inadequate nutrition. This can cause frustration for both the infant and the caregiver. Additionally, a labial tie can interfere with the infant's ability to create and maintain suction while feeding, leading to further feeding difficulties.
Lastly, a labial tie can impact chewing and swallowing by restricting the mobility and range of motion of the lips. The lips play an important role in chewing and swallowing by helping to keep food in the mouth, positioning it for proper chewing, and sealing the mouth during swallowing. When a person has a labial tie it can limit the ability of the lips to move and function properly. This can make it difficult to chew and break down food. Additionally, a labial tie can cause a person to compensate by using other muscles in the face, such as the cheeks, to help with chewing and swallowing, which can lead to overuse and strain on these muscles and contribute to the development of OMD.
BUCCAL TIES
Similar to labial ties, buccal ties can also contribute to OMD. Buccal ties occur when the tissue connecting the inside of the cheek to the gums or teeth is too tight or restrictive. This can limit the mobility and range of motion of the cheeks and lips, which are important muscles involved in chewing, swallowing, and speaking.
In order to compensate for the restricted movement, a person with a buccal tie may alter their oral resting posture or use other muscles in the face to complete oral tasks. This can lead to improper positioning of the tongue and teeth, causing dental problems such as malocclusion and teeth grinding. It can also impact the development of the jaw and airway, potentially leading to breathing difficulties and sleep apnea.
Additionally, buccal ties can impact feeding, as it can make it difficult for babies to form a proper seal around the nipple while breastfeeding, causing pain and frustration for both the baby and the mother. It can also lead to poor weight gain and inadequate nutrition.
SMALL JAW (MICROGNATHIA)
Small jaw, also known as Micrognathia, is a condition where the lower jaw (mandible) is abnormally small, causing it to be receded or positioned further back in the face. A small jaw can impact OMD in several ways. For one it can limit the available space in the mouth, leading to crowded teeth and other oral structural abnormalities. This can cause teeth to become misaligned, which can lead to malocclusion, a condition in which the upper and lower teeth do not come together properly. Malocclusion can cause difficulties with biting, chewing, and speaking, and can even lead to breathing difficulties or sleep apnea.
A small jaw can also impact tongue positioning and function, which is critical for proper orofacial health. The tongue is an important muscle in the mouth that helps with chewing, swallowing, and speaking. When the jaw is small, the tongue may be crowded and positioned lower in the mouth, which can impact proper tongue placement during rest and while performing these functions. This can lead to difficulties with chewing and swallowing, which can impact proper nutrition and digestion.
In addition, a small jaw can contribute to a narrow airway, which can lead to breathing difficulties and sleep apnea. Sleep apnea is a condition in which breathing stops and starts repeatedly during sleep, and it has been linked to OMD. It is important to address a small jaw as early as possible to promote proper facial and jaw growth and prevent future health issues associated with OMD.
NEUROLOGICAL CONDITIONS
Neurological conditions can cause OMD by affecting the nerves and muscles responsible for proper oral functioning. For example, conditions such as cerebral palsy, stroke, multiple sclerosis, and Parkinson's disease can cause muscle weakness, spasticity, or involuntary movements that make it difficult to control the muscles in the mouth, face, and jaw. This can lead to problems with chewing, swallowing, and speaking, as well as poor oral resting posture. Neurological conditions can also affect the sensation in the mouth and tongue, making it difficult to feel and control food or other objects in the mouth, which can lead to choking or aspiration.
