OROFACIAL MYOFUNCTIONAL THERAPY

WHAT IS AN OROFACIAL MYOFUNCTIONAL DISORDER?

Orofacial myofunctional disorder (OMD) is one of several terms describing the abnormal function of the oral and facial muscles during swallowing and at rest.  Oral rest posture refers to where your tongue, teeth and jaw are when you are not talking or eating. The term “tongue thrust” is often used, as it describes a pattern in which the individual pushes the tongue against or between the teeth while swallowing and in rest posture.

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HOW DOES POOR ORAL REST POSTURE IMPACT SPEECH ARTICULATION?

Where our tongue, jaw and lips sit at rest is where we begin talking from.  If your rest posture is abnormal (for example with the tongue resting low and forward in the mouth against the lower front teeth versus in correct position resting on the roof of the mouth) the tongue has further it has to move in order to produce clear and articulate speech.  This can result in "mumbled speech" or parents saying their child sounds like they have "marbles in their mouth".  Articulation of specific speech sounds may also be impacted and common speech sound errors include: t, d, n, l, s, z, r, "ch" and "j".  Without first correcting the oral rest posture it will be difficult to fully correct these sound errors with traditional speech therapy.

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HOW CAN POOR ORAL REST POSTURE IMPACT DENTAL DEVELOPMENT?

When a person has poor oral rest posture the lips, tongue, cheeks and dental structures do not work well together.  This may have a negative impact on dental growth and development.  Orthodontic treatment may be slowed or unstable and at risk of relapse.

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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 (not caused by 1 single thing).  Contributing factors include but are not limited to:

1. Restricted nasal airway due to enlarged tonsils/adenoids and/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 a tethered oral tissues (TOTS), ankyloglossia (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?

There are many diagnostic criteria that must be considered in the formulation of a therapy program.  Age, motivation, 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 and ability to commit to the therapy program (attention/behaviour).  Early identification and intervention such as eliminating sucking habits, or identifying other causative factors can allow for more typical dental growth and abnormal habits will not be ingrained. 

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WHAT FACTORS IMPACT THE PROGNOSIS FOR TREATMENT?

• Motivation - Success in therapy is directly and inescapably dependent upon the individual’s motivation,  cooperation and self-discipline with the home assignments.

• Parent involvement and encouragement is essential. Therefore, parents must participate in the therapy sessions with their child, to learn the exercises and assist in the daily exercises at home.

• Age and maturity of the individual.

• Severity of the poor oral rest posture and tongue thrust swallow.

• Control and coordination of the appropriate musculature.

• Attention span of the individual.

• Attitude of the individual and parents.

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HOW LONG DOES REST POSTURE/TONGUE THRUST SWALLOW THERAPY TAKE?

In order to succeed in habituating a new proper oral rest posture, the principles of neuroplasticity need to be considered in therapy (how the brain changes).  These include: intensity of practice (practice must be focused and uninterrupted), frequency of using the new skills (daily practice) and specificity (to improve rest posture and swallowing we need to work on rest posture and swallowing).  Changing habits takes time and new habits need to be practiced daily and over a long period of time to ensure that they replace the old habits and to minimize the risk of relapse.

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WHAT IS THE ROLE OF THE PARENT/PRACTICE PARTNER?

Participation, supervision and most importantly motivation!  Changing a habit, especially one that occurs so frequently (oral rest posture) requires a lot of tough and practice.  When a parent or practice partner is informed, interested and supportive, they will be instrumental in keeping practice positive and fun.  This will help the individual maintain a positive attitude toward treatment and will help keep them motivated to learn the new muscle patterns required to develop and maintain a new rest posture and swallow pattern. 

IS THERAPY DIFFICULT?

Definitely! Learning a new habit requires commitment, discipline and effort- for the client as well as for their practice partner.  Each therapy program is individually tailored to meet the needs of our clients.  We will work as a team to make therapy positive and successful!

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