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What is Orofacial Myofunctional Therapy?
Orofacial Myofunctional Therapy is the treatment of Orofacial Myofunctional Disorders (OMD). The prefix "myo" means muscle. Orofacial myofunctional disorders involve a variety of postural and functional disorders including sucking habits and inappropriate oral postures or functions of the muscles of the tongue, lips, jaw, and face. A common disorder familiar to the public is “tongue thrust", where the tongue rests against or between the front or side teeth during swallowing rather than lifting up into the palate (roof of the mouth). Tongue thrusting frequently occurs with a low, forward resting posture of the tongue, with a lips apart posture. Just as the controlled continuous forces of orthodontic appliances (braces) can move teeth, abnormal postures and functions in the oral cavity can contribute to the development of dental malocclusions such as incorrectly positioned teeth, an improper bite relationship or other problems related to oral or facial muscle dysfunction or a malformation of the bones of the dental arches.
Why Be Concerned?

Orthodontists have been concerned about OMD since the early 1900's because the abnormal functions and postures of OMD can: negatively influence dental growth, slow orthodontic treatment and it may undermine the stability of an orthodontic correction, resulting in a relapse.

Habitual open-lip resting posture (lip incompetence), commonly found among individuals with OMD, eliminates the beneficial influence that closed lips have on the development and maintenance of good dental arch form.

The presence of OMD may have a negative effect on the development of the dentition, particularly the eruption patterns and/or alignment of the teeth and jaws.incorrect tongue resting posture
This photo shows an incorrect tongue resting posture
Research has revealed that of those individuals who exhibit OMD 81% have speech problems. The /s/ sound is the most noticed speech error; others are /z/, /sh/, /ch/, /j/, /d/, /t/, /n/, /l/ and /r/. When there is a combination of OMD and related speech errors, it is often difficult to correct the speech problems through traditional speech therapy. Children or even adults with incorrect chewing and swallowing patterns frequently chew their food with their lips open, usually taking large bites and swallowing without completely chewing the food. This behavior often leads to food particles around the mouth, noisy chewing and swallowing (smacking and gulping) and a messy eating area. It can also cause an upset stomach from swallowing too much air.

What Causes an Orofacial Myofunctional Disorder?
All babies are born with a low forward swallowing pattern (tongue thrust). With normal growth and development, the tongue begins to lift up into and against the palate (roof of the mouth). This pressure against the palate helps the palate develop into the correct shape. Anything that adversely influences normal development of the dental arches or position of the teeth can result in an OMD. Oral and facial muscles must adapt to the oral structures to maintain a normal functional relationship.

Causative Factors

Oral habits — prolonged thumb or finger sucking, cheek/nail biting, tooth clenching.Restricted nasal airway — enlarged tonsils/adenoids, allergies/asthma, sinusitis or a restricted flow of air through the nasal cavity can promote a habitual open-lip posture.Structural or physiological abnormalities — a short lingual frenum (tongue-tie), macroglossia (abnormally large tongue) or micrognathia (abnormally small jaw).Neurological or developmental abnormalities — Down Syndrome, Cerebral Palsy or other neurological problems that limit the patient’s ability to achieve the necessary muscle function for corre

Hereditary predisposition to some of the above factors.

Orofacial Myofunctional Disorders (OMD) may be caused by one or several of the above reasons. A qualified therapist is able to evaluate your child and determine if he/she is a candidate for therapy.

How Prevalent Are Orofacial Myofunctional Disorders?

Research examining various populations found 38% have orofacial myofunctional disorders and, as mentioned above, an incidence of 81% has been found in children exhibiting speech/articulation problems.

What is Orofacial Myofunctional Therapy?

Therapy involves an individualized regimen of exercises to re-pattern oral and facial muscles. Exercises are used to correct tongue and lip resting postures as well as to develop correct chewing and swallowing patterns. Certified Orofacial Myologists (COM) are trained to help patients eliminate harmful habits by using positive behavioral techniques. They provide motivational therapy to eliminate such oral habits as: prolonged pacifier use, thumb and/or finger sucking, fingernail biting, cheek or lip biting, tongue sucking and clenching or grinding of the teeth.

Who Should Treat?

Orofacial Myologists who are certified by the International Association of Orofacial Myology (IAOM) have the appropriate training to provide treatment. The IAOM is the only international professional accrediting organization of this therapeutic specialty. Those members who have had additional training and successfully pass a written and clinical proficiency examination, earn the credential of Certified Orofacial Myologist (COM).
The IAOM, founded in 1972, is a non-profit organization that provides continuing education and approves additional training programs for professionals including speech pathologists, dentists, dental hygienists, and other allied health professionals who wish to evaluate and/or provide orofacial myofunctional therapy.

At What Age Can Therapy Begin?

Children as young as four years old can benefit from an in-office evaluation. They can be seen for an assessment to determine if there are causative factors that require prevention or early intervention. Children seven or eight years of age are often good candidates to receive orofacial myofunctional therapy. They are most often anxious to please adults and usually work well with the therapist. Motivated teenagers and adults of all ages are capable of success in treatment.
Age five is an ideal age to begin a modified program of treatment to help children discontinue thumb or finger sucking habits when intellectual and emotional skills are adequately developed. With early elimination of these habits, there is often spontaneous improvement in dental, speech and OMD problems. Children of seven or eight years of age are often mature enough to receive complete training in Orofacial Myofunctional Therapy.

Before starting orofacial myofunctional therapy, the therapist will evaluate the child’s potential for success and will consider:
1. The physical ability of the patient (can the patient do the exercises?)
2. Necessity for referral (should the patient be seen by an orthodontist, an Ear-Nose-Throat doctor or other specialists before starting orofacial myofunctional therapy? And
3. The physical and emotional maturity of the patient
.

Before and After Thumb-sucking Therapy



View of mouth of child with a thumb sucking habit
Mouth after eliminating thumb sucking

Mouth after eliminating
thumb sucking









How Effective is Orofacial Myofunctional Therapy?

There are many factors that contribute to the success of the therapy program. It is truly a team effort. Effective communication and cooperation between therapist and the dental and medical community is essential. In addition, successful orofacial myofunctional therapy depends on the patient's desire, dedicated cooperation and self-discipline to follow-through with therapy assignments and support from others. To ensure optimum results for children undergoing therapy, parental involvement and encouragement is important and necessary.

Orofacial Myofunctional Therapy has helped literally thousands of individuals, in dozens of countries, for over 30 years. Numerous studies have demonstrated its effectiveness including a study done by Hahn & Hahn (1992), which revealed that treatment for orofacial myofunctional disorders can be 80-90% effective in correcting rest posture, swallowing and other oral functions and that these corrections are retained years after completing therapy.