Nancy Magar specializes in orofacial myofunctional disorders.  Over 32 years of expertise as a speech-language pathologist, she  has discovered that patients who present with certain speech articulation disorders, sleep disordered breathing, and TMJ disorders  have orofacial myofunctional disorders as the root cause.  Most people are not aware of the term  “orofacial myofunctional disorder”,  yet early detection in children can help prevent abnormal oral muscle patterns from contributing negatively to proper dental/facial growth development.

​

What is an OMD --Orofacial Myofunctional Disorder?:

A definition that was created by S. R. Holtzman at Neo Health Services 2014 to include the wide range of concerns in describing orofacial myology is as follows:

“The study and treatment of oral and facial muscles as they relate to speech, dentition, chewing/bolus collection, swallowing and overall mental and physical health.”

 Orofacial myofunctional disorders include one or a combination of the following:

• Incorrect Swallowing Pattern (Tongue Thrust) – the improper placement and function of the tongue during swallowing.   When swallowing, the tongue thrusts in between, forward or sideways against teeth.

• Incorrect Lip/Tongue Resting Posture – includes open lip posture and low or forward tongue resting posture against the teeth.

• Oral Habits – Thumb, finger or pacifier sucking habits beyond an appropriate age.  Other oral habits include fingernail biting, lip biting, lip licking, and lip sucking.

 

Why Should OMD’s concern me?

OMD’s may negatively impact dental and facial growth patterns, particularly dental eruption patterns or alignment of teeth and jaws.  Research has shown that the consistent pressure from the resting posture of the tongue against the teeth is more influenced in malocclusions than an incorrect swallowing pattern (tongue thrust).  Constant pressure of the tongue against the teeth at rest can slow orthodontic treatment and undermine the stability of orthodontic correction.  Speech patterns may become distorted or misarticulated due to the low forward postural positioning of the tongue. Some additional signs of myofunctional disorders may include:

• Frequent mouth breathing in the absence of allergies or nasal congestion.

• Frequent open-lips resting posture.

• Habitual low tongue resting posture against the upper/lower teeth. 

• Lips are often dry, chapped, cracked and sore from excessive licking.

• Tongue protruding between or against the upper/lower front teeth when forming /t/, /d/, /n/, /s/, /z/, /l/, /sh/, zh/, /sh/, /ch/.

• During the act of swallowing the lips squeeze and the chin has a tightened appearance.

• Noisy chewing and swallowing (smacking and gulping).

• Tongue, lip and buccal (cheek) tie restrictions.

• Enlarged tonsils and adenoids.

• Acid reflux or belching due to swallowing of excess air.

• Neck, back, shoulder pain (due to overcompensations for inappropriate swallow or oral resting posture).

• Teeth bruxism and teeth grinding.

• Pain in the jaw joints (TMJ) or jaw muscles. 

• High arched and narrow palates (roof of  mouth).

• Sleep disorders including heavy breathing, snoring, sleep apnea, and night enuresis.

 

How are OMDs corrected?

Nancy Magar prefers to refer to orofacial myofunctional therapy as “Oral Rest Posture Therapy.”  A large focus of therapy whether we are working with  abnormal sucking habits, tongue ties or speech articulation goals is establishing a proper oral resting posture.  Proper oral resting posture begins with the tongue tip anchored to the incisive papilla (about 5-7 millimeters from the upper front teeth) with the rest of tongue making contact to the roof of the mouth within the upper dental arch, teeth resting lightly apart with about 2-3 millimeters of space between the molars and a closed lip posture with a nasal breathing pattern. This posture is not as easy as it sounds especially if an individual has established a different oral resting posture or does not have clear nasal passages to easily breathe through the nose. Therapy always begins with a thorough assessment to help establish a proper treatment plan which can involve assessments with other professionals including an Ear-Nose-Throat Specialist (to assure a patent has a clear nasal/pharyngeal airway), a sleep disorders specialist, an oral surgeon, a dentist who specializes with tongue-tie releases, orthodontist or physical therapist.   Once therapy begins it progresses in three phases with the first phase establishing awareness of the oral muscles, improving coordination and strength of the oral muscles and addressing the ability to move the tongue/lips/jaw properly without compensations.  The second phase of therapy addressing establishing proper oral muscle patterns including proper chewing, suctioning, bolus formation, swallowing and continuing to increase the frequency of the proper oral resting posture with nasal breathing both day and night.  The final phase of therapy is to integrate the new oral muscle patterns at the subconscious level during the day and night.   Length of therapy is variable depending on the age of the individual and the individual’s consistency with the exercises and activities given on a daily basis. An adult’s duration of treatment is usually shorter than that of a child.  Nancy Magar can give an estimate of length of therapy after the initial evaluation.  No treatment plan is the same as every individual brings forth various strengths and weaknesses.  Early intervention to address sucking habits or assessment of other causative factors may help prevent OMDs.  Children as young as 4 may be ready to start a thumb/finger sucking elimination program but depends upon cognitive maturity. For the “true” oral rest posture therapy children at the age of 6 and older usually have great success.  Children younger than this can benefit from a modified program and is considered a case-by-case basis.