Orofacial Myofunctional Disorders
The investigation, assessment, and treatment of oral myofunctional disorders are within the purview of speech-language pathology practice. Oral myofunctional phenomena, including abnormal fronting (tongue thrust) of the tongue at rest and during swallowing, lip incompetency, and sucking habits, can be identified reliably. These conditions co-occur with speech misarticulations in some patients. Tongue fronting may reflect learned behaviors, physical variables, or both.
The speech-language pathologist (SLP) who desires to perform oral myofunctional services must have the required knowledge and skills to provide a high quality of treatment. The provision of oral myofunctional treatment remains an option of individual SLPs whose interests and training qualify them.
Evaluation and treatment should be:
- interdisciplinary and tailored to the individual;
- in collaboration with other professionals, including an orthodontist, pediatric dentist, or other dentist;
- in collaboration with other medical professionals, including an otolaryngologist, pediatrician, or allergist as needed.
Goals for treatment should include retraining labial and lingual resting and functional patterns (including speech). Clinicians should avoid predictions of treatment outcomes based on tooth position or dental occlusal changes.
Research exists indicating that oral myofunctional treatment is effective in modifying disorders of tongue and lip posture and movement. However, more basic and applied research is needed regarding the nature and evaluation and treatment of oral myofunctional disorders.
Preparing to Serve Individuals With Orofacial Myofunctional Disorders
It is important that speech-language pathologists (SLPs) have adequate training and experience when serving individuals with orofacial myofunctional disorders (OMD). This resource provides information on how to gain the appropriate knowledge. An interdisciplinary approach is essential for study, evaluation, and treatment of OMD. Effective communication among SLPs and dental and medical specialists helps ensure optimal client/patient care.
Elements in understanding dentofacial patterns and applied physiology pertinent to orofacial myology include recognition/knowledge of:
- normal and abnormal dental, skeletal, and soft tissue anatomy and physiology;
- developmental anatomy, physiology, and cognitive factors as they affect evaluation and strategies for treatment;
- etiology and treatment modalities for dental and skeletal malocclusions;
- orofacial muscle compensatory adaptations to dental or skeletal variations;
- dental development and terminology relevant to orofacial myology;
- the role of dental and medical specialties and procedures related to the interdisciplinary management of orofacial myofunctional disorders;
- skills in analyzing/interpreting patient/client data regarding orofacial myology.
Elements in understanding contributing causative factors related to OMD include recognition/knowledge of:
- the complexity and potential interactions of etiological factors related to OMD (e.g., airway interference, thumb sucking, anterior malocclusion);
- the signs and symptoms of OMD;
- the complexity and potential interactions of etiological factors related to OMD;
- the role of dental and medical specialties and procedures related to interdisciplinary management of OMD.
Elements in understanding basic orthodontic concepts include recognition/knowledge with respect to:
- communicating pertinent orofacial myofunctional clinical findings to colleagues from other disciplines,
- incorporating knowledge of present and future orthodontic treatment procedures for individual clients/patients into treatment planning decisions,
- orthodontic evaluation and treatment procedures and appliances,
- basic interactions with dental specialists to develop appropriate treatment plans and formulate realistic treatment expectations.
Elements in understanding interrelationships between speech and OMD include recognition/knowledge with respect to:
- relating interrelationships of speech and orofacial myofunctional disorders to medical and dental specialists;
- inappropriate lingua-dental contacts during speech and whether they result in acoustically typical or atypical speech;
- interrelationships among dental malocclusions, abnormal articulatory patterns, and nasal airway patency;
- identification of articulatory patterns related to OMD;
- orthodontic appliances and their potential impact on speech function.
Elements in demonstrating competence in comprehensive assessment procedures and in identifying factors affecting prognosis, include recognition/knowledge with respect to:
- evaluating tongue and lip resting postures and tongue, lip, and teeth movements in the handling and swallowing of saliva, liquids, and foods;
- determining the likelihood of spontaneous modification of inappropriate myofunctional patterns without intervention;
- identifying positive and negative factors associated with the prognosis for treatment;
- relating assessment results to the total medical or dental plan of treatment;
- the relationships among orofacial structures and functions as they influence OMD;
- the complexity of oronasal airflow patterns and the need for interdisciplinary management;
- the physical and behavioral factors affecting patient selection or treatment outcomes;
- eliminating associated parafunctional behaviors and habits (e.g., chewing, sucking) that affect oral structures and function;
- physical and behavorial factors affecting patient selection or treatment outcomes.
Elements in demonstrating competency in selecting an appropriate, individualized, criterion-based treatment plan include recognition/knowledge with respect to:
- coordinating the OMD treatment program with other medical and dental procedures;
- establishing a home-based program as an integral part of treatment, as appropriate;
- educating the patient/client and family about treatment goals and procedures;
- the impact of family educational, linguistic, and cultural/ethnic background on treatment planning;
- establishing dismissal criteria and follow-up care in the treatment process.
The SLP must be knowledgeable with respect to appropriate clinical environments for the provision of professional services, specifically including infection control procedures.
Elements in demonstrating appropriate documentation of all clinical services include recognition/knowledge with respect to:
- obtaining a case history on each client/patient;
- incorporating case history and clinical findings into a report, including factors affecting prognosis and recommendations;
- documenting client/patient progress for each treatment session;
- clinical data recording, organization, and reporting.
Elements in demonstrating professional conduct within the scope of practice for speech-language pathology include recognition/knowledge with respect to:
- adhering to the ASHA Code of Ethics;
- recognizing orofacial myofunctional conditions to include in an orofacial myofunctional practice, such as digit and oral habits, lingual and labial posturing variations, and swallowing variations that are non-organic;
- establishing as the most important goal of orofacial myofunctional intervention the creation, reestablishment, stabilization, and maintenance of an oral environment conducive to normal processes of orofacial growth and development;
- educating referral sources regarding the goals and nature of orofacial myofunctional treatment.
Knowledge is obtained through course work and training specific to the evaluation and treatment of orofacial myofunctional disorders prior to the provision of clinical services in this area. Unless an SLP holds credentials in appropriate medical/dental specialty areas, the practice of orofacial myology does not include
- treatment of parafunctional problems related to temporomandibular joint disorders and myofacial pain dysfunction,
- nutritional counseling or management,
- craniosacral manipulation or practices,
- practices related to the reduction of medical conditions, such as sleep apnea.
Key Terms and Definitions
An interdisciplinary approach is essential for study, evaluation, and treatment of orofacial myofunctional disorders. Effective communication among speech-language pathologists and dental and medical specialists helps ensure optimal client/patient care. The following is terminology is used in clinical practice:
- Airway Competency
- sufficient patency of the nasal passages to permit effortless inward and outward flow of air
- Lip Incompetence
- a lips-apart resting posture or the inability to achieve a lips-together resting posture without muscle strain
- Obligatory Tongue Thrust
- a forward posturing or movement of the tongue induced by structural or physiological constraints
- Orofacial Myofunctional Disorder
- any pattern involving oral and/orofacial musculature that interferes with normal growth, development, or function of structures or calls attention to itself
- Orofacial Myology
- the science and clinical knowledge dealing with muscles of the mouth and face (orofacial muscles) and the typical and atypical variations of the functions thereof
- Tongue Thrust
- inappropriate or excessive lingual contacts against or between the teeth at rest or during vegetative or communicative functions
- Transitional Tongue Thrust
- tongue thrust accompanying developmental or other conditions that are temporary in nature
Resources and References
Additional Resources & References
International Association of Orofacial Myology (IAOM). The IAOM is the international professional association for orofacial myologists. The IAOM provides information, resources, and support for professionals, families, and patients who seek information, guidance, research, and therapy services for orofacial myofunctional disorders.
Mason, R. M. "A retrospective and prospective view of orofacial myology." The International journal of orofacial myology: official publication of the International Association of Orofacial Myology 31 (2005): 5.
Ray, J. "Effects of orofacial myofunctional therapy on speech intelligibility in individuals with persistent articulatory impairments." The International journal of orofacial myology: official publication of the International Association of Orofacial Myology 29 (2003): 5–14.
The information about orofacial myology on ASHA's website is drawn primarily from ASHA committees that developed resources on orofacial myofunctional disorders. Members of those committees included Robert M. Mason, Sheila Gideon, Richard Forcucci, Catherine Jackson, Sylvia M. Zante, Charlene E. Clark, Marvin L. Hanson, Ralph Shelton, Jr., Ida Wiedal, Galen L. Peachey, Gayle P. Snyder, James L. Case, Gloria D. Kellum, Joseph B. Zimmermen, and Michelle Ferketic, ex officio.