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Orofacial Myofunctional Disorders

See the Treatment section of the Orofacial Myofunctional Disorders evidence map for pertinent scientific evidence, expert opinion and client/caregiver perspective.  

The primary purpose of orofacial myofunctional therapy is to create an oral environment in which normal processes of orofacial and dental growth and development can take place, and be maintained (Hanson & Mason, 2003).

Establish Patent Nasal Airway

When structural or physiological impediments to nasal breathing, including allergies, have been ruled out or corrected via evaluations by an allergist and otolaryngologist (ENT), achieving lip closure at rest can serve to stabilize a nasal pattern of breathing. Closed mouth posture cannot be consistently established until any airway interferences have been successfully resolved (Hanson & Mason, 2003). In addition to adenotonsillectomy by an otolaryngologist and rapid maxillary expansion by an orthodontist, orofacial myofunctional services have been utilized to promote nasal breathing.

Improve Speech Sound Articulatory Placement

An incorrect oral rest posture of the tongue and lips can result in the tongue initiating speech productions from an abnormal rest position. In such situations, correcting the OMD can positively impact the correction of speech production errors.

When an OMD is related to an abnormal lingual or labial or mouth open behavior pattern that coexists with speech production errors, the articulation errors can be expected to be corrected more easily once the behavior pattern has been corrected in therapy.

See ASHA’s Practice Portal page on Speech Sound Disorders-Articulation and Phonology for more information.

Eliminate Nonnutritive Sucking    

Prolonged nonnutritive sucking (e.g., pacifier, finger, and object sucking) is a risk factor for increased malocclusion (Farsi & Salama, 1997; Poyak, 2006; Sousa, et al., 2014; Zardetto, Rodrigues, & Stefani, 2002). The American Academy of Pediatric Dentistry (2014) suggested dentists offer parents and caregivers guidance to help their children stop sucking habits by the age of 3 years or younger. In contrast, orthodontists do not usually make referrals to eliminate a sucking habit until close to the time that the adult incisors begin to erupt (Proffit, 2000). According to orthodontists, sucking habits that persist during the primary dentition years have little, if any, long-term negative effects on the dentition, and generally result in malocclusion only if sucking habits persist beyond the time that the permanent teeth begin to erupt.

Parents and caregivers can be taught to ignore problematic behaviors and offer praise, positive attention, and rewards as their child engages in appropriate mouth behavior to help the child break the habit. 

Dental professionals have observed a limited success rate with punitive dental habit elimination appliances (e.g., a rake, crib, or thumb guard). Moreover, these punitive appliances have been associated with excessive weight loss, pain, poor sensory perception, and development of atypical lingual movement secondary to the placement of these devices (Mason & Franklin, 2009; Moore, 2008).

Modify Handling and Swallowing of Saliva, Liquids, and Solids

Individuals with known OMDs may also demonstrate oral phase dysphagia which may require intervention. See ASHA’s Practice Portal pages on Pediatric Dysphagia and Adult Dysphagia.

Therapeutic intervention can involve the selection of appropriate oral tools such as straws, lip or bite blocks, appropriate food items, etc. for jaw-lip-tongue dissociation needed for eating and drinking.

Oral Rest Posture

A primary goal of orofacial myofunctional therapy is to create, recapture or stabilize a normal resting relationship between the tongue, lips, teeth, and jaws. Individuals who demonstrate difficulties with the patency of their nasal airway often remain mouth breathers, and this further affects normal resting postures of the tongue, jaw, and lips (Harari, Redlich, Miri, Hamud, & Gross, 2010). When the resting dimension (freeway space) has been achieved and stabilized in therapy, dental stability should follow (Mason, 2011).

Achieving a lips-together rest posture is another goal of orofacial myofunctional therapy. Therapy to achieve lip competence helps to stabilize the vertical rest position of the teeth and jaws, and may also positively influence tongue rest posture (Mason, 2011). Exercises to improve lip closure may include holding a tongue depressor between the lips (Ray, 2003), use of a lip gauge (Paskay, 2006), smiling widely and then rounding lips alternately (Meyer, 2000), and lip resistance activities (Satomi, 2001).

Labial-Lingual-Pharyngeal Muscle Resistance Exercises

Exercises to improve tongue, lip, and jaw differentiation include oral tactile stimulation and tongue movements without assistance from the jaw, such as tongue tip to alveolar ridge or tongue clicks against the palate (Meyer, 2000). Isotonic and isometric exercises target the lips and tongue, in order to teach closed mouth resting posture and nasal breathing.

Service Delivery    

Format refers to the structure of the treatment session (e.g., group vs. individual) provided.

Provider refers to the person offering the treatment (e.g., SLP, trained volunteer, caregiver).

Dosage refers to the frequency, intensity, and duration of service.

Setting refers to the location of treatment (e.g., home, community-based). OMDs are usually treated in a private practice, clinics or hospital settings. OMDs are not typically treated in public school settings.  See ASHA's resource on Eligibility and Dismissal in Schools.

Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.