Dana K. Hockenbury
Licensed Speech and Language Pathologist
Orofacial Myofunctional Disorders (OMD) describe abnormal rest postures and functioning of the oral and facial muscles. The prefix "myo" means muscle so our primary work begins with the muscles of the face and tongue.
A tongue thrust is the most common Orofacial Myofunctional Disorder. In the general population, the prevalence is from 30-40% throughout adolescence and adulthood (source: IAOM). It occurs when the tongue moves forward, between or against the sides of the teeth, rather than moving up against the roof of the mouth while swallowing.
An incorrect position of the tongue is another common Orofacial Myofunctional Disorder. When the tongue rests against either the front, sides or between the teeth, it can contribute to improper orofacial development and misalignment (malocclusion) of the teeth, such as an open bite. The light continuous pressure of the tongue against the teeth can move teeth which causes the bite to open up. If this occurs after braces are removed then this is referred to as 'ortho relapse'.
Therefore the fundamental work of an Orofacial Myologist begins with teaching and habituating proper tongue and lip resting postures. This can also be described as achieving proper dental freeway space. This is the most important aspect of our work; it is addressed in the beginning as well as as throughout the program.
A third common Orofacial Myofunctional Disorder is chronic non-nutritive sucking habits involving fingers, thumbs, blankets, clothes or pacifiers. During this constant sucking, the tongue is positioned low and forward in the bottom of the mouth and typically sits against the front teeth. From this incorrect tongue and lip resting posture, a tongue thrust swallowing pattern can easily develop.
In addition, the constant pressure of the fingers or pacifier against the hard palate can reshape it from a well formed wide dental arch into a high and narrow palatal vault. A cross bite may develop. If the sucking habit isn't extinguished before the age of five then this distortion of the palate and dental arches can become permanent. A palatal expander may need to be used in order to reshape and expand the width of the dental arches back toward a more normalized position. Orofacial Myologists can design a program for the young child to eliminate these non-nutritive sucking habits and prevent a tongue thrust from developing. If the elimination of these noxious oral habits are addressed early then any potential problems can be avoided in the future.
Tongue-tie or ankyloglossia may also cause a tongue thrust. It occurs when the 'cord' or frenum demonstrates a restricted range of motion of the tongue. This causes the tongue to sit low in the bottom of the mouth - not against the hard palate where it belongs. This restriction interferes with the movements of the tongue in sucking, eating and clearing food off the teeth in preparation of the swallow. If the tongue's elevation is restricted it will not be able to assume the desired resting posture against the palate; helping to maintain the arch.
Many specialists agree that a restricted lingual (tongue) or labial (lip) frenum can be a precursor to dental, speech, skeletal (jaw growth) and myofunctional concerns. Malformation of the palate and dental arch may occur along with a negative influence on speech production.
If a restricted lingual or labial frenum is suspected, the Orofacial Myologist will refer to the patient to an oral surgeon to have the frenum released. This will allow for better lip and tongue excursions. The Orofacial Myologist then prescribes home-based exercises post-op to eliminate scaring; keeping the tongue or lip long and flexible.
Infected and enlarged tonsils and adenoids compete with the tongue for space in the back of the oral cavity and upper pharynx. Because of the lack of space with the competing soft tissue, the tongue is displaced forward, causing the lips to be parted and the mouth open. Obligatory mouth breathing occurs due to this restricted and compromised posterior airway space. Here again is another opportunity for a tongue thrust to develop. Once the enlarged tonsils and/or adenoids are surgically removed or shrink on their own, the Orofacial Myologist will eliminate the tongue thrust and strengthen and tone the oral and facial muscles to recapture the appropriate lip and tongue resting posture. This ensures a normal dental freeway space in the oral cavity.
I welcome the opportunity to discuss these or any problems you or a loved one may be experiencing. Please read through my website and make an appointment for a full initial evaluation. If this therapy approach is right for you and you want to get started then a free therapy session is waiting. I look forward to hearing from you!