Orofacial Myofunctional Disorders: you may never have heard of them, but you probably know somebody that has one.

Orofacial Myofunctional Disorders: you may never have heard of them, but you probably know somebody that has one.

With a name as ostentatious as Orofacial Myofunctional Disorder, you may be thinking: why should I care about this rare, surely complicated disorder that nobody has ever heard of? And why is ALTA publishing an article about them?

Reason Number 1 to care: not only are Orofacial Myofunctional Disorders (OMDs for short) not rare, but research suggests that up to 38% of the general population has one. That’s right, more than one in three people have an OMD, which means that you or somebody you know is very likely living with one without even realizing it. And as one of the major causes of speech disorders in children and adults, they tap into our interest in all things language.

Definitions

Okay, now that I’ve scared you with the numbers – what is an OMD? Let’s break the name down. Orofacial can be separated into ‘oro,’ meaning mouth, and ‘facial,’ referring to – you guessed it – the face. Myofunctional can also be separated into ‘myo,’ which comes from the Greek word for muscle, and functional, or the way that it is used or formed. So, put that all together, and you’ve got a disorder in the way that the muscles of the mouth and face are used or formed.

Symptoms

But what does an Orofacial Myofunctional Disorder look like? What can happen when the muscles of the mouth and face either don’t develop properly or are not used properly? Well, a lot of things. Here are reasons one through sixteen why you should care about OMDs. This is also a list of potential symptoms of an Orofacial Myofunctional Disorder, so if you or your child presents with any of the following, consider consulting with a health professional.

Orthodontic issues, including:

  1. Improper alignment of the teeth
  2. Underbite or overbite
  3. Orthodontic relapse (e.g., teeth moving back after braces)
  4. Temporomandibular joint dysfunction (e.g., jaw pain, difficulty chewing, clicking, or locking of the jaw)

Speech issues, including:

  1. Lisp (i.e., difficulty pronouncing the ‘s’ sound, as in ‘sun’)
  2. Difficulty pronouncing other sounds, such as the ‘sh’ in ‘ship,’ the ‘ch’ in ‘cheese, or the ‘j’ in ‘jump’
  3. Imprecise or mumbled-sounding speech that’s hard to understand

Note: children who have difficulty saying sounds correctly often end up struggling when they start learning to read and write. It’s very hard to accurately sound something out if you’re not using the right sounds!

Eating difficulties, including:

  1. A restrictive diet (often with a preference for soft, processed foods)
  2. Difficulty breastfeeding
  3. Drooling while eating or drinking
  4. Messy or noisy eating

Sleep and breathing issues, including:

  1. Snoring (despite being common, snoring is not normal at any age, and should be checked out by an ear, nose, and throat doctor)
  2. Sleep apnea
  3. Poor sleep quality (which can lead to issues with attention and behavior and affect performance at school or work)
  4. Breathing through the mouth most of the time, rather than the nose. We will get into the reasons why this seemingly innocuous habit can have HUGE consequences later in the article.
  5. Allergies

Okay, now that you know some of the issues that an Orofacial Myofunctional Disorder can lead to, let’s get into the why. What are the specific causes of OMDs, and is there anything we can do to avoid them?

Causes – behavioral vs. structural abnormalities

Orofacial Myofunctional Disorders can be caused by structural or behavioral abnormalities, although they are most often caused by a combination of both.

A structural abnormality is when there is something wrong with the way the structures in the mouth or face have developed. A behavioral abnormality is when there is something wrong with the way a person is habitually using those structures while speaking, eating, or breathing.

Airway obstruction

Let’s start with an example of a structural abnormality – an airway obstruction. Imagine your airways like a hose with two nozzles, one at the nose and one at the mouth. In an ideal world, air will flow smoothly along the whole track into the lungs without running into any obstacles. But much like a hose, there are three ways that a blockage can occur:

  1. Something can get stuck inside, like a small pebble
  2. It can be pinched or pressed from the outside
  3. The hose itself might be too small to build up a good flow, to begin with

If we extend the analogy back to the airway, a pebble might equate to an enlarged set of tonsils or adenoids taking up more space than they should. Pressure from the outside might occur when excess weight pushes against the airway and narrows it. And some people may have an airway that is just too narrow for optimal airflow, either because their jaw sits too far back and takes up space in the airway, or because they’ve got narrow nostrils, a deviated septum, or allergy-related inflammation that restricts the flow of air.

One of the most recognizable symptoms of airway obstruction is snoring. Snoring might be quite common, but that does not make it normal or healthy. In fact, snoring can have long-term impacts on health, including poor sleep quality, anxiety, fatigue, and even an increased long-term risk of heart attack and stroke.

Airway obstruction also causes many people to become habitual mouth breathers, meaning that they breathe through their mouth most of the time rather than their nose.

Mouth breathing – what’s the big deal?

You may think that breathing is breathing, and it shouldn’t matter whether it’s done through the nose or the mouth, as long as we’re getting the oxygen we need to survive. In fact, if you’re a mouth breather, you may be getting enough oxygen not to keel over this very minute, but you’re likely not getting enough to optimize your health outcomes in the long term. This is because nose breathing releases an essential chemical called nitric oxide, which expands blood vessels and ensures that blood, nutrients, and oxygen travels to every part of the body efficiently and effectively. Nitric oxide is not released when mouth breathing, and over many years, this increases the risk of serious illnesses, including heart disease and diabetes.

On top of that, the nose is an incredible filtration system. When you take in air through the nose, you filter out dust, allergens, and pollen and prevent them from entering your lungs. When you breathe through the mouth, all that gunk and bacteria can get into the lungs and also start to build up on the teeth, leading to bad breath and tooth decay.

Additionally, breathing through the mouth means that the tongue’s resting posture is at the bottom of the mouth, rather than the top. In children, this can lead to issues with craniofacial development. This gets a bit complicated, but stick with me: The ideal resting posture of the tongue (yes, there’s an ideal posture!) is with the mouth closed and the tongue tip suctioned to the bumpy spot on the roof of the mouth just behind the front teeth. This spot is known as the alveolar ridge. Now think of the mouth as a lump of clay. What we do with our tongue over the course of many years molds the mouth, and in turn, the face into its adult shape. When the tongue sits up on the alveolar ridge, it helps the roof of the mouth to expand forward and outward. Essentially, it makes the mouth bigger. Not only does this give the teeth room to grow, but it also ensures the jaw is positioned far forward enough not to take up space in the airway.

Conversely, when the tongue sits down at the bottom of the mouth, its important duties in helping grow that space are neglected. Thus, children who mouth breathe may end up with tooth crowding, unclear-sounding speech, and feeding and breathing difficulties because their mouth doesn’t grow enough to accolade their adult teeth and tongue.

In summary, not only does nose breathing increase oxygen flow in the body and decrease the risk of serious long-term illnesses, but it also helps the mouth and face to develop properly, thus ensuring that the airway is wide enough for air to flow freely. If it seems like I’m talking in circles, that’s because the nature of Orofacial Myofunctional Disorders is often circular.

A structural issue, such as a deviated septum making it hard to breathe through the nose, often leads to a behavioral issue like habitual mouth breathing, which eventually leads to more structural issues, such as crowded teeth in a mouth that’s now too small because of the downward resting tongue posture. This creates a vicious circle, which can often only be stopped by addressing both the structure (e.g., working with an ENT to fix a deviated septum and an orthodontist to fix the teeth and make more room in the mouth) and the behavior (e.g., working with a speech pathologist to train nose breathing).

Usually, if there are no structural issues (e.g., no allergies, no enlarged tonsils), there are no behavioral issues. A child that can easily breathe through their nose will do so, thus optimizing their orofacial development, and decreasing their likelihood of having speech, feeding, or sleep difficulties.

Tongue tie

Okay, let’s briefly cover one of the other common structural issues that can cause Orofacial Myofunctional Disorders: tongue tie. A tongue tie is when a tight band of tissue at the base of the tongue tethers the tongue to the floor of the mouth, restricting its range of motion. Tongue tie occurs in between four and eleven percent of the population and is often first detected because of difficulty with breastfeeding. This happens because infants with tongue ties may be unable to move their tongues properly in order to latch onto or suck on the breast.

As children begin to develop speech, tongue ties may lead to difficulties saying certain sounds. Many sounds, including ‘t,’ ‘sh,’ ‘s,’ ‘d,’ ‘z,’ ‘th,’ ‘r,’ and ‘l,’ require the tip of the tongue to reach up to the top of the mouth, which may be difficult or impossible for children with tongue tie, depending on the degree of restriction.

Recall that the optimal tongue position for nose breathing is with the tongue tip up behind the front teeth. Difficulty getting the tongue up into that position means that kids with tongue ties are also at risk of becoming mouth breathers and developing the myriad of associated issues covered above.

Finally, tongue tie may lead to poor dental hygiene, as a restricted range of motion in the tongue makes it difficult to sweep away food that gets stuck in the teeth. It can also lead to a preference for soft, easy-to-chew food that doesn’t require as much manipulation by the tongue. This type of food tends to be processed and unhealthy.

The Link Between the Modern American Diet and OMDs

As a speech pathologist being trained in the area of Orofacial Myofunctional Disorders, I recall my mentor once saying, “processed foods have turned us all into human pugs.” At first, I didn’t quite understand what she meant by that, but as I continued along on my myo journey, I’ve come to understand just how big of an impact our diets have on our facial growth and development.

For many years, researchers believed that the overwhelming prevalence of issues like misaligned teeth, jaw pain, snoring, and sleep apnea in Westerners could be attributed to poor genetics. Nowadays, more and more researchers are of the belief that a diet high in processed foods may be to blame.

Highly processed foods like pasta, bread, and cheese tend to be soft and easy to chew. They require much less work of the muscles of the mouth and tongue than the typical diets of our ancestors, which consisted of more chewy meats, nuts, and fibrous fruits and vegetables.

If we return to the analogy of our mouth being like a lump of clay, it’s clear that underuse of the chewing muscles can lead to many of the same issues previously described. The mouth doesn’t grow outward the way it should, the tongue becomes too big for the oral cavity, there is dental crowding or crooked teeth, and we become more likely to be mouth breathers. Ultimately, much like in the humble pug, suboptimal orofacial development leads to breathing issues that are so prevalent most of us aren’t even aware they aren’t normal.

Oral habits

Thumb sucking, nail-biting, and chewing on pens and pencils – are all examples of oral habits. Why do they matter? Once again, we come back to the clay analogy. If you’re consistently putting a foreign object into your mouth, over time this is going to begin to affect the shape of the oral cavity and its surrounding structures.

Take thumb-sucking. When a child is sucking their thumb, the thumb sits against the roof of the mouth and pushes the tongue down into the bottom of the mouth. What might be the result of the tongue developing a penchant for sitting down in the mouth rather than up? Mouth breathing. And here the cycle starts again.

So, what can we do about OMDs?

If you suspect you or somebody you know has an OMD, don’t wait. Get it checked out by a professional. Not sure which professional to turn to? Here’s a quick guide to the areas of expertise of professionals that work with OMDs:

  • IBCLC (International Board Certified Lactation Consultant): can assist with breastfeeding difficulties, including those caused by tongue tie.
  • Dentists, dental surgeons, and ENTs: can diagnose and perform tongue tie release surgery. ENTs can also help with all things airway, including airway blockages and sleep-disordered breathing (e.g., snoring).
  • Speech-language pathologists and myofunctional therapists: can treat the behavioral issues associated with Orofacial Myofunctional Disorders by training nasal breathing, optimal chewing and swallowing patterns, helping eliminate oral habits, and providing pre and post-surgical care for people undergoing tongue tie release. Speech-language pathologists can also work on speech difficulties caused by OMDs.

Don’t worry if you’re not sure exactly which professional is best suited to your case. The starting point is much less important than ensuring that whoever you do see has training in Orofacial Myofunctional Disorders. This is still a nascent discipline within the health sciences, and therefore many professionals have not been trained to diagnose or treat OMDs, and some may not even be aware of them. Don’t be afraid to ask your health professional about their training in this area. With dentists and orthodontists, it’s also a good idea to seek out those who are ‘airway focused.’

Prevention

If there’s anything that became really clear to me from learning about Orofacial Myofunctional Disorders, it’s the incredibly interconnected nature of all the systems and structures in our body. It can be a bit scary to think that something as seemingly innocuous as allergies can lead to a mouth-breathing habit, which can then escalate into suboptimal mouth and face development and even increase the risk of serious health issues later in life.

But the good thing is that the domino effect moves in both directions, which means there is a lot we can do to promote the best health outcomes by thinking preventatively and taking action early.

Just by choosing to incorporate more chewy, fibrous foods, such as unprocessed meats, raw fruits and vegetables, and nuts into our diets and our children’s diets, we can help optimize craniofacial development and potentially save ourselves thousands of dollars on braces, palate expansion, or speech therapy to fix a lisp.

By paying attention to our breathing (e.g., figuring out whether it’s done mostly through the nose or mouth and whether or not we snore) and getting on top of any potential issues, we can promote long-term health outcomes and reduce the likelihood of diabetes or heart disease.

By limiting pacifier use beyond age one and getting oral habits, such as thumb-sucking beyond age four, checked out, we can promote proper tooth development and nasal breathing.

The list goes on. Step one is to educate ourselves. Once we know the facts, it becomes clear that there is a lot we can do to reverse the trend toward a society of ‘human pugs’ wrought with sleep, breathing, eating, speech difficulties, and start building a world of easy-breathing beagles or border collies (take your pick)!

 

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