Tongue thrust, articulation, language and /k/ommunication

Orofacial Myofunctional Disorders

Orofacial myofunctional disorders (OMDs) are inappropriate behaviors and patterns in muscle function and poor habits involving the tongue, lips, jaw, and face. The most typical orofacial myofunctional disorder is a tongue thrust, which commonly involves an incorrect resting posture of the tongue and lips and an incorrect swallowing pattern. Research has suggested that orofacial myofunctional disorders may result from improper oral habits such as thumb or finger sucking, a restricted nasal airway, structural abnormalities, developmental or neurological abnormalities, and hereditary predispositions. Often, but not in all cases, an articulation problem is present as well.

What are the signs of an orofacial myfunctional disorder?

Do you or your child:

  • Rest your lips open?
  • Have difficulty breathing through your nose exclusively?
  • Have a tongue rest posture that is low and forward in your mouth?
  • Have difficulty lifting your whole tongue to the roof of your mouth?
  • Notice the tongue reaching out towards the food or cup when eating or drinking?
  • Have forward thrusting of the tongue when chewing?
  • Have excessive lip and chin movements when swallowing?
  • Have more than an occasional cough or gag when swallowing?
  • Have any oral habits?
  • Appear to have protruding upper front teeth or a space between the upper and lower teeth (anterior open bite)?
  • Have excessive saliva when speaking, eating, or sleeping?

Most individuals with an OMD have a combination of symptoms and causes. The most common signs are a habitual open mouth posture, digit sucking, poor oral habits, improper forward tongue position at rest, improper chewing, poor food collection in preparation for swallowing, and an abnormal swallowing function. Incorrect speech patterns and distorted speech sounds may coexist when there is an OMD.

Why be concerned about rest posture of the lips, teeth, jaw and swallowing pattern?

Correcting rest postures of the tongue and lips can be crucial in supporting the development of normal patterns of dental eruption and alignment, or reestablishing normal processes of orofacial growth and development. If your physician, dentist, or orthodontist has referred you to me, your doctor would like assistance in guiding the teeth into a more functional relationship during treatment, as well as stabilizing a correction from orthodontic treatment or surgery.

The overall effects of correcting negative influences on the oral and facial muscles, and eliminating a tongue thrust, chewing, or swallowing disorder, are an enhanced physical appearance (cosmetic effects) as well as optimized and stabilized muscle functioning that will protect your oral health for a lifetime.

Do orofacial myofunctional disorders affect speech?

Traditional speech therapy alone may not always work to correct the speech-sound and/or intelligibility concerns of someone who has an orofacial myofunctional disorder in addition to an articulation issue.

Laura approaches the concomitant articulation errors using sensory and motor processes with techniques to activate oral movement and positioning, improve muscle tone, normalize tactile sensitivity, disassociate oral-facial movements, stabilize and control movements, and stimulate and regulate reflex responses.

If speech-sound errors exist along with an orofacial myofunctional disorder, they typically involve the sounds that require tongue-tip elevation and alveolar/palatal ridge precision. In error, the tongue protrudes between or presses against the teeth causing a distorted production of the /t/, /d/, /n/, and /l/ sounds and a frontal, lateral, or jaw protrusional lisp for the sounds /s/, /z/, “sh,” “ch,” “tsh,” or /j/.

Another condition that can also impede proper speech production is a restricted lingual frenulum (known as tongue-tie or ankoglossia). In this case, the tongue tip is held down by the thick, tight, and/or short length of the tissue that connects the tongue to the floor of the mouth. This condition can result in poor and limited tongue range of motion and a lack of the coordination needed for proper speech production, chewing, and swallowing. Tongue-tie can also contribute to a lateral lisp. People with ankoglossia can have difficulties with feeding, drooling, and may have a tongue-thrust swallowing pattern.  ** Laura can successfully work with patients post tonsillectomy and adenoidectony can benefit greatly with therapy to achieve optimal results post surgery.

All of these issues can be addressed by an orofacial myofunctional therapist who is also a speech therapist.

What is orofacial myofunctional therapy?

Orofacial myofunctional therapy is a systematic behavioral approach that aims to support the proper growth and development of the orofacial environment, promote the stabilization of dental and/or orthodontic treatment, improve the production of speech patterns and sounds, enhance a person’s appearance, and foster the maintenance of optimal oral health for a lifetime.

What is an orofacial myofunctional therapist?

An orofacial myofunctional therapist is a specially trained individual working within a multidisciplinary team that can include pediatricians; dentists; orthodontists; allergists; ear, nose, and throat physicians; head and neck surgeons; oral surgeons; physical therapists; and other health care professionals. Some certified orofacial myofunctional (COM) therapists have also completed the multi-step educational and certification processes of the worldwide International Association of Orofacial Myology (IAOM).

Is therapy with Laura right for me?

Laura S. Smith, MS, is a certified orofacial myologist (COM) as well as a certified speech-language pathologist (CCC-SLP). She has an unparalleled depth of experience working with children and adults in both acute and clinical settings. In her earlier work, she performed numerous swallowing evaluations, which have given her the knowledge and observational skill in how to adjust for swallowing various liquids and solids, modifying diets to meet the needs for her patients, and training them to use optional seating and positioning strategies to maximize their safety and nutritional needs. Her quest for more knowledge and precision skill in tongue thrust, swallowing, and related disorders, lead her to pursue extensive training and research to help individuals with oral-motor, speech, and orofacial myofunctional disorders, bringing her work full circle.

Her compassionate, fun, enthusiastic, and motivating personality delivers results. For more information about Laura and the work that she does, please read her many client testimonials.

Therapy goals

  • Correct the abnormal tongue and lip movement in swallowing, as well as lip and tongue rest posture differences; speech differences; oral habits; and structural/functional (oral /facial muscle imbalance) difficulties of the body, jaw, lips, and tongue.
  • Improve oral and facial muscle function through muscle and resting retraining techniques for body, jaw, lip, and tongue to correct a reverse-swallow pattern (tongue thrust), which may contribute to orthodontic complications and delays in treatment completion by forcing the teeth apart or forward.
  • Control the reverse-swallow pattern characterized as a strong, outward-pushing movement of the tongue that is seen in normally developing individuals, as well as in those with neurological dysfunction. 

Help is available!

Laura Smith, licensed speech-language pathologist and certified orofacial myologist, is specially trained to assist children and adults in overcoming their communication challenges. Her holistic approach takes into account the person as well as the problem.

Talk SLP LLC offices are located in the Northgate area of Seattle and on Mercer Island, allowing us to serve individuals and families throughout the greater Seattle region of Washington state. Telepractice appointments are also available, where clients can receive consultation and therapy services using online tools.

Contact us for more information or to make an appointment.