boy licks popsicle showing tongue range for orofacial development

Understanding Orofacial Disorders (OMDs)

Tongue Position, Nasal Breathing, and Your Child’s Health

Did you know that how your child breathes can greatly impact their dental health, as well as their overall health? The key to healthy swallowing and breathing depends a great deal upon your child’s tongue. Where your child’s tongue sits while at rest impacts their breathing and swallowing capabilities, which in turn can affect their sleeping, eating, speaking, habits and behavior. Tongue position also plays a crucial role in how your child’s face, jaw, palate and teeth develop!

 If you or a healthcare provider has noticed that when your child swallows their tongue does not rest on the roof of their mouth, your child might have what we at GBPD call a orofacial myofunctional disorder, otherwise known as an OMD. Below we will cover some common causes, signs, and side effects of OMDs, as well as offer solutions and treatment options!

Causes of Orofacial Myofunctional Disorders (OMDs)

Weak or Imbalanced Orofacial Muscle Function

When we swallow, all the muscles in our face, mouth, throat, cheeks, and tongue must work together.  When one group of muscles doesn’t pull its weight, other muscles try to make up for it and overcompensate.  Think of the person who develops a bad back because they have a weak knee and start walking with less balance.  The same type of strain and imbalance can occur in your child’s mouth.  When we consider that your child swallows 500-1000 times a day, there are plenty of opportunities for such an imbalance to develop problems!

Improper Tongue Posture

Think of your child’s tongue as nature’s orthodontic expander. It’s primary function in this process is to elevate to the roof of the mouth (palate) during swallowing to create pressure and naturally expand both the palate and the floor of the nasal cavity. However, when your child is unable to elevate their tongue to the roof of their mouth during swallowing or has a tongue thrust swallow, this natural process does not occur. Therefore, their upper jaw becomes narrow and their airway does not have the opportunity to expand. This ultimately leads to a domino effect where your child has to breathe through their mouth creating a cyclical cascade of imbalance. 

Understanding Orofacial Disorders (OMDs)

Few of us give much thought to swallowing. However, we all swallow hundreds if not thousands of times per day! It’s during childhood that we develop the framework for our swallow pattern, but if one or more things is preventing your child from creating a proper swallow pattern, their growth and development may be affected. 

Tongue or Lip Tie

We all have tongue and lip ties and most of us are functioning quite well. However, some tongue and lip ties are tighter than others and can impact the ability to swallow, sleep, speak clearly, and eat and chew efficiently. Children who suffer from a tethered oral tissue in which they are forced to find a way to function may develop an OMD. This is because their tongue and lip muscles cannot meet the full and ideal range of motion. Releasing the tongue tie or lip tie with a laser frenectomy may be needed as a key element in treating OMDs.

Thumbsucking or Finger Sucking

While for years past we gave little to no thought to a child who has a sucking habit, we now understand that this habit should alert parents to question whether their child has an OMD. Typically children with a finger or thumb habit have an underlying tethered oral tissue. Children who develop these habits are in fact using their fingers or thumb to help depress their tongue and open their airway to create a more optimal breathing environment, which allows for a more restful sleep. They also are using their finger or thumb to create the pressure sensation on the roof of the mouth that the tongue would typically provide, which is innate to babies and children. 

Mouth Breathing

child sleeping with mouth closed shows proper sleep resting position of jaw for OMD assessment

Enlarged or Swollen Tonsils

Nasal breathing filters the air from bacterial and viral particles. When your child is a mouth breather the structures in the back of their throats have to act as these filters. However, their tonsils and adenoid tissues were not created to take on this task, which leads to inflammation. This ultimately becomes a cyclical pattern because with enlarged tonsils your child’s airway is blocked off and asking them to breathe through their nose becomes unrealistic. Many times, the tonsils and adenoids need to be removed and your child needs to be retrained to nasal breathe. 

Additional Problems Caused by OMDs

Your child’s dental health and airway health are directly related. Proper tongue position and movement, along with proper swallowing and nasal breathing, work together to keep your child’s mouth and teeth healthy.

1. Children with an OMD are more prone to cavities.

The tongue works hard to keep the mouth clean after eating and drinking.  When the tongue’s movement is limited in some way, either from an OMD or tethered oral tissue, it cannot do its job sweeping away food particles, which allows food and bacteria to remain on the teeth. 

The mouth breathing often caused by an OMD adds to the problem.  Our saliva has a pH level that helps protect our teeth from the acids bacteria in our mouth produce.  It also helps wash away bacteria when we swallow.  A child who breathes with their mouth open creates a dry mouth, and a dry mouth encourages the bad bacteria to grow.  As these bacteria continue to eat, they release acids that erode tooth enamel.  This erosion turns into cavities.

2. Children with an OMD are more likely to need braces.

When the tongue is positioned correctly during rest, it places pressure at the roof of the mouth.  This helps your child’s palate develop properly and allows for their adult teeth to erupt without competing with the tongue for space.  A child who thrusts their tongue often develops teeth that begin to “stick out” or protrude. This happens because the tongue does not have enough room at the roof of the mouth and, therefore, has to create space by pushing the teeth forward. 

Others may develop an overly narrow or high palate because the tongue is not reaching the plate during swallowing to naturally expand it. With limited to no room for the teeth to erupt, the teeth are forced to come into the incorrect position crooked and crowded. Aside from the cosmetic issues there are underlying growth and development concerns, such as overbites and under bites. While these issues can be corrected with orthodontics ; ranging anywhere from $3,500 to $10,000, if the underlying issues causing the malfunction is not addressed relapse may occur. What we consider a “malocclusion” is actually an equilibrium and if we only change one piece of the puzzle (i.e., the teeth with braces), it will not last. 

3. TMJ dysfunction is common in children with an OMD.

Temporomandibular joint syndrome (TMJS) refers to a pain in the jaw that comes from the temporal bone. This bone is located right in front of the ear as it connects the lower jaw to the upper jaw.  A child who exhibits an OMD can often get this pain as a result of their orofacial muscles not working together properly. With TMJS, a patient may have symptoms such as headaches, airway obstruction, stomach pain and muscle pain. This can, in turn, cause basic functions such as speaking, eating and swallowing to become more challenging.

4. Speech difficulties are also common.

Twinsburg Myofunctional Therapy shows girls receiving services Great Beginnings Pediatric Dentistry

Each speech sound requires the tongue and lip position to function in unison at various spots in the mouth. A child with an OMD, though, often may struggle to speak clearly. Many times, the tongue muscle is not working at full strength, and this may make it hard for your child to pronounce certain sounds or drop sounds at the end of a word. Many times it could be sounds such as “th”, “r”, or “s”, but note that the limitations are not only restricted to these sounds.

5. Many children experience sleeping difficulties due to an OMD.

Sound and restful sleep require optimal oxygenated breathing. Typically this is best achieved via nasal breathing. Children with an OMD often present with sleeping difficulties. This may include, but is not limited to, snoring, restless sleep, frequent awakening at nighttime, nightmares/night terrors, bedwetting, gridding of their teeth and daytime ADHD behaviors. 

6. Food aversions and OMDs often go hand-in-hand.

Most probably have never connected that a “picky eater” or “slow eater” may truly just have difficulty eating. The energy and effort required to break down and sallow fibrous, chewy, tough foods is often not worth the energy. These kids self-select easy to swallow/ “pre-chewed” choices (e.g., a diet narrowed to crackers, nuggets and pouches). This is often due to the fact that their tongue and muscles of the mouth do not have the full strength to break down and move food around. Many of these children tend to be in the lower percentile of growth charts because a balanced diet is essential for proper growth and development! 

7. Sometimes, we can link behavioral problems to breathing or tongue difficulties.

Lack of deep sleep, suboptimal breathing, poor eating habits, and frustration over speech problems can add up. A child with an OMD, often demonstrates behavioral problems. They may be easily frustrated, have difficulty concentrating, anxious, disruptive and exhausted by the end of the day. However, many of the kids truly are misdiagnosed. In reality, their little bodies are struggling to get the air, sleep, and nutrients they need for their brains and bodies to be at their best.

7. An elongated face shape may signal an OMD.

When an OMD presents at a very young age, it can affect the skeletal growth of a child’s face. This is due to the fact that form follows function. If your tongue is not broadening your palate and floor of the nose to provide adequate nasal airway space, your body’s natural compensation is to elongate the nose and open the mouth to take in adequate oxygen. This results in a change in your overall face shape.

You will notice a longer, narrow face. With a tethered oral tissue (anterior or posterior restriction), chronic allergies or learned habitual mouth breathing, the palate is not naturally expanded and consequently results in a high, narrow, “v-shaped” roof of the mouth. This results in insufficient room for all your teeth, leading to protruding teeth and significant dental crowding! When the upper jaw is narrow and crowded it constricts the growth of the lower jaw, resulting in crowding there as well. In the old days, the solution was extraction and braces. Now, the puzzle pieces are coming together, and the ideal treatment is to treat dental crowding with an airway and OMD focused approach. 

Treatment for Orofacial Myofunctional Disorders

When some muscles of the face are weak, other muscles try to compensate and become fatigued. The solution is to work to strengthen the weaker muscles of the face so all the muscles can work in harmony! This is true of a tongue thrust or tongue restriction as well, it needs to be strengthened and guided. Myofunctional therapy is a set of exercises that works towards accomplishing the goals of optimal muscle strength to provide optimal nasal breathing, functional swelling and crisp, clear speech. Think of it as physical therapy for your tongue and orofacial muscles!

Who performs myofunctional therapy?

A Myofunctional therapist is a trained professional with an existing degree in dentistry, speech, physical or occupational therapy. These specialized therapists receive additional training above and beyond their already advance degrees to assess your child’s tongue position and breathing. Then, they develop a course of treatment: usually a course of exercises. Sometimes, a laser frenectomy may also be suggested as a necessary part of treatment, depending on your child’s unique case.

If you’re concerned your child may be sufferings from an OMD, give Great Beginnings Pediatric Dentistry a call.

Dr. Laura Adelman and Dr. Rachel Rosen are pediatric dentists who both received Myofunctional therapy training through the Academy of Myofunctional Therapy.  Dr. Rosen is also a TBI (the Breathe Institute) Ambassador, showing her training, passion, and commitment to connect oral, airway, and overall facial growth and development to a child’s overall health. They are accepting new patients under the age of 17 years for all their dental and breathing health needs. Call our office at (330) 425-1885 to schedule a consultation with them today.

This blog serves to provide information only and is not medical or dental advice. Anyone concerned about their child’s oral, dental, and/or breathing health should consult with their healthcare professionals to determine the correct diagnosis and best course of treatment.


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