Orofacial myofunctional disorders (OMD)

What are orofacial myofunctional disorders?

“Orofacial” means the mouth and face. “Myofunctional” means how muscles work. An orofacial myofunctional disorder, or OMD, is a pattern in how the tongue, lips and jaw rest or move that gets in the way of typical feeding, swallowing, chewing, breathing or speech.

Most OMDs involve one or more of these patterns:

• Tongue rest posture: where the tongue sits when you are not talking or eating. Typically, it rests gently against the roof of the mouth. In an OMD, it may rest low in the mouth or push forward against the teeth.
• Lip seal: whether the lips close comfortably at rest. Lips that are often apart can go along with mouth breathing.
• Swallowing pattern: whether the tongue pushes forward against or between the teeth when swallowing, often called a tongue thrust or atypical swallow.
• Breathing: whether breathing at rest happens mostly through the nose or the mouth.
• Feeding and chewing: for babies, how sucking, swallowing and breathing work together; for older children and adults, how food is chewed and moved in the mouth.
• Oral habits: thumb or finger sucking, prolonged pacifier use, nail, lip or cheek biting, and similar habits.

Why these patterns matter

The tongue, lips and cheeks apply gentle, constant pressure on the teeth and jaw. Over time, the way they rest and move can influence how teeth come in, how the bite develops and whether teeth stay in place after orthodontic treatment. That is why dentists and orthodontists often refer for a myofunctional assessment.

These patterns can also go along with feeding difficulties in babies and toddlers, messy or effortful eating, drooling beyond the toddler years, and some speech sound errors, such as a lisp. They do not always cause problems, and not every open mouth or tongue thrust needs therapy. A careful assessment helps tell the difference.

What we help with, by age

Babies

Feeding is a baby’s first oral-motor skill. It asks the lips, tongue and jaw to work together, and to coordinate sucking, swallowing and breathing.

Any feeding concern in a baby starts with a medical check by your physician, to rule out medical causes and make sure your baby is growing and breathing well. Many families also work with a lactation consultant (IBCLC). Once those checks are done, we can support your baby’s team when there are questions about oral function, such as:

• Difficulty latching or staying on the breast or bottle, clicking sounds, or milk escaping from the lips
• Long, tiring feeds, or a baby who seems to work very hard to feed
• A mouth that often rests open, or a tongue that seems to stay low or forward
• Questions about tongue tie and how the tongue actually moves during feeding
• Moving to spoon feeding, purées, textures and open cups in the second half of the first year

Our role with babies is mostly coaching. We look at how your baby’s mouth works during a feed and suggest positioning, pacing and gentle oral strategies. With your consent, we share our observations with your physician and lactation consultant so everyone works from the same picture.

Toddlers and preschoolers

In the toddler years, we often see families about:

• Open-mouth posture or mouth breathing during the day, once the airway has been checked by a physician
• Difficulty moving to textured foods, chewing or drinking from an open cup or straw
• Drooling that continues beyond the toddler years
• Pacifier, bottle or thumb habits that are hard to reduce

Before about age 4, most children are not ready for structured exercises, so therapy at this age is mainly parent coaching: how to support lip closure and chewing at mealtimes, how to reduce a habit gently, and how to build nasal breathing into play and routines.

School-age children and teens

From about age 4, and especially in the school years, myofunctional therapy can include direct exercises, because children can now notice their own habits and practise. We see:

• Tongue thrust and low or forward tongue rest posture
• Open-mouth posture and mouth breathing habits
• Thumb, finger or other oral habits that continue past the preschool years
• Children and teens before, during or after orthodontic treatment, when the dentist or orthodontist has raised concerns about tongue or lip function
• Children with a lisp or other speech sound errors alongside these patterns

Adults

Adults come to us when they notice a tongue thrust, open-mouth posture or a long-standing oral habit and want to change it, or when their orthodontist or dentist recommends it as part of an orthodontic plan. Some adults are referred by their physician as part of a broader plan for snoring or obstructive sleep apnea. In that case, myofunctional therapy is an addition to medical treatment, never a replacement for it.

What can contribute to an OMD

There is rarely a single cause. Common contributing factors include:

• Airway obstruction: allergies, a blocked nose or enlarged tonsils or adenoids can make nasal breathing hard and lead to mouth breathing
• Prolonged sucking habits: thumb, finger or pacifier use well past the preschool years
• A restricted lingual frenulum, in some people, though many people with a short frenulum have no difficulty
• Low muscle tone or neurological conditions that affect oral movement
• Facial and dental structure, which is influenced by genetics

Because the causes cross several professions, assessment and treatment are often a team effort.

When to see a physician first

Some signs need a medical opinion before, or alongside, myofunctional therapy. Talk to your physician, or seek urgent care when needed, if you notice:

• In a baby: poor weight gain, very long feeds, choking, coughing or colour changes during feeds, or laboured or noisy breathing
• At any age: loud snoring, pauses in breathing during sleep or gasping
• Constant mouth breathing, a blocked nose or frequent ear, nose or throat infections
• Coughing or choking when eating or drinking, or repeated chest infections

For swallowing safety concerns, see our page on swallowing and feeding (dysphagia).

How we assess it

A myofunctional assessment combines history, observation and a close look at function. Depending on age, we will:

• Ask about pregnancy and birth, feeding history, breathing, sleep, oral habits, allergies and any dental or orthodontic treatment
• For babies, observe a feed and look at how the lips, tongue and jaw move and coordinate
• Observe lip and tongue posture at rest and during conversation
• Watch how the person swallows water and food, and how they chew
• Look at the range and strength of movement of the tongue, lips and jaw, including how freely the tongue moves (a tight frenulum is diagnosed only by a physician or dentist)
• Screen speech sounds that can be affected, such as s, z, sh, t, d, n and l

You will leave with a clear explanation of what we observed, whether therapy is recommended, and which other professionals, if any, should be involved.

Working with your medical and dental team

OMDs sit where several professions meet: physicians and ear, nose and throat specialists for the airway, dentists and orthodontists for the teeth and bite, lactation consultants for breastfeeding, and speech-language pathologists for oral function, feeding, swallowing and speech. With your consent, we share our findings with your physician, dentist or orthodontist, and we recommend a medical check whenever we see signs that need one.

A careful approach to tongue tie

Families often ask about tongue tie, or ankyloglossia. What matters most is how the tongue functions, not only how it looks. Many people with a short frenulum feed, eat and speak without difficulty, and research on tongue tie and speech is mixed. Professional bodies have also cautioned that frenotomy procedures have become far more common than the evidence supports.

Speech-language pathologists do not decide on or recommend frenulum procedures. That decision belongs to a physician or dentist, with you. Our role is to describe how the tongue moves and functions during feeding, swallowing and speech, and to share those observations with the professionals involved. If a procedure has been done or is planned, we can support feeding and oral function alongside your team.

How therapy works at VoxLingue

Myofunctional therapy is a program of short, specific activities and habit changes, matched to the person’s age and pattern. It is usually done in a series of sessions spaced out over several months, so new patterns have time to become automatic.

What therapy can include

• Parent coaching for babies and young children: positioning and pacing during feeds, mealtime strategies, and gentle ways to support lip closure and chewing
• Awareness: learning to feel where the tongue and lips are at rest
• Tongue, lip and jaw exercises chosen for the person’s specific pattern, practised a few minutes at a time
• Swallow retraining: practising a swallow where the tongue stays behind the teeth, first with water, then with food
• Chewing and texture work for children moving to new foods
• Nasal breathing habits, once a physician has checked the airway
• Habit elimination for thumb sucking, pacifier use or nail biting, using gentle, positive plans that respect the child’s readiness
• Carryover: moving the new pattern into everyday moments like reading, screen time and sleep

What myofunctional therapy can and cannot do

We are clear with families about expectations. Research on myofunctional therapy is growing, but much of it is small or of mixed quality, and results depend a great deal on daily practice.

• It can help build new rest postures, swallowing patterns and breathing habits, and help stop long-standing oral habits.
• It can be part of an orthodontic plan, when your orthodontist feels it is relevant. Evidence that it prevents teeth from shifting back after braces is still limited.
• It does not replace medical treatment of the airway, of sleep apnea or of a feeding problem with a medical cause.
• It does not correct speech sounds on its own. Speech sounds are learned best through speech practice, and research does not support oral exercises on their own for that purpose. When a child also has speech sound goals, we plan both together.

Your role at home

Daily practice makes the biggest difference. Most plans involve a few short practice periods a day, built into routines you already have. For babies and young children, parents carry most of the plan. For older children, you help with reminders, encourage practice and notice progress.

We will show you how to:

• Build activities into routines, such as feeds, meals, tooth brushing or story time
• Use gentle reminders for lip and tongue posture that do not feel like nagging
• Track practice with a simple chart your child helps fill in
• Support a habit change with praise and patience

Bilingual and multilingual families

Feeding, breathing and swallowing do not depend on language, but understanding the plan does. Our team speaks many languages, and we will try to match you with a clinician who can explain the plan in the language your family is most comfortable with. Availability varies.

When a child also has speech sound goals, we consider all of the languages they speak. Some sounds differ between English, French and other languages, and a bilingual child’s speech may show patterns that are typical for learning two sound systems.

In person or by telepractice

We offer assessment and therapy in person at our Marché Central clinic in Montréal, or by telepractice anywhere in Quebec and Ontario. Exercises, habit work and parent coaching work well by video with good lighting and a camera close to the face. Some assessments, especially feeding assessments for babies, may be easier in person. We will help you decide what fits.

Getting started

You do not need a physician’s referral, although a note from your physician, dentist, orthodontist or lactation consultant is helpful if you have one. For babies, please make sure your physician has seen your baby about any feeding concern first. The first step is an assessment.

Call our Marché Central clinic at 514-467-9132, or request an appointment through our contact form. We provide receipts for private insurance.