Myofunctional Therapy for Sleep-Disordered Breathing

Types of Orofacial Myofunctional Disorders

There are several common types of OMDs, including:

• Tongue thrust – occurs when the tongue pushes against or between the front teeth during swallowing instead of resting against the palate. 
• Mouth breathing – the habit of breathing through the mouth instead of nasal breathing, especially during sleep. 
• Incorrect swallowing patterns – occurs when the tongue does not make proper contact with the palate when swallowing, which can lead to feeding and speech difficulties. 
• Poor posture in oral muscles – abnormal positioning of the tongue and facial muscles, which can lead to speech delays or disorders. 

What Causes Orofacial Myofunctional Disorders?

There is no single condition or action that causes OMDs, but there are several known risk factors that can increase a person’s chance of developing this disorder. These common risk factors include: 

• Chronic thumb sucking
• Using a pacifier or bottle longer than necessary
• Inflamed or blocked nasal passages due to allergies or swollen tonsils
• Chronic mouth breathing
• Excessive biting of lips or fingernails
• Bruxism (clenching or grinding of teeth, especially in sleep)
• Tongue tie (a condition that limits the tongue’s range of movement)
• Cleft lip or palate
• Genetic predisposition to OMDs

How Orofacial Myofunctional Disorders Can Impact Oral Health

When the muscles of the mouth and face do not function properly, it can lead to negative oral health effects. For example, untreated tongue thrust can lead to dental problems such as misaligned teeth or an open bite due to the constant pressure from the tongue against the teeth. 

If left untreated, OMDs can also lead to unwanted health conditions such as: 

• Dry mouth, which increases plaque development
• Tooth decay and gum disease
• Stress on the temporomandibular joints
• Altered facial appearance
• Sleep-disordered breathing patterns such as sleep apnea

Common Signs That Indicate Orofacial Myofunctional Disorders

There are several common signs that can indicate an OMD in children and adults, including: 

• Persistent mouth breathing when asleep
• Insufficient habitual nasal breathing when awake
• Speech delays or disorders, especially a lisp
• Messy eating (or trouble eating)
• Dental conditions such as overbite or underbite
• Trouble pronouncing “j,” “s,” and “sh” sounds
• Persistent drooling in children or adults over 2 years old
• Trouble closing the lips when swallowing
• Tongue consistently sticking out past the teeth
• Asymmetrical facial skeletal growth

Orofacial Myofunctional Disorders and Sleep-Disordered Breathing

The muscles that can lead to OMDs are the same ones that can lead to sleep-disordered breathing conditions like obstructive sleep apnea. These include your tongue, jaw, and the muscles surrounding your airway in your throat. If your tongue and orofacial muscles are not functioning properly, they can close off your airway during sleep and cause obstructive sleep apnea (OSA). 

How Do OMDs Contribute to Obstructive Sleep Apnea?

Not only can OMDs contribute to the development of sleep-disordered breathing conditions, but they can also increase the severity and persistence of sleep apnea. There are several ways that OMDs can contribute to new or worsening obstructive sleep apnea symptoms. Some of the most common ways include but are not limited to: 

• Weak orofacial muscle tone – your orofacial muscles include the tongue, soft palate, and muscles in your throat. These muscles need to coordinate with one another, especially during sleep, to ensure your upper airway remains open for easy breathing. If these muscles are weak or uncoordinated, your upper airway can collapse or become partially obstructed, leading to OSA. 
• Improper tongue position – the position (or posture) of your tongue during sleep is important because improper tongue position can contribute to reduced space in your throat. This can make breathing more difficult and increases your chances of your tongue obstructing your airway.
• Altered facial skeletal growth – untreated OMDs in children can actually change the way that the bones in their face grow. This can lead to a narrowing of the upper jaw, retracted lower jaw position, and other changes that can make the upper airway smaller and increase the risk of developing OSA. 

How Does Orofacial Myofunctional Therapy Work?

The goal of orofacial myofunctional therapy is to improve the function of the orofacial muscles, correct any dysfunctional habits, and promote overall oral and facial health. This is done by working on a personalized treatment plan with a qualified therapy provider. You can think of it as a specialized type of physical therapy focused on your orofacial muscles. 

The bulk of the treatment plan will include myofunctional therapy exercises designed to strengthen and retrain the movement patterns of your orofacial muscles. These exercises are usually done at home on a schedule as prescribed by your myofunctional therapist, who will educate and guide you on the correct way to perform these exercises for optimum results. As needed, myofunctional therapy may also address behavioral habits such as thumb sucking in small children.