What’s New with OMDs, and OMT?
Orofacial myofunctional therapy procedures with OMDs are effective, consistent, and successful. As the discipline of orofacial
myology grows and thrives, changes in terminology and perspectives are occurring. Some selected changes are shared here:
- Therapy has been recast as orofacial rest posture therapy. This change in perspective identifies the impact of oral
posturing on dental changes, and the adaptive, opportunistic nature of the functional activity of tongue thrusting. Even so, we
recommend that a tongue thrust should be corrected where there is an associated cosmetic problem or an accompanying
interdental tongue tip forward rest posture.
- We advise orofacial myologists, physicians and dentists to exercise caution in labeling of a patient as a mouth breather,
especially in the absence of aerodynamic testing and verification. A lips-apart, mouth-open rest posture is not necessarily
mouth breathing (Hanson and Mason, 2003).
- The concept of the freeway space is an important component associated with OMDs. This importance of the freeway space
with the development of OMDs distinguishes the focus of orofacial myofunctional therapists (OMTs) from orthodontists and
dental treatment. A primary goal of orofacial myologists is to recapture or establish a normal dental freeway space.
- Working to achieve lip competence is an important aspect of OMT. In many instances, therapy to achieve a resting lip seal
can obviate the need for tongue therapy and can also lead to a normal freeway space dimension.
- The current view in orofacial myology is that a tongue thrust and forward interdental resting posture of the tongue serve as
clues that there is likely a retained sucking habit or unresolved airway issue. Such patients are in need of referral to
pediatricians, family physicians, allergists, or ENT specialists for definitive evaluation of the airway as appropriate.
- We advise discontinuing the use of the inaccurate term muscle imbalance. Instead, we recommend a focus on, and
dialogue pertaining to tongue rest and functional patterns.
- In clinical reports, we recommend prefacing the term tongue thrust with an adjective wherever possible, such as transitional,
obligatory, adaptive, neuromotor, even cosmetic.
- We now recommend disuse of the term excessive pressure as applied to OMDs. Thrusting for example, does not involve
excessive pressures against the teeth (Proffit, Sarver and Fields, 2006).
- The term pattern is a better term to use to describe a tongue thrust. Many orthodontists respond negatively to the historical
(and inaccurate) focus and overemphasis on thrusting rather than resting tongue posture.
What does the future hold for the field of orofacial myology?
One of the aspirations for the continued evolution and elucidation of variables associated with orofacial myofunctional disorders is
for OMTs to participate more fully in the multidisciplinary activities and interests of other fields. The field will change and adapt as
research and clinical applications in medical and dental fields find applications to OMDs, and vice versa.
As an example of a multidisciplinary area of current interest, we are mindful of the exciting ongoing research activities with nasal
nitric oxide, a pluripotent and highly reactive free radical gas manufactured primarily in the paranasal sinuses that may be involved
in the regulation of, among many things, unilateral nasal airway resistance (Ferguson and Eccles, 1998). The implications to airway
interference and the therapy efforts to establish and maintain a nasal pattern of breathing by OMTs signals the need for a team
approach to understanding the individual problems that patients may exhibit.
Our interest in the posterior airway and its influence on anterior oral postures and functions will remain a focus of our clinical and
research interests. The possible role for the orofacial myologist in working with sleep-related problems is currently under discussion and study. Some preliminary results suggest that working to exercise the tongue and to tone or strengthen the tongue may help to alleviate the symptoms or sleep apnea.
The many opportunities and challenges ahead for the field of orofacial myology can be addressed successfully with improved
communication and collaborations involving those physicians and dentists who have mutual interests and intertwined roles to play
with individual patients. It is our hope that this web page may have elevated your understanding of the field of orofacial myology and
some of the ongoing activities, goals, and theoretical bases involved.
We invite your participation with us. Your ideas, support and enthusiasm for shared interests can help to advance the goals and
activities of the field of orofacial myology and better serve those patients of yours who may benefit from our services.
Working with orofacial myofunctional disorders continues to represent a challenging and exciting area of clinical endeavor. The field
is continuing to evolve, as evidenced from the terminology and conceptual emphases described here.
Orofacial myofunctional therapy is not speech therapy. OMT is therapy to correct muscle function problems which influence dental
occlusion; facial shape; chewing; swallowing; and tongue, lip, and jaw resting posture. Not all individuals who have a tongue thrust
have a speech problem and not all who have a speech problem have a tongue thrust.
Orofacial myologists are willing participants on interdisciplinary teams. Our members have already established collaborative clinical interests and interactions with university-related teams and with general dentists, dental specialists with TMJ disorders, orthodontists, oral and maxillofacial surgeons, pediatricians, allergists, ENT specialists, cranio-osteopaths, and craniofacial pain management physicians and dentists. The rapidly evolving field of orofacial myology maintains a commitment to collaborative interactions with potential referral resources in medicine and dentistry.
The References that follow include studies and texts cited in this update for dentists and physicians. Included as well are a list of
recommended classic studies by Proffit and colleagues from dental science that have documented related oral functions. Selected
reference texts are cited as resources that provide background information from dental science regarding OMDs, dental
development, and orofacial growth and development.
For those dental and medical professionals who may develop a specific interest in OMDs, especially pediatricians, allergists and
ENT specialists, the leading orthodontic text by Proffit, Sarver, and Fields (2006) is recommended. It is an excellent resource. The
Hanson and Mason text (2003) is specific to OMDs.
Articles Specific to OMD Theory and Practice
Mason, R.: (Ed.) Orofacial myology: Current trends [Special Issue], International Journal of Orofacial Myology, 14, 1, March, 1988.
Mason, R.: A retrospective and prospective view of orofacial myology. International Journal of Orofacial Myology, 31, November, 2005.
Flanagan, J.B.: Observations on the incidence of deglutition in man and measurement of some accompanying forces exerted on the
dentition by perioral and lingual musculature. Master’s thesis. Forsyth Infirmary, Harvard University, 1964.
Lear, C.S.C., Flanagan, J.B., and Moorrees, C.F.A.: The frequency of deglutition in man. Archives Oral Biol., 10:83-99, 1965.
Efficacy of Treatment: Does Myofunctional Therapy Work?
Alexander, C.D.: Open bite, dental alveolar protrusion, Class I malocclusion: a successful treatment result. American Journal of
Orthodontics and Dentofacial Orthopedics, 116, 5, 494-500, 1999.
Andrianopoulos, M.V., and Hanson, M.L.: Tongue thrust and the stability of overjet correction. Angle Orthodontist, 57, 2,121-135, 1987
Christensen M., and Hanson, M.L.: An investigation of the efficacy of oral myofunctional therapy as a precursor to articulation therapy for pre-first grade children. Journal of Speech and Hearing Disorders, 46, 160-167, 1981.
Cooper, J.S.: A comparison of myofunctional therapy and crib appliance effects with a maturational guidance control group.
American Journal of Orthodontics, 72, 333-334, 1977.
Hahn, V., and Hahn, H.: Efficacy of oral myofunctional therapy. International Journal of Orofacial Myology, 18, 21-23, 1992.
Hanson, M.L., and Andrianopoulos, M.V.: Tongue thrust and malocclusion. International Journal of Orofacial Myology, 20, 9-18, 1982.
Ohno, Y., Yogosawa, F. and Nakamura, F.: An approach to openbite cases with tongue thrusting habits with reference to habit
appliances and myofunctional therapy as viewed from an orthodontic standpoint. International Journal of Orofacial Myology, 7, 3-10,
Smithpeter, J., and Covell, D. Jr.: Relapse of anterior open bites treated with orthodontic appliances with and without orofacial
myofunctional therapy. American Journal of Orthodontics and Dentofacial Orthopedics, 137, 5, 605-614, 2010.
Toronto, A.S.: Long-term effectiveness of oral myotherapy. International Journal of Orofacial Myology, 1,132-136, 1975.
Umberger, F.G., and Johnston, R.: The efficacy of oral myofunctional and coarticulation therapy. International Journal of Orofacial
Myology, 23, 3-9, 1997.
Van Norman, R.A.: Digit-sucking: a review of the literature, clinical observations and treatment recommendations. International
Journal of Orofacial Myology, 12:14-34, 1997.
Van Norman, R.A.: Helping the Thumb-Sucking Child. Avery Publishing Group, NY, 1999.
Ferguson, E.A. and Eccles, R.: Relationship between nasal nitric oxide concentration and nasal airway resistance. Rhinology, 36, 3,
Mason, R., and Riski, J.: Airway interference: a clinical perspective. International Journal of Orofacial Myology, 9, 9-11, 1983
Riski, J.: Airway interference: objective measurement and accountability. International Journal of Orofacial Myology, 9, 12-15, 1983.
Vig, P., Sarver, D.M., Hall, D.J., and Warren, D.W.: Quantative evaluation of nasal airflow in relation to facial morphology. American
Journal of Orthodontics, 79, 263-272, 1981.
Warren, D.W., and DuBois, A.: A pressure-flow technique for measuring velopharyngeal orifice area during speech. Cleft Palate
Journal, 1, 52-71, 1964.
Watson, R.M., Warren, D.W., and Fischer, N.D.: Nasal resistance, skeletal classification and mouth breathing in orthodontic
patients. American Journal of Orthodontics, 54, 367-379, 1968.
Recommended Reference Texts
Enlow, D.H., and Hans, M.G.: Essentials of Facial Growth, W.B. Saunders, Philadelphia, 1996.
Hanson, M.L., and Mason, R.M.: Orofacial Myology: International Perspectives, C.C. Thomas, Springfield, IL, 2003.
Harvold, E.: The activator in interceptive orthodontics. C.V. Mosby, St. Louis, 1974.
Proffit, W.R.: Contemporary Orthodontics, C.V. Mosby, St. Louis, 1986.
Proffit, W.R., and Fields, H.: Contemporary Orthodontics, 3rd Edition, C.V. Mosby, St. Louis, 2000.
Proffit, W.R., Sarver, D.M., and Fields, H. W.: Contemporary Orthodontics, 4th Edition, C.V. Mosby, St. Louis, 2006.
Sicher, H., and DuBrul, E.L.: Oral Anatomy, 5th Edition, C.V. Mosby, 1970.
Woodside, D.G.:The activator. In T.M.Graber and B.Neumann, Removable Orthodontic Appliances. W.B.Saunders, Philadelphia 1977
Selected Pressure Transducer Studies by Proffit and Colleagues
Brown, W., McGlone, R., and Proffit, W.R.: Relationship of lingual and intra-oral air pressures during syllable production. J. Speech
Hearing Res., 16, 1973, 141-151.
Mason, R.M., and Proffit, W.R.: The tongue thrust controversy: Background and recommendations. J. Speech Hearing Disorders, 39, 2, 1974, 115-132.
McGlone, R., and Proffit, W.R.: Correlation between functional lingual pressures and oral cavity size. Cleft Palate J., 9, 1972, 229-235.
McGlone, R.E., and Proffit, W.R.: Patterns of tongue contact in normal and lisping speakers. J. Speech and Hearing Research, 16, 3, September, 1973, 456-473.
McGlone, R., Proffit, W.R., and Christiansen, R.: Lingual pressures associated with alveolar consonants. J. Speech Hearing Res.,
10, 1967, 606-614.
Proffit, W.R.: Lingual pressure patterns in the transition from tongue thrust to adult swallowing. Arch. Oral Biol., 17, 1972, 555-563.
Proffit, W.R., Chastain, B., and Norton, L.: Linguo-palatal pressures in children. Am. J. Orthodontics, 55, 1969, 154-166.
Proffit, W.R.: Muscle pressure and tooth position: A review of current research. Australian Orthodont., 3, 1973, 104-108.
Proffit, W.R., and Norton, L.: The tongue and oral morphology: Influences of tongue activity during speech and swallowing. In Speech and the Dentofacial Complex: The State of the Art, ASHA Reports 5. American Speech and Hearing Association, Washington D.C., 1970, 106-115.
Proffit, W.R., Palmer, H., and Kydd, W.: Evaluation of tongue pressure during speech. Folia Phoniatrica, 17, 1965, 115-128.
Proffit, W.R., and Mason, R.M.: Myofunctional therapy for tongue-thrusting: background and recommendations. J. Amer. Dental
Assoc., 90, February, 1975, 403-411.
Wallen, T.R.: Vertically directed forces and malocclusion: A new approach. J.Dental Res., 53, 1974, 1015-1022.
Davidovich, Z., Montgomery, R., Eckerdal, O., and Gustafson, G.: Demonstration of cyclic AMP in bone cells by immuno-
histochemical methods. Arch. Oral Biol., 19, 1976, 305-315.
Davidovitch, Z., and Shamfeld, J.:Cyclic AMP levels in alveolar bone of orthodontically-treated cats. Arch.Oral Biol., 20, 1975, 567-574.
Davidovich, A., and Montgomery, P.: Cellular localization of cyclic AMP in periodontal tissues during experimental tooth movement in cats. Calcified Tissue Res., 19, 1976, 317-329.
King, G.J., and Keeling, S.D.: Orthodontic bone remodeling in relation to appliance decay. Angle Orthod., 65, 1995, 129-140.
King, G.J., Keeling, S.D., McCoy, W.A., and Ward, T.H.: Measuring dental drift and orthodontic tooth movement in response to various initial forces in adult rats. Amer. J. Orthod. Dentofacial Orthoped., 99, 1991, 456-465.
King, G.J., Latta, L., Rutenberg, J., Ossi, A., and Keeling, A.: Effect of appliance removal on alveolar bone turnover in rats. J. Dental
Res., 74, 1995, 927 [Abstract].
Proffit, W.R.: Equilibrium theory revisited: Factors influencing position of the teeth. Angle Orthod. 48, 3, 1978, 175-186.
Growth and Development/Morphology
Creekmore, T.D.: Inhibition of stimulation of the vertical growth of the facial complex: its significance to treatment. Angle Orthod., 37,
Harvold, E.P. :( Chapter 2), Growth changes. The Activator in Interceptive Orthodontics, C.V. Mosby: St. Louis, 1974.
Ingervall, B., and Eliasson, G.B.: Effect of lip training in children with short upper lip. Angle Orthod., 52, 3, 1982, 222-233.
Mason, R.M., and Serafin, D.: The tongue: Interdisciplinary considerations. Chapter 38, in Serafin, D., and Georgiade, N.G: Pediatric Plastic Surgery, volume 2, C.V. Mosby, St. Louis, 1984, 711-732.
Pepicelli, A., Woods, M., and Briggs, C: The mandibular muscles and their importance in orthodontics: A contemporary review. Am.
J. Ortho Dentof. Orthoped., 128, 2005, 774-780.
Satomi, M.: The relationship of lip strength and lip sealing in MFT. Int. J. Orofacial Myology, 27, 2001, 18-23.
Schudy, F.F.: Vertical growth versus anteroposterior growth as related to function and treatment. Angle Orthod. 34, 1964, 75-93.
Thuer, U., and Ingervall, B.: Pressure from the lips on the teeth and malocclusion. Amer. J. Orthod., 90, 3, 1986, 234-242.
Vig, P.S., and Cohen, A.M.: Vertical growth of the lips: A serial cephalometric study. Amer. J. Orthdont., 75, 4, 1979, 405-415.
This article was prepared by Robert M. Mason, DMD, PhD., and based on information modified from an article entitled “An Update on Orofacial Myofunctional Disorders: More than Tongue Thrust”, published on the website www.SpeechPathology.com, and featured during February, 2009.