Why Isn’t Orofacial Myology Part of Core Coursework for SLPs?

As each of our training courses ends, we get the question, “Why isn’t orofacial myology part of the core curriculum for SLPs?” This is something
worth exploring, so let’s do so!

Without going deeply into the evolution of orofacial myology, let’s just say that it was the dentist who first "discovered" it in the early 1900's.

It wasn’t until the 1960’s that speech therapists (as we were known at the time), looked at orofacial myology (myofunctional therapy) and gave thought to its connection to speech and swallowing.

Several myo “adjacent” areas have been added or incorporated since that time: ankyloglossia, airway, sleep disorders, and many more. These various additions somewhat clouded this specialty area since they spanned diffrent scopes of practice. Some additions were off limits to dental professionals; other additions were off limits to SLP's. This blend of  the two professions is likely the main reason that teaching this subject matter at the university level has not caught on to a large degree. There is only a single RDH program that addresses orofacial myology by offering it to their students. They were able to do so because we worked in conjunction with them, providing them the opportunity to complete the speech pathology departments at the university level teach orofacial myology as part of their speech disorders or swallowing courses, but there is a general dearth of such programs nationwide.

A Specialized Discipline from the Start

Orofacial myology did not originate within university speech-language pathology programs. Its early development was shaped by dentistry, orthodontics, and behavioral habit training. Because it grew from these adjacent professions rather than from the academic SLP world, it did not become embedded in the standard coursework required for licensure. By the time interest in myofunctional therapy began to expand, SLP curricula were already well-established and focused on broad competencies that every clinician must master.

The Realities of Scope and Curriculum Requirements

SLP programs must prepare graduates to work across a wide range of settings, including schools, hospitals, rehabilitation centers, private practices, and long-term care facilities. Core coursework therefore centers on areas that all SLPs need, such as speech sound disorders, language development, voice, fluency, swallowing, neurogenic disorders, AAC, research, and ethics. Orofacial myology overlaps with several of these domains, but it is not essential for every SLP role. Clinicians working exclusively with voice clinics, or school-based language programs may never encounter the need to provide oral myofunctional therapy. Academic programs prioritize what is universally required, not necessarily what is valuable for certain specialties.

An Interdisciplinary Field by Nature

Orofacial myology requires knowledge that extends beyond traditional SLP training. Orofacial muscular physiology and function, dental anatomy, orthodontic principles, airway, and habit cessation are all part of the discipline. These topics fall outside the accreditation requirements set by ASHA’s Council on Academic Accreditation. To incorporate them into core coursework requires national consensus, curriculum redesign, faculty expertise, and clinical placement availability—none of which have yet reached the threshold needed to shift the national curriculum.

A Recognized Specialty, not a Foundational Skill

Much like voice specialization, dysphagia specialization, craniofacial disorders, augmentative communication, or cleft palate work, orofacial myology is considered an advanced practice area. It requires additional training, mentorship, and certification beyond the basic competencies needed for licensure. This specialty status is one of the main reasons it remains outside the core academic sequence.

Why This Landscape Is Beginning to Change

Interest in orofacial myology is growing rapidly. Airway-focused dentistry, sleep-disordered breathing research, early feeding and breastfeeding concerns, increased awareness of oral rest posture, pediatric feeding chalenges, and orthodontic relapse prevention have all contributed to a surge in demand for clinicians trained in myofunctional principles. As a result, many SLP programs now offer electives or continuing-education opportunities, even though the subject has not yet become part of the required curriculum.

Bottom Line

Orofacial myology is not included in core SLP coursework because it developed as a specialized, interdisciplinary field that extends beyond the foundational competencies required for licensure. However, its relevance is increasing, and the profession is gradually adapting. As awareness grows, more programs are exploring ways to integrate myofunctional concepts into elective offerings and advanced training pathways—signaling a shift toward broader recognition of this important discipline.

Never a Dull Moment! by Becky Ellsworth RDH, BS, QOM

Orofacial Myology treatment methods and therapy approaches have greatly evolved over the past 50 years as new information, education and research have emerged. While the barriers to successful treatment—airway issues, ankyloglossia, negative oral habits, and habit appliances—remain familiar, our knowledge of these barriers and the techniques used to address them continue to advance. This is especially true for airway concerns.

Addressing airway obstruction is one area where collaboration with a medical professional is essential. A thorough patient evaluation may reveal concerns such as the need for a sleep study or the presence of enlarged tonsils. These are only a few examples of areas where advances are being considered or have already been made.

One of the fastest-growing areas is sleep medicine. CPAP (Continuous Positive Airway Pressure) remains one of the most common treatment options. Although it has been refined over several decades and is highly effective, ongoing research continues to explore ways to improve comfort and compliance. In the article Dental Clinicians’ Observations of Combination Therapy in PAP-Intolerant Patients,1 the authors describe a pilot study evaluating whether a combination therapy device—connecting PAP (Positive Airway Pressure) with a Mandibular Advancement Splint (MAS)— could offer a more acceptable treatment option for patients with OSA who have abandoned conventional PAP therapy. According to the article, this approach “appears to oer improved comfort and interface stability and a reduction in air leakage.” With formal evaluation and prospective controlled clinical trials, this may be an option we hear more about in the future.

Another airway concern we frequently encounter is chronically enlarged tonsils, which often requires referral to an ENT for evaluation. The traditional removal technique, extracapsular tonsillectomy, is more invasive and often involves high heat. In this procedure, both the tonsil and the surrounding capsule are completely removed. Because the muscle connected to the outside of the capsule can be affected, patients may experience more bleeding, increased postoperative pain, and a longer recovery time. Among the newer techniques is Coblation® intracapsular tonsillectomy.2 With this approach, the muscle is not affected, and the tonsillar capsule remains, leaving a small remnant of tonsillar tissue. The low-temperature technique creates less thermal damage, which may reduce postoperative pain and support a faster recovery. Although this is only one specific tonsillectomy technique, several newer approaches are currently being used.

I will cover additional airway-related technology advancements in future newsletters. In the meantime, I would love to hear about your personal or patient-related experiences with sleep issues or tonsillectomies. Please write to me at beckyorofacialmyology@outlook.com. I look forward to reading and sharing your stories.
Till next time,
Becky

Decoding the Bunched Mentalis: Pitfalls & Problem-Solving

While training in Orofacial Myology can awaken a new perspective on certain clinical indicators that had been previously unobserved, in the case of learning to decode the bunched mentalis muscle, it can lead to clinical pitfalls.

The bunched mentalis is one of the easiest symptoms to spot. As a result, newer Orofacial Myologists might conclude far too often that a “hammer and nail” approach is needed, and thus see every bunched mentalis as a nail that needs to be addressed. While it feels good to gain a new skill, seeing everything through a lens of its being “disordered” can skew your clinical judgment too much one way. The bunched mentalis ends up becoming a pitfall, noticed by therapists during evaluation or treatment, where they immediately prescribe mentalis exercises without considering its clinical significance.

Analyzing the mentalis’ clinical significance can help you to avoid simple blunders. Here are five ways to avoid its pitfalls, as follows:

1. Observe “what” the mentalis does during rest

When the client is not talking, eating, or drinking and is at rest, observe if there is dimpling or bunching of the mentalis. As you learned in your Orofacial Myology: From Basics to Habituation training, you can also palpate it when the mouth is at rest to feel if the mentalis is an overdeveloped mass due to its overuse. You can also observe whether the client must engage the mentalis to achieve lip closure at rest.

2. Is the mentalis doing its regular job?

One of the main pitfalls is that clinicians notice the dimpling of the mentalis and race to the conclusion that they must assign exercises to relax it. The bunching of the mentalis in itself is not a problem. The mentalis does have a legitimate job to do after all: it lifts and protrudes the lower lip.  It’s important to realize that it is possibly doing a normal, expected job if it bunches. These include such activities as assisting in a sad facial expression, performing lip rounding for kissing or pursing the lips, or when compressing the lips together with effort (such as testing lip resistance with the Myo Lip Meter). It’s a misstep to assign mentalis exercises when it is engaged during such perfectly normal lip tasks.

3. Is the mentalis obligated to contract?

Mentalis bunching might indicate an underlying issue where the client is obligated to recruit it, such as an issue with lip competence due to excess vertical growth, recessed mandible, excessive overjet or an issue with the growth/function of the upper lip. Assigning mentalis exercises in situations where the mentalis is obligated to contract (due to a structural reason) will likely be ineffective to reduce its hyperactivity. The structural concern will have to be addressed first.

Context is everything here - ask yourself “why” it was engaging when you noticed the mentalis bunching. What oral task was the client doing when you noticed the contraction? Was the mentalis obligated to contract in order to achieve improved oral function?  If so, which oral function were they achieving? Someone with a short or tented upper lip, for example, might try to achieve lip closure by recruiting the mentalis to lift the lower lip to the top lip.

4. Don’t put the cart before the horse

If your client does need to work on the mentalis, you will want to consider the sequence of presenting exercises in order to provide effective treatment. In the case of lip incompetence due to a tented/short philtrum, work on improving philtrum length first, then lip competence. Once lip closure is more achievable, then assign the mentalis exercises   now that the oral structures are in better harmony and no longer require the obligatory recruitment of the mentalis.

5. Patience pays off

Two additional common pitfalls are (1) not assigning mentalis exercises for a long enough period and (2) ceasing mentalis exercises when the client can demonstrate them. Specific myo exercises can reduce mentalis hyperactivity, but meaningful change is expected to take months. Assigning a week or two of practice or “passing” the exercise once it is easy to demonstrate—misses the purpose of mentalis treatment.

Now that you are armed with a way to decode the bunched mentalis and can plan your next steps analytically, you can put down that hammer!

Nail Biting Facts

Here are some interesting, research-based facts about nail biting that can help you explain the habit to parents with clarity and confidence.
Nail biting, or onychophagia, is one of the most common body-focused repetitive behaviors, affecting both children and adults. Although often dismissed as a “simple habit,” it has meaningful implications for orofacial function, dental health, and overall well-being.

Nail Biting Fact 1: Nail biting is strongly linked to stress and anxiety.
Many individuals use it as a subconscious coping mechanism during moments of tension, boredom, or concentration.

Nail Biting Fact 2: It can alter orofacial muscle patterns.
Chronic nail biting changes the way the jaw, lips, and tongue rest and move, sometimes contributing to maladaptive oral habits.

Nail Biting Fact 3: Dental consequences are real.
Nail biting can lead to enamel wear, chipped teeth, gum irritation, and increased risk of infection around the nail bed and mouth.

Nail Biting Fact 4: It affects occlusion.
Repeated pressure from the fingers can influence tooth position over time, especially in children and teens whose dentition is still developing.

Nail Biting Fact 5: It’s part of the same behavioral family as thumb sucking and lip biting.
These habits share neurological and emotional drivers and often appear together in clinical histories.

Nail Biting Fact 6: Breaking the habit requires more than willpower.
Successful intervention includes the child’s desire to quit, a belief that the process will work and a cooperative parent utilizing a solid positive reinforcement program.

Are Early Feeding and Breastfeeding Part of Orofacial Myology?

The relationship between early feeding, breastfeeding, and orofacial myology is an important one, even though these early-life functions are not formally included in the core scope of orofacial myology. They exist in a meaningful overlap where tongue function, oral rest posture, and orofacial muscle coordination begin to develop from the very first days of life.

Tongue function begins with feeding. An infant’s earliest oral-motor tasks—cupping, elevating, lateralizing, and coordinating the suck-swallow-breathe sequence—establish the neuromuscular patterns that later shape oral rest posture, swallowing mechanics, airway development, and even speech sound production. Although early feeding is not labeled as “myofunctional therapy,” it is deeply intertwined with the same functional systems addressed throughout orofacial myology.

Many of the earliest signs of restriction appear during breastfeeding, presenting as poor latch, maternal discomfort, ineficient milk transfer, or fatigue during feeds. These early challenges frequently foreshadow later issues with oral habits, tongue posture, swallowing, speech, and airway function—areas where orofacial myologists commonly intervene. Understanding this early stage provides valuable context for later therapeutic decisions.

Another important connection comes from pediatric feeding specialists. Some speech-language pathologists receive advanced training in infant feeding, breastfeeding support, bottle-feeding mechanics, and early oral-motor development. Many of these clinicians pursue orofacial myology because the two fields complement each other naturally. They are interested in providing as much preventative care as possible to avoid later orofacial myology issues.

Orofacial myology traditionally focuses on oral rest posture, swallowing, speech, and oral habits, thus focusing on “drawing from,” rather than “doing to” the clients. Infant and very young children, on the other hand, require additional medical or lactation-specific training. Professional scopes vary among SLPs, lactation consultants, dentists, and bodyworkers, and not all myofunctional therapists have the additional myo-related areas of training. For these reasons, early feeding is considered “adjacent to”, rather than central to the discipline.

Featured Q&A: 6 year old reverting to sucking thumb

The Neo-Health Services team has spent many hours answering numerous questions from our course “grads”, patients and professionals. We have made these questions available and posted them to our website along with the answers to help others whoreach out for similar advice. They can all be found at Orofacial Myology Q&A.

6 year old reverting to sucking thumb

Q: I was wondering if you could give me any advice or suggestions for my six year old who’s had a relapse in his thumb sucking? We went through the Unplugging the Thumb program earlier this year and he did fantastic with it. You may remember my email a few months ago speaking so highly of the program. He had completely unplugged it for at least two months or more. Then for some reason he started up again just as much as before. We discussed things, re-watched the video and he got back on track for a few more weeks. But now he’s right back into the same habit of sucking it both day and night. I’m at a loss and as you can imagine very frustrated. Do you have any recommendations as to how to approach it now or what to do?? I would greatly appreciate any advice you may have.
Thank you

A: Hi, I can honestly say that this almost never happens under normal circumstances. I have tried to think this through and remember the few times it has occurred. It has usually been one of the following reasons. Though they might not apply to your son, perhaps it will spark some idea that will ring a bell and help you sort out what could have happened:

1. There was a child who literally pretended to have quit. She later admitted that she went under their dining room table and sucked her fingers but hid it from her parents until she completed the program. They have unfortunately offered her a very big reward, far too big, and she did it for the reward. After receiving the reward, she came out in the open and sucked her fingers.

2. There was a boy whose mother had tried everything prior to our program….and I mean EVERYTHING on the market. It was hard for him to believe that this would work based on all the negative past experiences with other contraptions and methods. He made it for a short term, can’t recall how long, but reverted back. He’d had years of failures with other methods and we could not fulfill one of the four requirements, Self fulfilling prophesy....the belief in himself that he will succeed.

3. We have had parents who wanted it more than the child did so the child stopped to please the parent….not something that lasts, unfortunately. The child must want to quit for themselves.

4. More often, there is something that occurs during that critical time once the habit is eliminated that puts the child in a state where sucking is used as a necessary comfort to overcome whatever happened. It is possible that the child doesn’t consciously even know what is going on inside his head, but he reacts. If a child has truly eliminated the habit and is enjoying life normally for two months, I do think something went on within his own mind or in the environment that sent him to the thumb again.

5. Perhaps he is not doing as many things actively as he did prior. Is he going outside as often, running as often, etc.? Drastic changes in activities and daily routine can contribute to backsliding. I don’t recall where you live, but during the COVID scare the children were hearing about it and fearing it, even if we tried to shield them. I can see how it might be diffcult to have a normal life when kids sense what those around are thinking, even if we try our best to keep things “normal.”

These are the only possibilities I can come up with. As for suggestions, involve him as follows.

1. Ask him what he thinks caused him to revert? It would be good to get his own explanation.

2. What does he want to do about it? Does he want to try again, with some interesting changes so it won’t be exactly the same? Does he want to wait awhile; if so, how long? Ask if he can come up with a time, ex. after my 7th birthday.

3. Does he want to continue as he is, sucking day and night? Ask him, non-judgmentally. Get HIS input and decision and for now, that’s all you can do.

I hope something above is helpful. Please let me know your thoughts and if any of the listed possibilities could be a contributing factor to the relapse.

6 year old reverting to sucking thumb - Orofacial Myology

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QOM Gems with Laura Pritchard (SLP)

What did you learn while doing the QOM process?
The QOM process was extremely rewarding and educational. I already had "myo eyes" and knew what to look for but the whole process took me to the next level. My biggest take away was in the evaluation process and truly what to look for, the proper referrals, what I may have been missing in the past. It was a "full circle" moment for me. Especially the high/palate and how important expansion is, when to expand, and how it may impact the airway without surgery. I feel much more confident treating OMDs and the Myo Manual provides me so much guidance and for that I'm grateful.

What does it mean to you to be a QOM and how has it helped you professionally?
I feel blessed to be a Qualified Orofacial Myologist. This course has already opened so many doors for me and allows me to help so many more people but now that I'm officially a QOM, I feel like I hold so much more responsibility and that it is my duty to spread the word and get this information out there to help children and adults. I feel like I hold myself at a higher standard and that the learning does not stop here.

It has given me the opportunity to collaborate and give/receive many more referrals, especially dentists, orthos, ENTs, etc. I have a growing private practice and a lot more myo kids coming in. I also realized how many other myo kids were already on my caseload.

What qualities do you think a QOM needs?
A QOM needs to be able to think outside the box, look beyond the surface, and push to find answers that no one else can provide. To be confident, pay attention to detail, be organized, communicative, professional and personable, and a life long learner.

What advice do you have for peers considering becoming Qualified?
Dive in and don't look back. Everyone in this field should be educated on what to look for and how to make the proper referrals. Too many kids are flying under the radar.

I highly recommend the QOM if you are ready to take your career and practice to the next level. This is life-changing and career shifting information that all SLPS and related professionals need to be educated on. The instructors of this course are extremely passionate about the information and teach it in a hands-on, easy to grasp way. You will leave this course excited to complete the clinical portion and start screening all your current clients for OMDs. Your future
self will thank you and so will all the families in your community who need your help!