My Personal Journey with Orofacial Myofunctional Disorders

Written By Elene Dolan

December 31, 2021

My “Why”…

During my childhood, my orofacial myofunctional disorders (OMDs) were initially undiagnosed, and then later only minimally treated. As a result, I have spent most of my life afflicted with migraines, tension headaches, sleep difficulties, malocclusion, temporomandibular joint (TMJ) pain, allergies, and asthma—all of which have been influenced in some way by my OMDs. As a child, my parents went to great lengths to provide me with as much help for these afflictions as possible, but it was only as an adult, well into my professional career, that I was able to finally receive proper diagnoses and begin to understand how the many health and dental puzzle pieces of my life all fit together.

 

The following story is about my personal experience with OMDs; how the symptoms presented themselves throughout my life, how they impacted my overall health and well-being, and how they finally came to be correctly assessed and treated.

 

My hope in sharing this story is two-fold.

 

One, that it will allow the clients that I work with to know that I truly understand the assessment and therapeutic process and what it feels like to “be the patient”.

 

Two, perhaps others may read this story and realize how similar it sounds to either their own experience, or that of someone they know, and it might encourage them to seek out their own orofacial myofunctional assessment. I know firsthand what a difference accurate diagnosis and effective treatment can bring to one’s quality of life and I would like everyone to be aware of OMDs so that they can have that same opportunity.

How it all began…

Infant feeding and developmental milestones:

According to my mother, breastfeeding was a difficult and painful experience as I struggled with latching. Due to her perseverance, I was breastfed until about 6 months old (when I self-weaned) and then was bottle-fed until I was 1 year old. Projectile vomiting following feeding was common—sorry Mom!

I used a pacifier until I was 2 years old. I was an early talker, crawled at 7 months (using a “bear” crawl), and walked at 9 months.

 

The health puzzle pieces:

Since birth, I have been a predominantly-mouth breather.

** Here you can see my mouth-open posture and mouth-breathing while sleeping .**

** This photo is a great demonstration of optimal closed-lip posture and nasal breathing (for my brothers) compared to my own open-mouth posture and accompanying mouth breathing.**

As a child, I frequently dealt with sinus infections, throat infections (tonsilitis, strep throat), chest infections (bronchitis), and constantly chapped lips (you would never find me without lip balm!).

 

I have scoliosis, forward head posture, frequent neck and trapezoid tension, and lower back pain. From middle childhood onwards, I’ve been afflicted with tension headaches and migraines. My migraines occasionally required hospitalizations for pain management (but, thankfully, since age 18, I’ve been able to manage the pain at home with prescription medication and behavioural modifications).

  

I have exercise-induced bronchoconstriction (“asthma”), which is a narrowing of the airways in the lungs triggered by strenuous exercise and causes shortness of breath, wheezing, coughing, and other symptoms during or after exercise. Other triggers for me include airborne allergens, smoke, and even laughing.

 

I’ve suffered from allergies on and off my whole life. In 2016, allergy testing revealed I had seasonal allergies along with allergies to pet dander, mold, dust mites, and mixed trees/grass (so, basically, the outdoors). I then had allergy immunotherapy (i.e., allergy shots) for several years. After moving to Vancouver Island in 2019, my allergies worsened to the point that I was struggling with increased asthma attacks, could no longer breathe through my nose at all, and was on daily antihistamines just to maintain a basic level of functioning.


In addition to all of the previously mentioned conditions, I also deal with sleep difficulties, chronic fatigue, and memory problems.

In effort to improve function and alleviate pain, I have participated in many forms of treatment including chiropractic, acupuncture, physiotherapy, massage therapy, yoga, and osteopathy. All brought varying levels of relief, but nothing seemed to be the magical cure. 

The dental puzzle pieces:

Given the fact that I have been predominantly-mouth breathing since birth, my typical posture at rest was to have my mouth open slightly and my tongue laying in the bottom of my mouth.

 

Around 8 years old I was diagnosed with an anterior tongue thrust swallow. Living in a remote location in the 1990s, treatment was provided in the form of a tongue crib (a brutal device) and a “Taming the Tongue Thrust” VHS (which I remember watching only a few times unfortunately. Apparently, I thought it might work by osmosis…).

 

** If you can look past this amazing hair, you can see my teeth have shifted as a result of my incorrect oral resting postures (open lips and low and forward tongue). **

 

I had a high and narrow hard palate (roof of the mouth), crowded teeth, an overbite, and an overjet that were treated with a retainer/ palatal expander (age 9-11) and braces (age 11-13).

My mother took me to 3 different orthodontists and chose the only one that did not recommend tooth extraction. (Side note: I am incredibly grateful for my mother’s gut instinct because even though that meant a 20-hour round trip each month from our home to the clinic, the fact that I kept my teeth helped prevent even further issues with the development of my face, jaw, airway, etc.).

Despite the best efforts of the tongue crib and Tongue Thrust video, when I finished my orthodontic treatment, I still had a tongue thrust swallow (albeit not as obvious), so permanent retainers were placed on my top and bottom teeth and have remained there ever since. As an adult, I had all four of my wisdom teeth removed.

I have a “gummy” smile (meaning that excessive gum line shows above my top teeth when smiling), a scalloped tongue (teeth indentations along the sides of my tongue), mandibular tori (bony outgrowths often resulting from bruxism/ teeth clenching), and temporomandibular joint (TMJ) disorder (popping, clicking, chronic pain). I’ve used night guards/splints to prevent the wearing of my teeth due to my clenching, but these don’t address the root cause (i.e., they don’t address the reason I am clenching in the first place). 

I’m also a fast eater who, until recently, chewed food insufficiently and ate with a slightly open mouth due to my need to breathe through it!  

I also have a history of oral habits including nail biting and chewing/sucking on my bottom lip.

HOW IT ALL STARTED TO “TIE” TOGETHER…

Gaining awareness:

In the fall of 2020, my cousin, who also deals with significant migraines and has seen a plethora of specialists, had been telling me that she had been receiving orofacial myofunctional therapy following treatment for her adult palatal expansion (i.e., expanding the roof of her mouth) and was diagnosed with a posterior tongue-tie.

As she described her symptoms, I felt she could have been talking about me, so I went home and researched posterior tongue-ties. (Side note: In my SLP program, we were only taught about anterior tongue-ties which are usually very noticeable because the tongue is held down all the way to the tip. A posterior tongue tie is located deeper in the mouth, further underneath the tongue, and even though it isn't as easily visible, it can cause the same problems as an anterior tongue-tie).

I then went to a mirror and looked under my tongue. While I did not feel confident in diagnosing myself at that time, this simple act ended up being an important first step in what would eventually become a life-changing journey for me. The following day I started booking the first of many assessments. 

** This was my tongue suctioned up to the roof of my mouth. Along with the limited opening, you can also see my tongue spilling over my teeth. “**

** Here you can see the frenulum under my tongue as I stretch up to touch the alveolar ridge (bumpy spot behind the top front teeth). **

** View of my vaulted (high) and slightly narrow hard palate. **

 

Assessments & Diagnoses: Function and Structure

My first assessment was with a Registered Dental Hygienist (RDH) who was providing orofacial myofunctional assessment and therapy through virtual service (in-person services were not available in my city). The assessment process, which involved providing a comprehensive case history (i.e., information regarding my gestation, birth, and development) and an examination of my orofacial complex (i.e., the muscles of my face and mouth), confirmed the presence of a posterior tongue-tie and a lip-tie. To my surprise, I was also diagnosed with an orofacial myofunctional disorder (OMD).

Orofacial myofunctional disorders are abnormal movement patterns of the face and mouth and include one or more of the following conditions:

  • poor nasal breathing

  • abnormal lip and/or tongue rest posture (e.g., open-mouth, low/forward tongue)

  • lip incompetence (an inability to maintain a lips-together, closed-mouth posture at rest and showing strain in the muscles around the face when a lip seal is attempted)

  • tongue protrusion while swallowing (also known as a “tongue thrust swallow”)

  • poor chewing and food management

  • oral habits (e.g., cheek/nail biting, thumb/finger sucking, etc.)

  • bruxism (teeth grinding)

  • atypical oral placement for speech sounds

Considering I presented with almost every condition of an orofacial myofunctional disorder (except for the last regarding speech sounds), it was a pretty slam-dunk diagnosis. Furthermore, most of the factors that could contribute to developing an OMD also applied to me including:

  • Restricted nasal airway due to enlarged tonsils/adenoids and/or allergies

  • Oral habits such as cheek/nail biting and tooth clenching/grinding

  • Habitual mouth breathing and/or open mouth posture

  • Structural or physiological abnormalities (e.g., tongue-tie, deviated septum)

  • Neurological or developmental abnormalities

  • Hereditary predisposition to some of the above factors

My next assessment was with an otolaryngologist (also known as an ENT or an Ear-Nose-Throat specialist). During this appointment, I had a nasal scope that revealed I have insufficient nasal breathing capability due to a deviated septum and bilateral enlarged nasal turbinates. Turns out I had even more contributing factors to my OMD…

Interpretation: health & dental puzzle pieces = signs & symptoms

As I learned more about my orofacial myofunctional disorder and structural issues, the seemingly random assortment of health and dental puzzle pieces of my life started to fall into place. Most of my “puzzle pieces” were actually signs and symptoms that could be linked to the abnormal development, structure, and functioning of my orofacial complex! At first it seemed a bit hard to believe, but quickly the connections became so obvious it was hard to deny.

 

How could so many seemingly unrelated health and dental issues be connected? One reason is because of a thin casing of connective tissue, called fascia. Fascia surrounds and holds every organ, blood vessel, bone, nerve fiber, and muscle in place in your body and it begins with your tongue and ends in your toes! 

Considering that the tongue frenulum (the small fold of tissue under the tongue that connects the tongue to the floor of the mouth) is made of fascia, it’s not surprising to learn that when a tongue frenulum is restricted (known as a tongue-tie or ankyloglossia), there can be repercussions on the functioning of the entire body. In my case, my posterior tongue-tie likely had an effect on my:

  • breathing (tongue-ties often lead to, or exacerbate, mouth breathing)

  • infant feeding (tongue-ties can cause latching difficulties, reflux, and vomiting)

  • swallowing (people with tongue-ties have a high incidence of tongue thrust)

  • oral resting postures (tongue-ties are often associated with low/forward tongue posture, open mouth posture, and mouth breathing)

  • body movement (tongue-ties can make it uncomfortable to crawl based on the positioning of the head so many children with tongue-ties find alternative ways of crawling and/or begin walking early)

  • flexibility (tongue-ties are associated with increased tension)

  • posture (the head follows the tongue, and if a person has a tongue-tie, this means that the head is tilted low and forward, also known as “forward-head posture”)


The tongue-tie also caused a domino effect, resulting in other health and dental issues. For example:

  • Forward-head posture affects the sternocleidomastoid, trapezius, and surrounding muscles, and can result in head, neck, and back pain and tension.

  • Low, forward tongue resting posture, open mouth resting posture, tongue thrust swallowing, and poor oral habits (e.g., prolonged pacifier use, nail biting, chewing/sucking on lips) can all result in problems with dental occlusion (e.g., overbite, overjet) and a vaulting/narrowing of the hard palate (i.e., a high and narrow roof of the mouth).

  • Habitual mouth breathing can exacerbate allergies, asthma, throat and chest infections, headaches, and sleep difficulties.

  • Children who mouth breath may also have large tonsils and experience changes in the development of their jaw, so they are more likely to have longer faces, a “gummy smile,” and jaws that are not positioned evenly. Poor positioning of the jaw may then lead to jaw pain, clenching/grinding of the teeth, and an irregular bite (e.g., overbite, overjet) that may need correcting.

  • People who habitually breathe through their mouth, especially at night, may have symptoms like dry/chapped lips, brain fog, poor memory, waking up tired and irritable, chronic fatigue, and dark circles under the eyes.

Obviously, one of the biggest factors for me was my habitual mouth breathing. I wish I had known earlier in life about the beneficial aspects of nasal breathing (e.g., its ability to filter, moisten, and warm the air coming into the body), as well as the many potential negative consequences of mouth breathing. If my mouth wasn’t already hanging open (because of my mouth-breathing habit), when I finally did learn the extent of it, my jaw would’ve dropped in shock!

 

For more information about these topics and others, please refer to the Orofacial Myofunctional Disorders SIGNS & SYMPTOMS section here.

My treatment and progress:

Thankfully, most of my orofacial myofunctional disorder could be corrected through specific and targeted exercises. I spent over 6 months participating in an orofacial myofunctional therapy program that focused on oral habit elimination, habituation of nasal breathing, correcting oral rest postures, and correcting the oral phase swallow. I diligently completed the 3x/day daily exercises and am now in what would be considered the “habituation stage” (when the newly corrected muscle movement patterns for my lips and tongue have become automatic so that I can do them without much thought or effort).

** Completing my daily orofacial myofunctional therapy exercises. **

 

As a result of the therapy, I’ve stopped lifelong oral habits (nail and lip biting), corrected my daytime tongue thrust swallow, and can maintain optimal oral resting postures during the day (i.e., my lips are closed, my back teeth are slightly parted, and my tongue is resting along the roof of the mouth). 

 

In June 2021, I had both my tongue and lip ties released through what is known as a functional frenuloplasty (a relatively minor surgical procedure that loosens or removes overly large, tight, or poorly positioned bands of tissue inside the mouth). When my tongue-tie was released, I felt an immediate improvement in my ability to swallow. It felt like a small weight had been lifted off the front of my throat, one that I didn’t even know was there until it was gone! It also became easier to achieve and maintain optimal tongue posture. Over time, I’ve noticed an overall reduction in my neck and shoulder tension as well. 

** Leaving the clinic right after having my functional frenuloplasty. **

 

The ability to breathe through my nose has noticeably improved. This is undoubtedly from my concerted effort to focus on continuous nasal breathing, the treatment of my enlarged nasal turbinates through prescription nasal steroid sprays, and a significant decrease in my allergy symptoms. (Side note: I no longer take antihistamines and allergy testing in March 2021 revealed my only remaining allergies are cats and dust mites! Yay immunotherapy and nasal breathing!).

 

Most importantly for me, my tension headaches have significantly decreased. While they haven’t completely subsided and I still suffer from migraines, any improvement is greatly appreciated.

GOING FORWARD:

Future Assessments:

I have corrected as much of my orofacial myofunctional disorder as I can through functional/ behavioural changes. Many of my remaining difficulties result from structural problems or medical conditions that still need addressing.

I will soon be resuming allergy immunotherapy (i.e., allergy shots) to treat my remaining allergies.

 

In the near future, I will undergo surgery for septal reconstruction and bilateral submucosal inferior turbinate reduction in order to improve my ability to breathe nasally.

 

I am in the process of being assessed for a sleep disorder (specifically UARS -Upper Airway Resistance Syndrome) as I am still dealing with migraines, temporomandibular joint (TMJ) pain, and nighttime mouth-breathing, tongue thrusting, and bruxism (clenching). These conditions can all be signs of sleep disordered breathing. In my case, a sleep disorder could be a result of my structural issues (high/ slightly narrow palate, deviated septum) exacerbated by my health conditions (allergies, asthma).

For more information on signs and symptoms of sleep disordered breathing, see the ‘Breathing & Sleep’ blog post.

 

I also have an upcoming assessment to determine if I am a candidate for palatal expansion (a slow expansion of the roof of the mouth in order to widen the upper jaw). This type of procedure has been known to help patients with migraines, TMJ pain, and sleep disordered breathing. Knowing this, my fingers are crossed that this could be a treatment option for me.

 

Even though there is still a long road of treatment ahead, I am so happy about (and proud of!) the improvements I’ve already achieved. I can’t wait to see what else happens as time (and treatment) goes on.

A FINAL NOTE ON THE IMPACT OF OMD ON MY LIFE

I’ll be forever grateful that I learned about my orofacial myofunctional disorders (OMDs), both for personal and professional reasons.


Personally,

Because I finally received accurate diagnosis and effective treatment, my overall health and well-being has significantly improved, and I finally have an explanation for how my health and dental “puzzle pieces” fit together.


Professionally,

Learning about my own OMDs inspired me to seek out more information and I now have advanced training in orofacial myology (the study and treatment of the oral and facial muscles as they relate to speech, dentition, chewing/bolus collection, swallowing, and overall mental and physical health).

 

This training has forever changed my professional practice as I can correctly assess and treat both speech sound disorders and orofacial myofunctional disorders (which may include speech sound errors as a symptom). Through differential diagnosis of these two disorders, I can help my clients address their specific concerns, thereby increasing success and decreasing overall time in therapy. 

 

Because the understanding of orofacial myofunctional disorders and the options for treatment are not yet common knowledge, I am passionate about educating other speech-language pathologists and health professionals about OMDs so that they too can be aware of possible signs and symptoms to better serve their own clients/patients.

 

I also aim to identify OMDs in children on my caseload as early as possible to give them the best chance for successful communication and a healthier life. Similarly, I endeavor to help those, at any age, who may have been misdiagnosed throughout their life, or were simply unaware of underlying OMDs, to find proper diagnoses and support them along their own healing journey.

WANT TO LEARN MORE?

If you are interested in learning more about orofacial myofunctional disorders, I found the resources below incredibly informative:

Orofacial Myofunctional Disorders - Resources:

Elene Dolan
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