The incidence of orofacial myofunctional disorders (OMDs) refers to the number of new cases identified in a specified time period. The prevalence of OMDs refers to the number of individuals who exhibit OMDs at any given time.

Estimates vary according to the definition and criteria used to identify symptoms of OMDs, as well as characteristics of the individual (e.g., age, presence of other disorders). Limited research evidence on incidence and prevalence shows possible correlations between OMD characteristics and symptoms but does not indicate causation.

• Tongue thrusting, or protrusion of the tongue between the teeth, may impact swallowing and articulation. Estimates of tongue thrust swallow in school-aged children range from 5.4% (Kasparaviciene et al., 2014) to 62.3% (Sasigornwong et al., 2016). Children with speech sound disorders are more likely to exhibit a tongue thrust swallow (Wadsworth et al., 1998).
• Chronic mouth breathing rates in children vary from 10.1% (Kasparaviciene et al., 2014) to 15.9% (Darwish, 2020). In one study, approximately 31% of children diagnosed with chronic mouth breathing exhibit a speech sound disorder (Hitos et al., 2013). According to parental report, children with sleep-disordered breathing who needed an adenotonsillectomy demonstrated moderate or greater problems with speech and swallowing (62.4%) before surgery (de Serres et al., 2002).
• Research on the impact of ankyloglossia, or tongue-tie, on newborn feeding and later speech development is conflicting but trends toward outcomes showing minimal to no impact on speech and feeding (LeFort et al., 2021; Messner et al., 2020). One study found that 25% of infants with a tongue-tie experienced breastfeeding difficulties compared to 3% of infants without a tongue-tie (Messner et al., 2000), whereas another study identified tongue-ties in only 4% of infants with breastfeeding problems (Ballard et al., 2002). Dydyk et al. (2023) identified a statistically significant association between the severity of ankyloglossia and the presence of speech sound disorders in individuals.
• Dental malocclusions demonstrate significant correlations with different signs of OMDs (i.e., tongue thrust swallow, oral habits) and speech sound disorders (Amr-Rey et al., 2022; Laganà et al., 2014; Thijs et al., 2022). Higher OMD estimates are reported for individuals receiving orthodontic treatment (62%–73.3%; Hale et al., 1988; Stahl et al., 2007).
• Sialorrhea, or chronic drooling, is common (31.2%) in individuals with oromotor dysfunction, intellectual disability, open mouth at rest, and epilepsy (Sjögreen et al., 2015), with even higher rates in individuals with cerebral palsy (44%–58%; Dias et al., 2016; Speyer et al., 2019) and individuals with Parkinson’s disease (70%–70%; Glickman & Deaney, 2001).
• Orofacial burn, scar, or skin contractures, which can impair oral motor range of motion and functioning, can negatively impact oral intake, facial expressions, and articulation (Arguello & Kerr, 2022). Such injuries significantly correlate with OMD severity (Magnani et al., 2019). An estimated 42.9%–47.5% of burn injuries affect the head and neck (Hamilton et al., 2018; Hoogewerf et al., 2013).
• A meta-analysis of adults with temporomandibular disorders (TMDs) found the prevalence rate of dysphagia symptoms in patients: impaired deglutition in 9.3% and impaired mastication in 52.7% (Gilheaney et al., 2018). Although TMDs may alter mandibular movement patterns during speech (Bianchini et al., 2008), no association has been found between TMDs and speech disorders (Pahkala & Laine-Alava, 2000; Pizolato et al., 2011).

Signs and symptoms of orofacial myofunctional disorders may include the following:

• Habitual open-mouth, lips-apart resting posture.
• Structural differences, such as
• a restricted lingual frenulum, also known as tongue-tie or ankyloglossia, and
• dental malocclusions, such as excessive anterior overjet and anterior, bilateral, unilateral, or posterior open bite and underbite.
• Abnormal tongue resting posture, either forward, interdental, or lateral posterior (unilateral or bilateral), which does not allow for a typical resting relationship between the tongue, teeth, and jaws, otherwise known as the interocclusal space at rest (Mason, 2011).
• Distorted productions of /s, z/, often with an interdental lisp, or abnormal lingual dental articulatory placement for /t, d, l, n, ʧ, ʤ, ʃ, ʓ/.
• Drooling and lack of oral control, specifically past the age of 4 years (Riva et al., 2022).
• Lack of a consistent lingual–palatal seal and/or tongue thrust during swallows.
• Sleep-disordered breathing or sleep apnea (Hoang et al., 2023; Ikävalko et al., 2018).
• Temporomandibular disorders such as bruxism, or teeth grinding.

A single cause of orofacial myofunctional disorders is unknown. Many researchers report multifactorial causes. The following factors may coexist and play a role in orofacial myofunctional disorders:

• Airway incompetency due to obstructed nasal passages. For example, enlarged tonsils, adenoids, hypertrophied turbinates, and/or allergies do not allow for effortless inspiration and expiration (Bueno et al., 2015). These may result in upper airway obstruction and open-mouth posture (Abreu et al., 2008; Vázquez-Nava et al., 2006) as well as an incorrect swallow pattern and mouth breathing (Hanson & Mason, 2003).
• Chronic nonnutritive sucking and chewing habits past 3 years of age (del Conte Zardetto et al., 2002; de Sousa et al., 2014; Poyak, 2006).
• Orofacial muscular or structural differences that encourage tongue fronting, such as delayed neuromotor development, premature exfoliation of the maxillary incisors, orofacial anomalies, and ankyloglossia.

Orofacial myofunctional interventions are conducted by appropriately trained speech-language pathologists (SLPs) as part of a collaborative team. SLPs provide these services as members of interprofessional teams that include the individual, family or caregivers, and relevant professionals (e.g., medical, dental, orthodontic personnel). See the Assessment section for more information about the interprofessional team.

As indicated in the ASHA Code of Ethics (ASHA, 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so. Additionally, clinicians should adhere to ASHA’s Scope of Practice in Speech-Language Pathology (ASHA, 2016) as well as local laws and regulations and employer standards to guide their practice.

According to ASHA’s Preferred Practice Patterns for the Profession of Speech-Language Pathology (ASHA, 2004), the SLP evaluates the following:

• The movement patterns related to the mouth and face muscles that affect the growth of facial structures, communication, and swallowing.
• How these movement patterns impact daily activities such as breathing, talking, and eating.
• Environmental factors that either help or hinder communication and participation.

Assessment may result in recommendations for SLP intervention and support or referral for other services, as appropriate. The SLP provides interventions to address the following (ASHA, 2004):

• Build on strengths and improve functional impacts related to these movement patterns and their effect on speech and swallowing.
• Help the person develop skills and strategies for better lip, tongue, and face control.
• Change environmental factors to reduce barriers, enhance support for communication and participation, and provide the necessary accommodations and training.

Visit ASHA’s Practice Portal pages on Adult Dysphagia, Pediatric Feeding and Swallowing, and Speech Sound Disorders—Articulation and Phonology for more information about the SLP’s respective roles and responsibilities for each population.

Comprehensive Assessment

Please see ASHA’s resource on assessment tools, techniques, and data sources for information on the elements of a comprehensive assessment, considerations, and best practices. Information specific to these practices in the comprehensive assessment of individuals with orofacial myofunctional disorders (OMDs) is discussed below.

Interprofessional Team

Interprofessional practice is essential because assessment of OMDs has many possible aspects, which often require an integrated team approach. See also ASHA’s resource on interprofessional education/interprofessional practice (IPE/IPP). The speech-language pathologist (SLP) makes a referral to and collaborates with one or more of the following professionals:

• allergist
• orofacial myologist
• dentist
• lactation consultant
• occupational therapist
• oral surgeon
• orthodontist
• otolaryngologist/ENT
• physician
• plastic surgeon
• respiratory therapist
• sleep apnea specialist

SLPs do not differentially diagnose medical conditions (ASHA, 2016). As members of an interdisciplinary team, SLPs may be asked to provide input on the functional implications caused by different medical diagnoses such as the following:

• Ankyloglossia, also known as “tongue-tie” or “tethered oral tissue(s)”: The decision to perform a frenectomy, frenotomy, or frenuloplasty is a medical decision made on a case-by-case basis by dentists, oral surgeons, and otolaryngologists. Not all patients with a tongue-tie need a frenotomy (Messner et al., 2020). If concerns regarding the frenulum’s structure or function arise during an examination of the orofacial complex, SLPs refer to a surgeon who has experience with frenectomies.
• Malocclusions, or “atypical alignment of teeth,” and temporomandibular joint dysfunction (TMJD): Diagnosing malocclusions or TMJD is not within the SLP’s scope of practice. If concerns arise about the symptoms of malocclusions or TMJD, then referrals to a dentist, an orthodontist, and/or an oral and maxillofacial surgeon are considered. 
• Obstructive sleep apnea and sleep-disordered breathing: As part of the interprofessional team, SLPs might be asked to provide input on the potential functional implications of obstructive sleep apnea and OMDs on the airway, respiration, and swallowing. SLPs refer clients to physicians for further medical examination and diagnosis if any concerns about sleep-disordered breathing arise during an SLP’s evaluation.

Case History

A diagnostic written history and interview with the client, or the parents/caregivers if applicable, is conducted to help gather the following information:

• birth and developmental history
• oral habits (e.g., thumb, digit, pacifier, object sucking)
• prior interventions (e.g., surgery, lactation, physical therapy, occupational therapy, speech-language pathology services)
• respiratory habits (e.g., nasal breathing vs. mouth breathing)
• medical history (specifically including conditions that might affect oral function)
• upper respiratory infections/allergies
• ear infections/myringotomy
• allergies (i.e., environmental, food)
• circulatory issues
• injuries or trauma
• snoring and sleep habits
• use of sleep appliances (e.g., continuous positive airway pressure machine)
• previous surgical history (e.g., frenectomy, tonsillectomy and/or adenoidectomy, or maxillofacial orthognathic [jaw] surgery)
• history of digestive disorders
• dental/orthodontic history
• palatal expansion
• orthodontic appliances and treatment plan
• history of TMJD
• feeding history
• maladaptive chewing patterns
• inability to chew purées or solids
• inability to progress to cup or straw drinking
• tongue thrust swallow during eating or drinking
• speech and language history
• hearing history

Assessment of the Orofacial Complex

The clinician will visually examine the client for structural differences or abnormalities (e.g., proportion and symmetry) of the orofacial complex. The orofacial complex includes the face, nose, eyes, ears, mouth, skull, and profile. The clinician observes the following:

• Symmetry, stability, and movement of the lips, jaw, tongue, masseters, mentalis, and velum.
• Stability and movement of the mandible and maxilla.
• Abnormalities of the tongue (e.g., macroglossia, microglossia, ankyloglossia), especially those with functional impacts on speech and/or feeding skills (Merkel-Walsh & Overland, 2017).
• Size of the tonsillar tissue compared to the airway. (Obstruction of the airway will force the tongue to move forward, creating an obligatory forward placement of the tongue.)
• Configuration of the hard and soft palates.
• Tactile sensitivity outside and inside the mouth.
• Status of the dentition, including occlusions and evidence of teeth grinding or clenching. (Although awareness of a malocclusion may be useful to the clinician, please note that diagnosing malocclusions is not within the SLP’s scope of practice.)
• Abnormal/excessive anterior overjet, often associated with a Class II Division 1 malocclusion.
• Excessive overbite, often associated with a Class II Division 2 malocclusion (upright maxillary central incisors and facially blocked upper lateral incisors).
• Excessive anterior position of the lower jaw and teeth, creating a negative anterior overjet in some individuals with Class III malocclusions.
• An open bite (lack of normal vertical overlap of the teeth) that may occur anteriorly or posteriorly on one or both sides of the dental arches.
• Dental cross bites may involve a single upper tooth or a segment of the upper teeth being positioned lingual to the lower teeth. A cross bite in the posterior dental arch may occur on one or both sides.

Diadochokinetic (DDK) Tasks

Clinicians frequently use DDK tasks to assess oral motor skills, such as motor coordination and articulatory agility (Icht & Ben-David, 2015; Kent et al., 2022). Irregular performance on DDK tasks is associated with speech sound disorders (Wren et al., 2012) and dental malocclusions (de Almeida Prado et al., 2015; Kent et al., 2022). Hale and colleagues (1992) found that slower rates in DDK tasks in children were associated with postural differences. For instance, on the single-syllable /pʌ/ measure, slower rates were associated with open-mouth postures. Performance on DDK tasks depends on age (Devadiga & Bhat, 2012; Lancheros et al., 2023) and language background (Alshahwan et al., 2020; Icht & Ben-David, 2014; Kent et al., 2022).

Oral Resting Posture

The typical oral resting posture consists of the lips closed; nasal breathing; the teeth slightly apart; and the tongue tip resting against the anterior hard palate, at the lower incisors, or overlying gingiva. A forward tongue resting position or the tongue tip protruding between the anterior teeth can impede normal teeth eruption and result in an anterior open bite (Mason, 1988; Mason & Proffit, 1984).

Difficulty achieving lip closure, or closure with accompanying muscle strain, could be related to the presence of lip incompetence. Lip incompetence is an abnormal lips-apart resting posture in children, adolescents, and adults (Mason, n.d.). This is often due to unresolved airway interferences (e.g., allergic rhinitis, enlarged tonsils).

Lips-apart mouth posture is normal and age appropriate before the lips are fully grown (Mason, n.d.). The child’s oral mechanism, including the lips, tongue, and jaw, continues to grow and change into the teenage years (Vig & Cohen, 1979). Most people can achieve lips-together resting posture around approximately 12–13 years of age (Mason, n.d.; Vig & Cohen, 1979).

Feeding and Swallowing

The clinician observes the client’s tongue and lip movements in the handling and swallowing of saliva, liquids, and foods. During the initiation phase of a client’s swallow, watch for the presence of an abnormal forward or interdental protrusion of the tongue tip. If happening beyond the age of expected elimination of this pattern, it may be a sign of an OMD or other underlying diagnosis (e.g., airway incompetence). Impaired chewing and anterior bolus loss are additional swallowing problems that may be associated with OMDs (Ray, 2006).

Breastfeeding difficulty for infants with a tongue-tie and their caregivers is a complex issue that requires multidisciplinary evaluation and management (Thomas et al., 2024). There is some evidence that releasing a tongue-tie may improve breastfeeding function (Buryk et al., 2011; Ghaheri et al., 2021; LeFort et al., 2021). If the SLP observes a functional impact on feeding due to a tongue-tie, the SLP determines the primary cause of feeding difficulties and provides nonsurgical interventions and feeding modifications (Caloway et al., 2019) and may refer to a surgeon who has experience with frenectomies.

See ASHA’s Practice Portal pages on Pediatric Feeding and Swallowing and Adult Dysphagia for more information.

Articulation

The clinician differentiates between developmental speech sound disorders (i.e., phonological processing), disorders of motor planning (i.e., childhood apraxia of speech), and muscle-based speech sound disorders. Speech assessment for clients with OMDs focuses on the placement of the articulators and the resting postures of the tongue, lips, and mandible. An OMD related to an abnormal lingual or labial pattern, or a “mouth open” behavior pattern, can coexist with speech production errors.

Imprecise articulation may be related to (a) the inability to separate or isolate the jaw and tongue movements within the oral cavity and (b) the incorrect resting posture of the tongue and jaw. Unless addressed prior to initiating traditional speech therapy approaches, the habitual resting pattern may continue to interfere with habituation of the desired sounds. For example, an orthodontist may need to treat a child’s open bite before the clinician provides interventions for a tongue thrust and/or an interdental lisp.

The SLP evaluates the following:

• Resting position of the tongue, mandible, and lips during pauses in conversation.
• Placement of the tongue for lingual–alveolar phonemes (note interdental, lateralized, or anterior productions).
• Deviations of the jaw during connected speech.
• Distortion of velar sounds or weak bilabial productions, including vowels and diphthongs.
• Nasal quality of vowels (i.e., hypernasal or hyponasal). A chronic, hyponasal voice quality suggests the presence of an upper airway interference and the need for ENT and allergy workups.

See ASHA’s Practice Portal page on Speech Sound Disorders—Articulation and Phonology for more information.

The primary purpose of orofacial myofunctional therapy (OMT) is to create an oral environment in which typical processes of orofacial and dental growth and development can take place and be maintained (Hanson & Mason, 2003). Orofacial myofunctional disorders (OMDs) are usually treated in private practice, clinic, or hospital settings. Treatment of OMDs involves an interprofessional team. See the Assessment section for more information about the roles of an interprofessional team and ASHA’s resource on interprofessional education/interprofessional practice (IPE/IPP). OMDs are not typically treated in public school settings. See ASHA’s resource on eligibility and dismissal in schools.

Establish a Clear Nasal Airway

Establishing a clear, unobstructed nasal airway can address the following.

Closed-Mouth Resting Posture

People who do not have an open nasal airway often breathe through their mouth. Open-mouth breathing further affects normal resting postures of the tongue, jaw, and lips (Harari et al., 2010). Closed-mouth posture cannot be consistently established until any airway interferences have been successfully resolved (Hanson & Mason, 2003).

Promotion of nasal breathing could include a combination of the following:

• adenotonsillectomy by an otolaryngologist
• maxillary expansion by an orthodontist
• OMT, with or without myofunctional devices, by trained practitioners (Shortland et al., 2021)
• nasal hygiene or clearance as recommended by an ENT based on medical findings via scoping/assessment
• correction of physical implications to the airway in the nose (i.e., deviated septum)

When the resting dimension—or “freeway space”—has been achieved and stabilized in therapy, dental stability is expected to follow (Mason, 2011). Isotonic and isometric exercises target the lips and tongue to promote a closed-mouth resting posture and nasal breathing. Exercises to build (a) awareness of the tongue, lip, and jaw as well as (b) the habit of a closed-mouth resting posture include oral tactile stimulation and tongue movements without assistance from the jaw, such as the tongue tip to the alveolar ridge or tongue clicks against the palate (Meyer, 2000). These awareness exercises require self-monitoring skills that younger children may not possess.

Lip Seal

Achieving lip closure at rest can serve to stabilize a nasal pattern of breathing. Lip competence can also stabilize the vertical rest position of the teeth and jaws and may also positively influence tongue resting posture (Mason, 2011). Lip closure is addressed after structural or physiological impediments to nasal breathing—including allergies—have been ruled out or corrected via evaluations by an allergist and otolaryngologist/ENT. Examples of exercises to encourage lip closure awareness may include holding a tongue depressor between the lips (Ray, 2003), using a lip gauge (Paskay, 2006), smiling widely and then rounding the lips alternately (Meyer, 2000), and lip resistance activities (Satomi, 2001).

Open Nasal Pathway During Sleep

Obstructive sleep apnea and sleep-disordered breathing are medical diagnoses, and treatment options are offered by a medical professional who is qualified to make that diagnosis. Because OMD is an interprofessional area of practice, treating sleep-disordered breathing might be within the scope of practice of many professionals. Speech-language pathologists (SLPs) might receive referrals to treat sleep-disordered breathing using OMT. More studies are needed to evaluate compliance and the long-term effects of OMT on obstructive sleep apnea outcomes (Saba et al., 2024). See ASHA’s position statement on multiskilled personnel, the Orofacial Myofunctional Disorders Evidence Map, ASHA’s Code of Ethics (ASHA, 2023), and ASHA’s Scope of Practice in Speech-Language Pathology (ASHA, 2016).

Currently, no specific billing codes address sleep-disordered breathing when services are provided by an SLP. Therefore, SLPs should check with individual payers on reimbursement and payer coverage of sleep-disordered breathing. For more information, please contact reimbursement@asha.org.

Improve Speech Sound Articulatory Placement

OMDs related to an abnormal lingual or labial pattern, or a “mouth open” behavior pattern, can coexist with speech sound errors. An incorrect oral resting posture of the tongue and lips can result in the tongue initiating speech productions from an abnormal resting position. In such situations, correcting the OMD can positively impact the correction of speech sound errors.

See ASHA’s Practice Portal page on Speech Sound Disorders—Articulation and Phonology for more information.

Eliminate Prolonged Nonnutritive Sucking

Prolonged nonnutritive sucking is a risk factor for increased malocclusion (del Conte Zardetto et al., 2002; de Sousa et al., 2014; Farsi & Salama, 1997; Poyak, 2006). Prolonged or persistent nonnutritive sucking is when a child sucks on a pacifier, a finger, or an object after a certain age. The American Academy of Pediatric Dentistry (2024) encourages that parents and caregivers have their children visit a dentist by the time they turn 1 year old to get guidance for preventative oral health practices—such as stopping nonnutritive sucking habits by 3 years of age.

Clinicians can educate parents and caregivers on how to help their child break the nonnutritive sucking habit. Strategies can include behavior modifications, such as offering praise, positive attention, and rewards when their child engages in the target mouth behavior (Maloney & Leith, 2023).

Dental professionals have observed a limited success rate with punitive dental habit elimination appliances (e.g., a rake, crib, or thumb guard). Moreover, these punitive appliances have been associated with excessive weight loss, pain, poor sensory perception, and development of atypical lingual movement secondary to the placement of these devices (Mason & Franklin, 2009; Moore, 2008).

Modify Handling and Swallowing of Saliva, Liquids, and Solids

People with known OMDs may also demonstrate oral phase dysphagia, which may require intervention. See ASHA’s Practice Portal pages on Pediatric Feeding and Swallowing and Adult Dysphagia.

ASHA Resources

• Assessment Tools, Techniques, and Data Sources
• Eligibility and Dismissal in Schools
• Interprofessional Education/Interprofessional Practice (IPE/IPP)
• Multiskilled Personnel | Technical Report
• Orofacial Myofunctional Disorders (Public page)

Other Resources

This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.

• Ages and Stages
• American Academy of Pediatric Dentistry | My Children’s Teeth
• American Dental Association
• International Association of Orofacial Myology
• Malocclusion | Cleveland Clinic
• National Maternal and Child Oral Health Resource Center
• OrofacialMyology.com
• RCSLT: New Long COVID Guidance and Patient Handbook
• Speech Dynamics
• The Oral Motor Institute

Abreu, R. R., Rocha, R. L., Lamounier, J. A., & Guerra, Â. F. M. (2008). Etiology, clinical manifestations and concurrent findings in mouth-breathing children. Jornal de Pediatria, 84(6), 529–535. https://doi.org/10.1590/S0021-75572008000700010

Alshahwan, M. I., Cowell, P. E., & Whiteside, S. P. (2020). Diadochokinetic rate in Saudi and Bahraini Arabic speakers: Dialect and the influence of syllable type. Saudi Journal of Biological Sciences, 27(1), 303–308. https://doi.org/10.1016/j.sjbs.2019.09.021

American Academy of Pediatric Dentistry. (2024). Policy on pacifiers. https://www.aapd.org/research/oral-health-policies--recommendations/p_pacifiers.pdf/ [PDF]

American Speech-Language-Hearing Association. (2004). Preferred practice patterns for the profession of speech-language pathology [Preferred practice patterns]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology [Scope of practice]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2023). Code of ethics [Ethics]. https://www.asha.org/policy/

Amr-Rey, O., Sánchez-Delgado, P., Salvador-Palmer, R., Cibrián, R., & Paredes-Gallardo, V. (2022). Association between malocclusion and articulation of phonemes in early childhood. The Angle Orthodontist, 92(4), 505–511. https://doi.org/10.2319/043021-342.1

Arguello, L. A., & Kerr, K. M. (2022). Speech-language pathology’s role in management of orofacial contractures after a facial burn. Perspectives of the ASHA Special Interest Groups, 7(5), 1514–1519. https://doi.org/10.1044/2022_PERSP-21-00337

Ballard, J. L., Auer, C. E., & Khoury, J. C. (2002). Ankyloglossia: Assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad. Pediatrics, 110(5), e63. https://doi.org/10.1542/peds.110.5.e63

Bianchini, E. M. G., Paiva, G., & de Andrade, C. R. F. (2008). Mandibular movement patterns during speech in subjects with temporomandibular disorders and in asymptomatic individuals. CRANIO, 26(1), 50–58. https://doi.org/10.1179/crn.2008.007

Bueno, D. D. A., Grechi, T. H., Trawitzki, L. V. V., Anselmo-Lima, W. T., Felício, C. M., & Valera, F. C. P. (2015). Muscular and functional changes following adenotonsillectomy in children. International Journal of Pediatric Otorhinolaryngology, 79(4), 537–540. https://doi.org/10.1016/j.ijporl.2015.01.024

Buryk, M., Bloom, D., & Shope, T. (2011). Efficacy of neonatal release of ankyloglossia: A randomized trial. Pediatrics, 128(2), 280–288. https://doi.org/10.1542/peds.2011-0077

Caloway, C., Hersh, C. J., Baars, R., Sally, S., Diercks, G., & Hartnick, C. J. (2019). Association of feeding evaluation with frenotomy rates in infants with breastfeeding difficulties. JAMA Otolaryngology—Head & Neck Surgery, 145(9), 817–822. https://doi.org/10.1001/jamaoto.2019.1696

Darwish, S. H. (2020). Prevalence of different types of oral habits among school-children aged 6–12 years in Alexandria (a survey study). Egyptian Orthodontic Journal, 58, 36–49. https://doi.org/10.21608/eos.2021.52935.1007

de Almeida Prado, D. G., Filho, H. N., Berretin-Felix, G., & Brasolotto, A. G. (2015). Speech articulatory characteristics of individuals with dentofacial deformity. The Journal of Craniofacial Surgery, 26(6), 1835–1839. https://doi.org/10.1097/SCS.0000000000001913

del Conte Zardetto, C. G., Rodrigues, C. R. M. D., & Stefani, F. M. (2002). Effects of different pacifiers on the primary dentition and oral myofunctional structures of preschool children. Pediatric Dentistry, 24(6), 552–580.

de Serres, L. M., Derkay, C., Sie, K., Biavati, M., Jones, J., Tunkel, D., Manning, S., Inglis, A. F., Haddad, J., Jr., Tampakopoulou, D., & Weinberg, A. D. (2002). Impact of adenotonsillectomy on quality of life in children with obstructive sleep disorders. Archives of Otolaryngology—Head & Neck Surgery, 128(5), 489–496. https://doi.org/10.1001/archotol.128.5.489

de Sousa, R. V., Ribeiro, G. L. A., Firmino, R. T., Martins, C. C., Granville-Garcia, A. F., & Paiva, S. M. (2014). Prevalence and associated factors for the development of anterior open bite and posterior crossbite in the primary dentition. Brazilian Dental Journal, 25(4), 336–342. https://doi.org/10.1590/0103-6440201300003

Devadiga, D. N., & Bhat, J. S. (2012). Oral diadokokinetic rate—An insight into speech motor control. International Journal of Advanced Speech and Hearing Research, 1(1), 10–14. https://api.semanticscholar.org/CorpusID:53629036

Dias, B. L. S., Fernandes, A. R., & Maia Filho, H. D. S. (2016). Sialorrhea in children with cerebral palsy. Jornal de Pediatria, 92(6), 549–558. https://doi.org/10.1016/j.jped.2016.03.006

Dydyk, A., Milona, M., Janiszewska-Olszowska, J., Wyganowska, M., & Grocholewicz, K. (2023). Influence of shortened tongue frenulum on tongue mobility, speech and occlusion. Journal of Clinical Medicine, 12(23), Article 7415. https://doi.org/10.3390/jcm12237415

Farsi, N. M. A., & Salama, F. S. (1997). Sucking habits in Saudi children: Prevalence, contributing factors, and effects on the primary dentition. Pediatric Dentistry, 19(1), 28–33. https://www.aapd.org/globalassets/media/publications/archives/farsi-19-01.pdf [PDF]

Ghaheri, B. A., Lincoln, D., Mai, T. N. T., & Mace, J. C. (2021). Objective improvement after frenotomy for posterior tongue-tie: A prospective randomized trial. Otolaryngology—Head and Neck Surgery, 166(5), 976–984. https://doi.org/10.1177/01945998211039784

Gilheaney, Ó., Béchet, S., Kerr, P., Kenny, C., Smith, S., Kouider, R., Kidd, R., & Walshe, M. (2018). The prevalence of oral stage dysphagia in adults presenting with temporomandibular disorders: A systematic review and meta-analysis. Acta Odontologica Scandinavica, 76(6), 448–458. https://doi.org/10.1080/00016357.2018.1424936

Glickman, S., & Deaney, C. N. (2001). Treatment of relative sialorrhea with botulinum toxin type A: Description and rationale for an injection procedure with case report. European Journal of Neurology, 8(6), 567–571. https://doi.org/10.1046/j.1468-1331.2001.00328.x

Hale, S. T., Kellum, G. D., & Bishop, F. W. (1988). Prevalence of oral muscle and speech differences in orthodontic patients. International Journal of Orofacial Myology and Myofunctional Therapy, 14(2), 6–10.

Hale, S. T., Kellum, G. D., Richardson, J. F., Messer, S. C., Gross, A. M., & Sisakun, S. (1992). Oral motor control, posturing, and myofunctional variables in 8-year-olds. Journal of Speech and Hearing Research, 35(6), 1203–1208. https://doi.org/10.1044/jshr.3506.1203

Hamilton, T. J., Patterson, J., Williams, R. Y., Ingram, W. L., Hodge, J. S., & Abramowicz, S. (2018). Management of head and neck burns—A 15-year review. Journal of Oral and Maxillofacial Surgery, 76(2), 375–379. https://doi.org/10.1016/j.joms.2017.09.001

Hanson, M., & Mason, R. (2003). Orofacial myology: International perspectives (2nd ed.). Charles C Thomas.

Harari, D., Redlich, M., Miri, S., Hamud, T., & Gross, M. (2010). The effect of mouth breathing versus nasal breathing on dentofacial and craniofacial development in orthodontic patients. The Laryngoscope, 120(10), 2089–2093. https://doi.org/10.1002/lary.20991

Hitos, S. F., Arakaki, R., Solé, D., & Weckx, L. L. M. (2013). Oral breathing and speech disorders in children. Jornal de Pediatria, 89(4), 361–365. https://doi.org/10.1016/j.jped.2012.12.007

Hoang, D. A., Le, V. N. T., Nguyen, T. M., & Jagomägi, T. (2023). Orofacial dysfunction screening examinations in children with sleep-disordered breathing symptoms. Journal of Clinical Pediatric Dentistry, 47(4), 25–34. https://doi.org/10.22514/jocpd.2023.032

Hoogewerf, C. J., van Baar, M. E., Hop, M. J., Bloemen, M. C. T., Middelkoop, E., & Nieuwenhuis, M. K. (2013). Burns to the head and neck: Epidemiology and predictors of surgery. Burns, 39(6), 1184–1192. https://doi.org/10.1016/j.burns.2013.03.006

Icht, M., & Ben-David, B. M. (2014). Oral-diadochokinesis rates across languages: English and Hebrew norms. Journal of Communication Disorders, 48, 27–37. https://doi.org/10.1016/j.jcomdis.2014.02.002

Icht, M., & Ben-David, B. M. (2015). Oral-diadochokinetic rates for Hebrew-speaking school-age children: Real words vs. non-words repetition. Clinical Linguistics & Phonetics, 29(2), 102–114. https://doi.org/10.3109/02699206.2014.961650

Ikävalko, T., Närhi, M., Eloranta, A.-M., Lintu, N., Myllykangas, R., Vierola, A., Tuomilehto, H., Lakka, T., & Pahkala, R. (2018). Predictors of sleep disordered breathing in children: The PANIC study. European Journal of Orthodontics, 40(3), 268–272. https://doi.org/10.1093/ejo/cjx056

Kasparaviciene, K., Sidlauskas, A., Zasciurinskiene, E., Vasiliauskas, A., Juodzbalys, G., Sidlauskas, M., & Marmaite, U. (2014). The prevalence of malocclusion and oral habits among 5–7-year-old children. Medical Science Monitor, 20, 2036–2042. https://doi.org/10.12659/MSM.890885

Kent, R. D., Kim, Y., & Chen, L.-M. (2022). Oral and laryngeal diadochokinesis across the life span: A scoping review of methods, reference data, and clinical applications. Journal of Speech, Language, and Hearing Research, 65(2), 574–623. https://doi.org/10.1044/2021_JSLHR-21-00396

Laganà, G., Fabi, F., Abazi, Y., Beshiri Nastasi, E., Vinjolli, F., & Cozza, P. (2014). Oral habits in a population of Albanian growing subjects. European Journal of Paediatric Dentistry, 14(4), 309–313. https://pubmed.ncbi.nlm.nih.gov/24313584/

Lancheros, M., Friedrichs, D., & Laganaro, M. (2023). What do differences between alternating and sequential diadochokinetic tasks tell us about the development of oromotor skills? An insight from childhood to adulthood. Brain Sciences, 13(4), Article 655. https://doi.org/10.3390/brainsci13040655

LeFort, Y., Evans, A., Livingstone, V., Douglas, P., Dahlquist, N., Donnelly, B., Leeper, K., Harley, E., Lappin, S., & the Academy of Breastfeeding Medicine. (2021). Academy of Breastfeeding Medicine position statement on ankyloglossia in breastfeeding dyads. Breastfeeding Medicine, 16(4), 278–281. https://doi.org/10.1089/bfm.2021.29179.ylf

Magnani, D. M., Sassi, F. C., Vana, L. P. M., & de Andrade, C. R. F. (2019). Correlation between scar assessment scales and orofacial myofunctional disorders in patients with head and neck burns. CoDAS, 31(5), Article e20180238. https://doi.org/10.1590/2317-1782/20182018238

Maloney, B., & Leith, R. (2023). An update in non-nutritive sucking habit cessation. Journal of the Irish Dental Association. https://doi.org/10.58541/001c.84513

Mason, R. M. (n.d.). Treating lip incompetence. http://orofacialmyology.com/files/LIP_INCOMPETENCE.pdf [PDF]

Mason, R. M. (1988). Orthodontic perspectives on orofacial myofunctional therapy. International Journal of Orofacial Myology and Myofunctional Therapy, 14, 49–55.

Mason, R. M. (2011). Myths that persist about orofacial myology. International Journal of Orofacial Myology and Myofunctional Therapy, 37, 27–38. https://orofacialmyology.com/wp-content/uploads/2017/10/orofacial-myology-myths-that-persist-about-orofacial-myology.pdf [PDF]

Mason, R. M., & Franklin, H. (2009). Position statement of the International Association of Orofacial Myology regarding: Appliance use for oral habit patterns. International Journal of Orofacial Myology and Myofunctional Therapy, 35, 74–76. http://www.suburbanmft.com/_pdf/Position%20on%20Oral%20Habit%20Appliances.pdf [PDF]

Mason, R. M., & Proffit, W. R. (1984). The tongue thrust controversy: Background and recommendations. Journal of Speech and Hearing Disorders, 39, 115–132. https://doi.org/10.1044/jshd.3902.115

Maspero, C., Prevedello, C., Giannini, L., Galbiati, G., & Farronato, G. (2014). Atypical swallowing: A review. Minerva Stomatologica, 63(6), 217–227. https://www.minervamedica.it/en/journals/minerva-dental-and-oral%20science/article.php?cod=R18Y2014N06A0217

Merkel-Walsh, R., & Overland, L. L. (2017, November). Functional assessment of feeding challenges in children with ankyloglossia [Poster presentation]. American Speech-Language-Hearing Association Convention, Los Angeles, CA, United States.

Messner, A. H., Lalakea, M. L., Aby, J., Macmahon, J., & Bair, E. (2000). Ankyloglossia: Incidence and associated feeding difficulties. Archives of Otolaryngology—Head & Neck Surgery, 126(1), 36–39. https://doi.org/10.1001/archotol.126.1.36

Messner, A. H., Walsh, J., Rosenfeld, R. M., Schwartz, S. R., Ishman, S. L., Baldassari, C., Brietzke, S. E., Darrow, D. H., Goldstein, N., Levi, J., Meyer, A. K., Parikh, S., Simons, J. P., Wohl, D. L., Lambie, E., & Satterfield, L. (2020). Clinical consensus statement: Ankyloglossia in children. Otolaryngology–Head and Neck Surgery, 162(5), 697–611. https://doi.org/10.1177/0194599820915457

Meyer, P. G. (2000). Tongue lip and jaw differentiation and its relationship to orofacial myofunctional treatment. International Journal of Orofacial Myology and Myofunctional Therapy, 26(1), 38–46. https://www.proquest.com/openview/72707e7d13befba363291e488e4dc2e7/1?pq-origsite=gscholar&cbl=6504639

Moore, N. L. (2008). Suffer the little children: Fixed intraoral habit appliances for treating childhood thumbsucking habits: A critical review of the literature. International Journal of Orofacial Myology and Myofunctional Therapy, 34, 46–78.

Pahkala, R. H., & Laine-Alava, M. T. (2000). Changes in TMD signs and in mandibular movements from 10 to 15 years of age in relation to articulatory speech disorders. Acta Odontologica Scandinavica, 58(6), 272–278. https://doi.org/10.1080/00016350050217127

Paskay, L. C. (2006). Instrumentation and measurement procedures in orofacial myology. International Journal of Orofacial Myology and Myofunctional Therapy, 32, 37–57.

Pizolato, R. A., Fernandes, F. S. D. F., & Gavião, M. B. D. (2011). Speech evaluation in children with temporomandibular disorders. Journal of Applied Oral Science, 19, 493–499. https://doi.org/10.1590/s1678-77572011000500010

Poyak, J. (2006). Effects of pacifiers on early oral development. International Journal of Orthodontics, 17(4), 13–16.

Ray, J. (2003). Effects of orofacial myofunctional therapy on speech intelligibility in individuals with persistent articulatory impairments. International Journal of Orofacial Myology and Myofunctional Therapy, 29, 5–14.

Ray, J. (2006). Orofacial myofunctional deficits in elderly individuals. International Journal of Orofacial Myology and Myofunctional Therapy, 32, 22–31.

Riva, A., Amadori, E., Vari, M. S., Spalice, A., Belcastro, V., Viri, M., Capodiferro, D., Romeo, A., Verrotti, A., Delphi panel experts’ group, & Striano, P. (2022). Impact and management of drooling in children with neurological disorders: An Italian Delphi consensus. Italian Journal of Pediatrics, 48, Article 118. https://doi.org/10.1186/s13052-022-01312-8

Saba, E. S., Kim, H., Huynh, P., & Jiang, N. (2024). Orofacial myofunctional therapy for obstructive sleep apnea: A systematic review and meta-analysis. The Laryngoscope, 134(1), 480–495. https://doi.org/10.1002/lary.30974

Sasigornwong, U., Samnieng, P., Puwanun, S., Piyapattamin, T., Tansalarak, R., Nunthayanon, K., & Satrawaha, S. (2016). Prevalence of abnormal oral habits and its relation to malocclusion in dental patients of the lower northern part of Thailand. Mahidol Dental Journal, 36, 113–122. https://api.semanticscholar.org/CorpusID:46903952

Satomi, M. (2001). The relationship of lip strength and lip sealing in MFT. International Journal of Orofacial Myology and Myofunctional Therapy, 27, 18–23.

Shortland, H.-A. L., Hewat, S., Vertigan, A., & Webb, G. (2021). Orofacial myofunctional therapy and myofunctional devices used in speech pathology treatment: A systematic quantitative review of the literature. American Journal of Speech-Language Pathology, 30(1), 301–317. https://doi.org/10.1044/2020_AJSLP-20-00245

Sjögreen, L., Mogren, Å., Andersson-Norinder, J., & Bratel, J. (2015). Speech, eating and saliva control in rare diseases—A database study. Journal of Oral Rehabilitation, 42(11), 819–827. https://doi.org/10.1111/joor.12317

Speyer, R., Cordier, R., Kim, J.-H., Cocks, N., Michou, E., & Wilkes‐Gillan, S. (2019). Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: A systematic review and meta‐analyses. Developmental Medicine & Child Neurology, 61(11), 1249–1258. https://doi.org/10.1111/dmcn.14316

Stahl, F., Grabowski, R., Gaebel, M., & Kundt, G. (2007). Relationship between occlusal findings and orofacial myofunctional status in primary and mixed dentition: Part II: Prevalence of orofacial dysfunctions. Journal of Orofacial Orthopedics, 68(2), 74–90. https://doi.org/10.1007/s00056-007-2606-9

Thijs, Z., Bruneel, L., De Pauw, G., & Van Lierde, K. M. (2022). Oral myofunctional and articulation disorders in children with malocclusions: A systematic review. Folia Phoniatrica et Logopaedica, 74(1), 1–16. https://doi.org/10.1159/000516414

Thomas, J., Bunik, M., Holmes, A., Keels, M. A., Poindexter, B., Meyer, A., Gilliland, A., & Section on Breastfeeding; Section on Oral Health; Council on Quality Improvement and Patient Safety; Committee on Fetus & Newborn; Section on Otolaryngology—Head and Neck Surgery. (2024). Identification and management of ankyloglossia and its effect on breastfeeding in infants: Clinical report. Pediatrics, 154(2), e2024067605. https://doi.org/10.1542/peds.2024-067605

Vázquez-Nava, F., Quezada-Castillo, J. A., Oviedo-Treviño, S., Saldivar-González, A. H., Sánchez-Nuncio, H. R., Beltrán-Guzmán, F. J., Vázquez-Rodríguez, E. M., & Vázquez Rodríguez, C. F. (2006). Association between allergic rhinitis, bottle feeding, non-nutritive sucking habits, and malocclusion in the primary dentition. Archives of Disease in Childhood, 91(10), 836–840. https://doi.org/10.1136/adc.2005.088484

Vig, P. S., & Cohen, A. M. (1979). Vertical growth of the lips: A serial cephalometric study. American Journal of Orthodontics, 75(4), 405–415. https://doi.org/10.1016/0002-9416(79)90162-3

Wadsworth, S. D., Maui, C. A., & Stevens, E. J. (1998). The prevalence of orofacial myofunctional disorders among children identified with speech and language disorders in grades kindergarten through six. International Journal of Orofacial Myology and Myofunctional Therapy, 24, 1–19.

Wren, Y. E., Roulstone, S. E., & Miller, L. L. (2012). Distinguishing groups of children with persistent speech disorder: Findings from a prospective population study. Logopedics, Phoniatricsand Vocology, 37(1), 1–10. https://doi.org/10.3109/14015439.2011.625973

Acknowledgments

Content for ASHA’s Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Orofacial Myofunctional Disorders page:

Primary Version

• Mary Billings, MS, CCC-SLP, COM
• Dianne Fonssagrives, MS, CCC-SLP, COM
• Honor Franklin, PhD, CCC-SLP, COM
• Patricia Grant, MA, CCC-SLP, COM
• Sandra Holtzman, MS, CCC-SLP, COM
• Gloria Kellum, PhD, CCC-SLP
• Robert Mason, DMD, PhD
• Patricia Taylor, MEd, CCC-SLP
• Elaine Wolkoff, MS, CCC-SLP, COM

Subsequent Versions

• Brianna Miluk, MS, CCC-SLP (2025)

ASHA seeks input from subject matter experts representing differing perspectives and backgrounds.  At times a subject matter expert may request to have their name removed from our acknowledgment. We continue to appreciate their work.

Citing Practice Portal Pages

The recommended citation for this Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Orofacial myofunctional disorders [Practice portal]. https://www.asha.org/practice-portal/clinical-topics/orofacial-myofunctional-disorders/