You may have noticed that your child frequently rests with their mouth open, pushes their tongue against their teeth when swallowing, or has difficulty producing certain speech sounds. Perhaps your dentist has mentioned tongue posture, or you’re an adult experiencing persistent oral-function concerns.
These observations can raise questions about an orofacial myofunctional disorder (OMD).
But how do you know whether an unusual habit is actually a clinical problem?
Orofacial myofunctional disorders involve atypical patterns of movement or resting posture affecting the tongue, lips, jaw and related structures. They may influence oral functions such as swallowing, speech production and maintaining appropriate resting posture.
Importantly, no single symptom proves that someone has an OMD.
At BreatheWorks, we believe the most useful starting point is understanding what a person is experiencing, why it may be happening and whether the findings are affecting everyday function.
Here are 12 signs that may warrant a closer look.
1. Habitually Resting With the Mouth Open
One commonly observed sign is a mouth-open, lips-apart resting posture.
You might notice this while your child watches television, reads, concentrates or sits quietly. Adults may also recognize that their lips remain apart much of the day.
There are several possible explanations, including nasal congestion, upper-airway obstruction, structural differences or learned oral-posture patterns.
The important distinction is whether comfortable nasal breathing is possible and whether the lips-apart posture is persistent.
What an evaluation considers: Habitual lip position, reported breathing difficulty, oral resting posture and whether medical airway assessment is needed.
Closing the lips is not an appropriate treatment goal until relevant nasal or airway obstruction has been considered.
2. Persistent Mouth Breathing
Breathing through the mouth occasionally during a cold is common.
Persistent mouth breathing, however, deserves investigation.
A child or adult may breathe through the mouth while awake, during sleep or both. Some people report chronic congestion, while others are unaware of any nasal breathing difficulty.
Mouth breathing may be associated with allergies, enlarged adenoids or tonsils, other nasal obstruction, or functional patterns that persist after medical issues have been addressed.
What an evaluation considers: When mouth breathing occurs, whether it varies with illness or allergies, associated symptoms, and whether an ENT or another medical professional should assess the airway.
An SLP can evaluate relevant oral-function patterns but does not diagnose nasal obstruction or sleep apnea through myofunctional assessment alone.
3. A Low or Forward Tongue Resting Position
The tongue has a resting position when a person is not talking, eating or swallowing.
Some individuals habitually position the tongue low in the mouth, against the front teeth or between the teeth.
Atypical tongue resting posture is one of the central findings considered during an OMD evaluation.
However, resting posture must be interpreted alongside anatomy, dental development, airway function and the person’s ability to maintain a comfortable position.
What an evaluation considers: Tongue position during natural rest, lip and jaw posture, relevant structural features, and how consistently the pattern occurs.
A clinician should not assume that an atypical tongue position is the cause of every associated speech, dental or breathing concern.
4. Tongue Thrust During Swallowing
Tongue thrust generally describes a swallowing pattern in which the tongue moves forward or between the teeth.
Parents may notice the tongue pressing against the teeth or becoming visible during swallowing.
Tongue movement during swallowing changes with development, and not every forward movement is clinically abnormal.
When the pattern persists beyond the expected developmental stage or occurs alongside functional concerns, further evaluation may be appropriate.
What an evaluation considers: Tongue and jaw coordination during saliva, liquid or food swallows when indicated; compensatory movements; and the person’s age and functional abilities.
Treatment decisions should be based on the complete swallowing pattern rather than a single observed movement.
5. A Persistent Lisp or Certain Speech Sound Distortions
Some individuals with OMDs also have difficulty producing particular speech sounds.
For example, the tongue may protrude between the teeth during /s/ or /z/, creating an interdental lisp. Other speech sounds may also be affected by atypical tongue placement or jaw movement.
However, not every lisp is caused by an OMD.
Speech sound disorders can reflect developmental, phonological, motor-planning, structural or other factors.
What an evaluation considers: Speech sound production, tongue placement during actual speech, jaw movement, developmental expectations and whether orofacial resting patterns are clinically relevant.
This is an important reason to work with an SLP who has additional OMD training: speech production and oral function can be assessed together without assuming they have the same cause.
6. Difficulty Keeping the Lips Comfortably Closed
Some people have difficulty maintaining relaxed lip closure while resting.
Others can close their lips but appear to strain the muscles around the chin or mouth to do so.
Possible contributing factors include nasal breathing difficulty, dental or skeletal relationships, or differences in lip and jaw function.
What an evaluation considers: Whether lip closure is comfortable, whether compensatory muscle activity is present, and whether anatomy or airway concerns require additional assessment.
The goal is not to force the lips together. It is to understand why comfortable resting posture may be difficult.
7. Chewing Difficulties or Unusual Food-Management Patterns
Chewing involves coordinated movements of the tongue, jaw, cheeks and lips.
Some children and adults experience difficulty moving food efficiently, managing textures, maintaining food within the mouth or coordinating chewing movements.
A patient may take unusually long to chew, avoid certain textures or use compensatory movements.
These difficulties have many possible causes, including feeding disorders, dental issues, sensory differences and other medical or developmental conditions.
What an evaluation considers: The patient’s feeding history, reported symptoms, relevant oral movement and coordination, and chewing or swallowing behaviors when clinically indicated.
Coughing, choking or other signs of swallowing difficulty require appropriate clinical assessment and should not be treated as routine OMD symptoms.
8. Drooling or Difficulty Managing Saliva
Persistent drooling or difficulty managing saliva can sometimes accompany reduced oral control or mouth-open resting posture.
In young children, drooling may be developmentally expected. In older children or adults, persistent or new drooling may warrant evaluation.
Possible explanations include oral-motor difficulties, medication effects, neurological conditions, swallowing disorders and other medical factors.
What an evaluation considers: Age, medical history, oral control, swallowing function and whether additional assessment or referral is needed.
New or sudden drooling accompanied by difficulty swallowing, weakness or other acute neurological symptoms requires urgent medical attention.
9. Dental or Orthodontic Concerns Occurring Alongside Oral-Function Differences
A dentist or orthodontist may notice an open bite, unusual tooth alignment or other dental findings.
Some individuals with these concerns also demonstrate tongue thrust, atypical resting posture or persistent oral habits.
These findings can coexist, but the relationship is not always straightforward.
Dental development is influenced by multiple factors, including genetics, anatomy, growth and oral behaviors.
What an evaluation considers: Relevant oral-function patterns, dental and orthodontic history, and whether coordinated care is appropriate.
An SLP evaluates functional implications. Dentists and orthodontists diagnose and manage dental alignment and orthodontic conditions.
Myofunctional therapy should not be presented as a guaranteed way to correct a bite or prevent orthodontic relapse.
10. Prolonged Thumb, Finger or Pacifier Habits
Thumb sucking, finger sucking and pacifier use are common during early childhood.
When certain nonnutritive sucking habits persist, they may become relevant to dental development or oral-function assessment.
The significance depends on the child’s age, frequency and intensity of the habit, and any associated functional or structural findings.
What an evaluation considers: The history and pattern of the habit, the child’s developmental readiness, family concerns and any related oral-function differences.
An individualized approach is more useful than assuming every child with a prolonged habit has an OMD.
11. Snoring or Other Sleep-Related Breathing Concerns
Some individuals with orofacial myofunctional disorders also report snoring, restless sleep or other sleep-related breathing symptoms.
These symptoms deserve attention because they may indicate a medical sleep or airway condition.
However, snoring is not itself a diagnosis of an OMD, and an OMD evaluation cannot establish whether someone has obstructive sleep apnea.
What an evaluation considers: The patient’s sleep-related history, reported breathing patterns, daytime symptoms and the need for referral to a physician or sleep specialist.
If a child snores habitually, has observed breathing pauses or experiences significant sleep disruption, medical evaluation should not be delayed while trying exercises.
12. Jaw Discomfort, Clenching or Teeth Grinding
Jaw discomfort, clenching and bruxism can occur for many reasons.
Some individuals with these symptoms also demonstrate oral-function differences, but that does not establish that an OMD caused the pain or grinding.
Temporomandibular disorders, dental factors, sleep-related conditions and other causes may require separate evaluation.
What an evaluation considers: Relevant jaw movement and oral-function observations, reported symptoms, and whether dental or medical assessment is appropriate.
An SLP may address functional concerns within their scope and competency, but diagnosing temporomandibular disorders belongs to appropriately qualified medical or dental professionals.
How Many Signs Do You Need to Have an OMD?
There is no reliable rule that says having three, five or seven signs means someone has an orofacial myofunctional disorder.
A person may have one clinically significant functional problem that deserves treatment.
Another person may demonstrate several observations that are developmentally expected, temporary or better explained by a medical or dental condition.
The number of symptoms matters less than their persistence, context and impact on everyday function.
A symptom checklist is a starting point for questions—not a diagnostic test.
What Happens During a Comprehensive Orofacial Myofunctional Evaluation?
At BreatheWorks, our clinical philosophy begins with a simple principle: ask the right questions and listen carefully before deciding what to treat.
A comprehensive evaluation is not just a visual inspection of the tongue or a demonstration of a few exercises.
It is a process of clinical investigation.
The clinician seeks to understand the patient’s concerns, identify meaningful functional patterns, determine whether other systems need closer examination, and recommend an appropriate next step.
First: Understanding the patient’s story
The clinician begins with a detailed history and conversation.
For a child, this often includes the parent’s observations. For an adult, it includes the patient’s description of symptoms and how those symptoms affect daily life.
Questions may address:
- What prompted the evaluation?
- When did the concern begin?
- Has the pattern changed over time?
- Does it interfere with speech, eating, swallowing or other daily activities?
- Is there a history of chronic congestion, allergies, snoring or sleep-related concerns?
- Have there been previous dental, orthodontic, medical or speech-language evaluations?
- Are there relevant feeding, developmental or oral-habit histories?
- What treatment has already been attempted?
- What are the patient’s priorities and goals?
This history helps determine what needs to be assessed and what may require referral.
Second: Examining the orofacial structures and resting posture
An appropriately trained clinician examines relevant aspects of the face, mouth, tongue, lips and jaw.
Depending on the clinical question, the examination may include:
Oral resting posture: The natural positions of the tongue, lips and jaw.
Movement and coordination: How the tongue, lips and jaw move during selected tasks and whether compensatory movements occur.
Structural observations: Features of the palate, tongue, frenulum or oral cavity that may influence function or require another professional’s evaluation.
Functional lip closure: Whether comfortable closure is possible without excessive strain.
Jaw stability and movement: How jaw movement interacts with relevant oral tasks.
The examination is selected and interpreted according to the patient’s age, symptoms and abilities.
Third: Evaluating function, not just isolated movements
A person may be able to move their tongue in a particular direction during an exercise but still demonstrate difficulty using it efficiently during a real activity.
That is why functional assessment matters.
When indicated, the clinician may examine:
- Tongue and lip movement during swallowing
- Chewing coordination and food management
- Speech sound placement and production
- Oral posture during natural conversation or quiet rest
- Functional consistency across different activities
A brief screening may also reveal that a separate, more comprehensive speech, feeding or swallowing evaluation is needed.
Fourth: Using assessment measures to answer specific questions
BreatheWorks’ broader clinical evaluation standards emphasize the appropriate use of patient history, functional observations, patient-reported measures, standardized assessments and dynamic assessment.
The specific instruments used in an OMD evaluation depend on the clinical questions being investigated.
A test or measurement is useful only when it helps clarify a finding, supports clinical reasoning or establishes a meaningful baseline.
The purpose is not to collect as many measurements as possible. It is to collect the right information and interpret it accurately.
Fifth: Identifying what may need medical or dental attention
A comprehensive evaluation also asks whether the patient’s symptoms fall partly outside the scope of myofunctional therapy.
Examples include:
- Suspected nasal or upper-airway obstruction
- Possible obstructive sleep apnea
- Dental malocclusion or orthodontic concerns
- Structural concerns requiring medical or surgical assessment
- Significant swallowing difficulties
- Jaw pain requiring dental or medical diagnosis
The clinician may recommend additional assessment or coordinate with an ENT, pediatrician, dentist, orthodontist, sleep specialist or another professional.
Sometimes medical or dental care needs to come before functional therapy.
Sixth: Connecting the findings to a treatment plan
The final step is clinical interpretation.
What did the patient report? What was observed? Which findings are clinically significant? Are they related to the patient’s main concern? What can reasonably be addressed through therapy, and what needs further investigation?
If treatment is appropriate, the clinician develops individualized functional goals and recommends interventions suited to the patient’s needs.
If treatment is not indicated, the appropriate recommendation may be monitoring, education or referral.
This is the difference between prescribing exercises based on a symptom and developing a plan based on a comprehensive clinical assessment.
Why Does Specialized SLP Training Matter?
Speech-language pathologists are trained to evaluate communication and, within their scope and competencies, feeding and swallowing function.
These areas share anatomical structures with the tongue, lips, jaw and other systems involved in orofacial myofunctional disorders.
An SLP with additional specialized OMD training can evaluate relevant relationships among these functions.
For example, a child with a lisp may also have a tongue thrust swallowing pattern. A comprehensive evaluation can distinguish the speech sound disorder from the swallowing pattern and determine whether either or both need intervention.
Similarly, a patient with chewing concerns may require evaluation beyond tongue posture alone.
This integrated perspective is valuable because symptoms can overlap without having the same cause.
Not all SLPs are trained in OMD assessment, and appropriately qualified professionals from other disciplines also contribute to care.
The priority is a clinician whose education, training and experience match the patient’s needs and who recognizes when collaboration is necessary.
Does Having an OMD Mean You Need Myofunctional Therapy?
Not always.
Treatment depends on the individual’s functional findings, developmental readiness, medical status and goals.
For some patients, therapy may focus on oral resting posture, swallowing coordination or other specific functional patterns.
For others, speech treatment, feeding and swallowing intervention, medical evaluation or dental care may be more appropriate.
In some cases, multiple professionals work together.
A comprehensive evaluation should make those distinctions clear.
Frequently Asked Questions
What is the most common sign of an orofacial myofunctional disorder?
Habitual mouth-open posture, atypical tongue resting posture and tongue thrust swallowing are commonly recognized findings. No single sign is sufficient to diagnose every OMD.
Can adults have orofacial myofunctional disorders?
Yes. OMDs can occur across the lifespan. Adults may seek assessment for persistent swallowing patterns, oral posture concerns or other functional difficulties.
Can an OMD cause a lisp?
OMDs and speech sound distortions can coexist. Whether an orofacial functional pattern contributes to a particular speech error requires individualized assessment.
Does mouth breathing always mean someone has an OMD?
No. Mouth breathing may result from nasal obstruction, allergies, illness or other factors. Medical causes must be considered before assuming a functional habit is responsible.
Can a dentist diagnose an OMD?
Dentists can identify dental and oral findings within their scope and may participate in interdisciplinary OMD care. The appropriate professional for a comprehensive functional evaluation depends on the patient’s needs and the provider’s qualifications.
Can a child outgrow tongue thrust?
Some tongue movement patterns change with normal development. Whether a persistent pattern requires intervention depends on age, associated findings and functional impact.
How do I know whether my child needs myofunctional therapy?
An evaluation by a qualified clinician can determine whether a clinically significant functional concern is present and whether therapy, monitoring or referral is appropriate.
The Right Questions Lead to Better Treatment Decisions
Recognizing a possible OMD is only the beginning.
A visible symptom may be important, but it rarely tells the whole story.
At BreatheWorks, our approach is to understand the patient first: listen to their concerns, investigate relevant functions, interpret findings in context and develop recommendations based on what the evaluation reveals.
If you or your child has persistent concerns involving tongue posture, mouth breathing, speech, chewing or swallowing, contact BreatheWorks to discuss whether a comprehensive evaluation would be appropriate.
This article is for general education and does not replace individualized medical evaluation, diagnosis or treatment.
