Does Orofacial myofunctional treatment (OMT) treat tongue dysfunction?

Patients with malocclusions such as anterior open bite are challenging to treat, as relapse is common after treatment. Anterior open bites are commonly associated with orofacial dysfunctions of which tongue dysfunction is a prominent cause.

Directing attention towards muscle training and habituation for such patients may help achieve a favorable long – term outcome following orthodontic treatment.

Orofacial myofunctional therapy (OMT) for tongue dysfunction could aid in establishing a new neuromuscular pattern and help correct abnormal functional and resting postures.

The following article sheds light on whether Orofacial myofunctional treatment treats tongue dysfunction:

The effect of orofacial myofunctional treatment in children with anterior open bite and tongue

dysfunction: a pilot study

Van Dyck C, Dekeyser A, Vantricht E, Manders E, Goeleven A, Fieuws S, Willems G. The effect of orofacial myofunctional treatment in children with anterior open bite and tongue dysfunction: a pilot study. European Journal of Orthodontics. 2016 Jun 1;38(3):227-34.


What did this paper assess?

This study investigated the effects of OMT on tongue behaviour in children with anterior open bite and a visceral swallowing pattern.

What was the protocol?

This was a prospective pilot randomized study with two groups – OMT patients and non-OMT patients . The sample was stratified based on the presence of a transversal crossbite ; thus the experimental and control groups had two subgroups – with and without expansion, respectively.

The OMT phase lasted 4–6 months and expansion was carried out thereafter in the respective subgroups.

Maximum tongue elevation strength was quantitatively assessed using the Iowa Oral Performance Instrument ( which measures the amount of pressure exerted on a small air filled bulb and digitally displays the pressure in KPa) functional characteristics such as tongue posture at rest, swallowing pattern and articulation were examined by means of a clinical evaluation at baseline (T0), at the end of treatment or after 6 months for the control group (T1) and after 6 months of follow-up (T2) .

What did their results show?

There was a significant difference in maximum tongue pressure between all OMT and non-OMT subjects at T1. The OMT subgroups displayed higher maximum tongue pressure than non- OMT subgroups.

At T2, there was a significant higher pressure for OMT subjects compared to non-OMT subjects which is an indication that the tongue musculature was effectively trained and strengthened.

More OMT subjects performed a physiological pattern of water swallowing than non-OMT children at T1 and T2 but the differences were not significant.

OMT did significantly change tongue elevation strength, tongue posture at rest, and tongue position during swallowing of solid food.

No interaction was observed between OMT and expansion was found in any of the groups.

Articulation of speech was not improved by OMT.

Critical appraisal :

The efforts of the authors to stratify the samples in the experimental and control group must be appreciated. However , according to the research question; it would have been suggestive to have two groups – an experimental and control group with no transverse malocclusions.

The effect of transverse correction on tongue dysfunction could then have been performed as a follow up study.

Although no consensus can be found in the literature regarding the ideal protocol to treat orofacial dysfunction , the formulation of a standardized protocol of myofunctional training would have helped eliminate bias.

The reliability of a clinical assessment of tongue function and posture is subjective in nature . Literature reports various objective methods to evaluate tongue posture – cinefluroradiography , palatography and ultrasound which could have been considered to strengthen the study.

What we would have liked to know

· Was the severity of the tongue thrust assessed when collecting the samples? If yes how? This is important as the severity of tongue thrust may have a bearing on the duration of OMT and the success post treatment.

· The study reported that the OMT phase lasted 4–6 months. Was OMT terminated based on the resolution of tongue dysfunction or was it blindly terminated with conclusion of the study at 6 months ?

· As the authors have mentioned , the resin of the expansion plate on the palate could interfere with the tongue position and this could have been assessed.

· What was the duration of expansion treatment?

Conclusion and scope for future studies

The study shows that OMT can positively influence tongue behaviour and may help to correct tongue dysfunction and prevent relapse of malocclusions caused by abnormal tongue position.

Future studies which assess the outcome over the long term will elaborate the success of OMT.

A comparison between OMT and conventional tongue cribs/spurs/ bluegrass appliance/tucat’s pearl in terms of achieving optimal tongue posture and preventing relapse .

As OMT aims to make the patient conscious of the false static and dynamic tongue position and retrains the tongue to a physiological position , future studies should assess whether all age groups benefit from OMT.

Contributors : Dr. Jaymi Anna George, Dr. Bhadrinath