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oral dysfunction 101

Everything you need to know about oral dysfunction and how it impacts breathing, talking, chewing, swallowing & more

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It’s easy to take breathing, chewing, swallowing, and talking for granted. It is only when something “goes wrong” that we begin to realize just how important oral function is to our lives.

Your orofacial muscles, jawbones, and teeth interact with a surprising amount of force and repetitive motion. This is why abnormal movement patterns of the face and mouth, also known as oral dysfunction, can impair important functions like digestion, sleep, and speech.
 

What is oral dysfunction?

The term oral dysfunction encompasses a broad array of conditions that impair the normal and healthy function of the face and mouth. If you have oral dysfunction you may experience difficulty moving the jaw, lips, cheeks, or tongue.

Orofacial myofunctional disorders (OMDs) can affect people of all ages, from newborns to senior citizens, for a variety of reasons. Whatever the root cause, orofacial disorders interfere with the function of the muscles of the face and mouth. This can have disastrous effects on your physical and mental health.


Signs & symptoms of oral dysfunction

People who have an oral dysfunction or orofacial myofunctional disorder often have problems breathing through their nose, swallowing, talking, and chewing. Oral dysfunction is deeply intertwined with feeding disorders, speech disorders, and airway obstruction. There are many signs and symptoms of oral dysfunction that you can keep an eye out for.

Feeding issues

Healthy digestion requires efficient chewing and swallowing. This depends upon seamless coordination between muscles in the face, mouth, and throat. Many parents begin to notice signs of an oral dysfunction in their children during infancy due to difficulties breastfeeding or feeding problems at mealtimes.

What's normal, and what's not

It is natural for babies to refuse new foods at first. It is normal and healthy for babies to make a mess as they explore new textures, colors, and flavors as they encounter solid table foods. This usually improves over time, but if food aversion and feeding issues persist and begin to hamper your child’s growth, there could be more at play.


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Speech issues

If you have difficulty controlling your lip, mouth, tongue, and jaw muscles, it can lead to speech problems. Dysarthria is a type of speech disorder related to weak muscles or challenges coordinating the muscles of the face and mouth. Parents often notice signs of apraxia of speech (also known as verbal apraxia) in their children as they begin to learn how to talk. This shows up as trouble speaking, poor articulation of phonemes, or difficulty saying what they want to say consistently. Apraxia of speech in adults can arise due to a stroke, a health condition, or physical trauma such as a head injury.

Sleep issues

In her book Sleep Wrecked Kids: Helping Parents Raise Happy, Healthy Kids, One Sleep at a Time, speech pathologist and myofunctional therapist Sharon Moore illustrates how airway issues and sleep disorders negatively affect children’s well-beings and physical, mental, emotional, and social development.

Behavioral and learning difficulties are often misdiagnosed as ADHD or hyperactivity. In many cases, the root cause is an oral dysfunction that affects airway function and causes sleep-disordered breathing. This increases the stress hormone cortisol, making it harder for children to sleep through the night and to wind down at the end of the day.

Oral dysfunction due to an overcrowded airway can lead to sleep-disordered breathing. In fact, it is estimated that about half of all children with Downs Syndrome experience some form of Obstructive Sleep Apnea (OSA). This is because babies with Downs Syndrome are often born with a narrow upper jaw, which means there isn’t enough room for their tongue. Furthermore, children with Downs Syndrome are more likely to have an oral restriction such as a tongue tie.

Sleep and behavior

Sleep is vital to development and health, yet many parents find it very hard to find the right kind of help for their sleep-deprived and oxygen-deprived children. That is why many leading health professionals advise parents of children experiencing behavioral issues, learning difficulties, aggression, or hyperactivity to have a full sleep study to find out if there is an underlying airway or sleep disorder.


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The signs and symptoms of oral dysfunction can be divided into many categories including:
  1. Sucking and swallowing
  2. Feeding and chewing
  3. Teeth, jaw, and tongue
  4. Speech and communication
  5. Airway, sleep, and breathing


1. Sucking and swallowing:
  • Difficulties with breastfeeding due to problems with latch and/or suck-swallow pattern
  • Difficulty sucking from bottles
  • Excessive drooling, especially past the age of 2
  • Difficulty swallowing food items or drinks
  • Difficulty using a straw to suck liquids
  • Delays in milestones such as using a sippy cup or open cup
  • Thumb sucking/finger chewing habits past the age of 3
  • Difficulty closing the lips to swallow

2. Feeding and chewing:
  • Eating may be excessively difficult and messy, even when children get older
  • Preference for soft, easily chewed foods
  • Very slow or inefficient chewing
  • Refusal to eat or excessive crying during mealtimes
  • Slow weight gain due to low intake of food
  • Avoidance of chewy foods such as meats
  • Avoidance of hard foods such as fresh vegetables or fruits
  • Food falling out of the mouth while eating
  • Food left in the mouth or stuck on teeth after eating
  • Vomiting, gagging, choking, and coughing during mealtimes

3. Teeth, jaw and tongue:
  • Crowded teeth (malocclusion)
  • Dental caries (cavities)
  • Misalignment of jaw (overbite, underbite, or crossbite)
  • An oral restriction such as tongue tie, buccal tie or lip tie
  • The tongue pushing past the teeth
  • Tongue thrust or fronting
  • Pain when yawning
  • TMJ temporomandibular joint pain or locking of the joint
  • Clicking sounds when moving jaw or chewing
  • Tooth grinding (bruxism)

4. Speech and communication:
  • Delays in milestones for speech and language development
  • Nasally-sounding voice
  • Limited tongue movement
  • Speech that is difficult to understand
  • Adding, switching, or omitting syllables from words
  • Difficulty saying long or complicated words
  • Excessive mouth movement during speech
  • Slurred or slow speech
  • Difficulty pronouncing sounds, like "s," "j,” “l,” and "sh"

5. Airway, sleep and breathing:
  • Holding the mouth/lips open while awake or asleep
  • Open-mouth breathing
  • Snoring and sleep apnea
  • Restless and disrupted sleep
  • Circles under the eyes or bags under the eyes
  • Stuffy nose and nasal-sounding voice
  • Insomnia
  • Tired and difficulty concentrating
  • Behavioral issues or hyperactivity
  • Bed-wetting
  • Excessive drool on pillow
  • Kicking and rolling
  • Waking up many times throughout the night
  • Nightmares and night terrors
  • Waking up with twisted, rumpled sheets and bedding
  • Enlarged tonsils and adenoids
  • Chronic upper respiratory infections, allergies, and asthma

If you notice signs and symptoms of oral dysfunction, it is important to create a circle of support with an interdisciplinary team of healthcare providers who understand and specialize in oral dysfunction diagnosis and treatment.


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Oral-motor dysfunction & oral-sensory dysfunction

Oral dysfunctions can be assessed according to oral motor and oral sensory parameters. These often overlap and are interrelated with other issues, which further complicate oral dysfunction.


Oral-motor dysfunction
affects how the mouth muscles function including:

  • Strength
  • Coordination
  • Range of motion
  • Ability to suck, swallow, talk, and chew


Oral-sensory dysfunction
affects how the mouth tissues perceive things like:

  • Texture
  • Taste
  • Temperature

What causes oral dysfunction?

Any disease, condition, or event that causes malfunction or damage to the nervous system (the brain, spinal cord, and nerves) can potentially affect oral function. Underdeveloped upper and lower jaws and oral restrictions such as tongue tie, lip tie, and buccal tie can also be at the root of oral dysfunction.

In adults, the causes of oral dysfunction are often easier to identify, such as physical trauma to the head, stroke, or a neurological disease like Parkinson’s or multiple sclerosis. In children, the causes of oral dysfunction can be harder to pin down.


Possible causes of oral dysfunction include:

  • Physical trauma
  • Neurological, congenital, and chronic conditions
  • Oral restrictions & airway obstructions
  • Developmental factors
  • Sensory issues & poor orofacial habits


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Physical trauma

Any event that damages the bones, muscles, teeth, or tissues of the mouth and face can cause oral dysfunction. Head trauma and spinal cord damage can cause neurological problems that impair the ability to coordinate muscle movements. Even tooth loss can affect chewing and talking.

Neurological, congenital & chronic conditions

Some types of oral dysfunction are related to conditions such as congenital hypotonia (also known as floppy infant syndrome), mitochondrial disease and muscular dystrophies. Babies who are born with structural abnormalities affecting the head or face, such as cleft palate often also have oral dysfunction. Oral dysfunction is also linked to neurological conditions, like hydrocephalus or cerebral palsy.

People with craniofacial syndromes and other chronic conditions are at higher risk of oral dysfunction and related airway issues. Syndromes that affect the position, size, and shape of the skull and facial bones often cause airway issues.


Some of these syndromes are:

  • Ehlers-Danlos (joint laxity)
  • Pfeiffer
  • Apert
  • Prader-Willi
  • Pierre Robin
  • Crouzon

Oral restriction and airway obstruction

Any issue that causes the tongue to be misplaced at rest or makes it difficult to keep the lips together at rest can disrupt normal and healthy oral function. In some cases, an oral restriction or an airway obstruction is at the root of oral dysfunction. Oral dysfunction is closely related to upper airway issues. For example, blocked nasal passages lead to mouth breathing, which has many negative effects on sleep, development, learning, and immunity.

Developmental factors

As they grow, children learn how to coordinate the muscles that control their lips, cheeks, tongues, jaws, and cheeks. This starts with mastering breastfeeding or bottle-feeding and evolves as they begin to eat solid foods, make sounds with their mouths, and eventually speak. If a child has oral-motor weakness this means that their muscles do not have the strength to function at an optimal level for these important milestones.

There are important developmental “windows” in which children learn new eating skills. Waiting too long or starting too soon to introduce solid foods can affect oral-motor and oral-sensory development. In some cases, oral dysfunction arises as a result of an event or condition that disrupts normal development. An illness, surgery, or hospitalization, especially if the situation requires feeding through a tube, can interrupt the normal stages of oral functional development.

Sensory issues and poor orofacial habits

Oral function, especially when it comes to oromotor dysfunction, can be affected by sensory issues. For this reason, oral dysfunction may be associated with Autism Spectrum Disorder. Nutrition can be compromised due to aversion to certain foods, textures, and issues with gagging or vomiting when eating. While some are hypersensitive, others have the opposite problem and are unable to sense the taste, texture, or temperature of foods.

Some oral dysfunction issues are due to poor orofacial habits (like open-mouth breathing, tongue thrusting, and tooth grinding). Proper, healthy habits can be relearned through exercises and practice with a specialist such as a myofunctional therapist or speech pathologist.

What to do if you suspect oral dysfunction

If you’re noticing signs and symptoms of oral dysfunction, it is important to consult with trusted healthcare providers who specialize in oral dysfunction diagnosis and treatment. Surround yourself with a circle of support to make sure you get the care you need. In most cases, an interdisciplinary team approach with healthcare professionals who understand oral dysfunction will yield the best outcome.

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Ready to learn more & get specialized support?

We created health:latch circle to increase education, awareness, and support around the issues of airway health, oral dysfunction & oral restrictions.

The circle makes it easy for you to surround yourself with caring and knowledgeable healthcare professionals across many healthcare fields and healing modalities who can guide and advise you through the ups and downs of diagnosing, treating, and recovering from the long-term effects of an oral restriction, early childhood cavities and more.

The health:latch circle is a radically kind, community-based online platform that allows interested parents and professionals to ask questions, learn together and connect to trusted professionals who are committed to helping families thrive.

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