Elizabeth Hafer

Chevy Chase, MD


What is Myofunctional Therapy?

Orofacial Myofunctional therapy (OMT) retrains the muscles of the face and mouth to eliminate behaviors and habits that cause structural and functional issues. We call these behaviors Orofacial Myofunctional Disorders (OMDs). Some signs of OMDs include but are not limited to tongue tie, tongue thrust, mouth breathing, difficulty breast feeding, drooling, speech issues, malocclusion (improper bite), snoring, dark circles under the eyes and ADHD. Myofunctional Therapists work collaboratively with other specialists including Dentists, Orthodontists, Osteopaths, Chiropractors, Pediatricians, ENTs, Physical Therapists, Speech Language Pathologists and any other specialist that might contribute to the interdisciplinary approach for treatment to achieve the goal of ideal health.


What is a Tongue Thrust?

A Tongue Thrust is an abnormal swallowing pattern that developed in response to structural issues or as a result of habits such as thumb sucking. Tongue thrusts can involve the tip of the tongue protruding forward over the front teeth or the tip and/or sides of the tongue pushing or spreading between the teeth. The force of the tongue muscle against the teeth can cause alignment issues, excessive overjet, and orthodontic relapse.

Babies have an infantile thrust and as they grow, they develop motor skills and oral muscles through breast feeding, chewing foods and drinking from real cups (not sippy cups). By age 6-7, children should have developed an adult swallow pattern. During a healthy swallow, the tip of the tongue elevates to “the spot” on the roof of the mouth located behind the front teeth. The rest of the tongue raises up against the roof of the mouth in a wave like pattern as the swallow progresses. The lips should remain sealed with the teeth lightly touching. An ideal swallow is the “silent swallow” – you can’t really see it or hear it. The lip muscles, chin and muscles of the neck should be calm and uninvolved.

How can it affect my health?

Ensuring an open airway is always the top priority – without proper breathing all else suffers. Tongue thrusts are notorious for causing airway issues, including disrupting a person’s O2/Co2 balance. Additionally, tongue thrust can cause snoring, sleep apnea and poor sleep quality. A person with tongue thrust may also have digestive issues, as their improper swallowing technique will introduce air into every swallow. The swallowed air can cause reflux, bloating and tummy aches. Over an extended period of time, these problems can take their toll on other different body systems.

How does a tongue thrust affect my teeth?

Tongue thrust will lead to teeth misalignment and difficulty in teeth cleaning. Tongue thrust can cause narrowing and crowding and the development of “food traps” – which, in turn, can lead to gum disease, decay and tooth loss

An open bite or cross bite can form as a result of improper tongue and muscle patterns during swallowing

The facial muscles can experience soreness, tension, inflammation, and dysfunction – such as limited mouth opening

The Temporomandibular Joint or TMJ can be affected by an open bite. Temporomandibular Disorder or TMD can occur due to lateral shifting of the jaw during chewing

Tooth eruption can be delayed

The need to repeat orthodontic treatments (orthodontic relapse). After years in braces the teeth will shift back if the tongue is not retrained to be in the proper rest position and swallow pattern. Myofunctional therapy can eliminate the tongue thrust pattern

Causes of Tongue Thrust:

Sippy cups/Thumb and finger sucking

Tongue Tie

Mouth breathing-associated with low tongue rest posture

Allergies, large adenoids, tonsils, nasal congestion

Natural jaw anatomy and a steep jaw angle

Tongue Thrust Signs:

Chapped lips / area around lips are red, dry, cracked from frequent licking

Habitual mouth breathing (mouth breathing when not congested or sick)

Open mouth rest posture with lips apart and/or tongue resting against top and or bottom teeth

Swallow requires lower lip to come up/forward to keep food/drink in

Tongue protrudes against top and/or bottom front teeth when articulating /s/,/z/,/t/,/d/,n/,/l/,or /sh/

How do you fix a Tongue Thrust?

Myofunctional therapy uses functional exercises based on the individuals muscle patterns to establish new neuromuscular behaviors. The “cookie cutter” approach to treatment doesn’t work in myofunctional therapy as each person usually has multiple factors contributing to the muscle dysfunction. By assessing and identifying the patient’s unique patterns and behaviors, I am able to create a treatment plan that addresses the factors involved in the OMD.


About Tongue Tie

The tongue’s natural resting position is on the palate, also known as the roof of the mouth. The tongue serves as a guide for the proper growth of the palate (maxilla) and the face. With each proper swallow of food, water and saliva, the forces of the tongue muscles form the shape of the palate. A tongue tie restricts the tongue’s ability to reach the top of the mouth. As a result, the palate develops in a narrow or “V shaped” pattern instead of a wide “U shaped” pattern. Narrow arch development contributes to crowding of the teeth and breathing issues. The lower jaw tends to follow the lead of the upper jaw – so the tongue tie will result in crowding for the lower teeth as well. Additionally, the sides of your tongue might present with a “scalloped” appearance from the teeth. This is an indicator that the tongue is too large and cannot rest comfortably on the palate (or roof of the mouth). With this, the airway can become restricted, due to the tongue being forced down and to the back of the throat instead of resting high on the palate. This sequence increases the risk of sleep disordered breathing, which leads to a pandora’s box of health issues.

What is a Tongue Tie?

Many people that I talk with assume that the term “tongue tie” is just a figure of speech. They are always surprised to learn that it’s a real medical condition which affects oral and facial development and has a range of health consequences that may take years to manifest. A tongue tie or ankyloglossia is a restriction of mobility in the tongue. Under the tongue is a tissue called the frenum or frenulum. The frenum attaches from the tongue to the floor of the mouth. A short frenum is short will limit the tongue’s range of motion. There are different degrees of restriction and different types of tongue ties. The tongue should be able to elevate and “suction up” across the roof of the mouth without compensating by using the muscles of the neck and the floor of the mouth. It should be a natural motion and not an effort or struggle for the tongue. As part of a Myofunctional assessment, I will check for the tongue’s range of motion and function.

Signs there might be a Tongue Tie

Speech issues

Jaw pain, clenching & grinding

Head/neck/shoulder tension

Forward head posture

Dry mouth which can cause increased risk for gum disease/cavities

Slow orthodontic movement

Orthodontic relapse

Tongue thrust

Snoring/sleep disordered breathing/upper airway resistance syndrome/mouth breathing

Difficulty breastfeeding for mom and baby

Gag reflex


Poor sleep / Sleep apnea


Dark circles under the eyes

Sensory issues

Selective diet

GI issues

Thumb, Digit or Object Sucking

Habits are hard to break but it’s worth the results! Thumb or digit sucking can lead to an irregular swallow pattern such as a tongue thrust, airway issues, crowded crooked teeth, cross and open bites and cosmetically it is not appealing. Habitual sucking can lead to dysfunctional muscle patterns of the face and mouth. The altered bite and tongue pattern can lead to speech issues such as a lisp or difficulty articulating sounds. Patients with speech issues will be referred to a Speech Language Pathologist if they are not already under the care of one as Speech Therapy is not in my abilities or licensure.

How does habitual sucking affect my health?

It can lead to a tongue thrust, open bite, cross bite

The TMJ can experience extra stress due to the heavy uneven biting forces in open bite situations. For example, If the bite is open on the side or posteriorly, the jaw may deviate to one side upon chewing which can lead to TMD

Headaches can occur due to overworked muscles

Sore facial muscles

Skin or nail issues

Stomach issues such as reflux and aches from swallowing air

Sleep breathing disorders

Forward head posture

Why do I need Orofacial Myofunctional Therapy?

With Orofacial Myofunctional Therapy, we will work together to create an understanding and awareness of the relationship between the muscles in the mouth, face and neck region. One important focus will be the tongue because it is an extremely strong and pivotal muscle to our health. Our tongue helps us chew, swallow, clean our mouth, form words and breathe, all while playing a critical role developing and maintaining the shape of the mouth.

If the tongue muscles are not functioning properly, our body will develop compensations and OMDs will occur. To achieve this, a myofunctional therapy program will teach the proper oral rest position for the tongue, lips and teeth, as well as nasal breathing. The exercises use neuromuscular re-education to re-pattern the oral rest posture – once this is achieved, one can obtain healthy habits for optimal health.

Myofunctional Therapy has helped thousands of individuals,
in dozens of countries, for over 40 years!

Give Chevy Chase Myo a call today!