Myofunctional Therapy and Orthodontics: When Should a Referral Be Considered?
Orthodontics and myofunctional therapy address different aspects of oral health, but there are situations where the two naturally overlap.
Orthodontic care focuses on the teeth, bite, and jaw relationships. Myofunctional therapy focuses on functional patterns involving the tongue, lips, jaw, swallowing, breathing, and oral resting posture.
When structural and functional concerns occur together, communication between providers can help determine what needs to be addressed, by whom, and at what point in care.
Where Do Orthodontics and Myofunctional Therapy Overlap?
The tongue, lips, cheeks, teeth, and jaws interact throughout the day. Because of that, oral-function patterns may sometimes be present alongside dental or orthodontic concerns.
Examples can include:
Tongue thrust during swallowing
Forward or interdental tongue resting posture
Difficulty maintaining comfortable lip closure
Persistent open-mouth posture
Mouth breathing
Thumb sucking or other persistent oral habits
Open bite or other bite concerns
Swallowing patterns that appear different
Dental or orthodontic concerns occurring alongside oral-function concerns
These findings can occur together, but one does not automatically mean that another caused it. Orofacial myofunctional patterns can involve a combination of learned behaviors, structural differences, airway concerns, development, and other factors. ASHA likewise emphasizes that OMDs can be multifactorial and that malocclusion should be evaluated by the appropriate dental or orthodontic professional.
When Might an Orthodontist Consider a Myofunctional Referral?
Not every orthodontic patient needs myofunctional therapy.
A referral may be helpful when an orthodontist or dentist notices that a functional pattern is occurring alongside the orthodontic concern.
For example, a patient may have:
Persistent tongue thrust during swallowing
A forward tongue resting posture
Difficulty comfortably keeping the lips together
Persistent mouth-open posture or mouth breathing
Thumb or finger sucking that continues beyond early childhood
Difficulty establishing a comfortable oral resting posture
Other swallowing or oral-function concerns
A myofunctional evaluation does not replace the orthodontic diagnosis. Its purpose is to evaluate the functional patterns occurring alongside the dental or orthodontic findings.
When Might a Myofunctional Therapist Recommend an Orthodontic Evaluation?
Referral also works in the other direction.
During a myofunctional evaluation, concerns involving the teeth, bite, jaws, or developing dentition may become apparent. In those situations, evaluation by a dentist or orthodontist may be appropriate.
Examples may include:
Open bite
Crossbite
Significant overjet
Tooth-position concerns
Crowding or eruption concerns
Jaw relationship concerns
Other structural findings that may influence comfortable oral function
Diagnosing malocclusion and deciding whether orthodontic treatment is needed belongs to the dental and orthodontic provider.
ASHA specifically recommends referral to a dentist, orthodontist, or other appropriate dental specialist when concerns involving malocclusion arise during an orofacial myofunctional assessment.
Which Should Come First: Orthodontics or Myofunctional Therapy?
There is no single sequence that is right for every patient.
For some people, myofunctional therapy may begin before orthodontic treatment to address oral habits, tongue awareness, swallowing patterns, breathing, or resting posture.
For others, orthodontic, dental, airway, or medical evaluation may need to happen first.
In some situations, the two types of care may occur at the same time.
For example, ASHA notes that an orthodontist may need to address an open bite before intervention for tongue thrust or an interdental speech pattern can progress appropriately. Airway concerns may also warrant medical or ENT evaluation before trying to establish a consistent closed-mouth resting posture.
The appropriate sequence depends on the individual findings and the goals of care.
Does Myofunctional Therapy Replace Orthodontic Treatment?
No.
Myofunctional therapy does not move teeth and does not replace orthodontic diagnosis, braces, aligners, appliances, or retention.
Likewise, orthodontic treatment is not designed to directly retrain swallowing patterns, oral habits, tongue resting posture, or other functional behaviors.
When both structural and functional concerns are present, different providers may address different parts of the overall picture.
It is also important not to overstate what combined treatment can accomplish. Research has explored myofunctional therapy alongside orthodontic treatment, but systematic reviews have found the available evidence inconsistent or limited in quality. That means it would be inappropriate to promise that myofunctional therapy will improve orthodontic results or prevent relapse for every patient.
What Does Collaborative Care Look Like?
With patient or parent consent, collaboration may include communication about relevant findings, treatment goals, timing, and progress.
Depending on the person, the care team might include a:
Orthodontist, dentist, myofunctional therapist, ENT, speech-language pathologist, physician, or another appropriate provider.
The goal is not to involve more providers simply for the sake of more treatment.
The goal is to make sure structural, dental, airway, and functional concerns are evaluated by the professionals best qualified to address them.
Wondering Whether a Referral Makes Sense?
If you or your child is undergoing orthodontic treatment and also has concerns involving tongue posture, swallowing, mouth breathing, or oral habits, a free 10-minute consultation can help determine whether a myofunctional evaluation may be appropriate.
Are you a dentist, orthodontist, or healthcare provider?
Sources & Further Reading
American Speech-Language-Hearing Association: Orofacial Myofunctional Disorders
American Academy of Pediatric Dentistry: Management of the Developing Dentition and Occlusion in Pediatric Dentistry
Dental Press Journal of Orthodontics: Effectiveness of Orofacial Myofunctional Therapy in Orthodontic Patients: A Systematic Review