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Orofacial Myofunctional Therapy

From frustrations to revelations

Pediatric oral examination

Expertise that makes all the difference

Orofacial Myofunctional Disorders (OMDs) affect how you breathe, sleep, eat, and speak, but can often go undiagnosed. Trestle founder Maureen Cooney is one of the most experienced Certified Orofacial Myologists (COMs) in the Midwest, and our team includes another highly accomplished COM and other qualified specialists. Our expert evaluations can identify these disorders related to abnormal breathing and oral development so that proper treatment can begin.

Signs & Symptoms

Identifying the foundational issues

Orofacial myofunctional disorders are abnormal movement patterns of the face and mouth that may interfere with normal growth and development of the muscles and bones. At Trestle, we screen all our speech patients for OMDs, as these disorders can be the root cause for feeding and swallowing issues, as well as speech disturbances like lisps. Other symptoms include voice disorders, language delays, and cognitive disorders such as reduced attention and the ability to participate fully in everyday life.
Symptoms for children
Symptoms for adults
  • Difficulty with breast or bottle feeding
  • Poor breastfeeding latch
  • Mouth breathing
  • Chronic congestion/colds
  • Open mouth posture
  • Low facial tone
  • Drooling
  • Oral habits like extended thumb sucking and nail biting
  • Extended bottle, sippy cup or pacifier use
  • Ear infections
  • Tongue thrust
  • Tongue- and lip-tie
  • Difficulty chewing or swallowing
  • Choking or gagging
  • Difficulty sleeping
  • Poor sleep quality
  • Decreased attention and concentration
  • Lisp
  • Speech sound distortions
  • Weak, breathy, hoarse speech
  • Facial asymmetry
  • Forward head posture
  • Chronic neck and back pain
  • Headaches
  • Gum disease
  • Grinding teeth
  • Orthodontic relapse
  • Reflux
  • Digestive problems

Possible diagnoses

Getting to the root of the symptoms

Most of our patients do not have a condition or diagnosis, but rather are struggling in certain areas where they need help. However, orofacial myofunctional disorders can be associated with Down syndrome.
Diagnoses for children
Diagnoses for adults
  • Obstructive Sleep Apnea (OSA)
  • Upper Airway Resistance Syndrome (UARS)
  • Sleep disordered breathing
  • Malocclusion
  • Bruxing
  • Temporomandibular Disorders (TMD)
  • Periodontal disease
  • GI disorders, including reflux and digestive issues
  • Abnormalities in growth and development of the orofacial complex
  • Tethered oral tissue of the tongue, lip or cheeks
  • Dysphagia
  • Failure to thrive
Father throwing daughter in the air

The supportive path forward

Our treatment plans are based on a hierarchy, and once a foundation is laid, we continually advance goals to target more complex skills. It’s a fluid and flexible process, working together to improve function and your overall quality of life. Parents frequently report that their kids feel more rested, perform better in school, and have fewer behavioral concerns.
Working together to reach and celebrate your achievements
Customized plan
1-on-1 sessions
Home assignments
Goals reached
Our feedback speaks volumes
“Our experience at Trestle Therapy has been wonderful. I have learned so much in just a few sessions with Maureen. I am way better prepared to help my son make the most of his tongue-tie and lip-tie release. My older son sees Erin and he loves coming to speech therapy! She gives us things to work on at home each week to maximize his progress.”
We know you’re looking for answers, and we’re here to help
See our FAQs

Frequently asked questions related to speech therapy

What is a Certified Orofacial Myologist, and who are the COMs at Trestle?

Speech-language pathologists who have completed advanced training through the International Association of Orofacial Myology (IAOM) are Certified Orofacial Myologists (COMs). Trestle founder Maureen Cooney is one of Chicagoland’s most experienced COMs. In addition, several other Trestle therapists have completed OM training under either Mary Billings, Dianah Davidson, or Kristie Gatto, some of the most accomplished COMs internationally.

What is OMT?

Orofacial Myofunctional Disorders (OMDs) include abnormal breathing and oral development, which affect how you breathe, sleep, eat and speak. An OMD can be the cause of speech disorders, like feeding and swallowing issues, speech disturbances like lisps, and voice disorders. Language delays, cognitive disorders, and behavioral concerns are also associated with OMDs due to poor sleep quality and atypical breathing related to reduced attention and the ability to participate fully in everyday life.

Orofacial Myofunctional Therapy (OMT) uses neuromuscular re-education, pre- and post-surgical frenum protocols, and specific techniques to retrain breathing, oral motor patterns, and swallowing. When we can identify the causes relating to the dysfunction and eliminate compensations, our patients report greater outcomes and overall improvements in their quality of life.

How can OMT help my child?

OMT can assist in developing a healthy orofacial muscle matrix by normalizing rest postures of the tongue, lips, and jaw, retraining nasal breathing, supporting diaphragm activation, using neuromuscular re-education to strengthen and balance orofacial muscles, and correct atypical chewing and swallowing patterns.

How can oral habits impact orofacial development?

Noxious habits of the mouth, including thumb sucking, nail biting, and extensive bottle use can change the way the palate is formed and how the teeth come together. When the mouth is developing, the palate is very soft and can be manipulated via pressure from the thumb, pacifiers, bottle, or sippy cup, causing the palate to become very high and narrow, reducing the oral volume in the mouth. When there is not enough room in the mouth for the tongue, the tongue’s rest posture and motor patterns can also become altered, further exacerbating the negative oral structure changes and function during breathing, speech, feeding, and swallowing.

I was told my child has a mild tongue-tie. Why should I be concerned?

The tongue is not only a muscle but also an organ. The tongue plays a major role in breathing, chewing, swallowing, and speech. To fully understand what a tongue-tie means, you have to understand the normal range of motion of the tongue and why the tongue needs to be free to move to support healthy oral function. The tongue must be free from the tip, as well as the back, to safely collect food, swallow, and make clear speech sounds without compensatory movements that can over time lead to facial asymmetry, orofacial pain, and Temporomandibular Disorders (TMD).

During breast or bottle feeding, the tongue has to have full posterior (back) elevation and contact with the soft palate around the nipple in order to get a complete seal to express the milk, like a vacuum, and swallow correctly. If the tissue is tight under the tongue, feeding and swallowing will be less efficient and may be a negative experience, as the baby will often develop an atypical motor pattern through using their jaw to chew the milk out of the nipple as opposed to sucking the milk out. When this occurs, babies usually fatigue early or feel as if they are choking due to poor oral control, and mothers can end up with nipple damage and pain.

During conversational speech, the tongue has to stabilize from the back of the mouth up along the upper molar region so the tongue can make its superfine motor movements going from sound to sound in connected speech at a very fast rate. If the tongue cannot correctly anchor from the back, the movements will be compromised and speech can sound distorted.

In conclusion, there’s no such thing as a mild tongue-tie. The severity should be determined by how severe the symptoms are and if the functions are compromised. At Trestle, we are experts at retraining the tongue to restore normal function without compensation.

Why is my orthodontist concerned about my child’s tongue thrust?

The tongue is often referred to as an antagonist, as it is a very strong muscle capable of causing teeth to shift and bites to change if it puts too much pressure on the teeth. Tongue thrusts can influence negative changes to the oral cavity and dentition, creating malocclusion and high, narrow palates. The goal of orthodontics is to correct the alignment of the teeth, but if your child has a tongue thrust, the long-term oral stability can become compromised if the tongue thrust is not eliminated prior to finishing orthodontics.

How can OMT support overall health?

Mouth breathing and hyperventilation are often associated with increased symptoms of allergies, asthma, high blood pressure, high cholesterol, reflux, etc. OMT can support the reduction of symptoms and reduced need for medication when breathing and swallowing patterns are improved, the orofacial complex is balanced, and oral habits are eliminated.

Through establishing lip closure and nasal breathing your patients can have fewer symptoms and may need less medication if their breathing and OMDs are targeted.

How can OMT support oral hygiene?

Did you know that mouth breathing and other atypical oral muscular patterns are associated with dental caries (cavities), periodontal disease (gum disease), halitosis (bad breath), and atypical chewing patterns associated with poor diet? Retraining nasal breathing and oral rest posture may lead to healthier mouths with less risk of dental disease, improve oral hygiene, develop better smiles, maintain dental stability, and improve nutrition and digestion. OMT can teach correct chewing so you can safely and efficiently chew a variety of hard and chewy healthy solids.

How can OMT support a healthy diet and improve nutrition?

Atypical chewing patterns are often associated with poor nutrition and diet. OMT can support your nutritional needs by using neuromuscular re-education to improve chewing skills. This helps you to safely and efficiently chew a variety of hard whole foods (nuts, raw vegetables, meats) and reduce intake of soft processed foods and smoothies. By retraining how to swallow and reducing air intake, reflux can be better managed. And digestion can also improve through OMT, as correct chewing skills can increase the production of digestive enzymes.

How can OMT support orthodontic intervention?

OMT can support stable, long-term orthodontic results and decrease the risk of dental relapse through normalizing the rest posture of the tongue, lips, and teeth and by removing atypical muscular forces and patterns of the tongue. OMT can also reduce the overall time in fixed appliances by removing atypical muscular forces and patterns of the tongue.

How can OMT reduce my orofacial pain?

Ninety percent of TMD is muscle-based and related to incorrect oral muscle patterns. OMT retrains the patient to use their orofacial muscles, which support breathing, speech, chewing, and swallowing without compensation. Because the orofacial muscles are all interconnected, when there are abusive oral habits, atypical rest postures of the mouth, or compensatory patterns with those muscles, they could put strain on other smaller muscles or the TMJ, causing pain, reduced range of motion, and dysfunction. Normalizing the oral rest postures and motor patterns could help reduce tension and aggressive forces on the jaw joint and other muscles, establishing harmony and balance.

How can OMT support intervention of Sleep Disordered Breathing (SDB)?

OMT can be another intervention to support the treatment of SDB, as OMT retrains and normalizes the muscles of the orofacial complex to improve rest postures, retrain nasal breathing, stabilize the dental freeway space (vertical dimension of the mouth), and optimize functional skills to improve breathing, reduce tension, and decrease symptoms that can exacerbate SDB. OMT can also reinforce compliance with CPAP and oral appliances.

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