Orofacial Myofunctional Therapy

With so much discussion around Orofacial Myofunctional Therapy (OMT) in the speech pathology space at the moment, I thought it would be helpful to briefly outline what it is and what it isn’t.

What OMT Isn’t: non-speech oral motor exercises

OMT is not the same as Non-Speech Oral Motor Exercises (NSOMEs).

NSOMEs refer to isolated, non-functional movements using the lips, tongue, cheeks, or jaw (e.g., blowing whistles, cheek puffing, lingual circles, tongue push-ups).

These movements:

• don’t reflect the movements or coordinated patterns used in speech

• don’t transfer into functional change

• and research consistently shows no meaningful evidence that NSOMEs improve speech sound production

OMT does not involve strengthening muscles for speech in isolation.
It is not “tongue gym,” blowing games, or repetitive oral movements with no functional purpose.

What OMT Is: Restoring Healthy Orofacial Function

OMT is a functional therapy approach aimed at restoring correct oral posture and normalising patterns used for breathing, chewing, swallowing, and speech.

OMT focuses on:

Optimal tongue resting posture

The tongue should rest gently suctioned to the palate. A low or forward tongue posture can contribute to open-mouth breathing, speech distortions, altered swallow patterns, and changes in facial growth.

Re-establishing nasal breathing

Nasal breathing supports filtration, humidification, facial growth, nitric oxide release, and proper tongue position. When nasal breathing is disrupted, compensations follow. Compensations are adjustments the body makes to work around an injury or limitation. For example, limping to reduce pain in an injured leg. These workarounds can be helpful in the short term, but if they persist, they may lead to inefficient patterns or secondary issues.

Normalising oral rest posture

Lips closed, tongue up, teeth slightly apart, breathing quietly through the nose.

Retraining a mature swallow

The tongue thrust reflex is a normal reflex seen in babies where the tongue naturally thrusts forward when the tip of the tongue is touched and typically integrates by approximately 7 months old. However, in some cases, this reflex may be retained beyond infancy.

A tongue-thrust or immature swallow can influence dental occlusion, feeding skills, speech clarity, and oral rest posture. OMT re-establishes the functional sequence of an efficient, mature swallow pattern.

The Role of the Speech Pathologist

As speech pathologists, we are uniquely positioned to recognise early signs of orofacial dysfunction.
OMT allows us to address the foundations — breathing, posture, swallow patterns, and oral rest positions — which then supports clearer speech, healthier feeding, improved sleep, more efficient growth and development, and better long-term outcomes.

OMT Is Bigger Than Just Speech

Although OMT supports clearer speech, it’s impact can be far broader.
The orofacial complex is part of a larger interconnected system, and changes in oral posture and breathing can create widespread effects.

Sleep and behaviour

Habitual mouth breathing or sleep-disordered breathing can significantly affect sleep quality. Poor sleep then contributes to challenges with attention, learning, emotional regulation, and daytime behaviour.

Breathing, airway function and immune health

Chronic mouth breathing bypasses the nose’s filtering and humidifying system.
It also reduces the natural production and delivery of nitric oxide. Nitric oxide is an antimicrobial, anti-inflammatory gas that supports immune function and healthy oxygen uptake.
Over time, this places additional strain on the airway and respiratory system.

Facial growth and palatal development

The tongue shapes the palate.

When it doesn’t rest on the palate:

• the palate can rise and narrow

• dental crowding and malocclusions increase

• airway space can become restricted

These changes are structural and long-lasting.

Ear health and Eustachian Tube Function

Efficient swallowing plays a part in opening and clearing the eustachian tubes. The eustachian tubes are small, narrow tubes that connect the middle ear (the space behind the eardrum) to the back of the nose and upper throat.
Low tongue posture (meaning the tongue is resting low in the mouth) can reduce activation of the muscles that support this process.

This may contribute to:

• recurrent ear infections

• persistent middle-ear fluid

• children requiring grommets

Clinically, we often see a strong overlap between habitual mouth breathing and chronic ear issues.

Long-term adult consequences

Years of compensations (low tongue posture, open-mouth breathing, inefficient swallowing) can contribute to:

• temporomandibular joint dysfunction

• tooth grinding (especially at night)

• headaches or migraines

• chronic jaw and neck tension

• airway restriction

• poor, restless sleep

Many adults present with these symptoms without ever having had the root cause addressed.

Why Might Someone Need OMT?

People may develop compensatory oral habits due to anything that disrupts nasal breathing or their tongue position.

Common contributors include:

• chronic colds/flus or recurrent respiratory illness

• allergies (seasonal or persistent)

• enlarged tonsils/adenoids

• any form of nasal obstruction

• prolonged periods of open-mouth breathing

• tethered oral tissues (tongue, lip, or buccal ties)

• habitual behaviours such as thumb sucking, dummy use, lip licking, nail biting

• structural issues such as a narrow palate or reduced nasal airway space

• poor oral rest posture becoming a learned habit over time

When nasal breathing is difficult, the body adapts by opening the mouth.

Over time, this creates new default patterns:

• the tongue drops low or forward

• the mandible rests lower

• lips no longer close passively

• swallowing compensations emerge where surrounding muscles jump in to ‘help’

• facial growth can be impacted

• dentition changes such as crowded teeth

• speech and feeding patterns can be affected

OMT works to “reset” these patterns once the underlying airway or structural issues have been medically addressed by the relevant professional ENT, dental, medical, orthodontic, and airway-focused practitioners.
This is why collaboration between professions is essential.