A dysfunction of the mouth is also known as orofacial disorder. The orofacial disorder affects the person’s breathing, communication, as well as food intake. For these reasons, it is important to begin therapy as soon as possible so that any complications and impairments can be treated.
What is an orofacial disorder?
The medical profession calls orofacial disorder any disorders that occur in the context of the mouth muscles as well as the facial muscles (oral as well as facial disorders). Especially children suffering from movement disorders are often affected by orofacial disorders. This often involves damage or even dysfunction of the child’s brain; the occurrence of orofacial disorder in polio, for example, is classic.
Causes
The causes of orofacial disorder are multifactorial. This means that it can be not only functional but also organic causes that trigger an orofacial disorder. The classic causes include – in addition to polio – chronic or permanent inflammation as well as enlargement of the palatine tonsils (tonsils) or frequent infections of the respiratory tract. Allergies, a shortened lingual frenulum or genetic skeletal anomalies can also promote or trigger an orofacial disorder. However, psychological strain and stress factors of any kind are also possible causes that can lead to an orofacial disorder. Also very long thumb sucking, lip licking as well as the long use of a pacifier promote an orofacial disorder. Occasionally, acquired misbehavior – such as “incorrect bottle-sucking” or postural problems and incorrect body tension can also cause orofacial dysfunction. Occasionally, orofacial dysfunction can also be triggered by tactile-kinesthetic dysfunction; occurrence in the context of general developmental disabilities (such as those due to Down syndrome) is also possible.
Symptoms, complaints, and signs
As a rule, orofacial dysfunction manifests itself by the fact that affected children cannot breathe through their nose. This is because there is a lack of oral closure. Occasionally, swallowing difficulties may also occur. Other symptoms also include communication impairments or even problems taking in food properly. Symptoms are relatively easy to recognize; if an orofacial disorder is suspected, a medical professional should be contacted.
Diagnosis and disease progression
If the first symptoms appear, sometimes suggestive of an orofacial disorder, a medical professional should be consulted as soon as possible. This is because – the earlier treatment begins – the course of the disorder can be positively influenced. The first step in treatment is a medical history interview; the attending physician also wants to know information about the course of development. Even possible causes play a role in the diagnosis, so that the parents should not only be aware of any favoring factors (thumb sucking), but also need to know the eating habits as well as the diet of the child. This is followed by a routine sound check and examination of the oral cavity as well as the dental status. Subsequently, the physician checks the perception and mobility of those muscles that are needed for the swallowing process. The swallowing process is examined using the “Payne technique”. During this process, the medical professional also classifies the use of so-called “lip retainers”.
Complications
In this disease, there are usually various complications and discomforts to the mouth of the affected person. In most cases, the patient’s communication is significantly disturbed as a result, so social problems may also occur. Children or adolescents in particular may suffer from bullying and teasing and may develop psychological complaints or depression as a result. Furthermore, the intake of food and fluids is no longer possible for the affected person without further ado, so that underweight or various deficiency symptoms may occur. The quality of life of the affected person is considerably reduced by this disease. Swallowing difficulties also often occur and make the patient’s everyday life more difficult. Furthermore, the parents and relatives of the patient are often also affected by this disease and thus suffer from depression or other psychological complaints.Treatment of this disorder is not associated with complications in most cases. As a rule, this is done with the help of various therapies. However, success cannot be guaranteed. It is possible that the affected person will thus be dependent on the help of other people for the rest of his or her life.
When should one go to the doctor?
If children suffer from a disorder of chewing movements, they need medical help. Refusal of food or fluid intake threatens the organism with malnutrition. A doctor must be consulted to prevent an acute health-threatening condition. Paralysis, difficulty swallowing, a decrease in body weight, or impaired phonation must be investigated and treated. Any withdrawal behavior, stress, or stressful life situations should be discussed with a physician. If the complaints persist unabated for several days or weeks, a visit to the doctor is necessary. An increase in health irregularities must also be presented to a doctor. A reduced sense of well-being, malaise or behavioral abnormalities are signs of a disorder. If participation in social life or family activities is refused, this is usually a warning signal. A depressed mood, fluctuations in mood or an aggressive demeanor require a visit to the doctor. There is also a need for action if there is a feeling of illness or if deficiency symptoms develop. Changes in skin appearance, sleep disorders, attention deficits or a pale appearance can be consequences of an orofacial disorder. A visit to the doctor is advisable, as the quality of life is already severely impaired and the affected person needs medical help. If pain or inconsistencies with an existing denture occur, clarification of the complaints is also indicated.
Treatment and therapy
In the context of orofacial disorder, a holistic therapy is applied. In the course of treatment, the physician tries to create a muscular balance, which naturally exists mainly in the orofacial area. This balance is based on the so-called whole-body balance, which includes grounding, symmetry, tone, breathing, and also the uprightness and posture of the patient. The first step is the KOST – this is the “body-oriented speech therapy” according to Codoni. In this process, the physician works out a manual speech and voice therapy, tries to promote elements from sensory integration and mainly pays attention to craniosacral therapy. After the KOST has been carried out and drawn up, an attempt is made to ensure that various promoting factors are discouraged. These include thumb sucking or the constant use of a pacifier. Subsequently, the main focus is on muscle training. This involves training the muscles of the tongue, lip, jaw and chewing muscles. Only in this way is it possible for orofacial balance to be achieved. This is followed by training the physiological tongue rest position, nasal breathing as well as also the physiological swallowing pattern. It is important that the therapy of orofacial disorder is carried out in sequence; the medical professional must go through the steps – together with the patient – from the very beginning, so that maximum success can be achieved. Due to the fact that every patient has individual problems and orofacial dysfunction can be more or less pronounced, it is important to use face shapers and ballovents. These can also be helpful in case of individual problems. Other methods that can be used in therapy include holistic therapies according to S. Codoni, myofunctional therapies according to A. Kittel, orofacial regulation therapy, PNF and manual therapy of the voice. Furthermore, elements from the so-called sensory integration therapy are also applied; finally, neurolinguistic programming is performed.
Outlook and prognosis
An orofacial disorder is a dysfunction of the muscular functions in the facial area around the mouth. Orofacial dysfunction causes swallowing and speech problems. All movements in this area are impeded, such as swallowing or speaking. The cheek, lip and tongue muscles are affected. The prognosis has improved slightly with newer treatment approaches. The previous therapy approach has been improved by a playful therapy approach.The treatment with it concerns mainly ill children from the age of four. The treating therapists and speech therapists can now correct or compensate for the orofacial dysfunction of those affected with whole-body coordination, stimulation and playful perception exercises. The therapy begins with an intensive phase. It is then transferred to a less intensive interval phase. In this phase, the achievements are tested again and again – for example with fun swallowing tests. Provided that the parents cooperate consistently to reduce the consequences of the orofacial disorder, the treatment successes are quite good. Articulation and residual dysfunction due to orofacial dysfunction can often be significantly improved. The prognosis is good if the therapy can be adapted to the individual circumstances of the child. The prerequisite is a developmental age between four and eight years, which allows active cooperation of the child. The orofacial disorder cannot be corrected, but it can be alleviated.
Prevention
There is limited prevention of orofacial disorder. For example, parents can make sure that their children do not suck their thumbs much, if at all, or are busy with a pacifier. However, if the orofacial disorder occurs because of a disease (for example, polio), preventive measures are usually not possible.
Aftercare
Orofacial disorders can take different forms and require individual therapy and follow-up care. Generally, follow-up care includes a check to determine whether the patient is symptom-free. During the anamnesis, the doctor also clarifies any open questions the patient may have. During the physical examination, any surgical scars and any remaining deformities are examined. For this purpose, the physician uses the necessary procedures and measuring instruments, such as imaging procedures or blood sampling. If necessary, contact can be made with a therapist. This is particularly necessary in the case of long-term illnesses, as mental problems often develop as a result of the speech disorders. These must be clarified and treated in discussion with the therapist. Drug treatment of any psychological problems requires comprehensive aftercare, often beyond the treatment of the physical disorders. Follow-up care for orofacial dysfunction is usually provided by the primary care physician or a speech therapist. In most cases, only one follow-up visit is scheduled because once an orofacial disorder is cured, it usually does not increase or worsen. If symptoms persist, therapy must be resumed. Isolated symptoms and complaints, such as the typical cleft lip and palate, require independent follow-up.
What you can do yourself
Sufferers of orofacial disorder suffer from respiratory impairment. In many cases, the impairments trigger diffuse anxiety. Therefore, it is especially important in everyday life to remain calm whenever possible. Panic should be avoided at all costs, as it leads to an increase in symptoms and thus to further respiratory distress. The disturbances in communication cause despair and helplessness in sufferers and their relatives. The restrictions should be met with a positive basic attitude. Slowly and with a lot of understanding, the adversities in everyday life should be handled. Sign language or body language can compensate for the lack of verbal communication. This allows for sufficient exchange in everyday life. In addition, care should be taken to maintain a positive basic attitude. The joy of life should be promoted despite the disease, so that the handling of the disease succeeds better. In the case of depressive phases, mood swings and apathy, the help and support of a therapist should be sought. Motivating words for the patient are important in everyday life. Contact with other sufferers can be helpful in providing mutual support Self-help groups and Internet forums are used to clarify open questions that move sufferers within themselves. Exercises and training sessions should be inserted between the therapy sessions on one’s own responsibility. These help to alleviate the symptoms.
