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NOT-S is a screening instrument that may be used to identify orofacial dysfunction in children aged three and older, in youths and in adults. The screening comprises a structured interview and a clinical exam and may be conducted by a variety of professional groups in dental and health care.

About NOT-S Development

NOT-S was developed in a joint Nordic project under the auspices of the Nordic Society for Disability and Oral Health (NFH). The work was conducted by a working group consisting of the dentists Merete Bakke, Copenhagen, and Birgitta Begendal, Jönköping, and the speech therapists Anita McAllister, Linköping, Lotta Sjögren, Göteborg and Pamela Åsten, Oslo.


NOT-S includes a structured interview and a clinical examination consisting of six domains each. The interviews contains the domains (I) Sensory function, (II) Breathing, (III) Habits, (IV) Chewing and swallowing, (V) Drooling, and (VI) Dryness of the mouth. The examination includes the domains (1) The face at rest, and tasks regarding (2) Nose breathing, (3) Facial expression, (4) Masticatory muscle and jaw function, (5) Oral motor function, and (6) Speech. One or more 'yes' for impairment in a domain resulted in one point (maximum NOT-S score 12 points).  

Content and Ordering

NOT-S consists of an illustrated manual and a screening form that are translated to all Nordic languages as well as English. The illustrated manual can be ordered via the Mun-H-Center’s homepage.

Requirements for translation of NOT-S

Download the Guidance to NOT-S

Download the illustrated manual as a PDF

Nordic languages and English


NOT-S in Danish
Responsible translator: Merete Bakke.


NOT-S in English
Responsible translator: Anita McAllister.


NOT-S in Finnish 
Responsible translator: Anneli Yliherva.


NOT-S in Icelandic 
Responsible translators: Elin Svarrer Wang and Ragnheidur Hansdottir.


NOT-S in Norwegian 
Responsible translator: Pamela Åsten.


NOT-S in Swedish

Other languages

Brazilian Portuguese

NOT-S in Brazilian Portuguese 
Responsible translator: Marina Severi Leme.


NOT-S in Chinese 
Responsible translator: Tailun He.


NOT-S in croatian
Responsible translator: Ana Malkoč and Ivana Miler.


NOT-S in Czech
Responsible translators: Juraj Traurig and Marietta Tesarova.


NOT-S in Estonian
Responsible translators: Veronika Raudsalu, Inna Marats, Tiiu Soopõld and Anna-Liisa Sutt.


NOT-S in French 
Responsible translator: Martine Hennequin.


NOT-S in German
Responsible translator: Frauke Mueller.


NOT-S in Italian 
Responsible translators: Claudia Fortuna and Andrea Ruggeri.


NOT-S in Japanese 
Responsible translators: Kenichi Goshima, Kumiko Kawashima and Hiroyuki Miura. Backtranslation: Kaoru Oyaizu.


NOT-S in Latvian 
Responsible translators: Eva Purina, Lolita Cibule, Andra Greitane, Ija Bauska, Ilze Blumentale and Ilze Klatenberga.


NOT-S in Portuguese 
Responsible translator: Rita Santiago.


NOT-S in Romanian 
Responsible translators: Carolina Bodea Hațegan and Dorina Talaș


NOT-S in Spanish 
Responsible translator: Joaquín Masoliver.


NOT-S in Turkish
Responsible translators: Alev ALAÇAM and Arzu Şükran İNCİOĞLU.


Baram S, Karlsborg M, Øzhayat EB, Bakke M. Effect of orofacial physiotherapeutic and hygiene interventions on oral health-related quality of life in patients with Parkinson's disease: A randomised controlled trial. J Oral Rehabil. 2021 Sep;48(9):1035-1043. doi: 10.1111/joor.13214. Epub 2021 Jun 26. PMID: 34129743; PMCID: PMC8457132. Read abstarct

Næss KB, Ostad J, Nygaard E. Differences and Similarities in Predictors of Expressive Vocabulary Development between Children with Down Syndrome and Young Typically Developing Children. Brain Sci. 2021 Mar 2;11(3):312. doi: 10.3390/brainsci11030312. PMID: 33801558; PMCID: PMC7998706.

Ozturk S, Ozsin Ozler C, Serel Arslan S, Demir N, Olmez MS, Uzamis Tekcicek M. Orofacial functions and oral health: An analysis on children aged 5-8 years old. J Texture Stud. 2021 Sep 5. doi: 10.1111/jtxs.12628. Epub ahead of print. PMID: 34482536. Read article



Baram S, Karlsborg M, Bakke M. Improvement of oral function and hygiene in Parkinson's disease: A randomised controlled clinical trial. J Oral Rehabil. 2020 Mar;47(3):370-376. doi: 10.1111/joor.12924. Epub 2020 Jan 5. PMID: 31837276. Read abstract

Mogren Å, Sjögreen L, Barr Agholme M, McAllister A. Orofacial function in children with Speech Sound Disorders (SSD) persisting after the age of six years. Int J Speech Lang Pathol. 2020 Mar 1:1-11. doi: 10.1080/17549507.2019.1701081. Epub ahead of print. PMID: 32114835.

Corsalini M, Rapone B, Cagnetta G, Carossa M, Sportelli P, De Giacomo A, Laforgia A, Di Venere D.  Orofacial Functions and Chewing Effiency in Elderly Patients with Parkinson’s Disease Rehabilitated with Removable Prostheses. The Open Dentistry Journal. 2020;(14):13-18. Doi:10.2174/1874210602014010013. Read articel

Kaczorowska N, Markulak P, Mikulewicz M. Assessment of orofacial dysfunction in a group of Polish children with unilateral cleft lip and palate: A preliminary report. Adv Clin Exp Med. 2020 Nov;29(11):1331-1336. doi: 10.17219/acem/128187. PMID: 33269820.


Montes ABM, Oliveira TM, Gavião MBD, Barbosa TS. Orofacial functions and quality of life in children with unilateral cleft lip and palate. Braz Oral Res. 2019 Sep 9;33:e0061. doi: 10.1590/1807-3107bor-2019.vol33.0061. Read abstract

Alaçam A, Çalık Yılmaz BC, Incioğlu AS. Assessment of orofacial dysfunction using the NOT-S method in a group of Turkish children with cerebral palsy. Eur Arch Paediatr Dent. 2019 Sep 6. doi: 10.1007/s40368-019-00475-z. [Epub ahead of print] Read abstract

Fromm L, Gotfredsen K, Wessel I2, Øzhayat EB. Oral health-related quality of life, oral aesthetics and oral function in head and neck cancer patients after oral rehabilitation. J Oral Rehabil. 2019 Aug;46(8):738-746. doi: 10.1111/joor.12806. Epub 2019 May 7. Read abstract

Mariano NCR, Sano MN, Neppelenbroek KH, Almeida ALPF, Oliveira TM, Soares S. Orofacial Dysfunction In Cleft And Non-Cleft Patients Using Nordic Orofacial Test - A Screening Study. Braz Dent J. 2019 Mar-Apr;30(2):179-184. doi: 10.1590/0103-6440201902376. Epub 2019 Apr 4. Read abstract

Linas N, Peyron MA, Hennequin M, Eschevins C, Nicolas E, Delfosse C, Collado V. Masticatory behavior for different solid foods in preschool children according to their oral state. J Texture Stud. 2019 Jun;50(3):224-236. doi: 10.1111/jtxs.12387. Epub 2019 Feb 6. Read abstract


Sundell AL, Marcusson A. A comparison of orofacial profiles in 5- and 10-year-old Swedish children with and without cleft lip and/or palate. Clin Oral Investig. 2018 Jul 16. doi: 10.1007/s00784-018-2562-3. [Epub ahead of print]. Read abstract

Malmenholt A, McAllister A, Lohmander A. Orofacial Function, Articulation Proficiency and Intelligibility in 5-year-Old Children With cleft Lip and Palate. Cleft Palate Craniofac J. 2018 Jan [Epub ahead of print]. Read article

Mariano NCR, Sano MN, Curvêllo VP, de Almeida ALPF, Neppelenbroek KH, Oliveira TM, Soares S.Impact of Orofacial Dysfunction on the Quality of Life of Adult Patients With Cleft Lip and Palate.Cleft Palate Craniofac J. 2018 Jan 1:1055665618760897. doi: 10.1177/1055665618760897. [Epub ahead of print] Read abstract

Scarponi L, de Felicio CM, Sforza C, Pimenta Ferreira CL, Ginocchio D, Pizzorni N, Barozzi S, Mozzanica F, Schindler A. Reliability and Validity of the Italian Version of the Protocol of Orofacial Myofunctional Evaluation with Scores (I-OMES). Folia Phoniatr Logop. 2018;70(1):8-12. doi: 10.1159/000488027. Epub 2018 May 30. Read abstract

Montes ABM, de Oliveira TM, Gavião MBD, de Souza Barbosa T.  Occlusal, chewing, and tasting characteristics associated with orofacial dysfunctions in children with unilateral cleft lip and palate: a case-control study. Clin Oral Investig. 2018 Mar;22(2):941-950. doi: 10.1007/s00784-017-2173-4. Epub 2017 Jul 31. Read abstract

Pinto VV, Alves LAC, Mendes FM, Ciamponi AL. The nutritional state of children and adolescents with cerebral palsy is associated with oral motor dysfunction and social conditions: a cross sectional study. BMC Neurol. 2016 Apr 26;16:55. doi: 10.1186/s12883-016-0573-8. Read abstract


Collado V, Pichot H, Delfosse C, Eschevins C, Nicolas E, Hennequin M.Impact of early childhood caries and its treatment under general anesthesia on orofacial function and quality of life : A prospective comparative study. Med Oral Patol Oral Cir Bucal. 2017 May 1;22(3):e333-e341. Read article

Knappe SW, Bakke M, Svanholt P, Petersson A, Sonnesen L. Long-term side effects on the temporomandibular joints and orofacial function in patients with obstructive sleep apnea treated with a mandibular advancement device. J Oral Rehabil. 2017 May;44(5):354-362. doi: 10.1111/joor.12485.  Read abstract

Cavalcante-Leão BL, Todero SR, Ferreira FM, Gavião MB, Fraiz FC.Profile of orofacial dysfunction in Brazilian children using the Nordic Orofacial Test-Screening.Acta Odontol Scand. 2017 May;75(4):262-267. doi: 10.1080/00016357.2017.1290823. Epub 2017 Feb 28. Read abstract

Pedersen LK, Maimburg RD, Hertz JM, Gjørup H, Pedersen TK, Møller-Madsen B, Østergaard JR. Moebius sequence -a multidisciplinary clinical approach. Orphanet J Rare Dis. 2017 Jan 6;12(1):4. doi: 10.1186/s13023-016-0559-z. Read abstract

Sardenberg F, Cavalcante-Leão BL, Todero SR, Ferreira FM, Rebellato NL, Fraiz  FC. A population-based study on the impact of orofacial dysfunction on oral health-related quality of life among Brazilian schoolchildren. Acta Odontol Scand. 2017 an 8:1-9. doi: 10.1080/00016357.2016.1275038. [Epub ahead of print]. Read abstract

Bergendal B, McAllister A. Orofacial function and monitoring of oral care in amyotrophic lateral sclerosis. Acta Odontol Scand. 2017 Jan 12:1-10. doi:10.1080/00016357.2016.1276212. [Epub ahead of print] Read abstract

Cheng SY, Kwong SHW, Pang WM, Wan LY. Effects of an Oral-Pharyngeal Motor Training Programme on Children with Obstructive Sleep Apnea Syndrome in Hong Kong: A Retrospective Pilot Study. Hong Kong J Occup Ther. 2017 Dec;30(1):1-5. doi: 10.1016/j.hkjot.2017.09.001. Epub 2017 Nov 23. Read abstract


Gonçalves ML, França CM, Fragoso YD, Deana AM, de Almeida LM, Bussadori SK. Orofacial evaluation in patients with multiple sclerosis using Nordic Orofacial Test-Screening. Clin Oral Investig. 2016 Sep 6. [Epub ahead of print] Read abstract

Pinto VV, Alves LA, Mendes FM, Ciamponi AL. The nutritional state of children and adolescents with cerebral palsy is associated with oral motor dysfunction and social conditions: a cross sectional study. BMC Neurol 2016;16(1):55. doi: 10.1186/s12883-016-0573-8. Read abstract

Edvinsson SE, Lundqvist LO. Prevalence of orofacial dysfunction in cerebral palsy and its association with gross motor function and manual ability. Dev Med Child Neurol. 2016;58(4):385-394. doi: 10.1111/dmcn.12867. Read abstract


Kent RD. Nonspeech Oral Movements and Oral Motor Disorders: A Narrative Review. Am J Speech Lang Pathol. 2015 Nov;24(4):763-89. doi: 10.1044/2015_AJSLP-14-0179. Read abstract

Amato JN, Tuon RA, Castelo PM, Gavião MB, Barbosa Tde S. Assessment of sleep bruxism, orthodontic treatment need, orofacial dysfunctions and salivary biomarkers in asthmatic children. Arch Oral Biol. 2015;60(5):698-705. doi: 10.1016/j.archoralbio.2015.02.011. Read abstract


Marquezin MC, Gavião MB, Alonso MB, Ramirez-Sotelo LR, Haiter-Neto F, Castelo PM. Relationsship between orofacial funtion, dentofacial morphology, and bite force in young subjects. oral Dis 2014,20:567-573. Read abstract

Leme M, Barbosa T, Castelo P, Gavião MB. Associations between psychological factors and the presence of deleterious oral habits in children and adolescents. J Clin Pediatr Dent 2014;38:313-317. Read abstract

Kobayashi FY, Gavião MB, Montes AB, Marquezin MC, Castelo PM. Evaluation of oro-facial function in young subjects with temporomandibular disorders. J Oral Rehabil 2014;41:496-506. Read abstract

Bakke M, Petersson A, Wiese M, Svanholt P, Sonnesen L. Bony Deviations Revealed by Cone Beam Computed Tomography of the Temporomandibular Joint in Subjects Without Ongoing Pain. J Oral Facial Pain Headache 2014;28:331-337. Read abstract

Bergendal B, Bakke M, McAllister A, Sjögreen L, Asten P. Profiles of orofacial dysfunction in different diagnostic groups using the Nordic Orofacial Test (NOT-S)-A review. Acta Odontol Scand. 2014 Nov;72(8):578-584. doi: 10.3109/00016357.2014.942874. Read abstract

Åsten P, Akre H, Persson C. Associations between speech features and phenotypic severity in Treacher Collins syndrome. BMC Med Genet. 2014 Apr 28;15(1):47. Read abstract


McAllister A, Lundeborg I. Oral sensorimotor functions in typically developing children 3 to 8 years old; assessed by the Nordic orofacial test, NOT-S. J Med Speech Lang Pathol 2013;22:51-55. Read abstract

Mariën P, Vidts A, Van Hecke W, De Surgeloose D, De Belder F, Parizel PM, Engelborghs S, De Deyn PP, Verhoeven J. Mastication dyspraxia: a neurodevelopmental disorder reflecting disruption of the cerebellocerebral network involved in planned actions. Cerebellum. 2013 Apr;12(2):277-89. doi: 10.1007/s12311-012-0420-4. Read abstract

Edvinsson SE, Lundqvist LO. Inter-rater and intra-rater agreement on the Nordic Orofacial Test-Screening examination in children, adolescents and young adults with cerebral palsy. Acta Odontol Scand. 2014;72:120-129. Read abstract 

Leme MS, de Souza Barbosa T, Gavião MB. Relationship among oral habits, orofacial function and oral health-related quality of life in children. Braz Oral Res. 2013;27:272-278. Read abstract

Bakke M, Larsen BM, Dalager T, Møller E. Oromandibular dystonia—functional and clinical characteristics: a report on 21 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115:e21-26. Epub 2012 Sep 21. Read abstract

Marquezin MC, Kobayashi FY, Montes AB, Gavião MB, Castelo PM. Assessment of masticatory performance, bite force, orthodontic treatment need and orofacial dysfunction in children and adolescents. Arch Oral Biol 2013 ;58:286-292.Epub 2012 Aug 29. Read abstract 


De Felício CM, Medeiros AP, de Oliveira Melchior M. Validity of the 'protocolof oro-facial myofunctional evaluation with scores' for young and adult subjects. J Oral Rehabil 2012;39:744-753. Epub 2012 Aug 1. Read abstract

Åsten P, Skogedal N, Nordgarden H, Axelsson S, Akre H, Sjögreen L.Orofacial functions and oral health associated with Treacher Collins syndrome. Acta OdontolScand. 2013;71:616-625. Epub 2012 Jul 12. Read abstract 


Strini PJ, Strini PJ, De Souza Barbosa T, Duarte Gavião MB. Assessment of orofacial dysfunctions, salivary cortisol levels and oral health related qualityof life (ORHQoL) in young adults. Arch Oral Biol 2011;56:1521-1527. Read abstract 

Saeves R, Asten P, Storhaug K, Bågesund M. Orofacial dysfunction in individuals with Prader-Willi syndrome assessed with NOT-S. Acta Odontol Scand 2011;69:310-315. Read abstract

Bakke M, Larsen SL, Lautrup C, Karlsborg M. Orofacial function and oral health in patients with Parkinson's disease. Eur J Oral Sci. 2011;119:27-32. Read abstract 


Bergendal B, McAllister A, Stecksén-Blicks C. Orofacial dysfunction in ectodermal dysplasias measured using the Nordic Orofacial Test-Screening protocol. Acta Odontol Scand 2009;67:377-381. Read abstract 

Lundeborg I, McAllister A, Graf J, Ericsson E, Hultcrantz E. Oral motor dysfunction in children with adenotonsillar hypertrophy--effects of surgery. Logoped Phoniatr Vocol 2009;34:111-116. Read abstract


Bakke M, Bergendal B, McAllister A, Sjögreen L, Asten P. Development and evaluation of a comprehensive screening for orofacial dysfunction. Swed Dent J 2007;31:75-84. Read article

Updated: 2021-04-22 15:02