Tongue thrust therapy

What is tongue thrust?

Tongue thrust typically refers to the incorrect placement of the tongue when swallowing, which is something the average person does between 1,200 and 2,000 times. Thrusting can also refer to a habit known as nervous thrusting, in which a person subconsciously pushes the tongue against the teeth.

The tongue is a powerful muscle. This constant or repetitive pressure against teeth can eventually push them out of alignment. Because thrusting is an involuntary action, it can be extremely difficult to correct.

What causes tongue thrusting?

There are many possible causes, including:

• The habit of thumb sucking
• Large tonsils or adenoids can lead to mouth breathing
• Allergies and nasal congestion
• A larger than average tongue
• Hereditary factors such as the shape and angle of the jaw
• Physiological, neurological, or muscular abnormalities
• The short lingual frenum, commonly known as tongue-tie

Types of tongue thrust

There are several different classifications of tongue thrust, all of which can contribute to orthodontic complications. These include:

• Anterior open bite: Lips do not properly close when the mouth is at rest. Often, the child will have an open mouth, with his or her tongue protruding past the lips. This is the most common type of tongue thrust.
• Anterior thrust: The upper incisors are protruding, while the lip pulls the lower incisors back. Often, this is accompanied by mentalis (an exceptionally strong chin muscle).
• Unilateral thrust: Generally, this involves an open bite on either side of the mouth.
• Bilateral thrust: The posterior (back) teeth are generally open on both sides, while the anterior (front) teeth are closed.
• Bilateral anterior open bite: Only the molars are able to touch, while the rest of the bite is open. Frequently, this is accompanied by a quite large tongue.
• Closed bite thrust: This is generally a dual-protrusion, where the upper and lower teeth are flared and spread apart.

How common is tongue thrust?

Although the condition has likely existed for generations, the term “tongue thrust” has been in use since the 1950’s. In that time, many specialists have noted that it is a common condition among young children.

Recent publications have reported from 67 to 95 percent of children between the ages of five and eight exhibit signs of tongue thrust and associated orthodontic or speech problems.

How does tongue thrust affect the teeth?

The pressure of the tongue pushing against teeth can cause them to move outward. It can be a significant contributing factor in malformation, which is often called a bad bite. This can happen even after orthodontic treatment. Many orthodontists have reported treating patients with perfect results, only to have those results reversed by the continuation of tongue thrusting.

How does tongue thrust affect speech?

Often, those with tongue thrust also have speech problems. In some cases, it can contribute to lisping. A latter lisp, which is caused by air moving to the side of the tongue instead of forward, may be improved by correcting the tongue thrust habit. There are also cases where a lisp is not related to the tongue thrust.

At what age is tongue thrust a cause for concern?

Tongue thrusting is the normal, healthy swallowing pattern for infants. Therefore, it is present in virtually every baby, and it is not a cause for concern. However, a child should outgrow this habit and transition to a more mature swallowing pattern by the age of four.

If a child continues the tongue thrusting swallowing pattern past the age of four, it is likely to strengthen. When that happens, it can negatively impact orthodontic development. A training program is needed to change the swallowing pattern.

How is tongue thrust diagnosed?

Unfortunately, diagnosis of this problem can be extremely challenging. Usually, a child is not diagnosed until tongue thrusting has caused a speech or dental problem. The diagnosis may be made by a dentist, pediatric dentist, orthodontist, pediatrician, or speech therapist.

How is tongue thrust treated?

The good news is that a tongue-thrusting swallowing pattern is treatable. In most cases, it can be successfully corrected, unless there is significant neuromuscular involvement. However, this requires cooperation and commitment from the parent and child.

On average, treatment is successful in 75 percent of cases. In about 20 percent of cases, treatment fails due to lack of commitment and poor compliance by the patients and their parents. Only about five percent of treatments are unsuccessful for other reasons, such as mental or physical developmental problems that make tongue thrust correction impossible.

Approximately half of the bite problems and misalignment in orthodontic patients are caused by tongue thrusting. Generally, tongue therapy is necessary in conjunction with orthodontic treatment to achieve lasting results.

There are two primary methods of correcting tongue thrust. In either case, speech therapy may be recommended as an adjunct if appropriate.

• Myofunctional therapy – With proper compliance, this approach has been proven to yield the best results. It involves corrective exercises, which are designed to retrain muscles in the tongue. First, your dentist will diagnose the tongue thrust problem. Then we will arrange an initial consultation with one of our oral health therapists or hygienists, who are trained in myotherapy. The therapist or hygienist will assess your child and recommend a specific set of exercises to be performed at home. Your child will need to have weekly appointments, during which the therapist or hygienist will assess progress, provide feedback, and recommend new exercises as needed. We are happy to answer questions and provide support throughout the program. The total treatment time depends on several factors, with the most important being patient compliance.
• Oral appliance – This is available as an alternative to myofunctional therapy. The appliance works by causing tongue thrusting to be uncomfortable, which discourages the habit. Often, these appliances are designed with a sharp spot that the tongue will contact when thrusting. This technique has been proven to be less effective than myofunctional therapy.

We are here to help

Our dentists, oral health therapists, and hygienists are trained in diagnosing and treating tongue thrusting. If you are concerned that your child may have a problem with tongue thrusting, please call Smile in Style at 03 8400 4104 (Moonee Ponds) or 03 8001 6021 (Sunbury) to arrange a consultation or book online at www.smileinstyle.com.au.