What is a tongue thrust?
Tongue thrust is a term that describes the habit of pushing your tongue forward between the upper and lower teeth when you swallow.
This swallowing pattern where an individual pushes the tongue against or between the teeth is hard to break without help. This habit has also been called deviate swallow, reversed swallow, oral myofunctional disorder, visceral swallow, infantile swallowing pattern, and abnormal swallow.
The proper positioning for the tongue is for the tip to push against the roof of your mouth on the gums behind your upper front teeth.
What Causes a Tongue Thrust?
Tongue thrust is the persistence of an infantile swallow pattern that continues into late childhood. It may lead to breathing and speech difficulties, open bite, and protruded teeth. During formative years, most children successfully transition from an infantile to a mature swallowing pattern.
However, some children develop a tongue thrust habit which could be due to habits caused by thumb-sucking, finger sucking or extended pacifier usage, enlarged adenoids and mouth breathing.
The adverse effects of these habits can be avoided by early detection and intervention in a growing child. Tongue thrust can be treated in different ways with early diagnosis, removal of underlying causes, correcting tongue posture, and breaking of habit with the use of orthodontic appliances or oral myofunctional therapy. (OMT)
OMT focuses on awareness and exercises which can help a child correct the tongue thrust. These can be performed at home under the supervision of the child’s parents. Orofacial myofunctional therapy has provided a dramatic and positive influence on patients treated for tongue thrust.
Eating, speaking, and correct breathing can also be regained along with confidence, self-esteem, and improved quality of life. Clinically, OMT plays a positive role by not only improving swallow but also the posture of tongue, improper muscle function, and reduces relapse of orthodontic treatments.
It also may be due to an untreated tongue-tie. Early diagnosis and treatment through myofunctional therapy corrects the improper tongue movements.
When the tongue pushes forward it can move the teeth and create what is known as an open bite. If it is not noticed and keeps happening, the tongue will continue to push through the space. It can also create a speech impediment.
Early diagnosis and treatment through myofunctional therapy correct the improper tongue movements. However, if the condition is left untreated, it could cause skeletal development problems as the child ages, resulting in the need for orthodontic care.
It is best to identify and treat tongue thrusts early in life. However, even adults can benefit from treatment. If you notice your tongue pushing against your teeth when speaking, eating, or swallowing, it is time to schedule an appointment for an evaluation with a dentist or myofunctional therapist.
If a tongue thrust is present before braces are put on and not addressed, there can be a relapse, which means the teeth can move back after the braces come off.
It is estimated a person swallows a total of 1,200 to 2,000 times every 24 hours with about four pounds of pressure per swallow.
This constant tongue pressure will force the teeth and arches out of alignment. Aside from the pressure exerted while swallowing, nervous thrusting also pushes the tongue against the teeth while resting. This is an involuntary, subconscious habit that is difficult to correct.
What are the signs and symptoms for someone who tongue thrusts?
- Tongue protrusion between or against the teeth when forming /s, z, t, d, n, l, sh/
- Frequent open mouth resting position with lips parted
- Mouth breathing
- Messy and loud eating
- Tongue visually near the front of the mouth or between teeth while speaking and swallowing
- Lips often cracked, chapped, and sore from frequent licking
- TMD (jaw or jaw joint) pain
- Orthodontic relapse
- Protruding teeth
- Open bite
What are the causes of a tongue thrust?
- High arches and narrow palate
- Allergies or congestion
- Enlarged tonsils
- Prolonged use of artificial nipples (bottles/ pacifiers)
- Prolonged sippy cup usage
- Thumb sucking
Can a tongue thrust be fixed?
Nationwide, successful correction of tongue thrust appears in 75% of treated cases; 20% of patients are unsuccessful due to poor cooperation and lack of commitment by parents and clients; and the remaining 5% are unsuccessful due to other factors that make correction impossible, such as physical or mental development problems.
Treatment may include the following: (a) education regarding the importance of proper tongue and lip postures when at rest and when swallowing, (b) awareness training to establish appropriate resting postures for the lips and tongue, and (c) exercises to develop an appropriate swallow movement.
How do you know if you have tongue thrust?
Although there is more than one symptom indicating tongue thrust, the primary sign is your tongue pushing against the back of your teeth when you swallow. Tongue thrust can be easier to detect when you attempt to swallow and see the tongue press against the teeth or the saliva push through the teeth.
In infancy, tongue thrust is a natural reflex that happens when something touches the baby’s mouth. This reflex causes the tongue to push out to help the baby breast or bottle-feed. As the child ages, their swallowing habits naturally change, and this reflex goes away.
Common Treatments of Tongue Thrusting
A tongue thrust will not go away on its own; it requires awareness and neuromuscular retraining of the brain.
- Myofunctional Therapy– Much like physical therapy for your body, myofunctional therapy uses specific exercises that train the tongue and mouth to function correctly when swallowing and breathing. In addition, it helps the tongue rest with closed lips, teeth together, and your tongue is pressing gently against the roof of your mouth in a natural position.
- Oral Appliances – Some oral appliances, like custom-fitted mouthguards, can be worn all or part of the day to help prevent your tongue from pressing against your teeth.
- Behavioral Changes – Tongue thrust could be caused by a repeated pattern. Once diagnosed, you can help your child recognize the behavior and change the habits through self-awareness and exercises with a myofunctional therapist.
- Orthodontics – Depending on the severity of your tongue thrust and the damage caused to your teeth, you may need orthodontic treatment.
Functional – ankyloglossia” or tongue tie can be diagnosed using a grading scale: and assessing the tongue’s range of motion. Tongue range of motion ratio had grades and % Grade 1 >80%, grade 2 50-80%, grade 3 < 50%, grade 4 < 25%.
It is important to understand that OMT cannot replace orthodontic correction. It is in conjunction with other modes of treatments. Myo functional therapy is active exercise and the success of which depends critically on the motivation levels and compliance of children and their parents, equally.
The team may include general dentists, orthodontists, pediatric dentists, speech pathologists, and pediatricians as well. It will be crucial to bring attention of the clinicians to the oral musculature and its functions, which will hold the key for successful treatment of oral functions.
Orofacial myofunctional therapy definitely has a role in the management of tongue thrust and should be included as a part of the comprehensive treatment plan for the patient. It makes the patient aware of the faulty rest position and dynamic positions of the tongue and helps to learn the physiological myofunctional behavior.
Orofacial myofunctional therapy in tongue thrust helps to:
- Improve tongue elevation strength.
- Correct tongue resting posture.
- Correct tongue placement while swallowing.
- Improve tongue motility.
- Improve maxillary constriction.
- Prevent relapse of corrected malocclusion.
- Improve sleep-disordered breathing.
Tongue thrust, if left untreated, could cause problems into adulthood. However, there are several options available to correct this disorder. If you think you or your child suffer from tongue thrust, feel free to contact me at.