Tongue Thrusting

Muscle Function Problems
by Gary Hirsh, D.D.S., M.S.

What is tongue thrusting?
Tongue thrusting, simply defined, is the habit of thrusting the tongue forward against the teeth or in between while swallowing. It is an infantile pattern of swallowing that has been retained by an individual.
According to Dr. T. M. Graber, we swallow a total of 1,200 to 2,000 times every 24 hours with about four pounds of pressure per swallow. This constant pressure of the tongue will force the teeth out of alignment its an individual with a tongue thrust problem. Besides the pressure exerted while swallowing, nervous thrusting also pushes the tongue against the teeth while it is at rest. This is an involuntary, subconscious habit that is difficult to correct.

What causes tongue thrust?
No one specific cause has actually been determined for the tongue thrust problem. Any of the following may cause tongue thrust:

Certain types of artificial nipples used in feeding infants

Thumbsucking

Allergies, nasal congestion or obstructions contributing to mouth breathing causing the posture of the tongue to be very low in the mouth

Large tonsils, adenoids, or many sore throats which cause difficulty in swallowing

An abnormally large tongue

Hereditary factors within the family, such as the angle of the jaw line

Neurological, muscular, or other physiological abnormalities

Short lingual frenum (tongue tied)

Is there more than one type of tongue thrusting?
There are several different types of tongue thrust and resultant orthodontic problems:

Anterior open bite - the most common and typical type of tongue thrust. In this case, the front lips do not close and the child often has his mouth open with the tongue protruding beyond the lips. In general, it has been noted that a large tongue usually accompanies this type of tongue thrust.

Anterior thrust - upper incisors are extremely protruded and the lower incisors are pulled in by the lower lip. This particular type of thrust is most generally accompanied by a strong mentalis (muscle of the chin).

Unilateral thrust - the bite is characteristically open on either side.

Bilateral thrust - the anterior bite is closed; however the posterior teeth from the first bicuspid to the back molars may be open on both sides. This is the most difficult thrust to correct.

Bilateral anterior open bite - the only teeth that touch are the molars with the bite completely open on both sides including the anterior teeth. Once again a large tongue is also noted.

Closed bite thrust - typically shows a double protrusion meaning that both the upper and lower teeth are flared out and spread apart.

Is tongue thrust very prevalent?
Since 1958 the term "tongue thrust" has been described and discussed in speech and dental publications by many writers. Authorities have noted that a significant number of school-age children have tongue thrust. For example, according to recent literature, as many as 67 to 95 percent of the children 5 to 8 years old exhibit tongue thrust which may be associated with or contributing to an orthodontic or speech problem. Throughout the country, from 20 to 80 percent of orthodontic patients have some form of tongue thrust.

What are the consequences?
The force of the tongue against the teeth is an important factor in contributing to malformation ("bad bites"). Many orthodontists have had the discouraging experience of completing dental treatment, with what appeared to be good results, only to discover that the case had relapsed because the patient had a tongue thrust swallowing pattern. If the tongue is allowed to continue its pushing action against the teeth, it will continue to push the teeth forward and reverse the orthodontic work.

Is speech affected by tongue thrusting?
Speech is not frequently affected by the tongue thrust swallowing pattern. The "S" sound (lisping) is the one most affected. The lateral lisp (air forced on the side of the tongue rather than forward) shows dramatic improvement when the tongue thrust is also corrected. However, one problem is not always associated with the other.

At what age does a child usually exhibit a tongue thrust swallowing pattern?
A child exhibits a tongue thrust pattern from birth. Up to the age of four, there is a possibility that the child will outgrow the tongue thrust pattern and develop the mature pattern of swallowing. However, statistics have shown that if the tongue thrust swallowing pattern is retained, it may be strengthened beyond the age of four. In all probability, the child will need some type of training program to develop the mature swallowing pattern.

Who diagnoses tongue thrust?
The most difficult problem of all is the diagnosis. As a rule, orthodontists, general dentists, pedodontists, some pediatricians, and speech therapists detect the problem. In many cases, tongue thrust may not be detected until the child is under orthodontic care. However, diagnosis usually is made when the child displays a dental or speech problem that needs correction.

What Is the probability of correction?
With sincere commitment and cooperation of the child and parent and if there is no neuromuscular involvement, correction is possible in most cases. At the present time, successful correction of T.T. appears to be:

70% of the treated cases are successful
25% of the treated cases are unsuccessful due to poor cooperation and lack of commitment of the parent, patient, or both.
5% of the treated cases are unsuccessful due to factors that make correction impossible.

Generally, the tongue thrust swallowing pattern may be handled in two ways:

An appliance that is placed in the mouth by the dentist (mechanical method)
Correction by oral habit training - an exercise technique that re-educates the muscles associated with swallowing by changing the swallowing pattern. This method must be taught by a trained therapist. Therapy has proven to give the highest percentage of favorable results, however the appliance is still used and is successful in some cases.

I'd have to say that one half (or more) of the patients we see in our office have some form of Tongue Thrust, therefore, you can see how important this subject is in diagnosis and treatment planning.

Should you have any questions regarding this or any other matter, please don't hesitate to call the office.

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Dr. Hirsh
San Diego Office
7189 Navajo Road, Suite D
San Diego CA 92119
619-461-4310

Dr. Hirsh
La Jolla Office
7301 Girard Ave. Suite 200
La Jolla CA 92037
858-456-8080