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Speech Pathology – Speech and language pathology is concerned with issues surrounding human speech and language communication disorders.

Child development has many milestones including taking that first step, first eating of solid foods, and speech. The maturation of the speech process is one of the most important milestones in any child’s development. Speech development is a form of learned behavior that is influenced by many things like environment, parental involvement, and the child’s own mind and musculature. For most children speech development is an easy process but for some children they have difficulties and need extra attention and help. Studies have shown about 10% of children have some form of speech pathology that if not corrected will cause issues for them later in their development.

Speech is defined as the expression of or the ability to express thoughts and feelings by articulated sounds in a language. The actual mechanism of speech can be complex. The actual speech is coordinated by various parts of a child including their musculature, breathing, teeth, and mental/neurological capacities.

Actual speech begins with a baby crying and how the baby learns to communicate its needs and desires. This is why shortly after birth that a baby has different cries and a mother can distinguish a cry of pain from a cry of hunger.

At about the 6 month mark most babies begin to make sounds very similar to speech, attempting words but not quite there yet. In most children this will ramp up quickly over the next 6 months. When actual talking begins words are formed in isolation and not in complete sentences. Some kids aquire words and language very quickly and amass a larger vocabulary at an early age while others are slower to develop. There is a large spectrum of what is considered normal.

Speech Pathology Disorders

A speech disorder refers to a problem with the actual production of sounds. A language disorder refers to a difficulty understanding or putting words together to communicate properly.

Speech disorders include:

-Articulation disorders: difficulties producing sounds in syllables or saying words incorrectly to the point that listeners can’t understand what’s being said.

-Fluency disorders: Another name is stuttering. Stuttering is characterized as abnormal stoppages of speech, repetitions, or prolonging sounds and syllables.

-Resonance or voice disorders: problems with the pitch, volume, or quality of the voice that distract listeners from what’s being said. These types of disorders may also cause pain or discomfort for a child when speaking.

-Dysphagia/oral feeding disorders: these include difficulties with drooling, eating, and swallowing.

Language disorders can be either receptive or expressive:

-Receptive disorders: difficulties understanding or processing language.

-Expressive disorders: difficulty putting words together, limited vocabulary, or inability to use language in a socially appropriate way.

How Do Teeth, Tongue, and Oral Cavity Affect Speech?

Teeth and tongue and oral structures play an important role in the pronunciation of the consonants f, v, s, z, etc..,  In general children can compensate for minor oral issues and have no problems with speech.  Some dental issues are more extreme and may prevent or hinder pronunciation. Here are a few:

1. Open Bite . This is an oral malocclusion in which the front teeth do not close together. Many speech sounds require closed front teeth to enunciate.

2. Short Frenum. This is the attachment under the tongue, which can be so short that the tongue is actually attached at the tip to the tissue at the bottom of the mouth. The tongue needs to move and touch different areas to produce t,d,n,l,r sounds. This can usually be relieved with a small surgery with an ENT doctor.

3. Lack of Teeth. Whether due to early loss or lack of normal tooth development, loss of front teeth can make it extremely difficult to produce sounds well.

4. Cleft lip or Palate. Lack of full closure of lip or palate allows air to disrupt proper formation of speech sounds. Surgical closure helps to fix the problem, but speech therapy is generally still necessary.

5. Thumb Sucking After Effects. Prolonged thumb sucking can push front teeth forward, cause an open bite, and deform the palate. This combination can make proper speech development a challenge.

6. Tongue Thrust. This is when the tongue, during swallowing or speaking, pushes through the teeth. If not addressed with orthodontics, myofunctional therapy, or orthodontic appliances, the problem will cause movement of teeth and increased difficulty with speech. Tongue thrust needs to be diagnosed by your dentist.


Since speech is an important part of development, disorders may hinder personal, social and educational experience. Your dentist may be able to help you with diagnosing oral issues related to your child’s speech issues. Proper referrals to specialists can help get your child on the right path to proper speech development.

Tongue Thrusting is a muscular habit of the tongue. It is an action which occurs while swallowing, speaking and at rest. The tongue is thrusted forward and and pushes outward onto the front teeth.

Tongue Thrusting Marielaina Perrone DDS

Early Diagnosis of Tongue Thrusting can prevent long term issues.

It is estimated that we swallow between 1,300 and 2,000 times per day with about 4-5 lbs of pressure per swallow. This constant pressure of the tongue against the teeth will cause the teeth to be forced out of alignment. Children will also sometimes perform tongue thrusting when at rest. This is called nervous thrusting and is a habit that is difficult to correct.

Causes of Tongue Thrusting

After countless studies, there has never been a definitive answer as to why tongue thrusting occurs. There are some ideas as to why tongue thrusting happens. These include:

1) Thumbsucking habit. This builds forward thrusting habits of the tongue, and subsequently, puts extreme pressure on front teeth.

2) Use of artificial nipples on bottles for feeding babies. The texture and rigidity of some nipples will cause the baby to abnormal thrust his or her tongue more than natural breast feeding.

3) Mouth Breathers. Children who breath through their mouths can cause the posture of the tongue to be very low in the mouth. Nasal congestion, allergies, or other nasal obstructions may contribute to this.

4) Swallowing Difficulties. Children sometimes can have difficulty swallowing from enlarged adenoids, enlarged tonsils, or frequent sore throats.

5) Anatomically large tongue. A child with a tongue that is too big for his or her mouth will cause issues with swallowing.

6) Genetics. A child’s jaw line angle may predispose them to tongue thrusting.

7) Muscular, neurological, or other physiological abnormalities

8) Short Lingual Frenum. Also called being tongue tied.

9) Anterior open bite. When there is an anterior open bite, you can not close your front teeth, and you have trouble closing the lips together. Often, a child with an open bite will also have their tongue protruding beyond their lips. This is sometimes due to an abnormally large tongue.

10) Orthodontics. The change in bite and possible constriction of tongue space may contribute to tongue thrusting.

Types of Tongue Thrusting

1) Anterior thrust. This occurs when the lower lip pulls the lower incisors inward, and the upper incisors are extremely protruded. The anterior tongue thrusting is frequently accompanied by a strong muscle of the chin.

2) Unilateral thrust.  This occurs when their is an open bite on one side or the other but not both.

Tongue Thrusting Marielaina Perrone DDS

4) Bilateral thrust. Posterior teeth from the first bicuspid through back molars can be open on both sides and the anterior bite is closed. This type of tongue thrusting is the most difficult to treat.

5) Bilateral anterior open bite. In this type the only teeth that touch are the molars. The bite is completely open on both sides, including the front teeth. A large tongue is often found.

6) Closed bite thrust. In this type of tongue thrusting both the upper and lower teeth are spread apart and flared out. The closed bite thrust is typically a double protrusion.

Is Tongue Thrusting Common?

It is actually quite common to encounter a child between the ages of 5-8 years old with a tongue thrusting issue. Recent studies have shown between 70-90% of children had a tongue thrusting issue that could contribute to an orthodontic or speech problem. In the United States alone between 20 and 80 % of all orthodontic patients exhibit some form of tongue thrusting issue.

Issues Associated with Tongue Thrusting

The force of the tongue against the teeth is an important factor in contributing to misalignment of teeth. Many orthodontists have had the discouraging experience of completing dental treatment, with great results, only to discover that the patient had a tongue thrusting swallowing pattern. This continuous habit will put pressure on the teeth and eventually push them out of alignment and reverse the orthodontic work.

Speech is not usually affected by the tongue thrusting 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 this happen most?

Most children exhibit a tongue thrusting issue from birth because it is considered an infantile swallowing pattern. It is perfectly normal to have this swallowing pattern up to about age 4. Most children outgrow this swallowing pattern and develop the mature pattern of swallowing. Thus they avoid developing a tongue thrust. If the tongue thrusting pattern is not outgrown by age 4 the thrusting gets stronger and becomes a real issue for development.

Tongue Thrusting Diagnosis and Treatment

Diagnosing tongue thrusting can be very difficult. Usually the people who diagnose this will be orthodontists, general dentists, pediatricians or speech therapists. In many cases it is not detected until the child is a bit older and they have a speech or dental problem that needs correcting.

Correction is possible with commitment and cooperation of child and parent. Studies have shown that successful correction of tongue thrusting occurs in 75% of treated cases. Failures occur from lack of commitment by child and/or parent and also when there is a physical or mental developmental issue.

Usually, the tongue thrusting swallowing pattern may be treated in two ways:

1) Correction by MyoFunctional Therapy or Tongue Therapy. This type of therapy is an exercise technique that allows for re-educating the tongue muscles. It is sometimes referred to as physical therapy for the tongue. This is usually performed by a speech therapist through in-office visits and at-home exercises. The length of therapy is often based on the patient and parents cooperation and dedication to following instructions and practice routinely. This type of therapy has proven time and again to give the highest percentage of favorable outcomes.

2) Fabrication of a custom appliance. This appliance is placed in the mouth by the dentist or orthodontist. It is usually not very successful. It does nothing to retrain the tongue so it really has little  long term value.


Tongue thrusting is the reason for misalignment and bite problems for many. Once diagnosed, it can be addressed and treated. Nearly 50% of all patients seeing an orthodontist have tongue thrusting issues. It is important to know if tongue thrusting is an issue for your child, especially before the end phase of orthodontic treatment, so that it can be corrected before a reversion back to malocclusion results. The last thing you want is to lose that pretty smile you’ve worked so hard to attain!

Thumb sucking is a common habit and natural reflex for children. Sucking on thumbs, fingers, pacifiers or whatever they can get in their mouth may make babies feel secure and happy and help them learn about their world. Thumb sucking can continue as a child grows. They will use the thumb sucking to soothe themselves or help themselves fall asleep.

Is Thumb sucking normal?

Babies have a natural rooting and sucking reflex. This can cause them to put their thumbs or fingers into their mouths. Thumb sucking can sometimes can occur even before birth. Because thumb sucking is soothing to babies, some slowly develop a habit of thumb sucking when they are tired, anxious or simply bored. Some children who are thumb suckers will only suck their thumb, while some will need to hold an object they treasure, like a security blanket or soft stuffed animal.

Does Thumb sucking cause any problems?

Unfortunately thumb sucking can cause problems for children if it continues. Thumb sucking in children younger than 4 is usually not an issue for development. Children who suck their thumbs often or with increased aggressiveness after 4-5 years of age, or those who are still sucking their

effects of thum sucking

Effects of Thumb sucking

thumbs at age 6, are at risk for dental  or speech problems. Once the permanent teeth begin to come in and develop in the mouth, the persistent thumb sucking may cause top teeth to push out and upward, and bottom teeth to push inward. This tooth movement can cause development of a “buck tooth” appearance, an inability to close the front teeth (open bite), damage to the roof of the mouth, and subsequent speech issues. Pacifiers cause similar issues as thumb sucking but the habit of using the pacifier is a far easier habit to break, it can be thrown out, a finger can not. What determines if thumb sucking causes dental problems or not is the intensity and length of time of the thumb sucking. Checking a child’s thumb for damaged skin and calluses can help determine the aggressiveness of the thumb sucking habit. Many children simply rest their thumbs in their mouth. These children are far less likely to develop any long term issues from their version of thumb sucking. On the other hand, an aggressive thumb sucker may develop issues with their primary and permanent teeth (if they are still thumb sucking at that point when they erupt.

Speech problems caused by thumb sucking are related to the misaligned teeth, distorted palate, and tongue thrusting. The tongue does not have the ability to find the correct placement for proper enunciation, and the tongue muscle needs to be retrained. Tongue thrusting is the pushing forward motion of the tongue when swallowing, causing a continued pressure on the teeth even when not thumb sucking.Speech problems can include not being able to properly say S’s, T’s and D’s, lisping, and tongue thrusting when talking.

Children who are thumb suckers may need treatment for the following reason:

-They have not stopped thumb sucking on their own by age 4-5.

-Speech problems are becoming noticeable.

-If they are teased or feel embarrassed by their sucking.


At home treatment by children can include:

-Gentle reminders from parents and loved ones. When you notice your child sucking their thumb, gently remind him or her to stop. You should always avoid criticizing or making fun of your child. This will only create stress.

-Positive reinforcement. Positive reinforcement goes a long way in this area. Provide small rewards when they are not sucking their thumbs for extended periods of time. A reward could be as simple as an extra trip to the park or a slightly later bedtime.

-Competing response. Parents should give their child encouragement to do a different activity when they feel the urge to suck their thumbs. Could be something like squeezing a pillow.

Parents should also take away the child’s security blanket or stuffed animal during certain times of day. This will limit the amount of sucking. Another option is putting gloves on the hands or placing band aids over the thumb in question. This can help the child by reminding them they should not suck their thumbs.

If home treatment does not work and you are worried or feel frustrated about your child’s thumb sucking you should talk with your child’s dentist or doctor. There may be other treatment options, such as behavioral therapy, special nail polish for thumbnail, thumb devices, or devices for the mouth (habit appliances). A dental habit appliance is only a good idea for children who have not been able to stop thumb sucking on their own and have asked for help. It is usually something non removable, blocking the roof of the mouth to make thumb sucking impossible. It is worn for a few weeks to months and then removed by the dentist.

thumb sucking nail treatment

Thumb sucking nail treatment

Remember that thumb-sucking usually is not a problem until a child starts kindergarten or later. Most children will cease the activity on their own if you give them enough time. Slowly but surely, most children begin to stop thumb sucking on their own around ages 3-6 years old. If you notice changes in your child’s primary teeth, or are concerned about your child’s thumb sucking consult your dentist.