Tongue Thrusting…What is It?
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.
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.
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.
Conclusion
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!
