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Tongue Thrust
Put simply a “tongue thrust” is a common name for the act of moving the teeth forward through the teeth while swallowing foods, liquids, or during speech production of certain sounds. Nearly all infants swallow by pushing the tongue forward, and for this reason it is also sometimes referred as a “reverse” or “immature” swallow. However, by the time most children are six years old, they establish a “normal” swallowing pattern of squeezing the tongue against the roof of the mouth instead of pushing it forward against the teeth.
Did you know that we swallow around 1,200 to 2,000 times every day (during a 24-hour period), and use 1-4 pounds of pressure per swallow? With this amount of frequency and pressure, tongue thrusting can push teeth into abnormal positions and cause growth distortions of the face. It is estimated that 20-80 per cent of patients requiring orthodontic treatment have some form of tongue thrust. Although speech is not frequently influenced by the tongue thrusting problem, it can affect the “S” and “Z” sounds and may result in lisping.
Although no one specific cause has been determined, some of the factors that may prohibit someone from developing a mature or adult swallowing pattern and continue to tongue thrust are:
• Hereditary factors, such as a large tongue, or the angle of the jaw line
• Mouth breathing, usually due from allergies, and/or nasal congestion
• Sore throats, enlarged tonsils or adenoids which cause difficulty in swallowing
• Short lingual frenum (tongue tie)
• Thumb sucking (for a look at some pictures, go to: www.braceface.com/oralhabit.htm)
• Premature loss of baby teeth
• Neurological, muscular, or other physiological abnormalities, such as loss of muscle coordination
Many general dentists, pedodontists, or pediatric doctors may notice and diagnose a tongue thrust. Or, when a child exhibits a speech problem and is evaluated by a speech therapist, a diagnosis may be made for a tongue thrust. Many times, it is not detected until the child undergoes orthodontic treatment (braces). However, if the tongue is allowed to continue to push against the teeth, it will reverse the orthodontic work once the braces are removed.
A tongue trust can be corrected in two ways. One way is by wearing an appliance made by a dentist (to view a picture of this type of appliance: http://library.thinkquest.org/5029/tongue.htm). However, the method that has the highest percentage of success is by oral habit training. This is an exercise technique taught by a qualified speech therapist that re-educates the muscles associated with swallowing by changing the swallowing pattern. (You can see an example of this type of therapy on YouTube – Tongue Thrust Therapy).
What are some warning signs to look for in your child that may indicate a tongue thrust? In addition to the “red flags” of thumb sucking, and/or prolonged pacifier or bottle use, look for:
• Mouth breathing due to history of allergies, or enlarged tonsils/adenoids
• An open mouth posture (lips do not touch when mouth is resting)
• Tongue is resting on the bottom lip
• Tightening of the face and lip muscles (grimace or pursing of lips) during swallowing
• Difficulty with speech, especially during the “s” and “z” sounds
As a parent, some things you can do to help prevent a tongue thrusting issue from developing are:
• Eliminate prolonged oral habits such as thumb sucking, bottle or pacifier use beyond 12 months.
• Manage your child’s allergies with medication.
• If there are structural problems such as enlarged tonsils contributing to a tongue thrust, consult with an Ear, Nose, and Throat specialist. A child must be able to breathe through the nose in order to develop a normal swallow pattern.
You can also raise your child’s awareness of the mouth posture by encouraging them to keep their lips closed (if you notice an open mouth posture), and their tongue behind their upper teeth when at rest. And good table manners can help, too! Ask them to chew with their mouths closed, which also helps to keep their tongue placed correctly when swallowing.
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