What is tongue thrust and why is it a problem?

November 22, 2014

  

Tongue thrust is an abnormal swallow pattern which has myriad effects on dental health. The person develops the habit of sticking the tongue out from between the front teeth. Normally when we swallow, the tongue touches the roof of the mouth and no air comes out of the mouth. In tongue thrust, the tongue pushes against the front teeth or through them and air escapes from the mouth while swallowing.

Why it Happens

Several factors are said to contribute to this habit.

1. Thumb or finger sucking
2. Prolonged bottle feeding or the use of certain nipples in feeding bottles
3. A tongue that is larger than normal
4. Enlarged tonsils, adenoids that may make swallowing difficult
5. Allergies and nasal congestion that cause difficulty in breathing
6. Tongue tie in which the membrane that attaches the tongue to the bottom of the mouth is shorter than normal
7. Heredity factors wherein the mouth size and the number of teeth along with strength of muscles in the mouth area may be a causative factor.

Health implications

Tongue thrust is a normal phenomenon for infants, but the infant should outgrow this by the time he is 6 months old. In some children this habit persists and its prevalence is very common. It is believed that a child may outgrow this habit by the time he is 4 years old, but intervention becomes necessary after that. Tongue thrusting has several implications for dental health.

The repetitive pressure against the front teeth causes misalignment. As a result, the child develops a malocclusion. The effect of tongue thrusting has been categorized according to the impact they have on the teeth.

1. Anterior open bite This is observed most frequently in which the lips do not close completely and the tongue can be seen from between the lips.
2. Anterior thrust In this type the upper front teeth jut out prominently while the lower front teeth are pushed inwards by the lower lip. It is likely that the child’s mentalis, lower lip muscle, be quite strong.
3. Unilateral thrust The unilateral thrust is in which the bite remains open on each side.
4. Bilateral thrust In this kind of thrust, the back teeth may remain open on both the sides while the front teeth close properly.
5. Bilateral anterior open bite The bite remains open totally including the front teeth with just the molars coming in contact. Often a large tongue is observed with this kind of thrust.
6. Closed bite thrust: This is characterized by teeth, upper as well as lower, that are jutting and spaced out.   

Often treatment to align the teeth properly may not be successful if tongue thrusting continues after the orthodontic intervention. It is crucial to get rid of the tongue thrust habit while carrying out the orthodontic treatment. In a few cases tongue thrusting can contribute to unclear speech and lisping.

Treatment for tongue thrust

Treatment can be taken up either by a speech therapist or by a dentist. Therapy involves retraining the individual and requires considerable practice and dedication on the part of the child. Also known as myofunctional therapy, it often yields good results, if there are no underlying physical causes for tongue thrusting.

A dentist can provide an appliance that can be put in the mouth at night. Sometimes a permanent device is fitted by the dentist that restrains the tongue and prevents abnormal tongue thrusting. The appliance keeps the tongue away from the anterior incisors and removes the reflex of putting the tongue in between the teeth while swallowing.

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