One of the most common issues that an orthodontist has to deal with is tongue thrust. Tongue thrusting, simply defined, is a swallowing pattern in which the tongue pushes against the teeth. The tongue rests low and forward in the mouth.

This is a normal pattern in infants and common up to 5-6 year-old children. Most children shift to the mature swallowing pattern, but some maintain the tongue-thrusting pattern through adulthood. This could be a contributing factor for malocclusions, such as anterior open bites and crossbites- narrower upper arch- and speech defects, such as lisping.

Some of the factors that are commonly considered to cause tongue thrust are:

  • Oral behaviors, such as thumb/finger sucking, prolonged use of a bottle, mouth breathing
  • Anatomical differences, such as high narrow palate - that does not allow adequate space for the tongue, short lingual frenum, the membrane that attached the tongue to the floor of the mouth-that does not allow the tongue to lift properly into the mouth.
  • Medical conditions, such as allergies, large tonsils and adenoids, nasal congestion contributing to mouth breathing - causing the posture of the tongue to be low in the mouth.
  • Hereditary factors, such as malocclusions.
  • Neurological, muscular or other physiological abnormalities.

An interdisciplinary approach is required to monitor tongue thrust. This most commonly includes an orthodontist, a physician and a speech therapist.

The orthodontist can expand the arch, to provide more space for the tongue, align the teeth and correct the open bite that is often a result of the tongue thrust.

It is important to understand, though, that the continuous tongue pressure on the teeth affects both the bite and the arch form. If the tongue thrust persists and is not treated, it causes difficulty in orthodontic movements during the treatment, but also causes relapse after treatment. Therefore, the safest way to correct the malocclusion and maintain the result of the orthodontic treatment is to remove the cause. This is the role of the speech therapist, or the physician - where medical factors are involved.

The speech therapist will educate the patient to achieve a proper tongue and lip posture when at rest and when swallowing.

The physician can detect and correct medical conditions.

Concluding, it is important to detect tongue thrust as early as possible, correct the malocclusion, remove the cause and educate patients to a proper function. 

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