Tongue Thrusting

Tongue thrusting is a commonly seen oral habit which acts as a major etiologic factor in development of dental malocclusion. It is a condition in which the tongue protrudes, or pushes through the anterior incisors during swallowing, speech, as well as when the tongue is at rest. Most children will usually outgrow this habit by the age of four. However, if it persists past this age most kids will need some form of intervention to eliminate the habit.

Causes of tongue thrusting include conditions such as ankyloglossia (tongue tie), macroglossia (enlarged tongue), enlarged tonsils, hereditary factors, learned behavior, prolonged thumb sucking, nasal congestion, and certain types of artificial nipples used to feed infants and toddlers.

There are three main treatment options to eliminate tongue thrusting. Removal of the etiology, retraining exercises and use of mechanical restraining appliances.

 

Removal of Etiology

This is the first and most important step in eliminating the habit. Depending on the cause of tongue thrusting, in some instances it is possible to eliminate the problem with appropriate intervention.  In the case of ankyloglossia (tongue tie),  a frenectomy can be performed to free the tongue.  Enlarged tonsils or nasal congestion  can also be treated accordingly.  After this initial treatment is completed, retraining exercises or mechanical restraining is still needed to permanently eliminate the habit.

Retraining Exercises

In this phase of treatment, tongue muscles associated with swallowing are retrained to prevent tongue thrusting.  Orofacial myofunctional therapy is an exercise technique in which the ultimate goal is to change the swallowing pattern. Exercise to help strengthen the lateral  tongue muscles is  part of the therapy.  Orofacial Myologists are professionals who receive specialty training and are qualified to treat oral habits, and orofacial myofunctional disorders like tongue thrusting.

 

Mechanical Restraining 

Tongue crib appliances are very effective in eliminating the tongue thrust habit because a mechanical

Tongue thrusting appliance
Appliance prevents tongue from placing pressure on incisors.

barrier is created preventing the tongue from getting to the incisors. Because of inability of the patient to repeat the behavior, this retains the tongue in a normal position.  Tongue bead appliance can also be very effective.  It also serves as a mechanical barrier and allows for retraining of the tongue muscles through interaction of the tongue with a bead.  Appliance that is used can be removable or fixed.  Compliance is always a concern when a removable appliance is used in children.