The habit of placing your tongue forward between upper and lower anterior or posterior teeth while you swallow is called tongue thrust. Please read the article to know about its effects on your teeth and the treatment options.
What Is Tongue Thrust?
Tongue thrust is the habit of placing your tongue forward between upper and lower anterior and/or posterior teeth when you swallow. Anterior tongue thrusting is when the tip of the tongue is placed between the incisors during swallowing. Tongue thrusting might be a major cause of malocclusion or it may be associated with skeletal open bite as an aggravating factor. It may be associated with children with long term thumb sucking habit.
Why Is Tongue Thrusting Bad?
As we all know, our tongue is a very powerful muscle and is strong enough to push our teeth out of their natural position, which causes loss of equilibrium. An individual swallows around 2000 times a day. In tongue thrusting, there is improper swallow. This improper swallowing becomes more apparent when it is persistent for a longer duration of time. It can also lead to open bite and malocclusion, in which only your back teeth touch together when you swallow and anterior teeth will not touch.
How Is Tongue Thrust Habit Classified?
The tongue thrust habit is classified into:
I) Primary and secondary.
II) Anterior, lateral, and complex.
III) Endogenous, habitual, and adaptive.
What Causes Tongue Thrust?
There are different schools of thought explaining about tongue thrust:
According to Graber - According to this theory, tongue thrusting is because of retained infantile swallow. Whatever may be the cause of tongue thrusting habit, be it size, posture or function, it serves as the effective cause of malocclusion.
According to Proffit - Whenever there is an open bite due to thumb sucking habit, the tongue tries to close the open bite by wrong placement, which accentuates the deformity. Placing the tongue between anteriors for making an anterior lip seal is successful achieved.
According to Equilibrium Theory - The pressure generated by tongue is very less to affect the equilibrium, but if there is forward resting posture of tongue on anteriors for a long duration, then even if pressure exerting is very light then it could be a precipitating factor for malocclusion.
Some thoughts about tongue thrust states that, tongue thrust is seen in two circumstances:
1) In younger children with normal occlusion in whom it represents a transitional stage during normal physiologic maturation.
2) In individuals of any age with displaced anteriors.
So, tongue thrusting habit or swallowing pattern can be considered as a result of displaced incisors and not the cause.
Effects of Tongue Thrust:
Increased overjet will be there because of the forward positioning of the tongue.
Increased overbite will be there because of faulty positioning of the tongue.
In tongue thrusting, tongue will not be positioned on the lingual cusps of posterior teeth and so it eliminates interocclusal clearance.
May be the cause for bruxism.
The maxillary arch becomes narrow, as the tongue is in a lower position in the mouth, which may be the cause of unilateral or bilateral crossbite.
In horizontal growth patterns, tongue thrusting leads to bimaxillary protrusion.
In vertical growth patterns, tongue thrusting leads to retroclination or lingual inclination of lower incisors.
Diastema may be present.
Deep bite in lateral tongue thrust.
One has to keenly differentiate and diagnose among simple, complex, retained infantile swallowing patterns, and faulty tongue posture. When we see the prognosis of tongue thrust, then it is good for simple tongue thrust, not very good for complex tongue thrust, and is poor for infantile swallowing patterns. Protracted tongue posture can be corrected when it is acquired. The method of examination of tongue dysfunction or posturing:
Intraoral recording of pressure exerted by the tongue.
Roentgen cephalometric analysis.
Simple Tongue Thrust -
It is when the teeth are in normal contact during swallowing. If there is excessive proclination of maxillary incisors, treatment of tongue thrust should be done after retraction of incisors. The patient should be educated about swallowing exercises with sugarless mint and should be instructed to follow the instructions 40 times a day and the patient is asked to maintain the record for the same. During the second appointment, there should be improvement in swallowing pattern and the patient should swallow correctly at will.
Another way to fix this bad habit is with the use of orthodontic rubber bands. First, place the rubber band on the tip of your tongue, then press the tip of the tongue right behind your upper front teeth. After that, bite normally and avoid forward biting. Do not panic if you accidently swallow the rubber band, as it will pass through your system without any harm. Initially, this exercise may be a little difficult to do, but with practice, you will master this exercise and soon you will be free of tongue thrusting. So, it is advised to do two sets of 30, once in the morning and once in the evening for better results. After this, if the problem still continues, soldered lingual arch wire having short and sharp spurs is used.
Complex Tongue Thrust -
It is when the teeth are apart during swallowing. It can cause malocclusions, such as poor occlusal fit and generalized anterior open bite. Open bite may not be present if the tongue is seated evenly at top.
The malocclusion is treated first. Muscle training should begin when treatment is in the retentive phase. Maxillary lingual arch appliance is necessary and as prognosis is not very good, the chances of relapse may be there.
Retained Infantile Swallow -
When the tongue thrust swallowing pattern is retained beyond age it is defined as retained infantile swallow. Individuals suffering from this swallow, have occlusion only on one molar in each segment. They have difficulty in breathing and are sensitive to gag reflux.
A tongue crib can be used with 3 to 4 projections and should extend to the cingulum of lower incisors. Prognosis is poor.
Abnormal Tongue Posture -
Endogenous Tongue Posture - It is an inherent tongue posture and is not a normal or ideal tongue posture. Here, the tip of the tongue lies between incisors, It results in a mild open bite. Prognosis is poor.
Acquired Tongue Posture - Acquired tongue posture may be because of respiratory problems, chronic pharyngitis, or tonsillitis. In that case, one should consult an otolaryngologist. After elimination of precipitating factors, the habit should be taken care by lingual arch wire with sharp spurs.
Adaptive Tongue Posture - Here, narrow maxilla may be the cause. After treatment of narrow maxillary arch with the help of rapid maxillary expansion, posterior intercuspation is corrected and normal posture is achieved.
For more information, consult a dentist online!
Tongue thrusting can be stopped by practicing certain exercises at home. Place a sugar-free candy on the tongue tip and press the tongue against the roof of the mouth such that the candy lies behind the front tooth. Then, bite the teeth by keeping your mouth open and swallow in the same position. Repeat this procedure thirty times twice daily in the morning and evening. If these exercises do not help, then dental treatment is suggested. In children, it includes placing a tongue crib or orofacial myology, which comprises swallowing therapy, along with approaching nasal, breathing, and allergic issues present, and speech therapy, if required.
- Pushing away the tongue against the teeth while swallowing.
- Mouth breathing.
- Tongue visibility between the teeth.
- Incomplete lip closure.
- Open bite.
- Speech impairments.
When the baby's mouth is touched, it is a natural reflex for the tongue to thrust in order to help in breastfeeding or bottle feeding. As the child gets older, the reflex goes away on its own with a change in the swallowing habits.
Tongue thrusting or rubbing occurs as a result of anxiety, which predominantly happens when the person is subjected to emotional stress.
Tongue enlargement, tonsillitis, thumb sucking, tongue-tie, hereditary factors, allergies, congestion of nose, and artificial nipples while feeding contribute to tongue thrusting.
In the natural position, the tongue should rest half an inch behind the front teeth, with the whole tongue pressing against the roof of the mouth, lips fully sealed, and the upper and lower teeth placed somewhat apart.
Eight to twelve weeks is the time taken to stop tongue thrusting if the baby is undergoing effective therapy.
Tongue thrusting is present if the baby denies the spoon and the tongue thrusts ahead. It has gone away or is fading if the child opens the mouth and accepts the spoon.
Speech impediment is associated with tongue thrusting, and there will be difficulty pronouncing sounds like sh, ch, zh, and j.
Until four to six months, tongue thrusting is natural in infants, which is essential for limiting food other than milk from entering the oral cavity to prevent choking.
Tongue thrusting is a problem of concern if the child has passed the infant stage and the child's tongue protrudes while speaking, swallowing, and resting, or has a speech impairment, difficulties in sucking, and misplaced teeth.
Last reviewed at:
10 Nov 2021 - 4 min read
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