Though tongue thrust is a common culprit behind a number of orthodontic problems, it’s not a term that a lot of people are familiar with. For this reason, it can go undiagnosed, leading to issues with the teeth, jaw and speech. At our Langley and Surrey, BC orthodontic practice, Dr. Vishal Sharma, Dr. Everett Lin and Dr. Julia Koo, certified specialists in orthodontics, are experts in diagnosing and treating tongue thrust, as well as the resulting complications.
In this post, we’ll cover:
- What is tongue thrust?
- What are the signs of tongue thrust?
- What happens if tongue thrust isn’t treated?
- What causes tongue thrust?
- How to stop tongue thrusting
- How to fix an open bite, crooked teeth and other tongue thrust complications
What is Tongue Thrust?
Tongue thrust is when the tongue thrusts against or protrudes in between the front teeth when a person talks and swallows. At rest, the tongue often sits in a forward position. The problem is a type of orofacial (mouth and face) myofunctional (muscle function) disorder and is usually related to an imbalance in the muscles around the mouth and face. Also called immature swallowing or reverse swallowing, tongue thrusting affects children and adults.
In a baby, tongue thrust is completely normal. Infants usually use their tongue to latch on and pull out milk or formula from the bottle or breast. This pattern of swallowing where the tongue protrudes is seen in the vast majority of very young children. Once babies move on to solid foods and begin speaking, tongue thrust usually naturally disappears. Even if it doesn’t, by age 4, most kids will have transitioned to a normal swallowing pattern.
What are the Signs of Tongue Thrust?
- The tongue protruding between the front teeth
- Licking of the lips or puckering of the lips before swallowing
- Chapped, cracked or sore lips from frequent lip licking
- The chin contracting and muscles around the mouth moving when swallowing
- Frequently having the mouth open and the tongue against the upper and/or lower teeth when at rest
- Inability to comfortably close the lips all of the way
- Mouth breathing that’s not due to an acute infection
- A lisp and/or difficulty producing certain speech sounds
- An open bite (the upper and lower front teeth don’t touch)
- Difficulty swallowing, leading to messy eating
What Happens if Tongue Thrust Isn’t Treated?
Kids swallow between 800 and 2,000 times a day, and with each swallow, the tongue exerts between one and six pounds of pressure. If the tongue isn’t in the correct position and hits against the front teeth or protrudes in between the upper and lower teeth every time a child swallows, it leads to excessive pressure against the teeth. At the same time, the facial muscles are also exerting pressure from the outside. This combination can cause misaligned teeth and bite issues.
The relationship between the facial muscles, tongue and lips also plays an important role in the development of a child’s facial structure and palate. For these reasons, if not treated, tongue thrust can cause:
- Generally crooked teeth
- Bite problems, including an anterior open bite ( the front top and bottom teeth don’t touch when the jaw is closed), overjet teeth (upper front teeth flare out over the bottom teeth) or a crossbite (some of the bottom teeth sit in front of some of the top teeth)
- Changes in face shape – most commonly an elongated face
- Speech problems, such as a frontal lisp (the tongue is between or against the teeth when producing /s/ and /z/ sounds and, occasionally, /sh/, /j/ and /ch/ sounds too)
- A relapse after orthodontic treatment if the tongue thrust reflex isn’t corrected prior to getting braces, Invisalign® or Invisalign Teen
What Causes Tongue Thrusting?
While there isn’t a single definitive cause of tongue thrust, it is tied to the following:
- Orofacial muscular imbalance
- A large tongue
- Oral habits, such as thumb sucking and finger sucking
- Mouth breathing
- Upper airway obstruction due to nasal congestion, allergies, tonsil size, etc.
- Certain developmental and neurological issues
- Prolonged pacifier or bottle use
- Tongue tie
- Anterior open bite (tongue thrust can cause an anterior open bite, but an anterior open bite can also cause tongue thrust if the open bite is due to poor resting tongue position)
- Missing teeth
- Genetics (reverse swallowing can run in families!)
How to Stop Tongue Thrusting
Dr. Sharma, Dr. Lin and Dr. Koo can align a patient’s teeth and bite with dentofacial orthopedics and/or orthodontic treatment. But, if the tongue thrust habit isn’t treated first, a relapse is extremely likely. The specific course of tongue thrust therapy recommended will depend on several factors, including the patient’s age and any concurring issues.
Options can include:
- A Habit-Breaking Appliance – A habit-breaking appliance, such as a tongue crib, can be used to break oral habits like tongue thrust and thumb sucking. The appliances, which can be fixed or removable, come in several different varieties. The aim is to prevent the tongue from protruding through the top and bottom incisors and encourage proper tongue resting position. This enables patients to adjust their swallowing pattern.
A habit-breaking appliance also acts as a reminder since the habit is often unconscious. When it comes to how to control tongue thrust while asleep, a tongue crib or night guard can be helpful.
- Myofunctional Therapy – Myofunctional therapy is another way to treat tongue thrusting. With this approach, exercises are used to re-train the orofacial muscles and help adjust the swallowing pattern and tongue resting position. Myofunctional therapy is often used in conjunction with orthodontic treatment.
- Speech Therapy – Speech therapists and speech-language pathologists also offer tongue thrust therapy using non-invasive speech therapy methods. They prescribe exercises to correct the tongue position that’s interfering with a child or adult’s ability to produce certain speech sounds.
- Orthodontic Treatment – As we said, the tongue thrust should usually be treated prior to or in conjunction with orthodontic treatment, so that the habit doesn’t cause teeth shifting after braces or Invisalign. That said, as mentioned above, a tongue thrust can be a chicken and egg situation. While reverse swallowing may lead to an open bite, issues like an open bite or missing teeth can also contribute to reverse swallowing. If the open bite is the cause, we can fix it with orthodontic appliances during phase 1 treatment or with braces or Invisalign.
While there are tongue thrust exercises you can do at home, it’s a very strong habit that often requires professional intervention. Tongue thrust therapy helps kids learn the proper tongue resting position and movement of the tongue and muscles. To get the most benefit, it’s important to practice regularly to establish the new habit.
How to Fix an Open Bite, Crooked Teeth and Other Tongue Thrust Complications
Once the tongue thrust habit itself is corrected and the underlying cause has been addressed, orthodontic treatment could be necessary to fix any resulting complications, such as an anterior open bite, crooked teeth, overjet teeth or a crossbite.
After Dr. Sharma, Dr. Lin or Dr. Koo examines you or your child and develops an accurate diagnosis, they may recommend:
- Dentofacial Orthopedics – When tongue thrust creates changes in the jaw and palate, early intervention with dentofacial orthopedics can be the best way to get the desired outcome. With this approach, often called two-phase orthodontic treatment, our Surrey and Langley orthodontists use certain orthodontic appliances to guide jaw and facial growth in phase 1 when a child is still developing.
After a resting period, where we allow the rest of the baby teeth to fall out and the permanent teeth to come in, the child starts phase 2 orthodontic treatment. Phase 2 consists of braces or Invisalign Teen to straighten the teeth and finetune the bite. In some cases, early intervention with phase 1 appliances will help kids avoid the need for surgery, extractions or lengthy treatment down the road.
- Braces – At Aura Orthodontics, we offer metal braces and clear braces in Surrey and Langley. Both types of braces can be effective for fixing an open bite, crooked teeth, overjet teeth and any other tongue thrust effects. For mildly crooked or overjet teeth, braces alone might do the trick. However, since braces straighten the teeth in each arch independently of each other, auxiliaries like rubber bands could be needed to connect the upper and lower teeth to simultaneously fix the bite.
- Invisalign/Invisalign Teen – We can also use Invisalign for overjet teeth, an open bite and any type of malocclusion that can be treated with braces. For mild issues related to the position of the teeth, again, Invisalign or Invisalign Teen could be effective on their own.
For moderate to severe misalignment or bite problems, we’ll pair Invisalign with rubber bands and/or attachments. Invisalign attachments are small, tooth-colored, composite buttons that are bonded to some of the teeth. They give the aligners something to push off of in order to achieve more complex tooth movements. Just like with braces, rubber bands provide the connective forces to bring the upper and lower teeth together properly to align the bite.
Connect With a Surrey or Langley, BC OrthodontistIf you or your child are exhibiting signs of tongue thrust or you’d like to find out your options for correcting any resulting bite problems, schedule a consultation at Aura Orthodontics. Our orthodontists can diagnose tongue thrust and create a personalized treatment plan to fix the issue and give you a healthy, straighter smile.