Tongue Thrusting Habit

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Definitions Classification Etiology Clinical manifestations Diagnosis Treatment considerations Treatment

Tongue thrusting is defined as a condition in which the tongue makes contact with any teeth anterior to the molars during swallowing. A tongue thrust is said to be present if the tongue is observed thrusting between & the teeth do not close in centric occlusion during deglutition.Brauer (1965)

• Tongue thrust is the forward movement

of the tongue tip between the teeth to meet the lower lip during deglutition & in sounds of speech, so that the tongue becomes interdental. - Tulley (1969)

• Tongue thrust is an oral habit pattern

related to the persistence of an infantile swallow pattern during childhood & adolescence & thereby produces an open bite & protrusion of the anterior tooth segments. - Barber (1975)

• Tongue thrust is a forward placement of

the tongue between the anterior teeth & against the lower lip during swallowing. - Schneider (1982)


1.Classification I (S. Braner & Hort) :

Type I : Non deforming tongue thrust Type II : Deforming anterior tongue thrust
Sub Group 1 : Anterior open bite Sub Group 2 : Anterior proclination Sub Group 3 : Posterior cross bite

Type III: Deforming lateral tongue thrust
Sub Group 1 : Posterior open bite Sub Group 2 : Posterior cross bite Sub Group 3 : Deep bite

Type IV: Deforming anterior & lateral tongue thrust
Sub Group 1 : Anterior & Posterior open bite Sub Group 2 : Proclination of anterior teeth Sub Group 3 : Posterior cross bite

2. Classification II:
A. Simple tongue thrust
Features : ♦ Normal tooth contact in posterior region ♦ Anterior open bite ♦ Contraction of lips, mentalis muscle & mandibular elevators

B. Lateral Tongue thrust
Features : Posterior open bite with tongue thrusting laterally


Complex tongue thrust
Features : a) b) c) Generalized open bite Absence of contraction of lip & muscle Teeth contact in occlusion

3. Classification III
1. Physiologic Tongue Thrust :
During infantile swallow the tongue is placed between the gum pads. After six months of life, several maturational events occur that alter the functioning of the orofacial musculature. With the arrival of incisors the tongue assumes a retracted posture. If the transition of infantile to mature swallow does not take place with the eruption of teeth, then it leads to tongue thrust swallow.

2. Habitual Tongue Thrust :
It is present as a habit after the correction of the malocclusion.

3. Functional Tongue Thrust :
It develops to achieve an oral seal.

4. Anatomic Tongue Thrust :
It occurs due to macroglossia.

Etiology of tongue thrust:

Retained infantile swallow

2. 3. 4.

Upper respiratory tract infection Mouth breathing Chronic tonsillitis

5. Neurological disturbances * * * * 6. Hyposensitive palate Moderate motor disability Disruption of sensory control Coordination of swallowing

Due to transient change in anatomy

* Tongue can protrude when the incisors are missing

7. 8.

Bottle feeding Thumb& finger sucking

9. Hypertonic orbicularis oris

10. Macroglossia

Clinical Manifestations of tongue thrust :
Clinical manifestations depend on • Intensity • Duration • Frequency & • Type of tongue thrust

Extra oral Findings
♦ Lip separation ♦ More erratic mandibular movements ♦ Speech disorders such as :

* Sibilant distortions * Lisping distortions * Problem in articulation of s/n/t//d/l/th/z/v/sounds ♦ Increase in anterior face height

Intraoral findings
• Jerky and irregular tongue movements • Lowered tongue tip because of :

a) b)

anterior open bite longer period of time required for tongue tip elevation

♦ Malocclusion

a) Proclination of maxillary anterior results in overjet b) Generalized spacing between teeth c) Retroclination or proclination of mandibular teeth d) Anterior & posterior open bite (depends on posture of tongue) e) Posterior teeth crossbite

Diagnosis Of Tongue Thrust
A. Take History • Ask about swallow pattern of siblings & •

parents to check for etiologic factor. Get information about upper respiratory tract infection, sucking habits & neuromuscular problems.

B. Examine : ♦ Detect perverted swallowing habit and correct it to facilitate normal development of the palate and dentitions. ♦ Study the tongue posture. ♦ Observe tongue movements during swallow.

Treatment considerations of tongue thrust
Age : Tongue thrust often corrects itself by 8 or 9 years of age. Self-correction is due to improved musculature balance during swallowing. 2. Presence/absence of associated manifestation: Treatment is not recommended when tongue thrust is present without malocclusion or a speech problem.


Tongue thrust with malocclusion & without speech defect: Orthodontic treatment may be carried out.


Speech defect with tongue thrust : Speech therapy is indicated. Surgery may be done to reduce the size of pharyngeal lymphoid masses. Treatment of associated habit first : If an associated habit like thumb sucking is present, it must be treated first.

* *

Treatment of tongue thrust
I. Training the tongue for correct swallow & posture

a) Myofunctional exercise :
1. The child is asked to place the tip of the tongue in the rugae area for 5 minutes. 2. Orthodontic elastic & sugarless fruit drop exercise. 3. 4s exercise.

• Includes : Identifying the spot * Salivating * Squeezing the spot * Swallowing 4. Ask the child to perform a series of exercises like * whistling * reciting the count from 60 to 69 * gargling or * yawning, to tone the respective muscles


b) Use of appliances to correct position of tongue : 1. Pre-orthodontic trainer for myofunctional training


Nance palatal arch appliance

II. Speech therapy * Not indicated before the age of 8 years III. Mechanotherapy * Fixed & removable appliances: can be fabricated to restrain the anterior tongue movements during swallowing * force the tongue downward & backward during swallowing * re-educates tongue position

• •

Removable appliance therapy : Hawley’s appliance is used Fixed habit breaking appliance.

• For posterior open bite modified habit crib is

•Oral screen

* modified acrylic plate * used to control muscle forces both inside & outside the dental arches * reduces development of malocclusion

Correction of Malocclusion V. Surgical Treatment

• •

For retained infantile swallow tongue thrust. For reduction of lymphoid tissue size improves abnormality to tongue thrust.

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