What is tongue thrusting or tongue placement habit?
Tongue thrusting is essentially the placement of tongue in an incorrect position during swallowing. On average you swallow a total of 1,200 to 2,000 times, with about four pounds of pressure per swallow. This constant pressure of the tongue will force the teeth out of alignment. Besides the pressure exerted while swallowing, nervous thrusting also pushes the tongue against the teeth while it is at rest. This is an involuntary, subconscious habit that is difficult to correct.
What can causes tongue thrusting ?
No single specific cause has actually been determined for the tongue thrust. There are several possible causes:
- Thumb sucking
- Some artificial nipples used for feeding infants
- Mouth breathing which can cause the tongue’s posture to be very low in the mouth. Nasal congestion, allergies, or obstructions may contribute to this.
- Difficulty swallowing which can be a result of adenoids, frequent sore throats or tonsils
- An exceptionally large tongue
- The angle of the jaw line or other hereditary factors within a family
- Muscular, neurological, or other physiological abnormalities
- Being” tongue tied” – a short lingual frenum
Different types of tongue thrusting:
There are several variations of tongue thrust and related orthodontic problems:
- Anterior open bite – is the most typical and common form of tongue thrust. In such cases the lips do not close properly, and a child often has an open mouth and tongue protruding beyond the lips. Generally this type of tongue thrust is accompanied by a large tongue.
- Anterior thrust – the lower lip pulls in the lower incisors and the upper incisors are extremely protruded. The anterior thrust is frequently accompanied by a strong muscle of the chin (mentalis).
- Unilateral thrust – in which the bite is typically open on either side.
- Bilateral thrust – posterior teeth from the first bicuspid through back molars can be open on both sides and the anterior bite is closed. The bilateral thrust is the most difficult to correct.
- Bilateral anterior open bite – the only teeth that touch are the molars. The bite is completely open on both sides, including the front teeth. A large tongue is often noted.
- Closed bite thrust – both the upper and lower teeth are spread apart and flared out. The closed bite thrust is typically a double protrusion.
What are the consequences?
The force of the tongue against the teeth is an important factor in contributing to malformation (“bad bites”). Many orthodontists have had the discouraging experience of completing dental treatment, with great results, only to discover that the patient had a tongue thrust swallowing pattern. This continual habit will push the teeth out of alignment and reverse the orthodontic work.
At what age does a child usually exhibit a tongue thrust swallowing pattern?
A child exhibits a tongue thrust pattern from birth, because it is an infantile swallowing pattern. It is acceptable to have this swallowing pattern up to the age of 4. Most children will outgrow the infantile pattern and develop the mature pattern of swallowing, not developing a problematic tongue thrust. IF the child has not naturally outgrown the pattern by age 4, the thrust is strengthened, becomes an issue, and will require a training program to correct the thrusting pattern.
What is a tongue crib?
A tongue crib is a custom orthodontic appliance that is used to help combat habits like tongue thrusting or thumb sucking. When it is identified that a child needs a tongue crib, your orthodontist will be able to provide the tongue crib.
The tongue crib is permanently attached by two rings (also known as bands) installed around the molars at the back of the mouth. The rings will connect to a small cage or gate that commonly sits behind the front teeth. This cage/gate will help:
- prevent the tongue from protruding and pushing against the teeth
- remind the child to not place their thumb in their mouth
- help the child keep their tongue back when swallowing
The length of time a patient has to wear a tongue crib varies from case to case. It can be worn in as little as a few months up to the entire duration of orthodontic treatment.
Who diagnoses tongue thrust?
The most difficult problem of all is the diagnosis. As a rule, orthodontists, general dentists, pedodontists, some pediatricians, and speech therapists detect the problem. In many cases, tongue thrust may not be detected until the child is under orthodontic care. However, diagnosis usually is made when the child displays a dental or speech problem that needs correction.
What Is the probability of correction?
With sincere commitment and cooperation of the child and parent, and if there is no neuromuscular involvement, correction is possible in most cases. At the present time, successful correction of tongue thrust appears in 75% of treated cases, 20% of patients are unsuccessful due to poor cooperation and lack of commitment by parents and patients, and the remaining 5% are unsuccessful due to other factors that make correction impossible, such as physical or mental development problems.
Generally, the tongue thrust swallowing pattern may be handled in two ways:
- Correction by MyoFunctional Therapy or Tongue Therapy, which is an exercise technique that re-educates the tongue muscles. It is similar to “physical therapy” for the tongue, which is taught by a trained therapist. There are in office visits and home exercises. The length of therapy is based upon the patient’s cooperation and dedication. Therapy has proven to give the highest percentage of favorable results.
- An appliance such as tongue crib, that is placed in the mouth by the dentist or orthodontist, which is simply a punishment for the tongue instead of retraining.
What are tips to help ensure successful tongue crib treatment
As we mentioned above, not all corrections of tongue thrust are successful. However, a patient’s commitment to the treatment can greatly help ensure a higher probability of success. Here are some tips we have for those that will be needing a tongue crib or who already have one:
- Remind yourself to keep your tongue behind the gate
- Avoid any hard, sticky foods while wearing the tongue crib
- Ensure oral hygiene and cleanliness of the tongue crib every day
- Check everyday to make sure the appliance is firmly in place
If you suspect that your child has a tongue thrusting problem. Please contact your local orthodontist for a consultation.