What Is a Tongue Thrusting or Tongue Placement Habit?
Tongue thrusting (commonly known as tongue placement habit) is the incorrect pushing of the tongue towards our teeth when swallowing. Human beings are constantly swallowing, so our tongues exert enormous pressure on our teeth every time we swallow. On average, you swallow a total of 500 to 700 times per day, and your tongue exerts about four pounds of pressure onto your teeth every time you swallow.
The correct position for the tongue is when the tip pushes against the gum above your upper front teeth, which is where the tip of your tongue should rest.
So when done incorrectly, the constant pressure of the tongue will force the teeth out of alignment. The act of thrusting your tongue against your teeth is an involuntary, subconscious habit that is difficult to correct.
What Causes Tongue Thrust?
Most of the common causes begin as habits when we are babies, while others might be genetic or physiological abnormalities. Let’s take a look at them:
- Excessive and overly-prolonged thumb sucking in babies.
- Some artificial nipples help feed infants.
- Nasal congestion, allergies, or obstructions might cause mouth breathing where the tongue’s posture is very low in the mouth.
- Difficulty swallowing as a result of adenoids, tonsils, or frequent sore throats conditions.
- An exceptionally large tongue.
- The angle of the jawline or any other hereditary factors within a family.
- Muscular, neurological, or other physiological abnormalities.
- Being “tongue-tied,” meaning the patient has a short lingual frenum.
What Are the Types of Tongue Thrust
There are several variations, and most of them are related to orthodontic problems:
- Anterior open bite – is the most 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, you can identify the patient has a large tongue along with this type of tongue thrust.
- Anterior thrust – the lower lip pulls in, and the lower incisors and the upper incisors protrude extremely from their normal position. An anterior thrust will usually result in overexertion of the patient’s chin muscles (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 patient’s bite is entirely open on both sides, resulting in frontal teeth that never touch. Typically, patients with a bilateral anterior open bite will also have large tongues.
- Closed bite thrust – both the upper and lower teeth are spread apart and flared out. The closed bite thrust is typically a double protrusion.
How to Detect a Pattern of Tongue Thrust?
A child exhibits a tongue thrust pattern from birth because it is an infantile swallowing condition. However, this type of swallowing pattern is not a cause for extreme concern up to age 4. Most children will outgrow the infantile pattern and develop a mature swallowing pattern without creating a problematic tongue thrust.
If the child has not naturally outgrown the habit by age 4, the thrust is strengthened, becomes an issue, and will require a training program to correct the problematic condition.
Who Diagnoses Tongue Thrust?
Orthodontists, general dentists, pedodontists, pediatricians, and speech therapists will detect the problem. In many cases, even if the condition is present from infancy, you may not be able to notice it until the child is under orthodontic care.
Keep in mind that most children will not report discomfort or the condition on their own, as tongue thrusting is entirely natural to them. They have had it, quite literally, most of their lives, so the diagnosis generally occurs when the child displays a dental or speech concern that needs correction.
What Is a Tongue Crib?
A tongue crib is a custom orthodontic appliance we use to help correct harmful habits like tongue-thrusting and thumb sucking. This metal device fits in the top front of the patient’s mouth, and we generally use it to help children who are in elementary or middle-school age.
Kids may suffer from abnormal tooth, jaw, muscular, and skeletal development due to harmful habits, and a tongue crib discourages these behaviors. Orthodontists and general dentists recommend using this appliance to avoid these problems with your child’s dental structures.
Usually, your kid’s orthodontist will recommend using the tongue crib for several months at a time, but you could try discouraging the habits at home through other means.
How Does a Tongue Crib Work?
The tongue crib will remain permanently attached by two rings (also known as bands) installed around the molars at the back of the mouth. The rings connect to a small cage or gate that commonly sits behind the front teeth.
As a consequence, the tongue will stop protruding and pushing against the teeth, and it will help the child keep their tongue back when swallowing. Unconsciously, your kid will stop placing their thumb in their mouth and stop the behavior.
The metal grate blocks access to the top front teeth and makes it impossible for any child to push on their teeth or suck on a finger. The problem occurs because when a child sucks their finger, they also push their tongue towards their front teeth. As you may have seen already in this explanation, such a movement alters the position of primary teeth and incoming permanent teeth, which inevitably affects their tooth alignment and skeletal growth.
This is no joke, as the skeletal development of any child could suffer significantly altering the roof of the mouth and how the palate bones align, potentially leaving your kid with an open bite and difficulty chewing, speaking, and swallowing.
Alternatively, a tongue crib also helps close the open bite gap to help your children’s incoming permanent teeth and begin solving the problem with the tooth protrusion.
Are Tongue Cribs Removable?
They can be. Tongue cribs can be either removable or not, and that will depend on several factors. An orthodontist may add a tongue crib to your child’s removable retainers, but they may also be permanent appliances requiring specialized tools to put them on or remove them. Make sure to consult with the orthodontist about the most efficient type for your child.
You may consider using a permanent one if you suspect your child may not commit to using the appliance as much as they require out of their own initiative. Keep in mind that some cases remain unsolved because the patients do not follow professional recommendations. Still, if you believe your child will follow all directions, you can ask the orthodontist about a removable appliance and remind your child to wear their tongue cribs and not lose them.
The critical part here is guiding your child through the correct use of the appliance, maintaining good oral hygiene during treatment, and joining them during the therapy exercises in-office or at home.
If you help your child throughout the entire process, it won’t matter much if the appliance is removable or not; they will feel comfortable and encouraged to progress on their own until they overcome their tongue thrust.
Tongue Thrust Treatment Length
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.
With sincere commitment and cooperation from the child and parent, correction is possible in most cases if there are no added layers of neuromuscular impairments.
Tongue thrusting is a highly treatable condition, and successful correction is possible in the majority of treated cases. There is a minority of cases where the patient cannot overcome the condition, but this is mostly due to a lack of commitment to the necessary therapy sessions and doctor recommendations.
Tongue Thrust Treatments for Teens and Adults
Sometimes tongue thrust is overlooked during childhood, and we find teens and adults that have never addressed the issue. For those teens and adults that have tongue thrust, we have different treatments at their disposal that may aid you to correct the teeth that have been misaligned for years; from Tongue Thrust Braces to night guard for tongue thrust, let’s explore our options:
- MyoFunctional Therapy or Tongue Therapy is an exercise technique that re-educates the tongue muscles. It is similar to “physical therapy” for the tongue, taught by a trained therapist. There are in-office visits and home exercises. The length of therapy heavily relies upon the patient’s cooperation and dedication. Therapy has proven to give the highest percentage of favorable results for all ages.
- Orthodontics and Tongue Thrust Braces involve correcting misaligned teeth by moving them into their correct position.
- Night Guards and Tongue Cribs can also help prevent the soreness that results from excessive pressure during excessive nighttime involuntary tongue movement. The appliances discourage the signature forward motion of the tongue every time the patient has to swallow.
Tips to Help Ensure Successful Tongue Crib Treatment
For any successful treatment, you will need the expertise of your orthodontist and the patient’s commitment to the treatment. Here are some tips we have for those that will be needing a tongue crib or who already have one:
- Remind the patient to keep their tongue behind the gate.
- Avoid any hard, sticky foods while wearing the tongue crib & tongue guard.
- Mealtimes will feel uncomfortable at first; try to stick to soft foods and a liquid diet for the first days.
- Ensure oral hygiene and cleanliness of the tongue crib every day.
- Check your tongue crib after brushing your teeth to ensure it’s not pressing against your upper gum and hurting it.
- Check every day to make sure the appliance is firmly in place.
- Use abundant water or a mouthwash to rinse your mouth after you brush your teeth and tongue crib to help your gums stay healthy
- and remove food debris.
- Keep some orthodontic wax handy and apply some to the spots of the tongue crib where it attaches to the bands to prevent any soreness.