What is a tongue thrusting or tongue placement habit?
Before talking about this orthodontic appliance, we should discuss why a patient would need it. Tongue thrusting is essentially the placement of the tongue in an incorrect position during swallowing. 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.
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. The act of thrusting your tongue against your teeth is an involuntary, subconscious habit that is difficult to correct.
What Can Causes Tongue Thrust?
Unfortunately, the medical community remains unable to determine a single specific cause for the tongue thrust observed in many patients. Still, there are several possible causes:
- Excessive and overly-prolonged thumb sucking.
- Some artificial nipples used for feeding infants
- Mouth breathing can cause the tongue’s posture to be very low in the mouth. Nasal congestion, allergies, or obstructions may contribute to this.
- Difficulty swallowing can be a result of conditions with your adenoids, tonsils, or frequent sore throats.
- An exceptionally large tongue
- The angle of the jawline or other hereditary factors within a family
- Muscular, neurological, or other physiological abnormalities
- Being “tongue-tied,” meaning the patient has a short lingual frenum
The Various Types of Tongue Thrusting
There are several variations of tongue thrust and its 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, 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. Usually, 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 Early Can You Detect a Tongue Thrust Swallowing Pattern?
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?
The most challenging problem of all is the diagnosis. As a rule, orthodontists, general dentists, pedodontists, pediatricians, and speech therapists 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.
The condition feels entirely natural for the patient because they have had it, quite literally, most of their lives, so children don’t usually report it on their own. Therefore, diagnosis generally occurs when the child displays a dental or speech problem that needs correction.
What is a tongue crib?
Ok, now onto the matter of how orthodontists treat tongue thrusting problems. A tongue crib is a custom orthodontic appliance used to help combat habits like tongue thrusting or thumb sucking.
Whenever a dental health professional determines that a child needs a tongue crib, they will provide you with one. Here in Alpharetta, you could consult an orthodontist like Dr. Nima to help you solve the issue.
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. This cage/gate will help:
- Prevent the tongue from protruding and pushing against the teeth
- Remind the child not to place their thumb in their mouth
- Help the child keep their tongue back when swallowing.
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 need 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, remember to wear their tongue cribs, and not lose them, you could ask the orthodontist for the removable alternative.
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.
How Long Does It Take to Correct Tongue Thrust?
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 with the necessary therapy sessions and doctor recommendations.
Finally, a small number of cases may remain unresolved due to physical or mental development problems that considerably complicate patient communication.
Generally, a dental health professional will handled the tongue thrust swallowing pattern in two ways:
- First, the patient undergoes correction through MyoFunctional Therapy or Tongue Therapy, 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.
- Second, a dentist or orthodontist will place an appliance such as a tongue crib in the patient’s mouth. This appliance actively discourages the signature forward motion of the tongue every time the patient has to swallow.
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 significantly 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 the patient to keep their 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 every day to make sure the appliance is firmly in place.
If you suspect your child has a tongue thrusting problem, please contact your local Roswell orthodontist for a consultation.