Tongue Thrusting

Tongue thrust is the forward movement of the tongue tip between the teeth to meet the lower lip during deglutition and ion sounds of speech, so that the tongue lies interdentally.

Approximately 97% of newborns exhibit tongue thrust. Tongue thrust decreases with age; 3% of 12 year-old children exhibit the habit.

What are the causes of Tongue Thrusting

There are several medical as well as environmental factors that can cause tongue thrust swallow pattern:

  1. Macroglossia (enlarged tongue)
  2. Thumb sucking: Thumb sucking may result in anterior open bite leading to tongue thrust associated swallowing pattern.
  3. Enlarged adenoids and tonsils: It is very common in children and results in blockage of nasopharynx leading to mouth breathing. This, in turn.may lead to tongue thrust while swallowing.
  4. Malocclusion: The incidence of tongue thrusting during swallowing has been reported to be higher in children with malocclusion.
  5. Hereditary factors
  6. Allergy
  7. Abnormal sleeping patterns
  8. Ankyloglossia (tongue tie), and
  9. Prolonged use of certain types of artificial nipples used in feeding infants

What are the types Of Tongue Thrusting

There are several types of tongue thrust and related orthodontic problems:

1.    Anterior open bite –This 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.

2.    Anterior thrust – The lower lip pulls in the lower incisors and the upper incisors are extremely protruded. The anterior thrust is commonly accompanied by a strong muscle of the chin (mentalis).

3.    Unilateral thrust – In such cases, the bite is typically open on either side.

4.    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.

5.    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 noticed in such cases.

6.    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 clinical features of Tongue Thrusting

Common manifestations of Tongue thrusting are:

  1. Open bite: It is a common feature of tongue thrust.
  2. Cross bite
  3. Midline diastema
  4. Short and flaccid upper lip

How can we prevent Tongue Thrusting?

1.    Eliminate thumb/finger sucking

How can we manage Tongue Thrusting

Management depends on:

  1. Severity of malocclusion
  2. Maturity of the patient
  3. Structural obstruction

Various treatment options include:

  1. Myofunctional therapy-Elastic Exercise
  2. Lip Exercise
  3. Subconscious Therapy
  4. Mechanotherapy-Hay Rakes
 

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