Tongue

Thrusting Habit

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TOPIC INCLUDES :
♦ Definitions
♦ Classification
♦ Etiology
♦ Clinical manifestations
♦ Diagnosis
♦ Treatment considerations
♦ Treatment

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DEFINITIONS :
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)
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• 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)

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• Tongue thrust is a forward placement of
the tongue between the anterior teeth &
against the lower lip during swallowing.
- Schneider (1982)

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CLASSIFICATION OF
TONGUE THRUSTING
HABITS

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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
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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

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

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

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

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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.

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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.

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 Etiology of tongue thrust:
1. Retained infantile swallow

2. Upper respiratory tract infection

3. Mouth breathing
4. Chronic tonsillitis

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5. Neurological disturbances
* Hyposensitive palate
* Moderate motor disability
* Disruption of sensory control
* Coordination of swallowing
6. Due to transient change in anatomy
* Tongue can protrude when the
incisors are missing

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7. Bottle feeding
8. Thumb& finger sucking

9. Hypertonic orbicularis oris

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10. Macroglossia

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Clinical Manifestations
of tongue thrust :

Clinical manifestations depend on

• Intensity
• Duration
• Frequency &
• Type of tongue thrust

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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
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 Intraoral findings

• Jerky and irregular tongue movements

• Lowered tongue tip because of :
a) anterior open bite
b) longer period of time required
for tongue tip elevation

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♦ 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

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 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.

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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.

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 Treatment considerations of
tongue thrust
1. 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.

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3. Tongue thrust with malocclusion &
without speech defect:
Orthodontic treatment may be carried out.
4. Speech defect with tongue thrust :
* Speech therapy is indicated.
* Surgery may be done to reduce the size of
pharyngeal lymphoid masses.
5. Treatment of associated habit first :
If an associated habit like thumb sucking
is present, it must be treated first.
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 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.
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 • 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
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 b) Use of appliances to correct position
of tongue :
1. Pre-orthodontic trainer for myofunctional
training

. Nance palatal arch appliance

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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

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

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• For posterior open bite modified habit crib is
used.
•Oral screen

* modified acrylic plate

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

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IV.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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