TONGUE THRUSTING

HABIT
 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)
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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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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Genetic factors
Anatomic or neuromuscular variations in orofacial
region
Hypertonic orbicularis oris
Leaned behaviour
-improper bottle feeding
-thumb sucking
-respiratory tract infections
-prolonged tenderness of gum
Maturational factors
retained infantile swallow
Mechanical restrictions
-macroglossia
-constricted dental arches
-enlarged adenoids

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 Neurological disturbances
* Hyposensitive palate
* Moderate motor disability
* Disruption of sensory control
* Coordination of swallowing
Psychogenic factors
-replacement of thumb sucking by tongue thrust

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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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 Clinical features
Open Bite (Anterior and Posterior)
Proclination of upper anterior teeth
Protrusion of anterior segment of both
arches with spaces between incisors &
canines
Narrow & constricted maxillary arch-
Posterior cross bite
 Spacing Between
Incisors and Canine

Anterior Open Bite

MANAGEMENT OF TONGUE
THRUSTING
Age consideration
3-11 Yrs:-
No need to concern
Reassure patient

11 yrs or older:-
Interpretation of habit
Treatment of Malocclusion
MANAGEMENT
Habit interception
Fixed and removable cribs or rakes

Taught correct method of swallowing

Muscle exercises

Oral screen
Treatment of malocclusion
By removable or fixed appliances
MOUTH BREATHING HABIT
 Habitual respiration through the
mouth intead of nose-CHOPRA (1951)

Prolonged or continued exposure of

the tissues of anterior areas of mouth
to the drying effect of inspired air-
CHACKER (1961)

Habitual respiration through the

mouth instead of nose-SASSOUUNI
(1971)
 Obstructive – Due to complete or partial obstruction of nasal passage.
 Deviated nasal septum
 Nasal polyps
 Chronic inflammation of nasal mucosa
 Localized benign tumors
 Congenital enlargement of nasal turbinates
 Allergic reaction of nasal mucosa
 Obstructive adenoids

 Obstructive – Due to complete or partial obstruction of

nasal passage.
 Deviated nasal septum
 Nasal polyps
 Chronic inflammation of nasal mucosa
 Localized benign tumors
 Congenital enlargement of nasal turbinates
 Allergic reaction of nasal mucosa
 Obstructive adenoids

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 Habitual – Deep rooted habit – One continues to breathe
through mouth even though nasal obstruction is removed.

 Anatomic – Short upper lip do not permit complete closure

of mouth

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 
Click to edit the
outline text format
ETIOLOGY

Second Outline
Level

1.Nasal Obstruction due to –

 Third Outline
-Enlarged turbinates Level
-Deviated nasal septum. 
Fourth Outline
-Allergic rhinitis Level
-Nasal polyps  Fifth Outline
-Enlarged adenoids
Level
-Chronic inflammation of
 Sixth
nasal mucosa
Outline
Level
 Seventh
Outline
Level
2.Abnormally short upper lip preventing proper lip seal
3.Obstruction in the bronchial tree or larynx
4.Obstructive sleep apnoea syndrome
5. Genetically predisposed individuals
-Ectomorphic children having a genetic type of tapering face &
nasopharynx are prone for nasal obstruction
6. Thumb sucking or other oral habits can be the instigating agent

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CLINICAL FEATURES

Effects on dentofacial structures-

Facial form –
- A large face height
- Increased mandibular plane angle
- Retrognathic mandible & maxilla

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Adenoid facies –Characterized By
-Long narrow face
-Narrow nose & nasal passage
-Flaccid lips with upper lip being short
-Dolicocephalic skeletal pattern
-Nose is tipped superiorly in front
-Expressionless face
-V shaped maxillary arch & high palatal vault.

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#anterior open bite
#anterior marginal gingivitis

#increased overjet of incisors

#posterior crossbite

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 History of patient
 Clinical examination
 Mirror test – Double-sided mirror is held between nose and mouth.

Cotton test – A butterfly shaped piece of cotton is placed over upper lip below nostrils.
 If cotton flutters down,it indicates nasal breathing
 Water test – Patient is asked to fill his mouth with water and retain it for a period of time.

While nasal breathers accomplish with ease, mouth breathers find task difficult.
 History of patient
 Clinical examination
 Mirror test – Double-sided mirror is held between nose and
mouth.
Cotton test – A butterfly shaped piece of cotton is placed
over upper lip below nostrils.
 If cotton flutters down,it indicates nasal breathing
 Water test – Patient is asked to fill his mouth with water
and retain it for a period of time.
While nasal breathers accomplish with ease, mouth
breathers find task difficult.

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Cephalometrics
Nasopharyngeal space,space of adenoid
Rhinomanometry
Study of nasal air flow characteristics

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 MANAGEMENT

Elimination of the cause

pharyngeal or nasal obstruction (ENT)

 Interception of the habit :-

Oral screen
◦ Adhesive tapes for lip seal during night

 Rapid maxillary expansion

increase nasal air flow and decrease nasal air resistance

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BRUXISM
 Defined as the clenching or grinding of teeth when not masticating or swallowing (Poselt and Wolff)
 Habitual grinding of teeth when the individual is not chewing or swallowing(Ramfjord 1966)
 Non-functional contact of teeth which may include clenching,gnashing,grinding and tapping of
teeth(Rubina 1986)

 Defined as the clenching or grinding of teeth when not

masticating or swallowing (Poselt and Wolff)
 Habitual grinding of teeth when the individual is not chewing or
swallowing(Ramfjord 1966)
 Non-functional contact of teeth which may include
clenching,gnashing,grinding and tapping of teeth(Rubina 1986)

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 Psychological and emotional stresses
 occlusal interference or discrepancy between centric relation and centric occlusion
 Genetics
 Mg++ deficiency
 Allergies
 Occupational factors

 Psychological and emotional stresses

 occlusal interference or discrepancy between centric relation
and centric occlusion
 Genetics
 Mg++ deficiency
 Allergies
 Occupational factors

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 Occlusal wear facets
 Fractures of teeth and restorations
 Mobility of teeth
 Tenderness and hypertrophy of masticatory muscles
 TMJ pain and discomfort

 Occlusal wear facets

 Fractures of teeth and restorations
 Mobility of teeth
 Tenderness and hypertrophy of masticatory muscles
 TMJ pain and discomfort

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 History and clinical examination are sufficient to diagnose
 Occlusal prematurities can be diagnosed by use of articulating papers
 Electro myographic examination – to check for hypertrophy of masticatory
muscles
 History and clinical examination are sufficient to diagnose
 Occlusal prematurities can be diagnosed by use of articulating
papers
 Electro myographic examination – to check for hypertrophy of
masticatory muscles

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 Appropriate psychological counselling
 Hypnosis, relaxing exercises and massage can help relieve muscle tension.
 Occlusal adjustments need to be carried out to eliminate prematurities
 Night guards can be given which cover the occlusal surfaces of teeth and prevent interferences and wear
 Biofeedback-utilizes positive feedback to enable the patient to learn tension reduction

 Appropriate psychological counselling

 Hypnosis, relaxing exercises and massage can help relieve
muscle tension.
 Occlusal adjustments need to be carried out to eliminate
prematurities
 Night guards can be given which cover the occlusal surfaces of
teeth and prevent interferences and wear
 Biofeedback-utilizes positive feedback to enable the patient to
learn tension reduction

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OTHER MINOR HABITS
 Lip biting most often involves the lower lip which is turned
inwards and pressure is exerted on the lingual surfaces of
maxillary anteriors.
 Lip biting most often involves the lower lip which is turned
inwards and pressure is exerted on the lingual surfaces of
maxillary anteriors.

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 Proclined upper anteriors and retroclined lower anteriors.
 Hypertrophic and redundant lower lip
 Cracking of lips
 Proclined upper anteriors and retroclined lower anteriors.
 Hypertrophic and redundant lower lip
 Cracking of lips

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 Lip bumpers can be used that not only keep the lips away but
also improve the axial inclination of anterior teeth due to
unrestrained action of tongue
 Lip bumpers can be used that not only keep the lips away but
also improve the axial inclination of anterior teeth due to
unrestrained action of tongue

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 It does not produce any gross malocclusion
 Minor local tooth irregularities such as rotation, wear of incisal edge and minor crowding
can occur
 Nut notch is seen which is wear of teeth in the form of notch. It is seen due to cracking
open of hard nuts using incisal edge of anteriors

 It does not produce any gross malocclusion

 Minor local tooth irregularities such as rotation, wear of incisal
edge and minor crowding can occur
 Nut notch is seen which is wear of teeth in the form of notch. It
is seen due to cracking open of hard nuts using incisal edge of
anteriors

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 Include picking at the gingiva with fingers and finger nails,chewing the inside of the cheek,lip or tongue.
 Sufferer derives pleasure from his own pain
 Associated with Lesch-Nyhan & de Lange’s syndromes
 Diverting the child’s attention each time habit is observed can solve the problem
 Restraints,protective padding,sedation can be used in mentally retarded children

 Include picking at the gingiva with fingers and finger

nails,chewing the inside of the cheek,lip or tongue.
 Sufferer derives pleasure from his own pain
 Associated with Lesch-Nyhan & de Lange’s syndromes
 Diverting the child’s attention each time habit is observed
can solve the problem
 Restraints,protective padding,sedation can be used in
mentally retarded children

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