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Orofacial Myofunctional Disorders

Tongue Thrust

What is Tongue Thrust?

Tongue thrust is one of many common disorders associated with orofacial myofunctional disorders.

Orofacial myofunctional disorders contain one or a combination of the following: abnormal thumb, finger, lip and tongue sucking habits; an inappropriate mouth open or lips open resting posture; a forward interdental rest posture of the tongue; a forward rest position of the tongue against the maxillary incisors; lateral, posterior interdental tongue resting posture; inappropriate thrusting of the tongue in speaking and/or swallowing.

Nearly all young children exhibit a swallowing pattern involving tongue thrust protrusion, but by the age of 6 most have automatically switched to a mature or “normal” swallowing pattern.

What Causes Tongue Thrust?

No one specific cause has actually been determined to cause the tongue thrust problem. The following might predispose a child toward a tongue thrust pattern

A tendency toward allergies and upper respiratory congestion

Muscular, neurological, or other physiological abnormalities

An imbalance between the number or size of teeth and the size of the oral cavity

An extremely high or narrow palatal arch

May be inherited but research hasn’t verified this factor

Being “tongue tied”- a short lingual frenum

Mouth breathing during the day and/or night

A restricted nasal passageway due to small nostrils or a deviated septum

Too much strength in facial muscles

The angle of the jaw line or other hereditary factors within a family

What is the Incidence of Tongue Thrust?

The term “tongue thrust” has been described and discussed in speech and dental publications since 1958 by many writers. The fact that a significant number of school-age children have tongue thrust has been noted by specialists. For example, recent literature reports that as many as 67 to 95 percent of five to eight-year old children exhibit a tongue thrust that may be associated with, or contribute to, an orthodontic or speech problem. In the United States, 20 to 80 percent of orthodontic patients exhibit some form of tongue thrust.

Tongue thrusting and consistent pressure against the teeth is the reason for malocclusion (misalignment) and bite problems for nearly half of orthodontic patients. Orofacial Myofunctional Therapy is usually completed before or during orthodontic treatment.

Why is it a Concern?

A person diagnosed with a tongue thrust or orofacial myfunctional disorder is applying a small amount of pressure against or between their teeth at all times. If a person suffers from tongue thrusting, this continuous pressure tends to cause teeth to misalign.

Many people who tongue thrust have open bites; the force of the tongue against the teeth is an important factor in contributing to “bad bite” (malocclusion). Many orthodontists have completed dental treatment with what appeared to be good results, only to discover that the case relapsed because of the patient’s tongue thrust.

If the tongue is allowed to continue its pushing against the teeth, it will continue to push the teeth forward and reverse orthodontic work.

What are Some Signs of Having a Tongue Thrust Problem?

One or more of the following conditions may clearly indicate tongue thrust disorder and should be investigated further with an evaluation from a trained and certified Orofacial Myofunctional Therapist:

Tongue protruding between or against the upper and/or lower “front teeth” when forming /s/, /z/, /t/, /d/, /n/, /l/, or /sh/.

Frequent open-mouth resting posture with the lips parted and/or the tongue resting against the upper and/or lower teeth.

Lips that are often cracked, chapped, and sore from frequent licking.

Frequent mouth breathing in the absence of allergies or nasal congestion.

Who Diagnoses Tongue Thrust?

The most difficult problem of all is the diagnosis. As a rule, orthodontists, general dentists, pedontists, some pediatricians, and speech therapists trained and certified as Orofacial Myologists detect the problem.

In many cases, tongue thrust may not be detected until the child is under orthodontic care. However, diagnosis is usually made when the child displays a dental or speech problem that needs correction.

If the tongue is allowed to continue its pushing against the teeth, it will continue to push the teeth forward and reverse orthodontic work.

Treatment for Tongue Thrust?

Treatment requires sincere commitment and cooperation of the child and parent. At the present time, successful correction of tongue thrust appears in 80% of treated cases, 20% are unsuccessful due to poor cooperation and lack of commitment by the parent and patients or neuromuscular involvement which makes correction impossible.

At Boise Speech and Hearing Clinic we use a program designed and developed at the Boise Speech and Hearing Clinic since the early 1970’s with evidence based practices. The program is an oral habit training method of exercises that re-educates the muscles associated with chewing, swallowing, lip strength and function to increase overall coordination. This method must be taught by a Speech-Language Pathologist trained and certified in Orofacial Myofunctional Disorders. This therapy has proven to give the highest percentages of favorable results.

Boise Speech and Hearing Clinic’s program is a 10-week program where the client is seen one time per week for 30-minutes. The client is given a series of exercises to practice at home. Each week the client will receive new exercises if homework has been completed. To ensure habituation into everyday environments the client will have 3 follow-up appointments after completing the 10-week program.

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