TONGUE THRUST CLINIC
What is a tongue thrust?
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Tongue thrust often refers to a forward resting posture, where the tongue sits over the lower teeth or lips. It also refers to a swallowing pattern where the tongue extends either too far forward or to the sides of the mouth, rather than making contact with the spot behind the top front teeth. Beyond infancy, tongue thrust is a problematic habit that may impact upon health, appearance and communication.
It is not simply a childhood issue. Many adults have a tongue thrust or tongue thrust swallow and do not even realise. Signs that you may have tongue thrust include headaches, a clicky jaw or reversal of orthodontic treatment results. Muscles are very powerful – if we don’t retrain the muscles, then the bones and teeth will move back. |
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What is a tongue thrust swallow?
A tongue thrust is a normal swallowing pattern for infants when breast or bottle feeding. However, upon transitioning to solids, we should begin to develop a more mature swallowing pattern where the tongue tip is placed against the roof of the mouth, behind the front teeth. The bolus is then propelled backwards with a wave-like movement of the tongue. When a tongue thrust swallow is used, food and drink are actually propelled forwards. Sometimes the tongue can be seen popping out of the mouth, but for others, close observation will reveal flexing of the muscles around the mouth. As mentioned above, many adults have a tongue thrust swallow. In adulthood people often learn not to poke their tongue right out of their mouth, but closer examination will enable us to establish what the tongue is doing inside the mouth. In a normal swallow, the lips and surrounding muscles should be relaxed.
A tongue thrust may be retained due to:
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What are the specific effects?
For those who have a forward resting tongue posture there is constant pressure on the teeth and jaw bone, which may affect teeth alignment and jaw development. It is estimated that we swallow 1200-2000 times per day. Each time an individual uses a tongue thrust swallow, even greater force is exerted upon the teeth and jaw.
The absence of tongue movement against the palate is also significant. We need the tongue to touch the roof of the mouth to stimulate expansion of the bone. If the palate remains narrow and becomes highly vaulted, there may be a structural barrier to the accurate production of speech sounds, despite therapy. Given that the roof of the mouth is also the base of the nasal cavity, the airway could be impacted. Troubles breathing comfortably through the nose will propagate the habit of opening the mouth and positioning the tongue in an anterior position.
Individuals who have a tongue thrust also often have speech disorders. Most commonly, they present with an inter-dental lisp, where the tongue protrudes between the front teeth when producing “s” or “z” sounds. When speaking normally the tongue should make contact with the roof of the mouth for a number of other sounds (“t, d, l, n”), and these may all be affected. For those with an open mouth posture, weaker or shorter muscles in the lips may also affect the production of ‘labial’ sounds (“p, b, m, f, v”).
Mouth breathing may seem benign, however, there are many health complications associated with it. When breathing through the mouth, inhaled air is cold and unfiltered. This leads to more frequent sickness. Dry, cracked lips and a dry mouth are also common. Over time, this leads to sensitive teeth, swollen gums and increased likelihood of tooth decay and infections.
Finally, snoring and sleep apnoea are serious sides effects of an untreated tongue thrust, affecting energy levels and attention. It is noted that allergies, enlarged tonsils and enlarged adenoids may be the primary underlying cause of the tongue thrust (i.e. people breathe through their mouth when the nasal passage is obstructed), however, once factors inhibiting the airway have been eliminated (e.g. through removal or the tonsils), there will not automatically be a return to normal function if a tongue thrust pattern has been established. This is where Orofacial Myology and Speech Pathology come into the treatment picture!
The absence of tongue movement against the palate is also significant. We need the tongue to touch the roof of the mouth to stimulate expansion of the bone. If the palate remains narrow and becomes highly vaulted, there may be a structural barrier to the accurate production of speech sounds, despite therapy. Given that the roof of the mouth is also the base of the nasal cavity, the airway could be impacted. Troubles breathing comfortably through the nose will propagate the habit of opening the mouth and positioning the tongue in an anterior position.
Individuals who have a tongue thrust also often have speech disorders. Most commonly, they present with an inter-dental lisp, where the tongue protrudes between the front teeth when producing “s” or “z” sounds. When speaking normally the tongue should make contact with the roof of the mouth for a number of other sounds (“t, d, l, n”), and these may all be affected. For those with an open mouth posture, weaker or shorter muscles in the lips may also affect the production of ‘labial’ sounds (“p, b, m, f, v”).
Mouth breathing may seem benign, however, there are many health complications associated with it. When breathing through the mouth, inhaled air is cold and unfiltered. This leads to more frequent sickness. Dry, cracked lips and a dry mouth are also common. Over time, this leads to sensitive teeth, swollen gums and increased likelihood of tooth decay and infections.
Finally, snoring and sleep apnoea are serious sides effects of an untreated tongue thrust, affecting energy levels and attention. It is noted that allergies, enlarged tonsils and enlarged adenoids may be the primary underlying cause of the tongue thrust (i.e. people breathe through their mouth when the nasal passage is obstructed), however, once factors inhibiting the airway have been eliminated (e.g. through removal or the tonsils), there will not automatically be a return to normal function if a tongue thrust pattern has been established. This is where Orofacial Myology and Speech Pathology come into the treatment picture!
How do we manage tongue thrust?
- Assessment: Case history and review of oral structures, posture, breathing, swallowing & speech
- Referral: If appropriate, consultation with other health care professionals may be recommended, particularly if there are any concerns regarding airway (Orthodontists, Paediatricians, Ear Nose & Throat Specialists, Sleep Specialists)
- Education: Learning about proper tongue placement and the importance of treatment
- Awareness training
- Establishing a new swallow pattern (exercises!)
- Speech therapy
Home practise is an important aspect of therapy throughout awareness training, swallowing and speech therapy.
If you would like to learn more about tongue thrust from one of our speech pathologists, please contact us.
