TONGUE THRUSTING: THE BIGGEST PROBLEM IN ORTHODONTICS

     Swallowing occurs 24 hours per day and about 2000 times per day. During each swallow, the tongue can exert momentary pressures of 1 to 6 pounds on the surrounding structures of the mouth. 
This pressure will push the teeth and bone forward or apart. Tongue thrusting will move teeth into abnormal positions and cause growth distortions of the face and teeth.

     It is natural for infants to swallow with the tongue between the gums, but a transition should be made about age seven where the tongue is placed on the roof of the mouth and the teeth are in full contact during the swallow. If the tongue is placed between the teeth during the swallow like an infant, the muscles surrounding the teeth and lips are used to gain suction rather than using the muscles of the throat. 
     Lip puckering and lip licking prior to a swallow are easy signs to look for when a tongue thruster is swallowing with the tongue between the teeth. The result of the tongue thrust is an open bite where the teeth do not touch. There is usually a protrusion of the upper front teeth.

     The majority of patients we treat for protrusion of the upper teeth are tongue thrusters! There is also a type of thrust which is to the sides of the mouth and is almost untreatable.

     If the front teeth are brought back into alignment, but if the tongue thrust habit is not broken, the teeth may be moved back out after treatment. So, what can be done to stop this habit? Habit correction (myofunctional therapy) by a speech therapist may be necessary if the exercises which we recommend during treatment are not followed.

     In situations where the habit is severe, a removable appliance may be necessary to block the tongue away from the front teeth. Unfortunately, some thrusters are never corrected due to lack of parental support or lack of cooperation on the part of the patient. In either case, orthodontic treatment is sure to be negatively effected.

     If you detect an open bite in your child, then they should be seen around age seven for a preliminary orthodontic exam. Rarely do I recommend speech therapy before treatment because the teeth are usually too far out of the normal range for early myofunctional therapy to be effective. 

     Our methods to deal with tongue thrusting involve education and exercises as well as removable appliances which block the forward positioning of the tongue during swallowing.

     During a normal swallow: the tongue is on the roof of the mouth and behind the front teeth the front and back teeth touch during the entire swallow and do not protrude the tongue is not between the teeth at any time during the swallow the lips contact normally.

     During an abnormal swallow (tongue thrust): the tongue is between the front teeth the lower lip is licked prior to the swallow and the lower lip is usually swollen, red, and cracked due to constant licking there is pursing of the lower lip and chin during the swallow the abnormal swallow pushes the upper teeth forward and keeps them apart in the front of the mouth, causing an openbite.

Why do you want to stop tongue thrusting? Because tongue thrusting delays completion of your treatment by forcing the teeth apart or forward. After the braces are removed, thrusting will ruin the results. It is a habit, just like sucking the thumb. Thrusting is a negative force. Thrusting will destroy your straight teeth. Bottomline: you are not going to get the braces off until you absolutely stop tongue thrusting and no amount of lying to yourself will cure it.
 

     Tongue thrusters don't even know it, but they make a lot of ugly faces each time they swallow. It is easy to catch them doing it. Just observe them when they don't know you are watching them. Why do you want to stop these people from doing something they obviously enjoy? Tongue thrusting delays completion of treatment by forcing the teeth apart or forward. 
     After the braces are removed, thrusting will ruin the results. It is a habit, just like sucking the thumb. Thrusting is a negative force. Thrusting will destroy your orthodontic investment!
 

     It's just a negative (or positive???) re-enforcement device used in combination with anterior vertical elastics to again re-enforce the habit of keeping the teeth from between the front teeth during a swallow. Wearing the elastics to keep the teeth together at night is essential. Otherwise, the jaw drops down and the tongue hangs out at night defeating the purpose of the appliance. There are two versions we use, one for use with braces and one without braces. Typically the latter is used after treatment for insurance purposes. Bottom line: it works and quick! But...you have to have the front teeth in the correct position (retracted) to break the habit. 

     Removable tongue habit appliance which can be used with or without braces in place and is removable by the older patient.

         Fixed tongue habit appliance for younger children.  It is not removable by the patient.

     During a tongue thrust, the mid-portion of the tongue is not pressed against the roof of the mouth, but is employed down and forward while the tip of the tongue is spread out between the teeth and touching the lips momentarily. Bottom line: during the tongue thrust, the mid-portion of of the tongue is not on the roof of the mouth and exerts little force against the palate. It's the constriction of the middle of the tongue that protrudes it. The tongue protrudes during a tongue thrust.

     With the tongue habit appliance, the mid portion of the tongue is forced backwards and up because if the patient parts the teeth to swallow, the wires of the appliance are moved downward off the roof of the mouth into a position where the tongue will be engaged if the tongue moves out between the lips. For this reason the patient should be instructed to keep the tip of the tongue under the wires during the swallow and concentrate on pressing the back half of the tongue against the palate.
 

Teaching the "click"position to initiate thew swallow without the tongue habit appliance, forces the tip of the tongue into an upward position to encourage the tongue against the roof of  the mouth and not between the teeth.  When the THA is added, it the teeth are held together, then the wires of the appliance will curve against the roof of the mouth and only come into play if and when the patient opens to do an abnormal swallow.  Otherwise, the tongue will be under the wires if the teeth are closed.  If the patient opens to show the position of the tongue, it should be under the wires and not on the roof of the mouth.  Once the teeth are closed, this will automatically position the tip of the tongue upward, and force the tongue to remain there to avoid being "stuck" if the patient tries to thrust with the teeth apart.

     Very few people know or understand ths information. It has taken 25 years to put together this information and it works...with a motivated patient.
 

This section contains technical information on clinical orthodontic problems and treatment, however, orthodontic treatment is highly personalized and varies from patient to patient depending on the situation and doctor. The following information is specifically for the office of Dr. Michael Echols and is copyrighted information.

We are more than happy to see your child for a brief consultation in our offices, but we cannot make decisions or offer advice on the Internet. Obviously, personal contact with the parent and child is necessary.