Tongue thrust

Last updated
Tongue thrusting in (A) shows the effect of oral seal to enable nasal breathing whilst awake , whereby lack of tongue thrust (B) ensures obligate oral breathing. When asleep in a supine position, tongue tone is lost, potentiating both oral and nasal airflow blockage (C). This is relieved by drawing both the collapsed tongue (glossoptosis) and small jaw forward through dependent thumb sucking, enabling normal nasal breathing. Diagram obtained from Coceancig, Paul. 6Ways To Design A Face: corrective jaw surgery to optimize bite, airway, and facial balance. Batavia: Quintessence Publishing. ISBN 978-086715966-0. The development of anterior open bite as a combined effect of both a small jaw (anterior mandibular hypoplasia) and adaptive thumb sucking.jpg
Tongue thrusting in (A) shows the effect of oral seal to enable nasal breathing whilst awake , whereby lack of tongue thrust (B) ensures obligate oral breathing. When asleep in a supine position, tongue tone is lost, potentiating both oral and nasal airflow blockage (C). This is relieved by drawing both the collapsed tongue (glossoptosis) and small jaw forward through dependent thumb sucking, enabling normal nasal breathing. Diagram obtained from Coceancig, Paul. 6Ways To Design A Face: corrective jaw surgery to optimize bite, airway, and facial balance. Batavia: Quintessence Publishing. ISBN 978-086715966-0.

Tongue thrust (also called reverse swallow or immature swallow) is a pseudo-pathological name of what is either considered a normal adaptive lip seal mechanism, whereby normal nasal breathing or normal swallowing can occur. Or, it is seen as an oral myofunctional disorder - a tongue muscle pattern that is perceived as clinically abnormal and in which the tongue protrudes anteriorly to seal otherwise incompetent lips.

Contents

Tongue thrusting is only seen during speech, swallowing or eating, and in order to close otherwise incompetent lips on background of an almost ubiquitous small lower jaw and anterior open bite. The behaviour is apparent only during a normal awake state, and whilst the tongue (and rest of the body) is in normal resting tone. By descriptive inference, tongue thrusting is impossible during deep sleep, or non-tone phases; or in particular during non-conscious states.

Nearly all infants exhibit a swallowing pattern involving forward tongue tip push as part of infant suckling behaviour . By six months of age most lose the forward extent of this push once paediatric incisal teeth erupt, and normal lip seal is automatically acquired as solid foods begin. [1]

There are thus two community and clinical professional views of the observation of tongue thrusting behaviour that persists past the neonatal period.

1. Either it is a normal adaptive means of closing an open (or incompetent) lip state, caused by a unique combination of anatomical reasons, or

2. Tongue thrusting is the cause or potentiator of an open or incompetent lip state, and which resists efforts at behavioural change or clinical attempt at remedy.

In generality, tongue thrusting is poorly understood. In particular it lacks consensus on many points of description, causality, effect or management and between the various clinical groups that each offer different forms of treatments or philosophies of professional interest.

The Classical view of Tongue Thrusting

Since 1958, the term "tongue thrust" has been described and discussed in speech and orthodontic (dental) publications and by a range of writers - and speaking from specific non-medical professional perspectives and clinical biases - as a pathological event that exists as an entity for itself and without fundamental or primary functional or necessary cause.[ citation needed ]

Both the general dental and speech pathologist classical views are that tongue thrusting causes both the dentofacial abnormality of anterior open bite, and the incompetent lip seal and swallowing and speech effects associated with tongue thrust.

In both professions, tongue thrust is represented as a behavioural disturbance which can be taught to be resisted. Such interventional therapy is represented to strongly assist orthodontic or speech pathologist efforts at resolution of both the speech and orthodontic effects of anterior open bite and the associated lip incompetence of both.

As with normal reflexes, most school-age children have tongue thrust if looked for. For example, according to recent literature, as many as 67–95 percent of children 5–8 years old exhibit tongue thrust, which may professionally be represented as associated with or contributing to an orthodontic or speech problem - depending on the clinical bias of proposal. Up to the age of four, as with the complex conversion of all simpler reflex events, there is a possibility that any observed child will normally outgrow tongue thrust as they transition to a fuller dentofacial development. However, if a tongue thrust pattern is retained beyond infancy, it can be seen through a lens of abnormality, and this vulnerable to clinical bias and attempts to clinically interact.

Types of tongue thrusting include:

Anterior thrust
This is the most common type of tongue thrust. It is often associated with a low, forward tongue rest posture. Sometimes the tongue can be seen protruding beyond the lips at rest and/or during the swallow. Upper incisors can be extremely protruded and the lower incisors are pulled in by the lower lip. An anterior open bite is a common malocclusion associated with this type of tongue thrusting pattern, especially in the presence of lip incompetence. This type of thrust is most generally accompanied by a strong mentalis.
Unilateral thrust
This occurs when the tongue pushes unilaterally to the side between the back teeth during the swallow. The bite can be characteristically open on that side.
Bilateral thrust
This occurs when the tongue pushes between the back teeth on both sides during the swallow with the jaw partially or subtly open.

Sometimes, the only teeth that touch are the molars, with the bite completely open on both sides including the anterior teeth. A large tongue can also be noted. This is the most difficult thrust to correct.

Causes

Factors that can contribute to tongue thrusting include macroglossia (enlarged tongue), thumb sucking, large tonsils, hereditary factors, ankyloglossia (tongue tie), and certain types of artificial nipples used in feeding infants, also allergies or nasal congestion can cause the tongue to lie low in the mouth because of breathing obstruction and finally contributing to tongue thrusting. In addition, it is also seen after prolonged therapy by levodopa in Parkinsonism, also it occurs as extra pyramidal side effect (acute muscular dystonia) after use of neuroleptics (anti-psychotics).

Effects

Tongue extrusion is normal in infants.

Tongue thrusting can adversely affect the teeth and mouth. A person swallows from 1,200 to 2,000 times every 24 hours with about 4 pounds (1.8 kg) of pressure each time. If a person suffers from tongue thrusting, this continuous pressure tends to force the teeth out of alignment. People who exhibit a tongue thrust often present with 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.[ citation needed ] If the tongue is allowed to continue its pushing action against the teeth, it will continue to push the teeth forward and reverse the orthodontic work.

Speech may be affected by a tongue thrust swallowing pattern. Sounds such as /s/, /z/, /t/, /d/, /n/, and /l/ are produced by placing the tongue on the upper alveolar ridge, and therefore a tongue thrust may distort these sounds. [2]

Chewing and swallowing with dysfunctional muscle patterning (as in a tongue thrust) is not as effective as a normal chewing and swallowing motion.

Treatment

Treatment options for tongue thrust may include orthodontic spikes, prongs or other tongue reminders, which redirect the tongue rest posture and swallow. Orofacial myofunctional therapists teach oral rest posture and chewing/swallowing mechanics without appliances. [3]

See also

Related Research Articles

Möbius syndrome

Möbius syndrome is a rare congenital neurological disorder which is characterized by facial paralysis and the inability to move the eyes from side to side. Most people with Möbius syndrome are born with complete facial paralysis and cannot close their eyes or form facial expressions. Limb and chest wall abnormalities sometimes occur with the syndrome. People with Möbius syndrome have normal intelligence, although their lack of facial expression is sometimes incorrectly taken to be due to dullness or unfriendliness. It is named for Paul Julius Möbius, a German neurologist who first described the syndrome in 1888.

Orthodontics

Orthodontics is a specialty of dentistry that deals with the diagnosis, prevention, and correction of malpositioned teeth and jaws, and misaligned bite patterns. It can also focus on modifying facial growth, known as dentofacial orthopedics.

Macroglossia

Macroglossia is the medical term for an unusually large tongue. Severe enlargement of the tongue can cause cosmetic and functional difficulties in speaking, eating, swallowing and sleeping. Macroglossia is uncommon, and usually occurs in children. There are many causes. Treatment depends upon the exact cause.

Prognathism Protrusion of the upper or lower human jaw

Prognathism is a positional relationship of the mandible or maxilla to the skeletal base where either of the jaws protrudes beyond a predetermined imaginary line in the coronal plane of the skull. In general dentistry, oral and maxillofacial surgery, and orthodontics, this is assessed clinically or radiographically (cephalometrics). The word prognathism derives from Greek πρό and γνάθος. One or more types of prognathism can result in the common condition of malocclusion, in which an individual's top teeth and lower teeth do not align properly.

Orthognathic surgery

Orthognathic surgery ; also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusion problems primarily arising from skeletal disharmonies, other orthodontic dental bite problems that cannot be easily treated with braces, as well as the broad range of facial imbalances, disharmonies, asymmetries and malproportions where correction can be considered to improve facial aesthetics and self esteem.

Malocclusion

A malocclusion is a misalignment or incorrect relation between the teeth of the two dental arches when they approach each other as the jaws close. The term was coined by Edward Angle, the "father of modern orthodontics", as a derivative of occlusion. This refers to the manner in which opposing teeth meet.

Ankyloglossia

Ankyloglossia, also known as tongue-tie, is a congenital oral anomaly that may decrease the mobility of the tongue tip and is caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth. Ankyloglossia varies in degree of severity from mild cases characterized by mucous membrane bands to complete ankyloglossia whereby the tongue is tethered to the floor of the mouth.

Oral myology is the postural training of the tongue, lips and cheeks. This technique is used to treat orofacial myofunctional disorders and other conditions that involve weakness of the tongue and facial muscles, often due to mouth breathing instead of nasal breathing.

Overjet

Overjet is the extent of horizontal (anterior-posterior) overlap of the maxillary central incisors over the mandibular central incisors. In class II malocclusion the overjet is increased as the maxillary central incisors are protruded.

Crossbite

Crossbite is a form of malocclusion where a tooth has a more buccal or lingual position than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.

Lingual arch

A lingual arch is an orthodontic device which connects two molars in the upper or lower dental arch. The lower lingual arch (LLA) has an archwire adapted to the lingual side of the lower teeth. In the upper arch the archwire is usually connecting the two molars passing through the palatal vault, and is commonly referred as "Transpalatal Arch" (TPA). The TPA was originally described by Robert Goshgarian in 1972. TPAs could possibly be used for maintaining transverse arch widths, anchorage in extraction case, prevent buccal tipping of molars during Burstonian segmented arch mechanics, transverse anchorage and space maintenance.

A jaw abnormality is a disorder in the formation, shape and/or size of the jaw. In general abnormalities arise within the jaw when there is a disturbance or fault in the fusion of the mandibular processes. The mandible in particular has the most differential typical growth anomalies than any other bone in the human skeleton. This is due to variants in the complex symmetrical growth pattern which formulates the mandible.

Orofacial Myofunctional Disorders (OMD) are muscle disorders of the face, mouth, lips, or jaw due to chronic mouth breathing.

Serial extraction is the planned extraction of certain deciduous teeth and specific permanent teeth in an orderly sequence and predetermined pattern to guide the erupting permanent teeth into a more favorable position.

Lingual braces are one of the many types of the fixed orthodontic treatment appliances available to patients needing orthodontics. They involve attaching the orthodontic brackets on the inner sides of the teeth. The main advantage of lingual braces is their near invisibility compared to the standard braces, which are attached on the buccal (cheek) sides of the tooth. Lingual braces were invented by Craven Kurz in 1976.

A lip bumper is a dental appliance used in orthodontics, for various purposes to correct a dentition by preventing the pressure from the soft tissue. Lip bumpers are usually used in orthodontic treatment where the patient has a crowded maxillary or mandibular teeth in an arch.

Activator Appliance is an Orthodontics appliance that was developed by Viggo Andresen in 1908. This was one of the first functional appliances that was developed to correct functional jaw in the early 1900s. Activator appliance became the universal appliance that was used widely throughout Europe in the earlier part of the 20th century.

Open bite is a type of orthodontic malocclusion which has been estimated to occur in 0.6% of the people in the United States. This type of malocclusion has no vertical overlap or contact between the anterior incisors. The prevalence varies between different populations, for instance, occurring with 16% in Black people and 4% in white people. The term "open bite" was coined by Carevelli in 1842.

Orthodontic indices are one of the tools that are available for orthodontists to grade and assess malocclusion. Orthodontic indices can be useful for an epidemiologist to analyse prevalence and severity of malocclusion in any population.

It is estimated that nearly 30% of the general population present with malocclusions that are in great need of orthodontic treatment. However, the term dentofacial deformity describes an array of dental and maxillo-mandibular abnormalities, often presenting with a malocclusion, which is not amenable to orthodontic treatment alone and definitive treatment needs surgical alignment of upper/lower jaws or both. Individuals with dentofacial deformities often present with lower quality of life and compromised functions with respect to breathing, swallowing, chewing, speech articulation, and lip closure/posture. It is estimated that about 5% of general population present with dentofacial deformities that are not amenable to orthodontic treatment only.

References

  1. http://www.educus.com/Journals/16818591
  2. Roberts, Lyndi. "The Use of Speech Therapy and Orthdontia in the Treatment of Tongue Thrust Disorder". onesearch.cuny.edu. Retrieved 2019-06-18.
  3. DMD, Robert M. Mason; PhD; Ph.D, Honor Franklin; MS; CCC-SLP; COM (2016-08-22). "Appliance Use for Oral Habit Patterns". IAOM. Retrieved 2019-06-24.