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Understanding Tongue Thrust

Did you know that 'tongue thrust' is a dysfunctional muscle pattern and constitutes a myofunctional disorder? Tongue thrust is defined as tongue protruding anteriorly or laterally when swallowing, during speech and when tongue is resting. The tongue should normally move upward against the roof of the mouth to form a seal so swallowing can occur. With a tongue thrust, the tongue moved between upper and lower front teeth. Over time this muscle pattern can lead to a narrow and V-shaped upper arch, cause the front teeth to tilt forward too much, and can contribute to the development of an open bite.


There are many etiologic factors contributing to tongue thrusting such as:


  • Hereditary (genetics)
  • Thumb or finger sucking
  • Tongue tied
  • Macroglossia (large tongue)
  • Enlarged tonsils or adenoids
  • Allergies/nasal congestion

Genetic factors and thumb or finger sucking habits can both result in a V-shaped (tapered) upper arch. This arch form frequently precluded the tongue from fitting in the correct position. As a result an anterior tongue position and tongue thrust can develop. At Orchard of Smiles Orthodontics we typically recommend an customized upper expander with a thumb/finger crib to help with arch correction and finger habit cessation.


For tongue-tied individuals, the lack of tongue mobility makes it impossible for the tongue to move to the correct position against the roof of the palate habitually and when swallowing. A lower positioned tongue may contribute to a broader lower jaw than upper jaw. When this is the case, we typically recommend an upper expander and a frenectomy (frenum removal) to release the tongue tethered attachment.


With macroglossia (enlarged tongue) the size of the tongue prohibits correct positioning of the tongue. Since it is typically prohibitive to reduce the size of the tongue, our team frequently recommends expanding the upper jaw as much as possible to accommodate the larger tongue in these cases.


Enlarged tonsils or adenoids cause the tongue to position forward. This occurs because the upper airway is constricted due to the size of the tonsils. As a result, the tongue will have to move forward to open the airway to facilitate breathing. Large adenoids make it challenging to breathe through the nose. As a result, an individual will position the tongue low and forward for mouth breathing (opening up the airway). The same is true for allergies and nasal congestion since they typically interfere with nasal breathing. An upper expander in conjunction with removal of the tonsils/adenoids or allergy treatment is typically our orthodontic treatment of choice.


Therapeutically, the treatment for tongue thrust is Myofunctional therapy and speech therapy. The goal of myofunctional therapy is to develop a normal oral resting position of the tongue. The goal is for the tongue tip to rest against the ridge behind the upper front teeth when the lips and teeth are closed. Orthodontic treatment is frequently also indicated to develop a broader more ideal arch shape, correct any misfit (crossbite) of the back teeth and close the anterior open bite as needed. At Orchard of Smiles Orthodontics we have various orthodontic appliances that are tailored to these specific needs. If you would like to learn more, please schedule your complimentary orthodontic consultation today!

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