What Are The Adverse Effects Caused By Tongue Thrusting Habit?

What is Tongue Thrusting?

Tongue Thrusting Habit is defined a forward placement of the tongue in between the front (anterior) teeth and against the lower lip during the swallowing process. Tongue thrust is considered to be present if the tongue is observed thrusting between, and the teeth do not close in centric occlusion during swallowing.

What Are The Different Types Of Tongue Thrusting?

In general, tongue thrusting habits can be classified into 4 main categories:

1. Anatomic Type – Persons who have huge tongue might be associated with tongue thrusting habit.
2. Habitual Type – The habit of tongue thrust swallow remains as a habit even after the malocclusion has been corrected.
3. Functional Type – A functional tongue thrust habit happens when the tongue thrust mechanism is an adaptive behaviour developed to achieve the oral seal.
4. Physiological Types – This comprises the normal tongue thrust swallow of infancy.

What Are The Causes Of Tongue Thrust?

1. Retained infantile swallowing pattern in children.
2. Bottle feeding of children.
3. Upper respiratory tract infection such as chronic tonsillitis & allergies.
4. Tongue size which is abnormally large (macroglossia).
5. Tongue tie (ankyloglossia).
6. Thumb or fingers sucking habit.
7. Large tonsils.
8. Hereditary factors.

What Are The Clinical Features Of Tongue Thrust?

The clinical features of tongue thrusting habit can be divided into 2 categories, namely extra-oral features and intra-oral features.

1. Extra-oral Features:
   • The gap between upper and lower lip is bigger than normal (greater lip separation).
   • The movement of the lower jaw is more erratic during the process of swallowing.
   • Speech disorders such as lisping & sibilant distortions.
   • Problems in the pronunciation of the certain sounds such as  s,n,t,d,l,th,v,z.
   • Anterior facial height is greater than normal.
2. Intra-oral Features:
   • The swallowing sequences are jerky and irregular.
   • Increased proclination of upper front teeth.
   • Greater spacing between the teeth.
   • Retroclination or proclination of lower front teeth.
   • Decreased width of upper jaw.
   • Anterior or posterior open bite.
   • Posterior cross bite.

What Are The Treatment Options For Tongue Thrust?

Various treatment options  are available for tongue thrusting habit. These treatments can be divided into various steps:

1. Training of correct swallowing technique and posture of the tongue.
   • Patients can be guided to the correct posture of the tongue during the deglutition (swallowing) process by various myofunctional exercises.
   • Use of certain oral appliances as a guide in the correct positioning of the tongue. One of the commonly used oral appliances that could be used is Nance Palatal Arch Appliance.
2. Speech therapy.
3. Mechanical therapy.
   • In mechanical therapy, both fixed and removable dental appliances can be used to restrain the anterior tongue movement during the process of deglutition (swallowing).
   • Examples of appliances that are used to correct the tongue thrusting habit include Tongue Thrust Appliance, Hawley’s Appliance, Fixed Habit Breaking Appliance, & Oral Screen.
4. Correction of malocclusion.
   • Orthodontic treatment is required if there is malocclusion such as anterior open bite or posterior cross bite.
5. Surgical treatment.
   • In some severe cases, orthognathic surgical procedure is indicated to correct skeletal malformation of the patient.

All the appliances mentioned above are uniquely designed and fabricated for each individual patient. These appliances should be prescribed by dentists or dental specialists (such as pedodontist and orthodontist). If you are in doubt, always consult your dentist to identify the most suitable treatment of choice.

Article written by,

Dr. Wong Kee Cheong (Tommy)
Dental Surgeon
BDS (AIMST), MBA (SEGi), YCDP