Tongue thrust

Tongue Thrusting
 Also called reverse swallow or immature swallow.
 It’s common name of orofacial imbalance , a human
behavior pattern in which the tongue protrudes
through the anterior incisor during swallowing ,
speech , and while the tongue is at rest

Clinical Features
 Short flaccid upper lip.
 Mandibular movement no correlation. between
tongue tip and mandible
 Speech : s , n , d , I , z, v , th.
 Increase the anterior facial hight .

Intraoral Finding
 Tongue movement irrgular .
 Malocclusion .
 Maxilla – proclination , increase in overjet .
 Mandibular proclination .
 Anterior open bite .

Etiology OF tongue thrust
 Retained infantile swallow .
 Upper respirotary tract infection .
 Neurological distrubances .
 Feeding practice.
 hereditary or tongue size.

1. Retained infantile swallow :
 During the eruption of the lower incisors the tongue
doesn’t drop back as it should continue to thrust
forward .

Upper respiratory tract infection :
 Such as mouth breathing and allergies that promote
forward movement of tongue due to pain .

Neurological distrbance :
 Such as
1. hyposensetive palate
2. distruption of sensory control
3. coordination of swallowing .

:4. Feeding practice
 Bottole feeding is more contributory to tongue thrust
than breast feeding .

5. Hereditary and tongue size :
 Macroglossia have effect on dentition lead to tongue
thrust.

Classifition of tongue thrusting :
A. Back lund :
 Anterior tongue thrust
 Posterior tongue thrust
B.Moyer :
 Simple tongue thrust
 Complex tongue thrust
 Retained tongue thrust

1. Backlund classification :
 Anterior tongue thrust : forceful anterior thrust
leading to anterior openbite .

 Posterior tongue thrust : lateral thrusting in case of
missing posterior teeth leading to posterior openbite
.

2. Moyer classification :
 Simple : normal tooth contact during the
swallowing act .
1. Anterioer openbite .
2. Good intercuspation of teeth .
3. The tongue thrust forward to established anterior
seal .
4. Abnormal mentalis muscle activity .

Incomplete over bite Anterior open bite

 Complex : teeth apart during swallow .
1. Diffuse or absent anterior openbite (bimaxillary
protrustion ) .
2. Absence of temporal muscles contraction during
swallowing .
3. Contraction of the circum oral muscles during
swallowing .
4. Poor occlusion of teeth .

 Retained infantile thrust (endogenous tongue
thrust ) :
 The persistence of infantile swallowing reflex even
after the permanent teeth appear
 The swallowing activity is accompanied by an
anterior thrust of tongue which appear to be
neuromuscular mechanism

 Endogenous tongue thrust associated with
1. Anterior lisp during speech.
2. Affecting to the teeth to extend of preventing the
full vertical development of dento-alveolar segment
3. Incomplete openbite.
4. Proclination of upper and lower incisor

Treatement :
Treatment consideration :
 Self correcting by age 8 – 9 yrs
Treatment modalities :
 1. training of correct swallow and posture of tongue .
 2. speech therapy .
 3. Mechanotherapy .
 Correction of malocclusion .

Training of correct swallow and posture of tongue:
1. Ask the patient to put tongue tip in the rugae area
for 5 mints then ask him to swallow .
2. Tongue tip hold against the palate using the
orthodontic elastics or sugarless friut drops .
3. 4S exercises .
4. Whistling .
5. Count from 60 – 69 .

Using appliance as guide in the correct
postioning of tongue preorthodontic trainer :
 It’s aids in correct the positioning of the tongue with
help on tongue tags .
 The tongue guards prevent tongue thrusting when in
place .

:Speech Therapy
NOT BEFORE 8 yrs .
To train the correct postion of the tongue .

Mechanotherapy :
 Fixed appliance
Tongue thrust
device
Palatal crib Myofunctional bead

Removable appliance
 Restriction of the tongue thrusting habit .
 Alignment of maxillary anterior teeth .
 Correction of open bite .
 Lip muscles exercises performed with ring attach in
anterior part of appliance .
Oral screen Hawley retainer

Bruxism
 Bruxism : habitual grinding of the teeth when the
individual is not chewing or swallowing .

Prevleance :
 Commence in infancy with eruption of the first
primary tooth .
 Common occurance is during sleep .
 Incidence of bruxism in chlidren varies widely from 7
% to 88% .

Clinical features :
 1. occlusal trauma .
 2. tooth structure loss .
 3. muscular tenderness .
 4. T.M.J disorder .
 5. headache .

Classification of bruxism :
 1. day time bruxism : it may conscious or
suboconscious and may along with other habit such
as nail biting , chewing pencil …..ect .
 2. night time bruxism : its subconscious grinding
of the teeth at night .

Mangement :
1. Determine the underlying cause and eleminate it .
2. Occlusal adjustment including restoratio and
occlusal splint – biteguard
3. Psychotherapy: like relaxtion exercises.
4. drugs like local anesthetic injection into T.M.J for
muscle , sedative , and muscle relaxant .

Bite guard
 Bite guard : prevent the abrasion of teeth

Mouth breathing :
 It’s habitual respiration through the month instead
of the nose .
 The main causes of the mouth breathing habit are
realted to nasal obtruction which may due to
hypertrophy of pharyngeal lymphoid tissues
adenoid) , defect in nasal septum , allergic rhinitis .

Classification
1.anatomical : mouth breather whose upperlip
is short that does’nt communicate the lower lip .
2. habitual : perisitence of habit after
elimination of obstructive cause .
3. obstrctive : increase resistance to compelte
obstruction of normal air flow to nasal passage .

Effect of mouth breathing habit :
1. Increase facial hieght .
2. Posterior teeth will supra-erupt .
3. Mandible will rotate down and back .
4. Openbite develop anteriorly , increase oj.
5. Narrowing of the maxillary arch --- increase
pressure from the stretch cheeks .
6. adenoid fade apperance.

Mangement
 ENT referral for mangement of nasopharyngeal
obstruction is necessary before any orthodontic
treatment .

Tongue thrust

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Tongue thrust