Tongue thrust, also known as reverse swallow, is a habit where the tongue presses forward against the back of the teeth during activities like speaking, swallowing, or even at rest. While common in infants, its persistence can influence teeth alignment and oral development.
Understanding Tongue Thrust
Tongue thrust occurs when the tongue improperly positions itself during swallowing or at rest, exerting pressure on the teeth. Infants naturally exhibit a “tongue thrust reflex” to aid nursing, which typically disappears around six months of age as they transition to solid foods. If this reflex becomes a prolonged habit, it can continue into childhood and even adulthood.
Common factors contributing to persistent tongue thrust include prolonged thumb-sucking or pacifier use past early childhood, as these habits can train the tongue and jaw into a forward and downward position. Chronic mouth breathing, often due to allergies, enlarged tonsils, or adenoids, can also encourage the tongue to rest lower in the mouth to facilitate airflow, leading to a thrusting pattern. In some instances, anatomical issues like a narrow upper jaw or a restricted lingual frenulum (tongue-tie) can limit the tongue’s space and movement, promoting a forward thrust.
Impact on Oral Health
The continuous pressure from a tongue thrust can have significant consequences for dental alignment and overall oral structure. One common issue is an open bite, where the upper and lower front teeth do not meet when the mouth is closed. This constant force can also lead to gaps between the teeth, particularly the two upper front teeth, or cause other forms of tooth misalignment like an overbite or underbite. Tongue thrust can also contribute to speech impediments, such as a lisp, making certain sounds challenging to produce clearly. Over time, the misalignment and improper oral muscle function may strain the jaw, potentially leading to discomfort or even temporomandibular joint (TMJ) disorders.
Simple Exercises and Habits
Retraining the tongue’s position and swallowing pattern can often begin with simple at-home exercises and conscious habit modifications. A fundamental practice involves learning proper tongue posture, where the tip of the tongue rests gently on “the spot”—the bumpy area on the roof of the mouth directly behind the upper front teeth, without touching the teeth. Throughout the day, consciously remind yourself to keep your lips closed, teeth together lightly, and the tongue resting on this spot.
For swallowing, a technique called “spot swallowing” can be practiced: place a small sugar-free candy or an orthodontic elastic on the tongue tip, press it firmly against “the spot,” keep lips apart and teeth together, then swallow while maintaining the tongue’s position. This exercise helps retrain the tongue to elevate upward and backward during swallowing, rather than thrusting forward. Consistency is important; performing these exercises twice daily can gradually build new muscle memory.
When to Seek Professional Guidance
While at-home exercises can be beneficial, clear indicators suggest professional guidance may be necessary. If, despite consistent practice, tongue thrust persists or significant dental misalignment develops, seeking expert evaluation is advisable. Speech difficulties, such as persistent lisps or challenges with specific sounds, that do not improve with self-correction also suggest professional assessment.
Any discomfort in the jaw, difficulty chewing or swallowing, or inability to comfortably close the lips should prompt a consultation. Various professionals can help, including general dentists, orthodontists, and speech-language pathologists or orofacial myofunctional therapists. Early intervention, particularly in children, can be beneficial in addressing developing issues before they become more entrenched.
Professional Treatment Approaches
Professional treatment for tongue thrust often involves a collaborative approach, with Orofacial Myofunctional Therapy (OMT) as a primary intervention. OMT is an exercise-based program designed to retrain the muscles of the face and tongue to establish proper resting posture, correct swallowing patterns, and encourage nasal breathing. An orofacial myofunctional therapist guides patients through specific exercises that strengthen oral muscles and improve coordination.
These exercises might include tongue push-ups, tongue suctions to the roof of the mouth, or targeted movements to improve tongue elevation and control. The goal is to develop a habit where the tongue rests on the roof of the mouth, lips are closed, and teeth are lightly together.
Orthodontic treatments, such as braces or clear aligners, are frequently used in conjunction with OMT to correct any existing dental misalignment caused by the tongue thrust. Orthodontists may also utilize specific appliances, like a tongue crib, a small barrier placed behind the front teeth to deter the tongue from thrusting forward and guide it into a correct position. This appliance trains the tongue to stay away from the teeth during swallowing.
Addressing underlying causes, such as enlarged tonsils or adenoids that contribute to mouth breathing, might also be part of a comprehensive treatment plan, sometimes involving an ENT specialist. Successful treatment often requires consistent commitment to practice prescribed exercises and maintain new habits, leading to lasting correction of tongue thrust and its associated oral health issues.