Tongue thrusting, formally known as an orofacial myofunctional disorder (OMD), describes an incorrect muscle pattern involving the tongue, lips, and jaw. This condition occurs when the tongue pushes forward or sideways against or between the teeth during rest, speech, or swallowing, instead of resting correctly against the palate. Since a person swallows hundreds of times daily, this incorrect posture creates constant pressure capable of shifting the teeth. When the pattern persists during sleep, it can lead to dental alignment issues such as an anterior open bite, where the upper and lower front teeth do not meet. Correcting this reflex is necessary to stabilize orthodontic treatment, improve breathing, and resolve sleep-disordered breathing patterns.
Underlying Factors Contributing to Tongue Thrusting
The tongue thrusting behavior that occurs during sleep is typically a learned reflex stemming from an underlying physical or habitual cause that prevents the tongue from achieving its proper resting posture. A common factor is chronic mouth breathing, which forces the tongue to drop to the floor of the mouth to clear the airway. This habitual mouth breathing often results from an obstructed nasal passage caused by chronic allergies, a deviated septum, or enlarged tonsils and adenoids. Positioning the tongue low and forward for breathing establishes an incorrect muscle memory that continues even when the nasal airway is clear.
The persistence of the infantile swallowing pattern is another contributor. This pattern naturally involves the tongue thrusting forward to assist in suckling. While most children transition to a mature swallow pattern by age four, a retained infantile swallow continues the forward thrusting movement. Prolonged non-nutritive sucking habits, such as thumb-sucking or extended pacifier use, also train the tongue and facial muscles to adopt this low and forward position. Additionally, anatomical issues, such as a short lingual frenulum (tongue tie), physically restrict the tongue’s ability to elevate and rest against the palate.
Retraining Techniques and Myofunctional Exercises
The primary non-appliance intervention for correcting tongue thrusting is Orofacial Myofunctional Therapy (OMT), which uses targeted daily exercises to retrain the oral and facial muscles. The goal of this therapy is to create a new muscle memory where the entire tongue rests against the palate, the lips are sealed, and breathing occurs exclusively through the nose.
A fundamental exercise is finding the “spot,” the small ridge of tissue, known as the alveolar ridge, located directly behind the upper front teeth. The patient learns to place only the tip of the tongue on this spot without touching the teeth. Once the spot is located, exercises focus on strengthening the tongue’s ability to suction the rest of its body up to the roof of the mouth, known as the palatal vault.
The “tongue suction hold” involves pressing the entire tongue surface against the palate and then dropping the jaw slightly while maintaining the suction, creating a vacuum or “cave” in the mouth. This isometric exercise is crucial because the correct resting posture requires the tongue to be suctioned up, gently shaping the palate and promoting nasal breathing. Another technique, the “Slurp and Swallow,” retrains the swallowing reflex by having the patient place the tongue on the spot, slurp the saliva back with a loud sound, and then swallow without allowing the tongue tip to move or the facial muscles to contract.
Lip competence is also essential, as sealed lips reinforce nasal breathing and proper tongue posture. Exercises specifically target the orbicularis oris muscle, the ring of muscle around the mouth. One popular technique, the “Button Pull,” involves holding a button attached to a string between the lips and resisting a gentle tug on the string, which strengthens the lip seal without involving the jaw or teeth. Other daily routines involve simply holding the lips lightly together for extended periods during quiet activities to ensure the mentalis muscle remains relaxed. Consistency is paramount, often requiring two to three daily sessions of conscious practice for several months to make the new posture automatic, especially during sleep.
Nighttime Appliances and Professional Interventions
While conscious exercises are performed during the day, physical appliances are often introduced to interrupt the subconscious thrusting habit. The most common fixed device is the tongue crib, an orthodontic appliance attached to the back molars with a wire frame that extends behind the front teeth. The crib acts as a physical barrier, making it impossible for the tongue to push forward against the incisors. The appliance mechanically reminds the tongue to stay back in the correct position, reinforcing the new muscle pattern over a period of several months.
Variations of the crib include the tongue rake, which features small, sharp projections that provide a tactile deterrent, and the Bluegrass roller, a small bead on a wire that encourages the patient to play with it using the tongue, promoting posterior tongue movement. For some patients, specialized removable retainers are used, such as a clear Essix retainer fitted with a small acrylic guard positioned to block the tongue from the front teeth. Professional consultation with an orthodontist is necessary to select and fit the appropriate appliance, which must be custom-made. Furthermore, an evaluation by an Ear, Nose, and Throat specialist (ENT) may be recommended to treat any underlying airway obstructions, such as enlarged adenoids, which would undermine the appliance or exercise regimen.