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What is a Tongue Thrust?

A tongue thrust is the most commonly known type of Orofacial Myofunctional Disorder. According to the American Speech-Language Hearing Association, this is when “the tongue moves forwardblog-tongue-thrust-main-landscape in an exaggerated way during speech and/or swallowing. The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing and at rest.”

A tongue thrust or an Orofacial Myofunctional Disorder may impact speech, chewing and swallowing as well as create changes in the dental pattern. An improper tongue resting pattern may develop as a result of enlarged tonsils or adenoids, allergies, extended thumb, finger, or pacifier sucking. It may also be related to restrictions in tongue movement, lip movement or the shape and size of the mouth.

Who Can Help With A Tongue Thrust?

This issue may be identified by a pediatric dentist or orthodontist due to the bite pattern seen in the child. An open bite (where the front teeth do not meet creating an open space) may indicate that there is a tongue thrust or an abnormal tongue resting position. A Speech-Language Pathologist trained in the area of orofacial myology or a Certified Orofacial Myologist (who may be a speech-language pathologist or a dental professional) are among the professionals who can diagnose an OMD.

To screen for the possibility of an OMD, it is beneficial to look at all the underlying factors including:

Habits – Thumb sucking, finger sucking, tongue sucking, extended bottle use and overuse of a “sippy cup.”

Airway – Open mouth breathing, enlarged adenoids and/or tonsils, allergies.

Lips – Do the lips rest apart or together habitually? Are there structural restrictions that don’t allow comfortable lip closure?

Tongue – Any difficulty moving the tongue to the roof of the mouth? Does the tongue appear to move forward during speech? Any structural restrictions impacting the movement? Sometimes the “lingual frenum” which is the attachment under the tongue is too short or tight and creates issues with tongue movement.

Teeth – What does the bite pattern look like? Is there an “anterior open bite” (the upper and lower incisors don’t meet when the teeth are together)? The “anterior open bite” is a very common pattern seen with tongue thrusts and other OMDs.

Speech – Speech may sound distorted especially the sounds “s,” “z,” “sh” and “j.”

Chewing and Swallowing – May show up as eating too quickly, too slowly, messy eater, as the swallow pattern is altered. This is sometimes referred to as a “reverse swallow.”

How is tongue thrust treated?

The approach to treatment involves first the proper diagnosis and designing a tailored approach to the particular OMD and how it is presenting in the individual patient. The therapist works closely with the rest of the OMD team, which may include the physician, ENT, gastroenterologist, oral surgeon, dentist and orthodontist. Any habits, structural issues, allergies or airway restrictions are addressed by the appropriate professionals.

Using tailored exercises, the treating therapist addresses forming correct placement of the lips, tongue and jaw at rest and the habituation of this over time. Addressing correct swallow patterns and the carryover into the ability to do this on an everyday basis with all foods is also addressed. Also addressed by the speech-language pathologist are any speech articulation issues with increased emphasis of the correct placement of the tongue and the appropriate tongue pattern.

Successful treatment involves ongoing treatment in weekly therapy, daily exercises done in the home and a collaborative approach with the family and the other professionals on the team.

Resources:

The American Speech-Language Hearing Association’s website information page: http://www.asha.org/public/speech/disorders/OMD/

International Association of Orofacial Myology information page: http://www.iaom.com/OMDisorders.html

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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Stephanie McCabe

Stephanie McCabe

Stephanie has been a speech-language pathologist for 22 years. She received both her BA (in English and Communication) and MS (in Communicative Disorders) from the University of Louisville in Kentucky. Stephanie’s diverse background includes direct treatment as well as owning and managing pediatric therapy practices. She has also developed mentoring, training programs, and curriculum. She has received specialized training in many assessment and treatment approaches including DIR/Floortime®, Talk Tools® Beckman Oral-Motor, Scientific Learning/Fast ForWord, Diane German's Word Finding Intervention Program, Joan Sedita's Key Three Routine Comprehension Strategy Instruction. She completed her certification in Orofacial Myology through the IAOM (International Association of Orofacial Myology) in 2007. Previously, she served as the Chairperson of the IAOM’s mentoring committee for members pursuing certification in the area of Orofacial Myology. She was appointed to the IAOM Board of Examiners in 2013. She is the author of the HALTTS Orofacial Myofunctional Disorder screening form (2010).

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