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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

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What is Tongue Thrust?

A tongue thrust, also commonly referred to as a reverse or immature swallow, occurs when the tongue protrudes out of the mouth or forcefully against the back of the front teeth when swallowing or talking. baby tongue thrustAdditionally, the body of the tongue may sit too far forward in the mouth and stick out between the teeth when at rest, and tongue thrusting can also be commonly observed when a child is talking or swallowing. During infancy, a tongue thrust is considered normal, however when children begin to transition to first foods they have typically outgrown this pattern. Some children do continue to present with a tongue thrust until age six without any impact on speech production, though if a child continues to present with the tongue pattern after this point, it can reek havoc on speech skills and dentition later on as the alignment of teeth can be significantly affected.

How does a tongue thrust affect speech?

If the pattern of the tongue thrust is not corrected, speech production and intelligibility may be negatively impacted. Children with a tongue thrust often present with errors on certain sounds, such as: /s, z/ and productions are often substituted with a “th”, due to the placement of the tongue when speaking. Other sounds involving the tip of the tongue may be impacted as well, such as “sh” or “ch”. Therefore, children often present with a “lisp” because of the placement errors and consequent production of certain speech sounds. In addition, if the tongue applies excess amount of pressure onto the teeth daily, this can have a profound effect on the placement and growth of teeth. Children with a tongue thrust may require additional orthodontic treatment to help resolve the misalignment of the jaw and teeth that may result from the increased pressure that is being placed upon by the tongue.

What can I do to help my child with Tongue Thrust?

  • Have your child evaluated by a licensed Speech-Language Pathologist to develop an appropriate treatment plan for your child.
  • Have your child evaluated by an Otolaryngologist (Ear, Nose, Throat doctor) if you have not already done so, in order to assess your child’s adenoids and tonsils.
  • Your child’s Dentist and/or Orthodontist will likely be the one who initially diagnoses the problem, but they will be an integral part of the therapeutic team in order to help monitor your child’s jaw development and alignment of teeth as you move through therapy.

A big step with remediating a tongue thrust is consistent speech therapy to address retraining the position of the tongue as well as to correct the subsequent speech sound errors. A specific home program will be developed for your child and you will be encouraged to practice in order to facilitate carry-over. While a tongue thrust is able to be corrected with intervention, it is imperative that you seek help as soon as you have concerns. The longer you wait to seek treatment, the more difficult a tongue thrust is to remediate. For more information on tongue thrusting, please reference the American Speech-Language Hearing Association’s website, and speak with your child’s pediatrician or a licensed Speech-Language Pathologist about your concerns.

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