Tongue thrusting, also known as orofacial muscular imbalance, is a condition in which the tongue protrudes from the mouth during swallowing and speaking. In some cases, the tongue will also protrude from the mouth when at rest. Tongue thrusting is common in children under age four, but can become a concern after that age. Tongue thrusting may affect speech and teeth alignment if not addressed.

Tongue Thrust Treatment

Causes of Tongue Thrusting

Children may be more prone to tongue thrusting due to hereditary factors. Certain types of artificial nipples and prolonged thumb sucking behaviors may also contribute to tongue thrusting. Allergies, nasal congestion, and other conditions affecting breathing may also increase the occurrence of tongue thrusting behaviors as individuals compensate for the obstruction by holding the tongue lower in the mouth.

Tongue Thrust Complications

Tongue thrust has been associated with movement of the teeth, and has been linked to the development of anterior open bites and other types of malocclusion. While tongue thrust during swallowing has shown to exert pressure on the teeth, tongue thrust while resting has been noted as an even larger contributor to orthodontic conditions. The misalignment caused by tongue thrusting can affect the way words are pronounced, causing a speech impediment. Malocclusions can also cause jaw pain, headaches, and ear pain. In addition to these complications, the misalignment and speech problems caused by tongue thrust can also affect an individual’s self esteem and relationships with others.

Tongue Thrust Treatment

Correcting bite patterns will sometimes correct the positioning of the tongue. This can be done using braces in some cases. Cases in which open bite patterns are more extreme may require the use of temporary anchorage devices, surgery, or tooth extractions. If jaw and tooth alignment is found to be correct, nighttime mouth guards and visits with an oral physiotherapist may be sufficient to correct tongue thrusting behaviors.

Follow-Up Treatment

If tongue thrusting behaviors are not addressed after bite patterns have been corrected, teeth will usually shift back to the original position. Follow up treatment for tongue thrusting may include visits with an oral physiotherapist and use of specific types of retainers. A wrap around retainer with a hole in the top often provides two types of support. The retainer serves to prevent teeth from shifting back to the original position, and the hole presents a diversion from the tongue which can prevent the tongue from falling between the teeth while at rest.

X-rays, also known as orthodontic radiographs, are an important tool for assessing a patient’s jaw, mouth, and bone health. There are several different types of X-rays used in dentistry and orthodontics. It may be necessary for orthodontists to use a few different types of X-rays in order to get a full picture of the patient’s mouth and facial structure before recommending treatment.

X-Rays for Orthodontists

How Do X-Rays Work?

When an X-Ray is being taken, a beam of radiation passes through the body and hits either a sensor or a piece of film. Dense tissue such as bone and teeth will not allow the radiation to pass through, so it shows as a white or light image on the film. Softer tissues and areas of lower density allow the radiation to pass through, so it shows as a darker image on the film. Analyzing the darker and lighter spots on an X-Ray gives orthodontists an idea of the tooth and bone health of a patient.

Types of X-Rays

There are two main types of X-rays used in general dentistry and orthodontics. Intraoral X-rays are taken of the inside of the mouth. Extraoral X-rays are taken outside of the mouth. There are several different types of X-rays that fall into these two categories that are used for different purposes in orthodontics and dentistry.

Intraoral X-Rays

Common types of intraoral X-rays which are used by orthodontists and dentists include:

  • Bite-wing X-rays show the upper and lower teeth from crown to bone in areas of the mouth
  • Occlusal X-rays show placement and development of full teeth and arch
  • Periapical X-rays show full teeth from crown to the end of the root inside of the jaw

Extraoral X-Rays

Common types of extraoral X-rays that orthodontists or dentists may order include:

  • Panoramic X-rays show the entire mouth in one X-ray
  • Cephalometric projections show one side of the head
  • Tomograms show one layer of the mouth while blocking other areas to provide a clear view
  • CT Scans show a three dimensional image of the head. These must be performed at a hospital
  • Sialography show the salivary glands through the use of a contrast medium

Use of X-Rays in Orthodontics

The primary use of X-rays in orthodontic applications is to help orthodontists diagnose problems like impactions, misalignments of the teeth, and asymmetries of the jaws. Comparing and analyzing different types of X-rays such as panoramic X-rays and periapical X-rays helps orthodontists get a well-rounded picture of the tooth and jaw structure so that proper treatment can be administered. X-rays can also be used throughout orthodontic treatment to evaluate progress and make corrections as needed. Although not a primary application, X-rays taken by orthodontists may also reveal health conditions such as abscesses and tumors in the head that can save patient’s lives.

Baby teeth, also called primary or milk teeth, serve an important function in the development of permanent tooth placement. If baby teeth are pulled too soon or stay in place for too long, it can adversely affect the eruption pattern and alignment of the permanent teeth. It is important to speak to an orthodontist before making any decisions about baby tooth extractions.

When to Pull Baby Teeth

Primary Tooth Loss Schedule

Baby teeth are typically lost at certain ages. These ages may vary slightly from child to child, but should follow a certain pattern that corresponds to the pattern of permanent tooth eruption. If a child begins to lose teeth in a pattern that is outside of the normal eruption schedule, it may cause crowding in the mouth or misalignments. If a child goes several years over the normal tooth loss schedule, it may delay permanent tooth eruption or cause existing permanent teeth to shift into unnatural placements.

Baby teeth are generally lost around the following ages:

  • Between ages six and eight the lower and upper central primary incisors are lost
  • After central primary incisors, the lower and upper lateral incisors are lost
  • Between ages eight and ten there is a one to two year pause
  • Between ages ten and thirteen the lower canines and first molars are lost
  • Following the first molar loss, the upper canines are lost, then upper and lower molars

Extraction Considerations

If a baby tooth is damaged or begins to decay, it may be necessary to extract the tooth in order to save gum health and eliminate pain. However, extracting a baby tooth before it is time for the permanent tooth to erupt can allow surrounding teeth to shift to fill the gap. If the tooth can be saved, orthodontists often recommend using other methods so that the gap is naturally filled until the permanent tooth comes in. If it becomes necessary to extract a primary tooth, the orthodontist may recommend filling the space with a prosthetic tooth until the permanent tooth comes in. It may also be necessary to fill a space with a prosthetic tooth if more than three months pass between the loss of a baby tooth and the eruption of a permanent tooth.

Primary Tooth Extraction Benefits

If primary teeth are pulled at an appropriate time, it can sometimes prevent later complications. Pulling primary teeth will not permanently solve crowding issues, but it can help orthodontists guide permanent tooth development patterns so that straightening procedures and surgeries that would have been necessary later can be avoided. However, every child develops differently. Parents and orthodontists should discuss all possible remedies for childhood tooth complications before making the decision to extract baby teeth.