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.
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 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.
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.
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.