Trishna PokhrelToday in this article we will know everything about tongue thrusting.
Tongue Thrust is defined as the forward movement of the tongue tip between the teeth to met the lower lip during deglutition and in sounds of speech, so that the tongue lies interdentally.
Classification of Tongue Thrusting:
Physological: This comprises of the normal tongue thrust swallow of infancy.
Habitual: THe tongue thrust swallow is presnet as a habit even after the correction of the malocclusion.
Functional: The tongue thrust mechanism is an adaptive behaviour developed to achieve oral seal.
Anatomic: Persons having enlarged tongue can have an anterior tongue posture.
Classification of Tongue Thrusting( Accoring to S.Brauer and T.V Holt)
Type 1: Non deforming tongue thrust.
Type 2: Deforming anterior tongue thrust.
- Subgroup 1: Anterior openbite
- Subgroup 2 : Associated procumbency of anterior teeth.
- Subgroup 3: Associated posterior crossbite
Type 3: Deforming lateral tongue thrust
- Subgroup 1 : Posterior openbite
- Subgroup 2 : Posterior closebite
- Subgroup 3: Deep overbite
Type 4: Deforming anterior and lateral tongue thrust
- Subgroup 1: Anterioir and Posterior Openbite
- Subgroup 2: Associated procumbency of anterior teth.
- Subgroup 3: Associated posterior crossbite
Diagnosis of Tongue Thrust:
Examination of the tongue thrusting: Check for size, shape and movement.
- Functionary Examination:
- Observe the tongue position, while mandible is in the rest position.
- Observe the tongue during various swallows:
- Conscious Swallow
- Command swallow of saliva
- Command swallow of water
- Consious swallow during mastication
- Palpatory Examination:
- Place the water beneath the patient's tongue tip and ask him to swallow.
Normal: Mandible rises and teeth comes together but no contraction of lip of facial muscles.
Tongue Thrusting: Marked contraction of lip or facial muscle. - Place hand over temporalis muscle and ask to swallow.
Normal: Contaction of temporalis muscles and mandible elevated
Tongue Thrusting: No contraction of temporalis - Hold the lower lip and ask patient to swallow
Normal: Swallow can be completed
Tongue Thrusting: Patient cannot complete swallow.
Clinical Features of Tongue Thrusting:
- Simple Tongue Thrusting:
- Normal tooth contact in posterior region
- Anterior openbite
- Contraction of lips, mentalis muscle and mandibular elevators.
Complex Tongue Thrusting:
- Proclination of anterior teeth, bimaxillary protrusion.
- Generalized openbite
- The absence of contraction of lip and oral muscles.
Treatement Consideration:
Tongue Thrusting is the self correcting habits by 8-9 years of age by the time permanent teth erupt. Also, it is associated with other habits, then those associated habit must be treated first.
- Myofunctional Therapy: It is useful to correct posture of the tongue during swallowing by various exercises like asking the child to place his/her tongue in the rugae for 5 min and asking him to swallow.
- Orthodontic Elastics: Here, tongue tip is held against the palate using orthodontic elastic and sugarless fruit drop.
- Lemon candy Exercise: This , instead of elastics lemon candy is placed on the tongue tip and asking the patient to hold the candy against the palate by tongue top. and then asking to swallow.
-2s Exercise: This helps to identifying the spot and the sequeezing the spot, keeping the tongue at same position.
- 4s Exercise: This includes the identifying the spot, salivating, squeezing the spot and swallowing.
- Other Exercise: Child is asked to perform exercise such as whistling, reciting the count from 60 to 69, gargling, yawning etc.
- Mechanotherapy: Both fixed and removable appliances can be fabricated. the appliance re-educates tongue so that the dorsum of tongue approximates the palatal vault, and tip of the tongue contacts palatal rugae during deglutition.
Some of the appliances that can be used to prevent tongue thrusting are:
- Preorthodontic trainer
- Modification of Hawley appliance
- Tongue crib
- Oral screen