"There are no specific causes for tongue thrust, but we suspect many things may contribute to the habit," says Dr. Aly Kanani, a Surrey orthodontist "Thumbsucking, bottle use by infants, mouth breathing and a large tongue could be to blame. Additionally, patients who are tongue tied, those with a short lingual frenum, as well as the angle of the jaw line, and muscular, neurological and other abnormalities could be to blame."
Orthodontists see patients presenting with variations of tongue thrust that each result in different orthodontic issues. An anterior open bite is the most common. The lips will not close properly, and typically a child will have their mouth open and the tongue protruding. The most common culprit is a large tongue.
Anterior thrust occurs when the lower lip pulls in the lower incisors, leaving the upper incisors severely protruded. Anterior thrust is usually accompanied by a strong chin muscle.
A unilateral thrust can leave the bite open on either side, while a bilateral thrust will have the anterior bite closed, but the posterior teeth will be open. This is the most difficult case to treat.
In a bilateral anterior open bite, the only teeth in the mouth that touch are the molars. A closed bite thrust occurs when the upper and lower teeth are spread apart and flared out.
In the United States, some 20-80 percent of orthodontic patients may exhibit some form of tongue thrust. Some believe that 67-95 percent of all children ages five to eight may exhibit some level of tongue thrust that can contribute to either orthodontic or speech problems.
Malocclusions, or bad bites, result from the force of the tongue against the teeth. If the tongue thrusting habit isn't rectified before or during orthodontic treatment, the continued habit will undo all of the work that was done.
Tongue thrusting is an infantile swallowing pattern that is normal until around the age of four. Most children outgrow this and will not develop any problems. However, if the habit isn't naturally outgrow, patients will require training to stop it before they cause damage to their mouths. In most cases, tongue thrust won't be diagnosed until a child is under orthodontic care because the issue can go unnoticed by parents and caregivers. Diagnosis usually isn't made until there is a problem that needs correction.
"Correction is possible in most cases, but it takes commitment from the child and parent," says Dr. Kanani. "There are typically two ways tongue thrust is handled by an orthodontist, through either myo-functional therapy or through the use of an appliance."
Myo-functional therapy, or tongue therapy, are exercise techniques to retrain the tongue muscles. It's basically physical therapy for the tongue and requires the patient to dedicate time to the therapy. In other cases, an appliance will be placed in a patient's mouth that prevents the tongue from thrusting.
Once the issue tongue thrusting has been resolved, patients may then undergo orthodontic treatment, such as braces, to repair the damage. It is very important that patients have the necessary work done to properly align their teeth in order to avoid more serious oral health issues in the future. Crooked teeth aren't just unsightly, they can cause issues that lead to periodontal disease and eventual tooth loss if not corrected.
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Dr. Aly Kanani
Dr. Aly Kanani