Tongue thrust, or reverse swallow, is an atypical swallow in which the tongue pushes into the palatal side of the upper teeth. Since humans characteristically swallow close to 1500 times a day, the repetition of this habit may cause or contribute to misalignment of the teeth, impede speech, cause mouth breathing, and other problems. The tongue is the strongest muscle in the body. Since orthodontists utilize pressure to move teeth, contra lateral pressure from the tongue may inhibit its effectiveness.
A tongue thrust commonly causes malocclusion such as an anterior open bite, or the open bite may contribute to tongue thrust. There is a direct interplay between these conditions. Tongue thrusts may be forward or lateral (to the side) which may prevent the back teeth from touching.
Since the tongue is used for speech, it may cause problems enunciating certain sounds. Because the tongue is not functioning ideally, a patient may not be able to swallow correctly. Patients may develop TMJ disorder, headaches, breathing problems and nasal allergies. Some develop thumb sucking habits, often causing or related to an open bite. When a dentist or orthodontist attempts to close an open bite, the tongue re-opens it. The tongue exerts more pressure on the back of the teeth than orthodontic wires.
Tongue thrust therapy is particularly challenging on patients who are mouth breathers. In these cases, the patient must first visit an allergist to eliminate the cause (sometimes, swollen nasal turbinates due to allergies). Some patients may improve with nasal surgery by an ear, nose and throat (ENT) specialist to clear the breathing passage. If the patient can better utilize nasal breathing, there is no need to keep the tongue positioned low in the mouth and the tongue thrust may often be eliminated.
Swallowing therapy is often multifaceted, utilizing tongue exercises and retraining speech patterns. The placement of cleats behind the upper teeth may be effective in restraining and retraining tongue movements during swallowing, prior to the completion of orthodontic treatment. The cleats bond to the back of the front teeth and help the patient remember not to force the tongue forward.
Speech therapists may use tongue and speech exercises as a therapy to retrain the tongue. Normally, the tongue pushes onto the palate when swallowing. A person who has an anterior tongue thrust pushes the tongue forward instead of placing it upward on the palate.
If tongue thrust therapy does not successfully eliminate the tongue thrust before completing orthodontic treatment, the patient's teeth will not remain where they were orthodontically positioned. This often causes relapse. Small orthodontic palatal cleats may be placed on the back of the top two front teeth after completion of orthodontics to help patients know when they are thrusting. The cleats along with tongue thrust therapy exercises often help patients minimize or eliminate their tongue thrust habit.
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