Orthodontics and Speech Therapy: Tongue Thrust and Articulation

Tongue thrust (also called "reverse" or "immature" swallow) is the common name given to orofacial muscular imbalance, a human behavioral pattern in which the tongue protrudes through the anterior incisors during swallowing, speech and while the tongue is at rest. Nearly all young children exhibit a swallowing pattern involving tongue protrusion, but by the age of 6 most have automatically switched to a normal swallowing pattern. (Wikipedia).

Why is it a concern?

Dentists and orthodontists are concerned with the effects of the tongue and facial muscles on the occlusion (how teeth fit together) of teeth because of the evidence proving that too much tongue pressure against the teeth on the inside and an unequal amount of facial muscle pressure from the outside - as is the case with a tongue thrust swallow and/or incorrect tongue resting posture - may result in a malocclusion or misalignment of the teeth - the resting posture of the tongue and facial muscles play an even more vital role: If the tongue is constantly resting against the front teeth and the upper lip in short or flaccid (weak and flabby), the front teeth will be pushed forward.

Thus, correcting this tongue thrust using special speech techniques will play a crucial role in any good orthodontic treatment, making the treatment's results long lasting and much easier to achieve.

What are some signs of having a tongue thrust problem?

One or more of the following conditions may clearly indicate tongue thrust disorder and should be investigated further with an evaluation of speech pathologist

1. Tongue protruding between or against the upper and/or lower "front teeth" when forming /s/, /z/, /t/, /d/, /n/, /l/, or /sh/

2. Frequent open-mouth resting posture with the lips parted and/or the tongue resting against the upper and/or lower teeth

3. Lips that is often cracked, chapped, and sore from frequent licking

4. Frequent mouth breathing in the absence of allergies or nasal congestion

Treatment of tongue thrust and subsequent articulation disorders.

To correct tongue thrust, speech pathologists prescribe exercises designed to promote a normal swallowing pattern, as well as correct speech production. In the evaluation session the patient will be given swallowing and articulation inventory tests. If only "pure" tongue thrust is found without any articulation errors then usually three sessions are enough.

At this evaluation session the patient will be given the main set of drills against tongue thrust that he has to do on a daily basis for 60 days following this session. A second session will be scheduled 4 weeks later to follow up on the results of this oral physiotherapy and consider adding another set of drills for the next 4 weeks after which the third session is scheduled with follow up on the results.

If the patient has misarticulated consonants (usually the high pitched ones: /s/ , /z/ , /sh/ , /ch/ , /ts/) - then each sound will have to be corrected in a 8-session weekly speech therapy while doing the same oral physiotherapy for 60 days - as well as specially designated speech drills to correct each sound...The good news are that by successful correction of one sound we may correct another (for example: correcting the /s/ may solve the problem with the /ts/ sound).

I trust you have gained some insight from this educational note.