Tongue thrust, also known as immature or reverse swallow are common names for medical term for orofacial muscular imbalance. In this condition, the tongue tends to project out and impinges on the upper or lower incisors during speech, swallowing and even during rest. Tongue thrust is the primary swallowing mechanism in infants and two to three years old children, and tends to fade away by the age of four. However, under certain circumstances, it can persist in the adult age and cause various medical and dental problems.
Causes of Tongue Thrust
Tongue thrust is a multifactorial problem. Some most common causes are given below:
- Prolonged bottle feeding can also result in the persistence of tongue thrusting habits beyond childhood and even into adulthood in some cases.
- Macroglossia or enlarged tongue. In these patients, there is not sufficient room for the tongue to rest within the oral cavity, and hence constantly impinges on the anterior teeth. Similarly, excessive forces are applied to the incisors during swallowing.
- Problem with enlarged tonsils and adenoids.
- Allergies and nasal obstruction
- Various genetic factors pertaining to oral musculature, number and sizes of teeth and presence of a tongue tie can also result in adult tongue thrust habits
Implications on Oral and Dental Health
As discussed earlier, tongue thrusting habits should wither away at the age of three to four years, and its persistence beyond this age warrants intervention to correct this abnormal habit. Tongue thrusting can not only cause severe dental problems, but can also lead to various medical conditions.
- An anterior open bite is an abnormal occlusion pattern of teeth in which the anterior teeth are projected outwards and do not meet at the standard position. As a result the lips do not close properly and the tongue can be seen protruding out of them, giving a highly unpleasant look.
- Since these individuals have an abnormal swallowing pattern, routine activities such as eating and speech become difficult
- Oral hygiene maintenance becomes extremely difficult in these patients as the front teeth are protruding outwards and there are greater chances of periodontal and gingival infections as a result of enhanced plaque and calculus formation.
- If an orthodontic treatment is initiated while adult tongue thrusting habits persist, it is bound to fail.
- Since swallowing, hence digestion is effected, individuals with this habit are at high risk of suffering from gastric problems and malnutrition.
Management involves a team work of a dentist, an orthodontist and a general physician. However, psychiatric intervention may also be required in certain cases.
The first step in treatment is the eradication of the habit, followed by reversal of any damage that have been caused to the dentition as a result of tongue thrust. Behavioral therapy aims at inculcating the importance of getting rid of this habit is necessary for the patient to live a normal and healthy life.
Certain orthodontic devices, also known as the myofunctional appliances are used by dentist to eliminate any muscular causes of tongue thrust. However, these appliances can only be used in growing children, and their efficacy can be greatly reduced if the child is not cooperative or does not adhere to dentist’s instructions.
Sometimes when the patient is uncooperative or is unable to tolerate the myonfuctional appliances, a surgical approach may be considered by the dental team. Additionally, surgical therapy is also warranted when there is a non-dental cause of tongue thrust such as enlarged adenoids or macroglossia. An oral and maxillofacial surgeon who specializes in the correction of dentofacial abnormalities usually performs the corrective surgery under general anesthesia. However, continued orthodontic therapy in the form of retainers in required to prevent reversal of treatment in most cases.