08 August 2012
TONGUE THRUSTING | pedodontic dentistry
Tongue thrust (also called reverse swallow or immature swallow) is the common name of orofacial muscular imbalance a human behavioral pattern in which the tongue protrudes through the anterior incisiors during swallowing, speech and white the tongue is at rest.
Genetic factors- Hypertonic orbicularis oris.
Behavior (habit) –Tongue thrust can be acquired as a habit.
The following predisposing factors that can lead to tongue thrusting.
- Improper bottle feeding
- Prolonged thumb sucking
- Prolonged tonsillar and upper respiratory tract infection
- Prolonged duration of tenderness of gum or teeth can result in a change in swallowing pattern to avoid pressure on the tender zone.
Maturation –Tongue thrust can present as part of a normal childhood behavior that is gradually modified as age advances.
The infantile swallow changes to mature swallow once the posterior decidious teeth start erupting. Sometimes the maturation is delayed and thus infective swallow persists for a longer duration of time.
Mechanical Restrictions- The presence of certain condition known as macroglossia, constricted dental arches and enlarged adenoid predispose to tongue thrust habit.
Neurological disturbance-Neurological disturbances affecting the oro-facial region such as hyposensitive palate and moderate motor disability can cause tongue thrust habit.
Psychogenic factors- Tongue thrust can sometimes occure as result of forced discontinuation of other habits like thumb sucking.
IMAGES:
CLASSIFICAION OF TONGUE THRUST
James Braner & Holt have classified tongue thrust as follows:
Type 1: - Non deforming tongue thrust
Type 2: -Deforming anterior tongue thrust
Subgroup 1: Anterior open bite
Subgroup 2: Anterior proclination
Subgroup 3: Posterior cross bite
Type 3: -Deforming lateral tongue thrust
Sub group 1 –Posterior open bite
Sub group 2 –Posterior cross bite
Sub group 3 –Deep over bite
Type 4: -Deforming anterior and lateral tongue thrust
Sub group 1 –anterior and posterior open bite
Sub group 2 –Proclination of anterior teeth
Sub group 3 –Posterior cross bite
Effects of tongue thrusting
- Proclination of anterior teeth
- Anterior open bite
- Bimaxillary protrusion
- Posterior open bite in case of lateral tongue thrust
- Posterior cross bite
- The “s” sound (lisping) is the one most affected because air forced on the side of tongue rather than forward.
TREATMENT
A)Habit Interception
1) The tongue thrust can be intercepted by use of habit breakers as describe for thumb sucking.
Both fixed and removable cribs or rakes are valuable aids in breaking the habit.
2) The child is taught the correct method of swallowing.
3) Various muscle exercise of the tongue can help in training it to adapt to the new swallowing pattern.
B)Treatment of malocclusion: Once the habit is intercepted the malocclusion associated with tongue thrust is treated using removable or fixed orthodontic appliances.
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