Sydney SPOT Tongue Thrust Clinic
For Children and Adults
What is a Tongue Thrust?
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Tongue thrust refers to a forward or downward resting posture, where the tongue rests against or over the lower teeth (and possibly even over the lower lip). It is also often used to refer to a swallowing pattern in which the tongue either pushes against the lower teeth, or protrudes between the teeth when swallowing. A forward movement pattern is most often observed, however, pushing or bulging of the tongue to the sides is also characteristic of a tongue thrust swallow. If this pattern continues beyond infancy, effects may be observed in facial growth and appearance, health and communication (speech).
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Tongue thrust is not simply a childhood issue. Many adults also present with a forward tongue resting posture or swallowing pattern that is not ideal, without even realising. Some common signs of these issues in adults include headaches, snoring, sleep apnoea, a clicky jaw (TMJ Syndrome), tooth and gum disease and regression of orthodontic treatment. The force of muscles is great – if they are not retrained, teeth and bones will easily shift back to their starting place.
What is a Tongue Thrust Swallow?
A tongue thrust swallowing pattern is normal when observed in infants who are breast or bottle feeding (although bottle feeding does not always encourage this). Upon transitioning to solids we should begin to adopt the habit of placing the tongue tip against the roof of the mouth behind the top front teeth when swallowing. Food is then propelled backwards with a wave-like movement of the tongue, rather than forwards (which is the result when a tongue thrust swallow is present).
Sometimes, the tip of the tongue can be seen popping out of the mouth during eating and drinking. This is certainly more common in children. It is noted that chewing with the mouth open is always a major warning sign and further investigation is definitely recommended for those who tend to chew with their mouths open when in good health. Adults often learn to keep their tongues in their mouth when swallowing, but hypertrophy or excess activation of the facial muscles during swallowing can still be observed. This is because the lips are working hard to counter the thrusting force of the tongue. During a normal swallow, the muscles of the face should be relaxed.
Sometimes, the tip of the tongue can be seen popping out of the mouth during eating and drinking. This is certainly more common in children. It is noted that chewing with the mouth open is always a major warning sign and further investigation is definitely recommended for those who tend to chew with their mouths open when in good health. Adults often learn to keep their tongues in their mouth when swallowing, but hypertrophy or excess activation of the facial muscles during swallowing can still be observed. This is because the lips are working hard to counter the thrusting force of the tongue. During a normal swallow, the muscles of the face should be relaxed.
A Tongue Thrust Swallow may be retained due to:
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What are the Specific Effects of a Tongue Thrust?
When the tongue rests in a forward or downward position there is constant pressure on the teeth and jaw bone, which may affect the alignment of teeth and jaw development. Swallowing places even greater force on the lower teeth and jaw. It is estimated that we swallow 1200-2000 times per day, so this is a significant amount of pressure (remembering that we are constantly swallowing our saliva; not just food and drink).
The absence of tongue pressure against the palate is also significant. Normal swallowing stimulates the growth and expansion of bone in the roof of the mouth. The bone cells in those sutures are different to those in other parts of our body. They do not grow in accordance with a genetically predetermined outcome. They only grow when stimulated. By age 6, the sutures of the hard palate have knitted together and for those with a tongue thrust it is often narrow and highly vaulted.
When the palate does not expand, there may be a structural barrier to the accurate production of speech sounds that therapy alone cannot overcome. Given that the roof of the mouth is also the base of the nasal cavity, the airway may also be affected. Any barrier to comfortable nose breathing will perpetuate the habit of mouth breathing and resting the tongue in an anterior position.
Those with a tongue thrust often have speech disorders. It is most commonly associated with an inter-dental lisp on “s” and “z” sounds, where the tongue protrudes between the front teeth. Sometimes this pattern extends to other fricative sounds such as “sh”, “ch” and “j.” Many other sounds require contact between the tongue tip and the alveolar ridge (the bump behind the top front teeth). We frequently see that “t, d, l and n” are also affected, although it can be quite subtle (particularly in some adults). A persistent open mouth posture may also be associated with weakness and shortening of the lip muscles, affecting the ability to produce ‘labial’ sounds (“p, b, m, f, v”) clearly and accurately.
While mouth breathing may seem benign (and even cute in children), there are many health complications associated with it. The turbinates in our nasal cavity act as air filters. When we inhale air through the mouth it enters the lungs cold and unfiltered. This leads to more frequent upper respiratory illnesses. Over time, this may lead to sensitive teeth, swollen gums and an increased likelihood of tooth decay and infections. We certainly work with 5 years olds who have had to be placed under a general anaesthetic to have numerous silver fillings put in their mouth. Dry, cracked lips and a dry mouth are also common.
Mouth breathing also means that carbon dioxide and oxygen levels in the lungs are not balanced (as when hyperventilating). This impacts the parasympathetic nervous system and the release of diuretic hormones. Children who mouth-breathe are prone to bed wetting (enuresis). Adults may simply report frequent waking in the night to go to the toilet.
Finally, snoring and sleep apnoea are serious conditions associated with a tongue thrust, and the constellation of problems that cause it. Energy levels and attention may be affected - when you have a bad cold, half the reason you feel so terrible is that you cannot breathe properly!
The absence of tongue pressure against the palate is also significant. Normal swallowing stimulates the growth and expansion of bone in the roof of the mouth. The bone cells in those sutures are different to those in other parts of our body. They do not grow in accordance with a genetically predetermined outcome. They only grow when stimulated. By age 6, the sutures of the hard palate have knitted together and for those with a tongue thrust it is often narrow and highly vaulted.
When the palate does not expand, there may be a structural barrier to the accurate production of speech sounds that therapy alone cannot overcome. Given that the roof of the mouth is also the base of the nasal cavity, the airway may also be affected. Any barrier to comfortable nose breathing will perpetuate the habit of mouth breathing and resting the tongue in an anterior position.
Those with a tongue thrust often have speech disorders. It is most commonly associated with an inter-dental lisp on “s” and “z” sounds, where the tongue protrudes between the front teeth. Sometimes this pattern extends to other fricative sounds such as “sh”, “ch” and “j.” Many other sounds require contact between the tongue tip and the alveolar ridge (the bump behind the top front teeth). We frequently see that “t, d, l and n” are also affected, although it can be quite subtle (particularly in some adults). A persistent open mouth posture may also be associated with weakness and shortening of the lip muscles, affecting the ability to produce ‘labial’ sounds (“p, b, m, f, v”) clearly and accurately.
While mouth breathing may seem benign (and even cute in children), there are many health complications associated with it. The turbinates in our nasal cavity act as air filters. When we inhale air through the mouth it enters the lungs cold and unfiltered. This leads to more frequent upper respiratory illnesses. Over time, this may lead to sensitive teeth, swollen gums and an increased likelihood of tooth decay and infections. We certainly work with 5 years olds who have had to be placed under a general anaesthetic to have numerous silver fillings put in their mouth. Dry, cracked lips and a dry mouth are also common.
Mouth breathing also means that carbon dioxide and oxygen levels in the lungs are not balanced (as when hyperventilating). This impacts the parasympathetic nervous system and the release of diuretic hormones. Children who mouth-breathe are prone to bed wetting (enuresis). Adults may simply report frequent waking in the night to go to the toilet.
Finally, snoring and sleep apnoea are serious conditions associated with a tongue thrust, and the constellation of problems that cause it. Energy levels and attention may be affected - when you have a bad cold, half the reason you feel so terrible is that you cannot breathe properly!
How do we Manage Tongue Thrust?
- Assessment: Gathering background information and examining oral structures, posture, breathing, swallowing and speech.
- Referral: Depending upon our impression of underlying causes of the tongue thrust, consultation with other health care professionals may be advised (particularly if there are any concerns regarding the airway). Typically, we collaborate with Ear, Nose & Throat Specialists, Specialist Dentists, Orthodontists and Sleep Specialists.
- Education: Learning about proper tongue posture and the importance of treatment.
- Awareness training to establish a new tongue resting posture and swallowing pattern (exercises!).
- Speech Therapy.
Home practise is an important aspect of therapy throughout awareness training, swallowing and speech therapy.
If you would like to have a chat about tongue thrust and any associated issues, please do not hesitate to contact us. We’ll be very happy to have a chat!
If you would like to have a chat about tongue thrust and any associated issues, please do not hesitate to contact us. We’ll be very happy to have a chat!
