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Tongue thrust and braces

What is tongue thrusting?

Tongue thrust (also called reverse swallow or immature swallow) is the common name of an oral myofunctional disorder, a dysfunctional muscle pattern in which the tongue protrudes anteriorly or laterally during swallowing, during speech, and while the tongue is at rest. Nearly all infants exhibit a swallowing pattern involving tongue protrusion, but by six months of age most lose this reflex allowing for the ingestion of solid foods.

What causes tongue thrust?

When the tongue is not in its appropriate resting position the result can be a tongue thrust or reverse swallow pattern, other factors may include:

  1. Thumb sucking

  2. Some artificial nipples used for feeding infants

  3. Mouth breathing, which can cause the tongue’s posture to be very low in the mouth. Nasal congestion, allergies, or obstructions may contribute to this.

  4. Difficulty swallowing which can be a result of adenoids, frequent sore throats, or tonsils

  5. An exceptionally large tongue

  6. The angle of the jaw line or other hereditary factors within a family

  7. Muscular, neurological, or other physiological abnormalities

  8. Being “tongue tied”: having a short lingual frenum

There are several variations of tongue-thrust and related orthodontic problems:

  1. Anterior open bite — This is the most typical and common form of tongue thrust. In such cases, the lips do not close properly, and a child often has an open mouth and tongue protruding beyond the lips. Generally, this type of tongue thrust is accompanied by a large tongue.

  2. Anterior thrust — The lower lip pulls in the lower incisors and the upper incisors are extremely protruded. The anterior thrust is frequently accompanied by a strong muscle of the chin (mentalis).

  3. Unilateral thrust — The bite is typically open on either side.

  4. Bilateral thrust — Posterior teeth from the first bicuspid through back molars can be open on both sides and the anterior bite is closed. The bilateral thrust is the most difficult to correct.

  5. Bilateral anterior open bite — The only teeth that touch are the molars. The bite is completely open on both sides, including the front teeth. A large tongue is often noted.

  6. Closed bite thrust — Both the upper and lower teeth are spread apart and flared out. The closed-bite thrust is typically a double protrusion.

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