Tongue Thrusting-It is said to be present if the
tongue is observed thrusting btw,& teeth don’t
close in centric occlusion during deglutition.
Etiology
Retained infantile swallow
-Upper Resp Tract infection
-Neurological disturbances
-Functional adaptability to
transient change in anatomy.
-Feeding practices
-Tongue size
Clinical Manifestations
Extra oral findings- Intra oral findings-
• Lip posture- lip separation is • Tongue movements-
greater swallowing is jerky and
• Mandibular movt- Erratic,no inconsistent.
correlation btw movt of tongue • Tongue posture- tongue tip at
tip and mandible itself. rest is lower in the tongue
• Speech – disorders seen – thrust group.
lisping,articulation
s,n,t,d,l,th,z,v.
• Facial form – increase in
anterior facial height
Intraoral findings- Malocclusion
Maxillary Mandibular
• Proclination of maxillary • Retroclination or proclination
anteriors, generalised spacing. of mandibular teeth depending
• Ant. or Post open bite based on the type of thrust.
on posture of tongue, posterior
crossbite
Diagnosis
Types of tongue thrust
• History (same paatern in • Simple
siblings or parents,upper resp • Lateral
tract infn,NM problem) • Complex
• Examination(different clinical
types)
Simple lateral complex
Treatment considerations
• Age – often self corrects by 8- • Speech defects - speech
9 years of age by the time therapy is require.
permanent incisors are
completely erupted.improve
muscular balance suring
swallowing is seen.
• Associated
• Malocclusion – only manifestations- if neither
malocclusion and no speech speech problems nor
problems – orthodontic malocclusion seen, generally
treatment. no treatment is recommended.
• 4s-Spot,salivating,squeezing,
swallowing.
Treatment • Sugarless fruit drop exercise –
Place the fruitrop in the mouth
and hold it against the palate
Habit interception till it dissolves. Inevitably the
• Training of correct swallow patient swallows.
and posture of tongue- • Whistling,yawning,counting
myofunctional exercises (4s from 60-69,gargling.
exercises, sugarless fruit drop
exercise, touching the rugae
for 5 mins and swallowing)
All exercises help toning muscles and patient is familiar with new
tongue position . Appliance is now given for training of maintaining the
correct position.
Preorthodontic trainer for
myofunctional training
• The tongue tags aid in correct
positioning of the tongue and
tongue guard prevent tongue
thrusting and lip bumber
discourage the overactive
mentalis muscle activity.
Removable appliance therapy
• Habit breaking appliance with
tongue crib.
• Nance palatal arch – acrylic
button guides the tongue.
• Oral screen
Fixed appliances with fixed
rake/crib also used.
Oral screen.
• It is a modified acrylic plate.
Either an acrylic or wire loop
barrier may be constructed to
prevent tongue thrusting.
Surgical treatment Correction of malocclusion
• Orthognathic surgery for
retained infantile swallow to If anterior tongue placement is result
correct skeletal malocclusion. of adaptation to previously existing
anterior open bite the solution is
correction of malocclusion.
This changes the swallow pattern
and tongue adapts to new position.
Cheek biting Nail biting
• Habit of biting cheek muscles • Is absent before age 3.
btw upper & lower postr teeth. • Incidence rises btw 4-6 and is
• Clinical features- constant btw 7-10 and peaks at
1. Ulcer at level of occlusion adolesence.
2. Open bite • Etiology – emotional problem,
3. Tooth malposition in buccal internal stress.
segment • Effects –
• Treatment – A removable Crowding,rotation,attrition of
crib may be constructed.A mandibular incisal edges.
vestibular screen may also be Inflammation of nail/nail bed.
used. • Management- motivation,
treat emotional
distress,encourage outdoor
act. ,appln of nail polish and
cotton mittens.
Self injurious habits- habits in which patient
enjoys inflicting self damage.
Organic functional
• Syndromes and syndrome like • Type A –injuries
maladies – lesh nyhan superimposed on pre existing
syndrome. lesion
• Type B – injuries secondary to
another established habit.
• Type C – injuries of unknown
or complex etiology. (stress
release)
Frenum thrusting Bobby pin opening
• If max incisors are slightly • Opening bobby pins with
spaced apart,child may lock anterior incisors.
labial frenum between these
teeth and keep it like that for • Clinically-
several hours.
• Treatment – Notched incisors and partially
psychotherapy.Requires denuded labial enamel.
multi disciplinary approach.
1. Palliative therapy- bandages
for oral ulceration helps in
healing and reminder of
habit.
2. Mechanotherapy-oral sheild.
