ABNORMAL SWALLOW & TONGUE
Please note: this information is
about kids. Not adult abnormal swallowing habits.
Tongue (abnormal swallow)
thrusting is the abnormal habit of placing the tongue between the teeth before
and during the act of swallowing. During a normal swallow, the mid-tongue
should be placed on the roof of the mouth, not between the teeth.
Placing the tongue between the teeth pushes the teeth apart and out.
Tongue (abnormal swallow) thrust
and abnormal facial muscle habits are all part of a complex myo-functional
environment which produce many of the problems associated with orthodontics
and braces. Unless we successfully treat the myo-functional problems,
orthodontic treatment will be much more likely to fail.
Swallowing occurs 24 hours per
day and about 2000 times per day. During each swallow, the tongue can exert
momentary pressures of 1 to 6 pounds on the surrounding structures of the
mouth. This pressure will push the teeth and bone forward or apart. An
abnormal swallow will move teeth into abnormal positions and cause growth
distortions of the face and teeth.
It is natural for infants to
swallow with the tongue between the gums, but a transition should be made
about age seven where the tongue is placed on the roof of the mouth and the
teeth are in full contact during the swallow. If the tongue is placed between
the teeth during the swallow like an infant, the muscles surrounding the teeth
and lips are used to gain suction rather than using the muscles of the throat.
Lip puckering and lip licking
prior to a swallow are easy signs to look for when a child is swallowing with
the tongue between the teeth. The result of the forward tongue position is an
open bite where the teeth do not touch. There is usually a protrusion of the
upper front teeth and constriction of the dental arches.
Lip biting or sucking can be a
major factor in moving the front teeth. The cracked and swollen lower
lip is a prime indicator of a lip habit.
The majority of patients we
treat for protrusion of the upper teeth have a forward tongue positioning
thrust! There is also a type of thrust which is to the sides of the mouth
(lateral thrust) and is almost untreatable unless normal arch form is
established early in treatment.
If the front teeth are brought
back into alignment, but the thrust habit is not broken, the teeth may be
moved back out after treatment. So, what can be done to stop this habit? Habit
correction (myo-functional therapy) by a speech therapist may be necessary if
the exercises which we recommend during treatment are not followed.
Finding a knowledgeable speech therapist is very difficult. They all
know what it is, but few know how to effectively treat it.
In situations where the habit is
severe, a removable appliance may be used to block the tongue away from the
front teeth. Unfortunately, some thrusters are never corrected due to lack of
parental support or lack of cooperation (or denial) on the part of the
patient. In either case, orthodontic treatment is sure to be negatively
See the page on
oral habits of compulsion
for additional information on related habits which adversely effect treatment.
Some of the nicest people we know have abnormal swallows...!
Who me? A
thruster? No way! D-E-N-I-A-L....!
If you detect an open bite,
where the front teeth don't touch, then the child should be seen around age
seven for a preliminary orthodontic exam.
During a normal swallow: the
tongue is on the roof of the mouth and behind the front teeth. The front
and back teeth touch during the entire swallow and do not protrude. The
tongue is not between the teeth at any time during the swallow and the lips
During an abnormal swallow: the
tongue is between the front teeth, the lower lip is licked prior to the
swallow and the lower lip is usually swollen, red, and cracked due to constant
licking. There is pursing of the lower lip and chin during the swallow.
The abnormal swallow pushes the upper teeth forward and keeps them apart in
the front of the mouth, causing an open bite.
done by the tongue to the skeletal features and teeth can be seen in
this x-ray which shows the back teeth in full contact while the front
teeth are completely wide apart and forward. This is an open bite
due to an abnormal swallowing pattern.
Click the x-ray to
habit often lead to an abnormal swallowing pattern. The
distortions caused by the thumb or a finger habit will severely distort
the teeth and bone positions.
In the lower photo, you can
see the distortion caused by the thumb position shown above. This
patient has just had the braces placed to move the teeth back into
position during a Phase One treatment.
An abnormal swallowing pattern
is associated with:
- a retruded lower jaw
- long narrow face with lack of
development of the maxilla
- flaccid muscles of the lips
- elongation of the nose and
abnormal airway path
- lips which do not touch
without contracting the chin muscles
- abnormal muscle contraction
during thrusting which causes the face to prematurely wrinkle due to
hyperactivity of the facial muscles
- narrow, abnormal development
of the palate
- an open bite, where the front
teeth do not contact...
Why do you want to stop the
abnormal swallow? Because thrusting delays completion of your orthodontic
treatment by forcing the teeth apart or forward. After the braces are removed,
thrusting will ruin the results. It is a habit, just like sucking the thumb.
Thrusting is a negative force. Thrusting will destroy your straight teeth.