Articles by Dr. O'Reilly ....

By
Mairead M O'Reilly, D.D.S., M.S.
888 Bestgate Road
Suite 301
Annapolis, MD 21401
410-266-0025

Tongue Thrusting and Abnormal Swallowing
This is a kind of habit that is difficult to notice, but has serious potential effects. This habit is called "tongue thrusting" and it occurs during swallowing. The reason it is of so much concern is that tongue thrusting can cause some of the same detrimental effects on the teeth and jaws in growing children that we see from thumb sucking. (For more information on thumb and finger sucking, click here to see the first article in this series, "Mommy, my thumb feels so good! -- A Look at Thumb- and Finger Sucking"). These harmful effects (shared with thumb-sucking) include a high arched palate, an open bite in the front of the mouth, protrusion of the upper front teeth, and the tendency of the lower jaw to fall back from the upper.

Tongue thrust swallows that can cause deformities in the mouth are of two types:

1) the simple tongue thrust swallow, and

2) the complex tongue thrust swallow.

In a normal swallow, the teeth usually meet, the lips are lightly closed and the tongue is held against the roof of the mouth behind the upper front teeth.

Tongue thrusting is quite different from a normal swallow.

Let's look at the simple tongue thrust first. The simple tongue thrust swallow is usually associated with a history of thumb or finger sucking, even though the thumb sucking may no longer be practiced. The reason is that prolonged thumb sucking can cause an open bite between the front teeth. A child who has an open bite in front has to thrust his or her tongue forward into the open bite in order to achieve a seal with the lips during the swallow. This type of tongue thrust is defined as tongue thrust with a "teeth together" swallow. This force of the tongue constantly being pushed forward against the front teeth causes spacing and protrusion of the upper and lower front teeth.

The complex tongue thrust, on the other hand, is more likely to occur when a child has a stuffy nose that blocks normal breathing and causes him or her to breathe through the mouth. This kind of blockage can also occur with tonsillitis or pharyngitis. When the tonsils are enlarged, for example, and the nose is blocked at the same time, the back of the tongue has no room, and has to come forward (otherwise the child can't breathe!) To help the tongue move out of the way, the lower jaw drops as a reflex, separating the teeth and providing more room for the tongue to be thrust forward during swallowing to a more comfortable position. This type of swallow is called the "teeth apart" swallow. Again, the force of the tongue pushing forward on the front teeth causes an open bite in front and characteristic spacing between the upper and lower front teeth.

Both the "teeth together" and the "teeth apart" swallow favor the development of protrusion of the upper jaw, protrusion of the upper teeth and an open bite.

Is There A Cure??? -- Treating Simple Tongue-Thrusting

Many simple tongue thrusts are corrected spontaneously during orthodontic treatment, since this helps create a better arrangement of the teeth in which to position the tongue. Generally, a child has to relearn how to swallow. Steps in treatment include the following:

1. Conscious learning of a new swallowing pattern by actually showing the child how "good" and "bad" swallows feel to the tongue and roof of the mouth, and having the child practice "good" swallows over and over.
2. Using special techniques to make the conscious "good" swallow an unconscious habit. This can include using flat sugarless fruit drops held in the right position in the mouth, and asking the child to hold the fruit drop for longer and longer periods of time. The growing length of time discourages the old "bad" swallow.
3. As a last resort, we may install something that one of my patients called "the fangs" -- really only harmless spurs that make it uncomfortable for the patient to put their tongue near their teeth in the improper position. It gently encourages the child to put the tongue in the proper position, so often that this new swallowing pattern becomes second nature.

Is There A Cure??? -- Treating Complex Tongue-Thrusting

Orthodontic treatment is essential to deal with the more serious deformities which occur from complex tongue thrusting. After successfully changing the positions of the teeth and tongue through orthodontics, the child has to begin concentrating on learning how to retrain their muscles to develop a "good" swallow again. Other steps must follow, including 'fruit drop' coaching, and using a retainer with spurs to discourage improper positioning of the tongue. Treatment must continue for a relatively long time after braces have been removed, to reinforce the newly-learned reflexes.

Copyright © 1997, 2005 by Mairead M O'Reilly. All rights reserved. No reproduction without written permission.

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About the author: Dr. O'Reilly practices orthodontics and dentofacial orthopaedics in Annapolis, Maryland. Dr. O'Reilly's unique expertise includes early interceptive orthodontic treatment for children ages 6 to 10, adolescent and adult orthodontic treatment, employing growth modification techniques, traditional metal braces, ceramic (tooth-colored) braces, and the latest in orthodontic technology: self-ligating braces. She is also a certified provider of Invisalign, the invisible way to straighten teeth.

She has worked extensively with children with craniofacial deformities in London, England; Rochester, New York; Washington, D.C.; and Baltimore and Annapolis, Maryland. Dr. O'Reilly's emphasis is on people and the difference her profession can make in their lives. Good orthodontic care can greatly enhance the way people feel about themselves. The changes are more than cosmetic, however. Orthodontics can substantially prolong tooth longevity, prevent periodontal (gum) problems, and successfully treat TMJ problems, jaw deformities, and those related symptoms such as chronic headaches, clicking and grinding. In addition the improved appearance one enjoys from treatment also dramatically affects self-esteem. Dr. O'Reilly sees her patients as partners in treatment and brings sincere concern for each individual.

Dr. O'Reilly welcomes any questions or comments you may have regarding this, or any other article, in our series. We are happy to provide reprints. Contact our office at the address, phone, or email address at the top of the article.