This document summarizes information about tongue thrusting, including its causes, characteristics, classifications, and treatment. Tongue thrusting is when the tongue protrudes through the front teeth during swallowing, speech, and at rest. It is common in children and can be caused by factors like retained infantile swallow reflex, mouth breathing, neurological issues, or feeding practices. Tongue thrusting can lead to malocclusion and is classified in different ways, including by whether it involves anterior or posterior thrusting. Treatment involves training correct swallowing and tongue posture, speech therapy, appliances to guide the tongue, and orthodontics if needed.

1. Tongue Thrusting
 Also called reverse swallow or immature swallow.
 It’s common name of orofacial imbalance , a human
behavior pattern in which the tongue protrudes
through the anterior incisor during swallowing ,
speech , and while the tongue is at rest

2. Clinical Features
 Short flaccid upper lip.
 Mandibular movement no correlation. between
tongue tip and mandible
 Speech : s , n , d , I , z, v , th.
 Increase the anterior facial hight .

3. Intraoral Finding
 Tongue movement irrgular .
 Malocclusion .
 Maxilla – proclination , increase in overjet .
 Mandibular proclination .
 Anterior open bite .

4. Etiology OF tongue thrust
 Retained infantile swallow .
 Upper respirotary tract infection .
 Neurological distrubances .
 Feeding practice.
 hereditary or tongue size.

5. 1. Retained infantile swallow :
 During the eruption of the lower incisors the tongue
doesn’t drop back as it should continue to thrust
forward .

6. Upper respiratory tract infection :
 Such as mouth breathing and allergies that promote
forward movement of tongue due to pain .

7. Neurological distrbance :
 Such as
1. hyposensetive palate
2. distruption of sensory control
3. coordination of swallowing .

8. :4. Feeding practice
 Bottole feeding is more contributory to tongue thrust
than breast feeding .

9. 5. Hereditary and tongue size :
 Macroglossia have effect on dentition lead to tongue
thrust.

10. Classifition of tongue thrusting :
A. Back lund :
 Anterior tongue thrust
 Posterior tongue thrust
B.Moyer :
 Simple tongue thrust
 Complex tongue thrust
 Retained tongue thrust

11. 1. Backlund classification :
 Anterior tongue thrust : forceful anterior thrust
leading to anterior openbite .

12.  Posterior tongue thrust : lateral thrusting in case of
missing posterior teeth leading to posterior openbite
.

13. 2. Moyer classification :
 Simple : normal tooth contact during the
swallowing act .
1. Anterioer openbite .
2. Good intercuspation of teeth .
3. The tongue thrust forward to established anterior
seal .
4. Abnormal mentalis muscle activity .

14. Incomplete over bite Anterior open bite

15.  Complex : teeth apart during swallow .
1. Diffuse or absent anterior openbite (bimaxillary
protrustion ) .
2. Absence of temporal muscles contraction during
swallowing .
3. Contraction of the circum oral muscles during
swallowing .
4. Poor occlusion of teeth .

16.  Retained infantile thrust (endogenous tongue
thrust ) :
 The persistence of infantile swallowing reflex even
after the permanent teeth appear
 The swallowing activity is accompanied by an
anterior thrust of tongue which appear to be
neuromuscular mechanism

17.  Endogenous tongue thrust associated with
1. Anterior lisp during speech.
2. Affecting to the teeth to extend of preventing the
full vertical development of dento-alveolar segment
3. Incomplete openbite.
4. Proclination of upper and lower incisor

18. Retained infantile thrust :

19. Treatement :
Treatment consideration :
 Self correcting by age 8 – 9 yrs
Treatment modalities :
 1. training of correct swallow and posture of tongue .
 2. speech therapy .
 3. Mechanotherapy .
 Correction of malocclusion .

20. Training of correct swallow and posture of tongue:
1. Ask the patient to put tongue tip in the rugae area
for 5 mints then ask him to swallow .
2. Tongue tip hold against the palate using the
orthodontic elastics or sugarless friut drops .
3. 4S exercises .
4. Whistling .
5. Count from 60 – 69 .

21. Using appliance as guide in the correct
postioning of tongue preorthodontic trainer :
 It’s aids in correct the positioning of the tongue with
help on tongue tags .
 The tongue guards prevent tongue thrusting when in
place .

22. Nance palatal arch appliance

23. :Speech Therapy
NOT BEFORE 8 yrs .
To train the correct postion of the tongue .

24. Mechanotherapy :
 Fixed appliance
Tongue thrust
device
Palatal crib Myofunctional bead

25. Removable appliance
 Restriction of the tongue thrusting habit .
 Alignment of maxillary anterior teeth .
 Correction of open bite .
 Lip muscles exercises performed with ring attach in
anterior part of appliance .
Oral screen Hawley retainer

26. Bruxism
 Bruxism : habitual grinding of the teeth when the
individual is not chewing or swallowing .

27. Prevleance :
 Commence in infancy with eruption of the first
primary tooth .
 Common occurance is during sleep .
 Incidence of bruxism in chlidren varies widely from 7
% to 88% .

28. Clinical features :
 1. occlusal trauma .
 2. tooth structure loss .
 3. muscular tenderness .
 4. T.M.J disorder .
 5. headache .

29. Sings of bruxism

30. Classification of bruxism :
 1. day time bruxism : it may conscious or
suboconscious and may along with other habit such
as nail biting , chewing pencil …..ect .
 2. night time bruxism : its subconscious grinding
of the teeth at night .

31. Mangement :
1. Determine the underlying cause and eleminate it .
2. Occlusal adjustment including restoratio and
occlusal splint – biteguard
3. Psychotherapy: like relaxtion exercises.
4. drugs like local anesthetic injection into T.M.J for
muscle , sedative , and muscle relaxant .

32. Bite guard
 Bite guard : prevent the abrasion of teeth

33. Mouth breathing

34. Mouth breathing :
 It’s habitual respiration through the month instead
of the nose .
 The main causes of the mouth breathing habit are
realted to nasal obtruction which may due to
hypertrophy of pharyngeal lymphoid tissues
adenoid) , defect in nasal septum , allergic rhinitis .

35. Classification
1.anatomical : mouth breather whose upperlip
is short that does’nt communicate the lower lip .
2. habitual : perisitence of habit after
elimination of obstructive cause .
3. obstrctive : increase resistance to compelte
obstruction of normal air flow to nasal passage .

36. Effect of mouth breathing habit :
1. Increase facial hieght .
2. Posterior teeth will supra-erupt .
3. Mandible will rotate down and back .
4. Openbite develop anteriorly , increase oj.
5. Narrowing of the maxillary arch --- increase
pressure from the stretch cheeks .
6. adenoid fade apperance.

38. Mangement
 ENT referral for mangement of nasopharyngeal
obstruction is necessary before any orthodontic
treatment .

39. Thank you