14 23gowrisankarTONGUETHRUSTHABIT Areview.
14 23gowrisankarTONGUETHRUSTHABIT Areview.
14 23gowrisankarTONGUETHRUSTHABIT Areview.
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Abstract:
There is interrelation ship between the form and function. The different abnormal habits may effect the
form of orofacial structures. The presence of one oral habit may induce the other. In this review article a new
induction chart is prepared to show the interrelation between different abnormal habits and their effect on form.
The chart also in turn explains how form can lead to development of different habits. Thus there is interrelation
ship between form and function.
Key words: form and function, etiology, tongue thrust habit, induction chart.
c. Induction The other habits like thumb d. Psychogenic factors : Tongue thrust can
sucking may result in anterior openbite. The sometimes occur as a result of forced
tongue thrusting may develop as a discontinuation of other habits like thumb
compensatory mechanism and is seen to sucking. It is often seen that children who are
protrude between the anterior teeth during forced to leave thumb sucking habit often take
swallowing to form a lip tongue seal instead of upon tongue thrusting.
lip to lip seal as seen in normal swallow.( see
flow chart on induction)( Fig3 and 4)
4,5,6
Classification of tongue thrust Classification of tongue thrust by james s.
2
Braner and Holt
Table gives the james and Holt
classification of tongue thrust. The term non- Type I Non deforming tongue thrust
deforming in this classification implies that the inter Type II Deforming anterior tongue thrust
digitation of teeth and the profile are acceptable and Sub group 1: anterior open bite
within normal range. Deforming tongue thrust is Sub group 2 : associated
associated with some dento- alveolar defect. procumbency of anterior teeth
Sub group 3: associated posterior
cross bite
Type III Deforming lateral tongue thrust
Sub group 1: posterior open bite
Sub group 2 : posterior cross bite
Sub group 3: deep overbite
Type IV Deforming anterior and lateral tongue
thrust
Sub group 1: Anterior and posterior
open bite
Sub group 2 : proclination of anterior
teeth
Sub group 3: posterior crossbite.
Intra oral features held apart during swallow in order that the tongue
1. Proclined, spaced and some times flared upper can remain in a protruded position
anteriors resulting in increased overjet.
2. Retroclined or proclined lower anteriors Features
depending upon the type of tongue thrust.
3. Presence of an anterior open bite. The following features are seen :
4. Presence of posterior crossbites. 1. Proclination of anterior teeth
5. The simple tongue thrust is characterized by a 2. Bimaxillary protrusion
normal tooth contact during the swallowing act. 3. This kind of tongue thrust is characterized
They exhibit good intercuspation of posterior by a teeth apart swallow.
teeth in contrast to complex tongue thrust. 4. The anterior open bite can be diffuse or
6. The tongue is thrust forward during swallowing absent.
to help establish an anterior lip seal. At rest the 5. Absence of temporal muscle constriction
tongue tip lies at a lower level. during swallowing.
6. Patients with a complex tongue thrust
2. COMPLEX TONGUE THRUST: ( ANTERIOR combine contractions of the lip, facial and
6-10
AND POSTERIOR TONGUE THRUST)(FIG 7) mentalis muscle.
It is defined as tongue thrust with a teeth apart 7. The occlusion of teeth may be poor. Poor
swallow. It is usually associated with chronic occlusal fit, no firm intercuspation.
nasorespiratory distress, mouth breathing, tonsillitis, 8. Posterior open bite in case of lateral tongue
and pharyngitis. thrust
9. Posterior crossbite
Etiology
Simple Complex
5. Usually will have a previous history of 5. Usually will have history of tonsillitis or
thumb sucking. airway obstruction.
3.Lateral tongue thrust (posterior tongue It may be unilateral or bilateral and depends upon
thrust) Some patients usually develop into a habit the type of tongue thrust. A double oral screen is
by thrusting the tongue on to the lateral aspect. used to correct this problem
Clinically lateral open bite can be seen.
but no speech problem orthodontic correction of the First exercise is spotting exercise. Spot should be
malocclusion will usually eliminate the tongue the rest position of the tongue . Next is the 2 S
thrust. exercise. Place the tongue on the spot. It results in
If the tongue thrust is present along with salivation. It should be followed by squeezing the
malocclusion and a speech problem, speech-and tongue vigorously with the teeth closed against the
orthodontic correction are needed. spot. 'Squeeze' is done by squeezing followed by
relaxing. This is 3S exercise. This should be
Management of Simple tongue thrust followed by 4S exercise.
The patient should practice the new swallowing
The management of tongue thrust involves pattern at least 40 times a day. After learning the
interception of the habit i.e., to remove the etiology new swallowing pattern at conscious level, it is
followed by treatment to correct the malocclusion. necessary to reinforce it subconsciously for
Once the habit is intercepted the malocclusion transforming the control of the reflex from conscious
associated with the tongue thrust is treated using to unconscious level. Citric acid tablet with bi
removable or fixed orthodontic appliances. concave surface is used for the above said
transformation. Ask the patient to hold the tablet
The treatment of tongue thrust can be divided into using the tongue tip against the hard and soft palate
various steps: as long as possible. Initially the patient can hold for
only a few seconds, gradually the duration can be
I. Training of correct swallow and posture of the extended. The patient concentration should be
tongue diverted towards a hand held clock to note down the
duration of holding the tablet in correct position.
a. Myofunctional exercises Most of the patients can be treated using the above
said treatment protocol. If is not corrected, the
Educate the patient about normal swallowing by patient has to go to the next step of the treatment.
asking the patient to keep the tongue tip against the
junction of soft and hard palate. Various muscle II. Appliances to guide the correct positioning
exercise of the tongue can help in training it to of tongue( Fig 8-11)
adapt to the new swallowing pattern.
Once the patient is familiar with the new tongue
i.. The child is asked to place the tip of the tongue position an appliance is given for training the
in the rugae area for 5 minutes and is asked to correct positioning of the tongue.
swallow.
Pre orthodontic trainer/ Tongue trainer This
ii. The tongue tip against the palate can hold small appliance aids in the correct positioning of the
orthodontic elastics during swallowing. If the tongue with the help of tongue tags. The tongue
swallow is correct the elastic will be retained in guards prevent the tongue thrusting when in place
position. .it can also used to correct mouth breathing habit(
fig 8)
5. Maguire JA. The evaluation and treatment of pediatric 13. Michael Speidel, Robert J. Isaacson, Frank W.
oral habits. Dent Clin North Am. 2000 Jul;44(3):659-69. Worms. Tongue-thrust therapy and anterior dental open-
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mature and tongue-thrust swallowing—an ultrasound
investigation, Am J Orthod Dentofac 14. Winders RV. Forces exerted on the dentition by the
Orthop,2004:125;5:562-570. perioral and lingual musculature during swallowing. Angle
doi:10.1016/j.ajodo.2003.06.003PMid:15127025 Orthod 1958;28:226-35.
7. Fred S. Fink .The Tongue, the Lingometer, and the 15. Takada K, Yashiro K, Sorihashi Y, Morimoto T,
Role of Accommodation in Occlusion. The Angle Sakuda M. Tongue, jaw and lip muscle activity and jaw
Orthodontist: 1986:56 (30:225-233. movement during experimental chewing efforts in man. J
Dent Res 1996;75:1598-606
8. Curtis E. Weiss. A Directional Change in Tongue doi:10.1177/00220345960750081201
Thrust. Int J Lan Com Dis1972;. 7(2):131-134 PMid:8906129
doi:10.3109/13682827209011565 Corresponding Author
9. Burford, Daniel Noar, Joe H. Etiological aspects of S. Gowri sankar
Professor of Orthodontics
anterior open bite. Dent update,2003;30(5):235-41 St. Joseph Dental College, Eluru
PMid:12861760 Ph.919440012443, Email: drgowrisankar@gmail.com