Tongue thrust

bad habit

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 hyposensetive palate distruption of sensory control 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 : 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 . Anterioer openbite . Good intercuspation of teeth . The tongue thrust forward to established anterior seal . Abnormal mentalis muscle activity .

14. Incomplete over bite Anterior open bite

15. Complex : teeth apart during swallow . Diffuse or absent anterior openbite ( bimaxillary protrustion ) . Absence of temporal muscles contraction during swallowing . Contraction of the circum oral muscles during swallowing . 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 Anterior lisp during speech. Affecting to the teeth to extend of preventing the full vertical development of dento -alveolar segment Incomplete openbite . 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: Ask the patient to put tongue tip in the rugae area for 5 mints then ask him to swallow . Tongue tip hold against the palate using the orthodontic elastics or sugarless friut drops . 4S exercises . Whistling . 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 : Determine the underlying cause and eleminate it . O cclusal adjustment including restoratio and occlusal splint – biteguard Psychotherapy: like relaxtion exercises. 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 : Increase facial hieght . Posterior teeth will supra-erupt . Mandible will rotate down and back . Openbite develop anteriorly , increase oj . Narrowing of the maxillary arch --- increase pressure from the stretch cheeks . adenoid fade apperance .

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

38. Thank you