Tongue thrust, also known as reverse swallow or orofacial myofunctional disorder (OMD), is a common condition involving the improper positioning of the tongue during swallowing, speaking, or at rest. When a person has a tongue thrust, the tongue pushes forward against or between the teeth instead of resting correctly against the roof of the mouth. This habitual pattern exerts continuous pressure on the teeth, negatively impacting dental alignment, speech clarity, and overall oral function. This condition is highly treatable through specialized therapies that retrain the muscles of the mouth and face.
Understanding Tongue Thrust
The mechanics of a tongue thrust involve the tongue moving forward during the act of swallowing, which occurs approximately 1,200 to 2,000 times every 24 hours. This consistent, abnormal pressure can force the teeth out of alignment, resulting in dental malocclusions. A frequent outcome is an open bite, where the upper and lower front teeth fail to meet when the mouth is closed.
The physical symptoms often include a lisp or speech impediment, particularly a frontal lisp that distorts sounds like /s/, /z/, and /sh/. Other signs are chronic mouth breathing, difficulty with chewing or biting into certain foods, and the tongue being visibly positioned between the teeth even when resting. The underlying causes often involve prolonged habits like thumb or finger sucking, extended pacifier or bottle use, and chronic nasal obstruction due to allergies or enlarged tonsils.
Professional Assessment and Diagnosis
A professional assessment is necessary to confirm a tongue thrust diagnosis and determine the appropriate path forward. Dentists and orthodontists frequently notice the condition first, as they observe the dental consequences like tooth misalignment and bite problems. They may use imaging techniques to evaluate the alignment and potential damage caused by the tongue’s pressure.
The primary specialists for functional diagnosis are Speech-Language Pathologists (SLPs) or Certified Orofacial Myofunctional Therapists (OMTs). The assessment process involves a thorough evaluation of the oral structures and functions, including observations of the resting posture of the tongue and lips. Professionals also analyze the patient’s chewing and swallowing patterns, often asking them to swallow water while watching for the abnormal forward tongue movement.
Core Treatment Methods
The primary professional approach for correcting a tongue thrust is Orofacial Myofunctional Therapy (OMT), which is a non-invasive, exercise-based program. OMT is a specialized form of neuromuscular re-education designed to retrain the muscles of the face, mouth, and tongue for correct function. The therapy focuses on establishing new, healthier muscle patterns to override the habitual forward thrust.
Treatment works toward four main goals:
- Achieving proper tongue resting posture.
- Establishing a correct swallowing pattern.
- Maintaining a lip seal.
- Encouraging nasal breathing.
Proper resting posture involves the entire tongue resting against the roof of the mouth, not just the tip. For swallowing, the goal is to retrain the tongue to elevate and move backward rather than pushing forward between the teeth.
A therapy program typically involves a structured series of exercises that are practiced daily, often taking only a few minutes each time. Many patients successfully correct the improper resting posture and swallowing pattern within 10 to 12 treatment sessions, though the total duration can vary. The success of OMT is often seen as a preventative measure, reducing the risk of relapse after orthodontic work is completed.
Practical Exercises for Home Practice
While professional guidance is necessary for a full treatment plan, certain exercises are commonly prescribed for consistent home practice to reinforce therapeutic goals. These exercises focus on building strength and awareness in the muscles required for a correct swallow and resting posture. One fundamental exercise is finding the “spot,” which is the small ridge or rugae located directly behind the upper front teeth.
A common strengthening exercise involves “tongue pops,” where the entire tongue is suctioned firmly to the roof of the mouth and then released with a distinct popping sound. This action strengthens the muscles responsible for holding the tongue in its proper elevated position. Another frequent practice involves holding a small sugar-free mint or a drop of water on the “spot” and then swallowing without allowing the tongue to move forward.
These simple actions, repeated multiple times a day, help integrate the correct motor pattern into daily function. Consistent repetition builds the muscle memory necessary for the tongue to maintain a proper rest position and execute a correct swallow. These exercises are supplemental and must be performed under the guidance of a qualified Orofacial Myofunctional Therapist or Speech-Language Pathologist to ensure correct technique.