Tongue thrust means the tongue pushes forward against or between the front teeth when you swallow, instead of lifting to the roof of the mouth. In young children this is the normal way to swallow, and many grow out of it without help.1PubMed. Tongue thrust, tongue tip position at rest, and sigmatism: a review Fixing it is less about the tongue alone and more about retraining a habit while removing whatever keeps it going, such as a blocked nose. The payoff people notice most is not the swallow itself but teeth that stay where braces put them.2PubMed. Relapse of anterior open bites treated with orthodontic appliances with and without orofacial myofunctional therapy
When Tongue Thrust Needs Treatment
Forward-tongue swallowing is the rule rather than the exception in children under 10.3PubMed. Tongue thrust, tongue tip position at rest, and sigmatism: a review As children grow, swallowing normally shifts toward a mature pattern, with the tongue tip on the ridge behind the upper teeth. A thrust that is still there in the preteen or teen years, or in an adult, is less likely to fade on its own.
What changes the picture is the company it keeps: a visible gap between the front teeth when biting, a lisp that persists, or breathing through the mouth most of the day. Treatment is usually considered when those show up. If none are present, the usual plan is to keep an eye on it at regular dental visits rather than start therapy.
Motivation matters as much as the problem itself. Therapy tends to work poorly for people whose teeth are already nearly normal, who don’t want it, or whose parents can’t support practice.4American Journal of Orthodontics. Oral myofunctional therapy
You can check for it at home. Have your child swallow some water with the lips slightly parted and see whether the tongue tip shows. Watch for straining or puckering of the lips and chin during the swallow. Notice whether the tongue rests against or between the front teeth when the mouth is relaxed, and listen for a lisp on s and z sounds.
If a dentist raised the issue, ask whether there is an open bite or forward tipping of the teeth right now, and whether they want to watch and recheck or start treatment. Also ask whether nose breathing or tongue tie should be checked first.
What Causes Tongue Thrust
When the nose is blocked, people switch to breathing through an open mouth.5PubMed Central. Nasal Obstruction and Palate-Tongue Position on Sleep-Disordered Breathing Mouth breathing pulls the tongue back and down out of its usual resting spot.6PubMed Central. Nasal Obstruction and Palate-Tongue Position on Sleep-Disordered Breathing Children who breathe through their mouths also more often seal their mouths by pushing the tongue to the lips, 56% versus 30% of nose breathers.7PubMed. The effect of mouth breathing versus nasal breathing on dentofacial and craniofacial development in orthodontic patients So enlarged adenoids, allergies, or a stuffy nose can keep a tongue thrust going.
A child can practise exercises faithfully and still slip back if the nose stays blocked. Snoring, sleeping with the mouth open, or a dry mouth on waking can be signs of blocked nasal breathing, and dark circles under the eyes with constant congestion can be one clue to allergies. An ear, nose and throat check may be needed before exercises can succeed.
Sucking habits matter too. Children who used pacifiers had abnormal swallowing more often in one weaker study, with about 44% versus 30% of non-users.8PubMed Central. The effect of pacifier sucking on orofacial structures: a systematic literature review Long thumb or pacifier sucking keeps the tongue low and forward, and the habit matters more the longer it lasts past the toddler years. Stopping it usually comes before or alongside tongue retraining.
A tight band under the tongue can stop it lifting to the roof of the mouth, leaving it low and forward.9PubMed Central. Treatment and retention of relapsed anterior open-bite with low tongue posture and tongue-tie: A 10-year follow-up There may also be a sensory piece: children with tongue thrust and an open bite had a duller sense of shape and touch on the tongue than other children.10PubMed. Altered oral sensory perception in tongue thrusters with an anterior open bite
How Tongue Thrust Affects Teeth and Speech
An open bite is a gap between the upper and lower front teeth when the back teeth meet. Constant forward tongue pressure is considered a cause of it.11PubMed Central. Tongue Behavior in Anterior Open Bite—A Narrative Review Lips in these patients are often weak, so the tongue pushes harder than the lips push back and the upper front teeth tip forward.12PubMed Central. Tongue Behavior in Anterior Open Bite—A Narrative Review
The tongue’s resting position matters more than the swallow itself. People swallow hundreds of times a day, but the tongue may rest against the teeth for hours. Light, constant pressure moves teeth more than brief strong pushes, which is why therapy targets where the tongue sits at rest, not just the swallow.
Tongue thrust is not closely tied to crooked teeth in every child.13PubMed. Tongue thrust, tongue tip position at rest, and sigmatism: a review Many children with the habit have normal bites, which is why dentists weigh it case by case.
Tongue thrust does not stop a child learning clear s and z sounds, but it may delay it.14PubMed. Tongue thrust, tongue tip position at rest, and sigmatism: a review A lisp alongside tongue thrust is worth a speech therapist’s look if it lasts past the early school years.
Myofunctional Therapy The Main Treatment
Orofacial myofunctional therapy is a program of exercises for the tongue, lips, and face muscles, usually taught by a speech therapist or trained dental hygienist. It aims to strengthen the tongue’s lift, correct where the tongue rests, and correct where it goes during swallowing.15PubMed Central. Orofacial Myofunctional Therapy in Tongue Thrust Habit: A Narrative Review It may also help with sleep-disordered breathing.16PubMed Central. Orofacial Myofunctional Therapy in Tongue Thrust Habit: A Narrative Review
A typical course starts with an evaluation visit that checks rest posture, swallow, speech, and breathing. Weekly or biweekly sessions then teach a few exercises at a time, and daily home practice of 10 to 15 minutes is usually expected. Programs often run several months, then taper to checkups.
Early sessions focus on awareness, helping the person feel where the tongue is and find the spot behind the upper teeth. Next come strengthening exercises for the tongue and lips, so the tongue can hold its position without effort. Only then does the person practise swallowing in the new position, starting with small sips and moving to food. The last stage is making it automatic, so the pattern holds when the person isn’t thinking about it.
About 83% of studies reported better swallowing and tongue posture, especially when therapy was combined with braces.17International Journal of Orofacial Myology and Myofunctional Therapy. Myofunctional Therapy in Atypical Swallowing: A Scoping Review There is not yet enough top-quality evidence to fully confirm that it works.18PubMed Central. Effectiveness of orofacial myofunctional therapy in improving orofacial function and oral habits: a scoping review
Therapists score how the lips, tongue, and face look and work at rest, in swallowing, and in speech.19PubMed Central. Myofunctional orofacial examination tests: a literature review Some use a small air-filled bulb that the patient presses with the tongue to measure strength.20European Annals of Otorhinolaryngology, Head and Neck Diseases. Impact of oral myofunctional therapy on orofacial myofunctional status and tongue strength in patients with tongue thrust Ask for a baseline score at the first visit so you can see change later.
Exercises only work if done daily for months. Younger children need parents to prompt and track practice, and sticker charts or small rewards help.
Tongue Thrust Exercises to Try
These are the common exercises used to retrain the tongue:
- The spot: touch the tongue tip to the bump just behind the upper front teeth and hold for a few seconds, repeating several times.
- Tongue click: suck the whole tongue up to the roof of the mouth and release it with a pop.
- Hold-and-swallow: place the tongue tip on the spot, close the back teeth, and swallow a sip of water without the tongue moving forward.
- Lip closure: hold a button or tongue depressor between closed lips to build lip strength against tongue push.
- Tongue lift and hold: press the tongue flat against the roof of the mouth for counted seconds to build lifting strength.21PubMed Central. Orofacial Myofunctional Therapy in Tongue Thrust Habit: A Narrative Review
For the spot exercise, touch the tip to the small ridge just behind the upper front teeth, not to the teeth themselves. Keep the lips relaxed and the teeth lightly apart so the tongue is doing the work, not the jaw. Hold for the number of seconds the therapist suggests, then rest and repeat, since a tired tongue leads to sloppy form.
For hold-and-swallow, take a small sip of water and put the tongue tip on the spot before swallowing. Close the back teeth lightly and swallow while keeping the tip in place. Watch in a mirror to see that the tongue doesn’t slide forward or the lips pull tight, and stop if the child gets frustrated.
A mirror helps a child see the tongue staying behind the teeth. Short daily sessions beat long occasional ones, and new exercises should be added only once earlier ones feel easy. The rest position can be practised during quiet activities like reading or screen time.
Exercises alone have limits. Online routines done without an evaluation may miss tongue tie or a blocked nose, and doing them wrong can reinforce the forward push. A therapist adjusts exercises to the child and checks progress.
Appliances, Tongue Tie Release, and Other Treatments
Orthodontists can fit a habit appliance, often a small metal crib or spurs behind the front teeth, that blocks the tongue from pushing forward. Fixed and removable versions close open bites about equally well,22Clinical and Investigative Orthodontics. Evaluation of fixed and removable habit-breaking appliances for overbite correction in tongue thrust–associated anterior open bite: a systematic review and meta-analysis so the choice can come down to comfort and whether a child would reliably wear a removable one.
An appliance is generally considered for a child with a persistent open bite and a tongue that keeps pushing forward. It works as a reminder and a barrier, not a cure, so exercises are often done alongside it. An orthodontist decides after looking at the bite, and it isn’t needed for every child with the habit. Speech may sound odd for the first days, and eating feels awkward at first, then adjusts. It is usually worn for months while habits change.
Tongue tie is a short, tight band under the tongue that limits how high it can lift. When it is present and limiting tongue movement, specialists recommend releasing it combined with therapy before and after.23Dental Sleep Practice. A Team Approach to Functional Laser Frenuloplasty and Optimal Orofacial Function Therapy prepares the muscles beforehand and retrains the new tongue pattern afterward.24PubMed Central. Tongues Tied by Orofacial Myofunctional Therapy about Tongue Tie: A Narrative Review In a few reported child cases, laser release plus exercises improved speech and tongue movement without pain or complications.25PubMed. Effect of myofunctional exercise combined with laser-assisted frenectomy in the management of paediatric tongue tie
If allergies or large adenoids block the nose, tongue training may not hold. Doctors may treat the allergies or refer to an ear, nose and throat specialist.
Keeping Teeth From Shifting Back After Braces
Braces move teeth into new positions, but the surrounding tissues and the forces on the teeth remain. If a tongue still pushes forward every day, it keeps pressing on teeth that have just been moved. Open bites are among the corrections most likely to slip back, which is why the tongue deserves attention.
In adults after jaw surgery, those with atypical swallowing after treatment were far more likely to see their bite shift back.26PubMed. Is Atypical Swallowing Associated With Relapse in Orthognathic Patients? A Retrospective Study of 256 Patients In one long-term case, the tongue dropped low years after treatment and the open bite returned.27PubMed Central. Treatment and retention of relapsed anterior open-bite with low tongue posture and tongue-tie: A 10-year follow-up
Relapse looks like the gap between the front teeth slowly reappearing over months or years, sometimes with the front teeth tipping forward again. Catching it early at checkups makes correction easier.
Open bites treated with braces plus therapy reopened by about 0.5 mm on average, versus 3.4 mm with braces alone.28PubMed. Relapse of anterior open bites treated with orthodontic appliances with and without orofacial myofunctional therapy If tongue thrust was noted, ask your orthodontist whether therapy should run alongside braces. Keep wearing retainers as instructed, since tongue habits can return later.
Tongue Thrust in Adults
Adults can do the same exercise programs, though a swallowing pattern used for decades is deeply automatic and takes more repetition to change. Adults also often have more fixed teeth and bone, so therapy may aim to keep teeth stable rather than close a gap. The therapist can say what is realistic given the bite.
In adults, lower tongue and jaw posture is tied to worse sleep apnea.29PubMed. Natural head posture, upper airway morphology and obstructive sleep apnoea severity in adults Adults who snore or wake tired should mention it, as a sleep evaluation may be part of care. Adult tongue tie can be released with therapy before and after.30Dental Sleep Practice. A Team Approach to Functional Laser Frenuloplasty and Optimal Orofacial Function Therapy fits adult life more easily with small habits: exercises during a commute or desk breaks, phone reminders to check tongue rest position, and pairing therapy with retainers or aligners if teeth have moved.
Who to See for Tongue Thrust
Orthodontists handle bite and appliances, myofunctional therapists or speech therapists teach exercises, and ENT doctors check nasal blockage. Treatment usually works best as a team, especially with tongue tie.31PubMed Central. Tongues Tied by Orofacial Myofunctional Therapy about Tongue Tie: A Narrative Review
If the concern came from a dentist or orthodontist, start there, since they can see the bite and decide whether treatment is needed. If the main worry is a lisp, a speech therapist is a natural first stop. If a child snores or is always congested, a pediatrician or ENT doctor may be the right first visit.
At a first consultation, ask what they think is keeping the thrust going and whether breathing or tongue tie has been ruled out. Ask how much home practice is expected and for how long. Ask a therapist about their training in myofunctional therapy and how they measure progress.