Understanding Tongue Thrust: Evaluation and Treatment Options

Tongue thrust—also referred to as reverse swallow or immature swallow—is a myofunctional disorder characterized by the habitual forward positioning of the tongue against or between the teeth during swallowing, speech, and at rest. This abnormal tongue posture can significantly impact both oral development and speech articulation.

From a dental standpoint, tongue thrust may contribute to malocclusions, such as open bites or protrusion of the anterior teeth, caused by the consistent pressure of the tongue against the dentition. Over time, this can lead to changes in bite alignment, often requiring orthodontic treatment to correct the resulting misalignments of the teeth and jaw.

In terms of speech development, tongue thrust is frequently associated with articulation disorders, particularly affecting the accurate production of sounds such as /s/, /z/, /t/, /d/, /n/, and /l/. These errors may persist without targeted intervention. Early identification and interdisciplinary management—typically involving orthodontists, dentists, and speech-language pathologists—are essential in addressing tongue thrust. Timely intervention can help prevent or reduce long-term complications, supporting optimal oral health, facial development, and communication skills.

Causes of Tongue Thrust

While genetic predisposition may play a role in the development of tongue thrust, environmental and behavioral factors are often more influential in its onset. Early oral habits and tongue behaviors during infancy—particularly those associated with feeding and swallowing—can significantly shape tongue posture and function.

Common contributing factors include prolonged thumb sucking, extended pacifier or bottle use, and the imitation of oral habits observed in parents or caregivers. These behaviors can disrupt the natural development of swallowing mechanics and tongue positioning, leading to maladaptive oral postures and dysfunctional swallowing patterns.

Over time, these habits may reinforce a forward tongue thrust during swallowing, speech, and even at rest. Recognizing the combined impact of genetic and environmental influences is essential for effective early detection, preventive strategies, and interdisciplinary treatment of tongue thrust.

Types of Tongue Thrust

At Textbook Orthodontics, we understand that tongue thrust—a condition involving the abnormal positioning of the tongue during swallowing, speaking, or at rest—can take several forms, each with distinct effects on oral health and development.

The most common form is anterior (or middle) tongue thrust, where the tongue pushes forward against the front teeth. This pressure can lead to spacing between the teeth or an open bite, where the upper and lower teeth do not come together properly. Left unaddressed, this type of thrust can contribute to malocclusion, speech difficulties, and an increased risk of periodontal issues due to misalignment.

Lower tongue thrust occurs when the tongue presses downward behind the lower front teeth, often contributing to underbites and spacing issues. Meanwhile, lateral tongue thrust involves the tongue pushing against the side teeth, which may cause crossbites, open bites along the dental arch, and uneven tooth wear. This lateral pressure can also increase the risk of developing TMJ (temporomandibular joint) disorders.

Because each type of tongue thrust can affect both function and appearance, early diagnosis and targeted treatment are essential to prevent long-term dental complications. At Textbook Orthodontics, we take a comprehensive approach to evaluating and treating tongue thrust to support optimal oral health and facial development.

Symptoms and Diagnosis of Tongue Thrust

Identifying tongue thrust begins with recognizing key signs, such as abnormal tongue posture and the presence of tooth movement patterns caused by consistent forward tongue pressure. This may result in noticeable dental misalignment, including spacing between the teeth, open bites, or the development of overbites and underbites.

A proper diagnosis involves a comprehensive evaluation by a trained professional. One of the primary diagnostic methods includes observing the patient's swallowing pattern. In individuals with tongue thrust, the tongue typically moves forward between the teeth during swallowing, rather than pressing against the roof of the mouth. In addition to physical examination, a speech evaluation is often essential. Tongue thrust can interfere with proper articulation, particularly with sounds such as /s/, /z/, /t/, and /d/. A collaborative assessment by an orthodontist and a speech-language pathologist may be necessary for accurate diagnosis and effective treatment planning.

At Textbook Orthodontics, we take a holistic and individualized approach to diagnosing tongue thrust—ensuring each patient receives a tailored treatment plan to support optimal oral function and development.

Tongue Thrust in Children

When tongue thrust persists beyond the ages of four to six, it may signal underlying functional or developmental concerns that warrant professional evaluation. This condition can have wide-ranging effects on a child’s growth, including impaired oral function, misaligned teeth, and speech articulation difficulties.

An orthodontic assessment by age 7 is recommended to evaluate the influence of tongue thrust on the child’s orofacial development and to determine whether early intervention is necessary. At this stage, guided treatment may help prevent more complex issues in adolescence.

If left unaddressed into the teenage years, tongue thrust can contribute to more severe orthodontic problems—potentially requiring orthognathic surgery in conjunction with braces to fully correct the resulting jaw and dental misalignments. Early diagnosis and intervention can significantly reduce the need for invasive procedures later in life.

Treatment Options for Tongue Thrust

Effective treatment of tongue thrust often involves a multidisciplinary approach that addresses both the functional and structural aspects of the condition. Behavioral therapy, typically guided by an orthodontist or a speech-language pathologist, is a foundational component. This therapy focuses on retraining the tongue's posture and movement, helping to minimize its impact on both speech articulation and dental alignment.

In cases where tongue thrust has already contributed to malocclusion, orthodontic treatments such as braces or palatal expanders may be necessary to correct misaligned teeth and restore proper bite function. Additionally, specialized dental appliances, such as tongue cribs, may be used when behavioral therapy alone is insufficient. These appliances serve as a physical reminder to discourage forward tongue pressure against the teeth, reinforcing proper oral habits.

Early intervention is critical. Addressing tongue thrust during childhood—while facial and dental structures are still developing—can prevent more severe complications later in life, reducing the need for invasive treatments and supporting long-term oral health and function.

Myofunctional Therapy for Tongue Thrust

Myofunctional therapy is a specialized, non-invasive treatment approach designed to correct tongue thrust by retraining swallowing patterns and improving tongue posture. This therapy focuses on strengthening the orofacial muscles and establishing proper neuromuscular function, with the goal of promoting efficient, balanced oral movement.

Treatment consists of a structured series of exercises targeting tongue elevation, lateralization, and coordination during swallowing, while also reinforcing proper lip seal and nasal breathing. These techniques work together to eliminate harmful habits that contribute to tongue thrust, ultimately supporting healthy oral development and reducing the risk of malocclusion, speech difficulties, and other functional impairments.

Under the guidance of a trained myofunctional therapist, patients—particularly children—can build the muscle tone and motor patterns necessary for long-term improvements in oral posture and function. When integrated with orthodontic care, myofunctional therapy offers a powerful solution for achieving and maintaining optimal oral health.

Long-Term Management and Prognosis of Tongue Thrust

Successful long-term management of tongue thrust requires a comprehensive and sustained approach that integrates targeted therapy, ongoing education, and regular monitoring. Key components of effective treatment include myofunctional therapy, orthodontic correction, and habit modification—each playing a vital role in reinforcing proper oral function and minimizing the risk of relapse.

Myofunctional therapy helps retrain the orofacial muscles, promoting correct tongue posture and swallowing mechanics, while orthodontic treatment addresses any underlying dental misalignments that may contribute to or result from tongue thrust. These combined interventions help establish a stable foundation for long-term success. Patient education is essential in maintaining progress. Understanding the causes, consequences, and corrective techniques for tongue thrust encourages patients to stay committed to prescribed exercises and remain mindful of habits that may trigger recurrence.

Regular follow-up visits with orthodontists and/or myofunctional therapists allow for the ongoing assessment of progress, timely adjustments to treatment plans, and reinforcement of positive behavioral changes. With early intervention and consistent management, the long-term prognosis for tongue thrust is highly favorable. Most individuals experience lasting improvements in oral function, dental alignment, and speech, significantly reducing the likelihood of recurrence and the need for more invasive treatments later in life.

FAQs

  • Common signs include an open bite, misaligned teeth, a lisp, or difficulty swallowing. Mouth breathing and the tongue pushing between the teeth when swallowing are also indicators. A professional evaluation by an orthodontist, dentist, or speech-language pathologist is the best way to confirm diagnosis.

  • Stopping tongue thrust can prevent further misalignment, but it usually won’t reverse existing dental issues. Orthodontic treatment, such as braces or aligners, is typically needed to correct alignment.

  • Treatment usually includes myofunctional therapy to retrain the tongue, speech therapy if articulation is affected, and sometimes orthodontic appliances to guide tongue posture. A personalized treatment plan should be created by a qualified professional.

  • Orofacial myofunctional therapy, speech therapy, and orthodontic treatment are commonly used. In some cases, dental appliances like tongue cribs may be recommended. An interdisciplinary approach ensures the best outcome.

  • Yes. Consistent tongue pressure can cause teeth to move out of alignment over time, especially in children but also in adults. This habit may require orthodontic correction.

  • Tongue thrust can counteract the effects of braces by pushing teeth out of place, delaying treatment progress or causing relapse. Managing tongue posture is essential for a successful orthodontic outcome.

  • A combination of myofunctional therapy, orthodontic appliances like tongue cribs, and addressing nasal obstruction (if present) can help. A healthcare provider can tailor a sleep-specific treatment strategy.

  • Practice resting the tongue lightly against the palate during the day. Address nasal blockages that may lead to mouth breathing, and consider a dental appliance if recommended by your provider.

  • Tongue thrusting is a normal reflex in infants and usually resolves by 6 months. If it continues beyond infancy, consult a pediatrician or speech-language pathologist for evaluation.

  • Yes. Adults can benefit from myofunctional therapy, orthodontics, and in some cases, surgery. While early treatment is ideal, adults can still achieve excellent outcomes with the right care.

3 Ways to Schedule your Free Consultation

and start Braces for as low as $87/Month or Invisalign for $127/Month!

Schedule Online

With our online scheduling tool you can book your appointment right now on our website. We'll follow up after you've scheduled to confirm.

Request a Call-back

Complete the form to the right and a scheduling coordinator will call you as soon as possible to schedule your appointment.

Call/Text: (818) 510-3440

If you'd like to contact the office directly call/text us anytime. If you call outside of working hours leave a message and we will return your call.