Tongue Thrust: Symptoms, Types, Causes and Treatment

Tongue thrust is a common oral habit that can impact dental development, speech, and even breathing. Whether seen in young children or persisting into adolescence and adulthood, tongue thrust can be both a normal developmental stage and a cause for concern if left unaddressed. In this comprehensive guide, we'll explore the symptoms, various types, underlying causes, and evidence-based treatment options for tongue thrust, drawing on current research and clinical expertise.

Symptoms of Tongue Thrust

Tongue thrust often goes unnoticed in its early stages, but it can present with a range of symptoms affecting oral health, speech, and facial development. Recognizing these signs early is crucial for timely intervention and preventing long-term complications.

Symptom	Description	Impact	Source(s)
Tongue Position	Tongue moves forward between/against teeth	Affects swallowing, speech, teeth	1 2 3 6
Open Bite	Gap between upper and lower front teeth	Leads to malocclusion	1 2 10
Speech Issues	Lisping, dentalization of consonants	Impacts articulation of /s/, /z/, etc	1 7 11
Mouth Breathing	Breathing through mouth instead of nose	Increases risk of atypical swallowing	1 4 5

Table 1: Key Symptoms

Common Signs and How to Spot Them

Tongue thrust is primarily identified by the forward movement or placement of the tongue during swallowing, speech, or even at rest. This anterior positioning can be subtle at first but often becomes more noticeable as it affects dental alignment and oral function 1 2 6. Some children exhibit a visible tongue pushing between the teeth while swallowing or speaking, and may even rest their tongue against or between their teeth when the mouth is closed.

Dental and Facial Implications

One of the hallmark dental symptoms is an open bite, where the front teeth do not touch when the mouth is closed. This can lead to protrusion of the incisors and hinder the proper development of the jaw and palate 1 2 10. Over time, the persistent pressure from the tongue can move teeth and alter the shape of the dental arches.

Speech and Breathing Concerns

Speech difficulties, particularly a lisp or the dentalization of certain consonants like /s/, /z/, /t/, and /d/, are common in individuals with tongue thrust 1 7 11. These speech distortions occur because the tongue interferes with the normal placement needed for clear articulation.

Mouth breathing is a frequently associated symptom and can compound the effects of tongue thrust. This altered breathing pattern increases the risk of developing or perpetuating atypical swallowing and related issues 1 4 5.

Types of Tongue Thrust

Tongue thrust is not a one-size-fits-all phenomenon. It presents in several distinct forms, each with unique features and implications for treatment. Understanding these types helps tailor interventions for better outcomes.

Type	Description	Typical Features	Source(s)
Anterior Tongue Thrust	Tongue pushes forward between front teeth	Open bite, incisor protrusion	1 2 6
Lateral Tongue Thrust	Tongue pushes against side teeth	Posterior open bite, arch distortion	2 6
Bilateral Tongue Thrust	Tongue thrusts both anteriorly and laterally	Combined open bites, speech issues	2 6
Retained Infantile Swallow	Persistence of infant swallowing pattern	Tongue between teeth during swallow	6 7 8

Table 2: Types of Tongue Thrust

Anterior vs. Lateral Patterns

The most commonly recognized type is anterior tongue thrust, where the tongue consistently pushes forward against or between the front teeth. This often results in anterior open bite and may cause the upper incisors to protrude 1 2 6. In contrast, lateral tongue thrust involves the sides of the tongue pressing against the back teeth, contributing to posterior open bites and distortion of the dental arch 2 6.

Bilateral and Mixed Presentations

Some individuals display a combination of anterior and lateral thrusts—termed bilateral tongue thrust. This pattern can cause more extensive open bites and complicate treatment, as both the front and sides of the dental arches are affected 2 6.

Retained Infantile Swallow

Infants naturally exhibit a swallowing pattern where the tongue protrudes between the gums. While most children outgrow this by early childhood, some retain this pattern—known as retained infantile swallow—into later years, which can lead to functional and structural issues if not addressed 6 7 8.

Causes of Tongue Thrust

Tongue thrust arises from a blend of anatomical, functional, and behavioral factors. Understanding the root causes is vital for effective management and prevention of complications.

Cause	Description	Contribution	Source(s)
Oral Anatomy	High/narrow palate, crowded teeth, large tonsils	Space issues promote thrust	1 6 7
Mouth Breathing	Habitual mouth breathing	Increases risk and persistence	1 4 5
Oral Habits	Thumb-sucking, pacifier use	Reinforces tongue thrust pattern	1 4 6
Developmental Stage	Delayed maturation of swallowing reflex	Normal in some children, may persist	6 7
Neuromuscular Issues	Motor control problems (e.g., cerebral palsy)	Impairs normal swallowing	8 9

Table 3: Key Causes

Anatomical and Structural Factors

Certain oral structures can predispose a child to tongue thrust. A high or narrow palatal arch, dental crowding, or enlarged tonsils reduce the available space for the tongue, prompting it to move forward or laterally during swallowing and speech 1 6 7. These anatomical differences can be congenital or develop due to other underlying habits.

Mouth Breathing and Its Role

Mouth breathing, whether due to allergies, chronic nasal congestion, or habit, is strongly associated with tongue thrust. Studies show that individuals who habitually breathe through their mouth have a significantly higher risk of developing atypical swallowing and tongue thrust 1 4 5. The altered airflow and lip posture disrupt the normal function and positioning of the tongue.

Habitual Behaviors

Oral habits such as thumb-sucking, prolonged pacifier use, or digit-sucking are well-recognized contributors to tongue thrust. These behaviors reinforce abnormal tongue positioning and swallowing patterns, making it harder for the child to transition to a mature swallow 1 4 6.

Developmental and Neuromuscular Factors

For many children, tongue thrust is part of a delayed transition from the infantile to the mature swallowing pattern and may resolve naturally with age. However, in some cases, especially those involving neuromuscular disorders (e.g., cerebral palsy), the persistence of tongue thrust is due to impaired motor control and requires targeted intervention 6 7 8 9.

Treatment of Tongue Thrust

Treating tongue thrust involves a multidisciplinary approach that considers the individual's age, symptoms, underlying causes, and motivation. Interventions range from behavior therapy to orthodontic appliances and, in some cases, surgical or medical management.

Treatment	Approach	Indications	Source(s)
Myofunctional Therapy	Exercises to retrain tongue muscles	Persistent thrust with symptoms	2 7 8 11
Orthodontic Appliances	Devices (e.g., tongue crib, spurs)	Dental/facial changes, open bites	2 10
Speech Therapy	Articulation and tongue placement training	Speech issues, mild cases	7 11
Addressing Habits	Cessation of thumb-sucking, mouth breathing	Contributing behavioral factors	1 4 6
Medical/Surgical	Removal of enlarged tonsils, treat nasal blockage	Anatomical/airway issues	1 5

Table 4: Main Treatment Options

Myofunctional and Behavioral Therapies

Myofunctional therapy uses targeted exercises to retrain the tongue and orofacial muscles, promoting a correct swallow and resting posture. This therapy is most effective when tongue thrust persists beyond typical developmental stages and is associated with speech or dental problems 2 7 8 11. Therapy typically focuses on stabilizing the tongue tip, encouraging upward and backward movement, and improving lip and molar approximation during swallowing 11.

Speech therapy is also beneficial, particularly for those with articulation errors or lisps related to tongue thrust. Exercises may focus on correcting tongue placement during speech and swallowing 7 11.

Orthodontic Intervention

When tongue thrust has resulted in dental malocclusion or structural changes, orthodontic appliances such as tongue cribs, spurs, or palatal devices are often recommended 2 10. These appliances act as reminders or barriers, helping redirect the tongue to a more appropriate position during swallowing and at rest. Various designs exist, including fixed and removable options, often soldered to the maxillary molars 2. In complex cases, orthodontic treatment may be combined with myofunctional therapy for optimal results 10.

Addressing Underlying Habits and Medical Causes

Eliminating contributing habits, like thumb-sucking or chronic mouth breathing, is essential for long-term success. For cases where anatomical issues such as enlarged tonsils or nasal obstruction are present, medical or surgical intervention may be necessary to remove these barriers to normal tongue function 1 5.

Special Considerations

Some children may naturally outgrow tongue thrust as their oral structures mature. For others, especially those with neuromuscular conditions or developmental delays, long-term therapy and support are required 8 9. Treatment should always be individualized, systematic, and based on a careful assessment of the specific tongue-thrust pattern and associated symptoms 11.

Conclusion

Tongue thrust is a multifaceted condition that can affect oral health, speech, and facial development. Early recognition and a personalized, evidence-based approach to treatment are key to preventing long-term complications.

Main Points Covered:

• Tongue thrust is characterized by the forward movement or resting position of the tongue, leading to dental, speech, and breathing issues.
• It presents in various forms—anterior, lateral, bilateral, and retained infantile swallowing—with each requiring tailored management.
• Causes include anatomical factors, mouth breathing, oral habits, developmental delays, and neuromuscular disorders.
• Effective treatment often involves myofunctional and speech therapy, orthodontic appliances, habit cessation, and addressing underlying medical issues.
• Not all cases require intervention—some are normal transitional stages, while others need multidisciplinary care for best outcomes.

With timely, individualized intervention, most individuals with tongue thrust can achieve healthy oral function, confident speech, and optimal dental development.