Tongue Thrust and Treatment of Subsequent Articulation Disorders

What is tongue thrust?

Tongue thrust (also called “reverse” or “immature” swallow) is the common name given to orofacial muscular imbalance, a human behavioral pattern in which the tongue protrudes through the anterior incisors during swallowing, speech and while the tongue is at rest. Nearly all young children exhibit a swallowing pattern involving tongue protrusion, but by the age of 6 most have automatically switched to a normal swallowing pattern. (Wikipedia).

Why is it a concern?

Dentists and orthodontists are concerned with the effects of the tongue and facial muscles on the occlusion (how teeth fit together) of teeth because of the evidence proving that too much tongue pressure against the teeth on the inside and an unequal amount of facial muscle pressure from the outside – as is the case with a tongue thrust swallow and/or incorrect tongue resting posture – may result in a malocclusion or misalignment of the teeth – the resting posture of the tongue and facial muscles play an even more vital role: If the tongue is constantly resting against the front teeth and the upper lip in short or flaccid (weak and flabby), the front teeth will be pushed forward.

Thus, correcting this tongue thrust using special speech techniques will play a crucial role in any good orthodontic treatment, making the treatment’s results long lasting and much easier to achieve.

What are some signs of having a tongue thrust problem?

One or more of the following conditions may clearly indicate tongue thrust disorder and should be investigated further with an evaluation of speech pathologist:

  1. Tongue protruding between or against the upper and/or lower “front teeth” when forming /s/, /z/, /t/, /d/, /n/, /l/, or /sh/
  2. Frequent open-mouth resting posture with the lips parted and/or the tongue resting against the upper and/or lower teeth
  3. Lips that is often cracked, chapped, and sore from frequent licking
  4. Frequent mouth breathing in the absence of allergies or nasal congestion

Treatment of tongue thrust and subsequent articulation disorders

To correct tongue thrust, speech pathologists prescribe exercises designed to promote a normal swallowing pattern, as well as correct speech production. In the evaluation session the patient will be given swallowing and articulation inventory tests. If only “pure” tongue thrust is found without any articulation errors then usually three sessions are enough.

At this evaluation session the patient will be given the main set of drills against tongue thrust that he has to do on a daily basis for 60 days following this session. A second session will be scheduled 4 weeks later to follow up on the results of this oral physiotherapy and consider adding another set of drills for the next 4 weeks after which the third session is scheduled with follow up on the results.

If the patient has misarticulated consonants (usually the high pitched ones: /s/ , /z/ , /sh/ , /ch/ , /ts/) – then each sound will have to be corrected in a 8-session weekly speech therapy while doing the same oral physiotherapy for 60 days – as well as specially designated speech drills to correct each sound…The good news are that by successful correction of one sound we may correct another (for example: correcting the /s/ may solve the problem with the /ts/ sound).

Gal Levy M.Sc. CCC-SLP, has more than 21 years of experience in clinical treatments of Voice, Fluency, Articulation and Language. Gal is working as a school based SLP, Home health SLP and in his private practice at Frisco, TX. He also writes professional articles on various speech disorders and state of the art treatments on Google’s new Encyclopedia, Helium and AC writers websites. Gal participated on Community Focus radio monthly shows with Dr. Griffin advising KEOM 88.5 FM listeners on voice, fluency and tongue thrust clinical issues.

Comments

  1. Lydia Longoria, M.S.,CCC-SLP says:

    Mr. Levy can you provide more detailed information regarding the exercises for the oral? I have an 8 year old that I am currently working with who was making excellent progress. However,these last few weeks he has regressed significantly. We were to the point of releasing from therapy. Any ideas? Thank you for your response.

  2. Sure Ms. Longoria , be happy to assist you…if you could only send this request to my clinical e-mail please : galslp@galwave.biz
    Waiting to hear from you.

  3. I am not finding any specific evaluation assessments other than the Tongue Thrust Articulation Test (1977). Do you have any newer assessments specfic for Tongue Thrust – also any specific programs? I have the The Tongue Thrust Book form Communication Skill Builders – 1985. We are just recently having patients being referred for assessment/treatment. Any advice would be helpful.
    Thanks!
    Mona Ryan

  4. Amanda Perry says:

    Mr Levy,

    I am a senior undergraduate student in a Speech Language and Hearing program. I am working on a project where I have to create a treatment plan for an adolescent girl with reverse swallow that is also causing distortion of some of her alveolar sounds-/t/, /d/, /z/ and /s/. I have been trying to find EBP treatments for artic disorders on the ASHA website but everything requires that I buy access. Can you direct me to another site where I may find similar information without it costing me?

    Thank you,

    Amanda Perry

  5. Casandra Ragsdale says:

    At what age should you begin remediating the tongue thrust?

  6. Deb Kellogg says:

    I have had a parent speak with me about providing tongue thrust therapy to both of her children (an 8 year old and a 3 year old) upon recommendation of the children’s dentist. The older child has occasional distortions of the /s/ and /z/ sounds in the final position of words but does not exhibit misarticulations of other sounds. She does exhibit an overbite and will eventually have braces. I also couldn’t detect significant tongue thrusting during swallowing. The younger child has some interdental placement during production of the /s/ and /z/ but is able to produce these sounds following modeling. What recommendations could you give me for these children? Using the guidelines for placing a child in therapy in my state, neither of these children would qualify for services. Thank you for your advice.

  7. Ms. Kellog – Thank you ! Per your description:
    Age 3 – too young….Retest at age 6….if TT – start treatment at age 7.
    Age 8 – if disarticulations not consistent ….maybe it is not lisping but rather some mild verbal apraxia?…Or just lateral air stream problem?!? Or just an old articulation disorder coming to an end ?!? Anyhow, it is hard to give you advise on that – as he is able to articulate initial and middle positions correctly – no real need for speech therapy recommended….just monitor in 6 months.
    All the best…

  8. Margaret Holland says:

    Mr. Levy:

    I just emailed you a request for additional information regarding evaluation and treatment of tongue thrust as described in this blog entry. I am particularly interested in the drills/exercises. My client is 8 years old and articulation is not affected.

    Thank you!

    Margaret Holland
    M.Ed. SLP

  9. Dominique Chung says:

    Mr Levy,

    My son is 4 years old and has a lisp which, after reading your article, I now know to be a tongue thrust problem. He also stutters. I have been concerned ever since he began speaking full sentences at 2 1/2 years of age. The lisp and stutter have not gone away as suggested by his pediatrician and preshcool teachers. He has trouble with s, z and th (he says Kafy instead of Kathie). Any recommentations would be appreciated.

    Best regards,
    Dominique Meurer-Chung

  10. Dear Dominique – First, he is too young for TT treatment….let nature take its course until age 6…Then, reconsider TT treatment….I am more concerned now about his stuttering…until age 6 it might be only normal dysfluency but at age 4 it is better to diagnose it with a local certified SLP – go to ASHA.com for referrals in your area….if you live near Dallas TX….shoot me an e-mail to galslp@galwave.biz and I will be happy to schedule an appointment for him….I must tell you that if this will turn out in the assessment to be a pathologic stuttering this will be contrindication for any articulation treatment – since if you will work on articulation it may aggrevate the stuttering….hope this helps.

  11. Here is a good assessment tool from WKU:
    http://tonguethrust.weebly.com/contact-us.html

    All the best !

  12. Honor Franklin says:

    Dear Mr. Levy,
    It was with great interest I read your blog about ” tongue thrust “.
    I have been in private practice since 1977 in Dallas, Texas working with “tongue thrust” and articulation patients only.80% of my patients are for “tongue thrust” and 20% are for articulation disorders. I am not only a licensed speech-language pathologist but a Certified orofacial myologist. (As a Certified orofacial myologist, I am trained to work with “tongue thrust”).
    The organization that trains and certifies its members to treat “tongue thrust” is the International Association of Orofacial Myology. In fact, orofacial myofunctional therapy has changed considerably. Our emphasis is no longer primarily on the swallow but is on the correct resting posture of the tongue and lips. We also have tried to get rid of the term “tongue thrust” and instead refer to it as resting posture therapy.
    I feel the cause of an incorrect resting lip and tongue posture are prolonged sucking habits and nasal airway problems.( For patients who have a sucking habit, I offer a digit elimination program based on behavior modification) . My referrals come from orthodontists and maxillofacial surgeons in the Dallas and surrounding areas. I feel prolonged sucking habits and nasal airway problems cause the incorrect resting posture of the tongue and lips and incorrect swallowing pattern( referred to in the past as “tongue thrust”). Before I initiate orofacial myofunctional therapy on any patient, they are referred to an ENT and allergist to determine if they are able to achieve a patent nasal airway.
    I can tell you are passionate about what you do and would be happy to discuss this further with you and encourage you to go to the website of the IAOM ( International Association of Orofacial Myology) to learn more about the more recent findings and research.
    Sincerely,
    Honor Franklin
    972-233-1312
    5438 Alpha Road
    Dallas, Texas 75240

  13. Rene Tolentino says:

    Gal Levy,

    Its been since childhood that I have difficulty pronouncing the letter “r”. It not simple because in my field of work it is very important to let people understand what you are trying to say and sometimes I need to think of another word just to express what I would like to tell them exactly. What are the causes of this kind of articulation disorder and is there a cure? It is really affecting my self-esteem and hope you could enlighten me with a good advise how to overcome or maybe treatment.

    thanks,
    rene’

    • Dear Rene !
      Thank you for your letter…/r/ sound is not connected to the TT subject…./r/ is an extremley difficult sound to fix….for best results I would search ASHA.ORG for a CCC-SLP in your area – all certified SLPs under ASHA are very good with articulation problems like yours and could be of great assistance to you…Thanks again !
      G. Levy

  14. I have a grandaughter that is 11 months old, she was dx with TT, my concern is she cannot swallow food, she chokes on everything including mash potatoes. Any suggestions would be appreciated.

    Thank you,
    Barbar Fox

    • Dear Barbar !
      I would search ASHA.org for a near by CCC-SLP that specialize in Dysphagia/swallowing disorders….Do a full speech and swallowing evaluation . The SLP may refer you within the scope of his findings to either an ENT surgeon or to MBS study to further investigate the cause of chocking from food….I would not delay that as this does not seem to be a typical TT complain….It is more of a Dysphagia disorder type ( While she may have both…)
      All the best !
      G.L.

  15. Dear readers !
    You are all cordially invited to join a new professional TT forum on LinkedIn:
    http://www.linkedin.com/groups?about=&gid=4224683&trk=anet_ug_grppro
    Will be happy to see you there !
    Gal Levy

  16. Here is a much better link – you need to have a Linkedin account for that:

    You are all cordially invited to join a new professional TT forum on LinkedIn:
    Tongue thrust forum
    Will be happy to see you there !
    http://www.linkedin.com/news?viewArticle=&articleID=5569158419518066693&gid=4224683&type=member&item=91793794&articleURL=http%3A%2F%2Fwww%2Elinkedin%2Ecom%2Fgroups%3Fabout%3D%26gid%3D4224683%26trk%3Danet_ug_grppro&urlhash=tEgi&goback=%2Egde_4224683_member_91793794

  17. Lauren Jodoin says:

    Hello,

    I am a first year graduate student in SLP at Northeastern, University in Boston. I have a client who presents with a tongue thrust and misarticulations of the /s/ phoneme. He is almost 22 years old. What specific exercises would you recommend? I only have 7 1-hour sessions left, so I would like to make the most of therapy time.

    Thank you!

  18. Dear Lauren – These drills are only for certified CCC-SLPs . I have just sent a copy to your supervisor which hold a CCC-SLP please ask her guidance while doing them with your patient. Thank you for your interest and understanding ! G. L.

  19. Sandy Schneider says:

    My granddaughter is 7 years old. Her speech sounds different. She has problems saying certain sounds and has been working once a week with a school speech therapist for 3 years. She has improved but still cannot say certain sounds like ch etc. She also makes a smacking sound when she eats and seems to have a hard time eating with her lips together. Her lips are often chapped. She has seen an orthodonist and will need braces. Is there a doctor in Portland, Oregon that is known for his/her success in working with children with her difficulties.

  20. Natalie Loden says:

    I am a certified CCC/SLP. I would like to know what your treatment plan is for tongue thrust. I work in a preschool setting with 3-5 year olds and see many students with this problem.
    Thanks,
    Natalie Loden MA CCC/SLP

  21. Christina says:

    Hi,
    I have an 8 year old who has an open bite due to tongue thrust. The orthodontist recommends a tongue appliance. I would prefer not to do that. I am leaning toward therapy instead. Do you know where I can find a Speech Pathalogist in the Fairfield County, CT area? Thank you.

  22. Jonzey M.S. CCC-SLP says:

    Mr. Levy,
    I am a school-based SLP. A 9 year 4 month female was referred to me by a reading coach. She reported that this student’s reading fluency was regressing to the point it was showing in the disordered range. All other academics, including reading fluency, to this point are average or above. At the same time that she was referred to me she was also seeing a dentist for a routine checkup. It was reported that the dentist would not refer for orthodontics until after she received speech therapy.
    My screening showed severe protrusion of the top teeth. She thrusts her tongue between her teeth during isolated sounds but not during conversation.
    Since I am school-based I am having a hard time proving that this is affecting her academic performance. Reading coach thinks her fluency is affected as characterized by “slowing down” to pronounce her words. I don’t see that as I report minimal to no errors during conversation.
    Where should I go from here? Is it typical for dentists/orthodontists to have no treatment plan until after speech therapy? What if the IEP team decides no speech therapy is necessary? Will this child have severe protruded front teeth forever?
    Help please,
    thx

  23. I am a single father, and have an eight year old daughter who has this condition. Her mother is not cooperative in getting or coordinating our daughter’s care. Do you have any suggestions to maximizing some success, given I am with my daughter 3 days per week, and she is with her mother 4 days per week, where she will not likely get the support or daily exercises prescribed?

    Thank you!

  24. Can you make recommendations for a single parent who has an eight year old, who has an uncooperative parent that will not obtain or coordinate care, or participate in the daily exercises needed.

    Thank you.

  25. Karis Locke, MS, CCC/SLP says:

    Please send a list of your tongue thrust exercises. I have a new patient, who is 7, referred by his dentist and I am certain that tongue thrust is the culprit.

    Thanks so much in advance,

    Karis Locke

    • Could you please let me know where I may obtain the exercises for tongue thrust, I have a new client with this problem.

      Thank you!

      M.B. SLP

  26. As was mentioned. Anyone that would like more details please e.mail me on my clinical e.mail for that. thank you.
    GAL

  27. Gaby MOra says:

    I am a single mother of a 3 year old who was recently diagnosed with a severe open bite and high pallet in addition to the Tounge thrust disorder. I have found that medical insurance does not cover treatment for this condition. We have started working with a speech pathologist who is working on excersises to help correct the tongue thrust. At the beginning she was excited and eager to do the excersises, now she is not so eager they are not easy for her. What would be the ideal age to work with her before it gets too late and her teeth start to solidify, I want to avoid surgery if possible.

    • Dear Gaby Mora,
      If you read the article you would know that I would not treat typically before age 6, I am usually giving nature another year and starting only at age 7…But do not delay any articulation treatment that was designed by your SLP – Drills will be much easier to perform at age 7.Thank you !

  28. Dear Mr. Levy,

    I think from the some of the signs you gave, my 8year old may have tongue thrust. Can you please send me the prescribe exercises for normal speech so that I can help him at home. By the way, he is receiving speech therapy at a public school.

  29. Hi there,

    I noticed fairly recently that I have this problem with tongue thrust and mouth breathing. I had braces when I was 16, I am now 19 and continue to wear my essix retainers but my teeth have slanted out instead staying vertical. My orthodontist didn’t even mention there was a problem when I had my braces. There are no SLPs in my city (Leicester, England). I don’t even know if there are any SLPs in England. Would you be able to send me some exercises that will help me swallow correctly? Also, is it even possible to correct my swallow without the help of a professional?

    • Margaret Acutt says:

      Hamid, There are no SLP’s in England because they are called SLT’s. The profession chose to retain the name ‘Speech and Language Therapist” as the professional title. There is a university in Leicester which ‘trains’ (the British term) SLT’s. If you would like help, you can contact the Association for Speech and Language Therapists in Independent Practice at http://www.helpwithtalking.com. The Royal College of Speech and Language Therapists, which is the professional organisation, not an educational establishment, (www.rcslt.org) may help you locate your nearest NHS Speech and Language Therapy Department. However, an independent therapist may be your best bet, since you may not be priority on an NHS treatment list unless you have a medical diagnosis.
      Margaret Acutt, Isle of Wight, England, RCSLT, ASLTIP, & ASHA Member

  30. Hello-I have been working with twin boys since preschool. They had a phono disorder and that’s been corrected. They are now 1st graders, both have open bites, tongue thrusts, hyponasal vocal quality and now they are starting to lose their teeth. We have gotten an approximation of SH and CH, but their /s/ and /z/ are still an issue. One of them can place the tongue behind the bottom teeth, but doesn’t do it in conversation. The other one looks like an interdental lisp all of the time. Any suggestions?

  31. Hello! I have several students that would greatly benefit from these exercises. Would you please send me a copy of the exercises? Thank you so much! roem@aaps.k12.mi.us

  32. will you please send me the different excercises mkamran917@gmail.com…i will be thankful to you..

  33. Kathleen skokan says:

    Hello. Would you please send me the exercises? Kathleenskokan@yahoo.com
    Kindly,
    Kathleen

  34. Could you please send me the exercises? Thanks so much! jdstoneslp@yahoo.com

Trackbacks

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  2. [...] the severity of the correction later if you catch some problems early.” For instance, a child who tongue thrusts while swallowing can drastically deform their tooth alignment and form speech impediments. [...]

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  4. […] besides shifting teeth, retainers may also be used to help kids with speech impediments like a tongue thrust (a condition where your tongue sneaks through your teeth when you talk). Some retainers called […]