HORIZON OF TONGUE IN

ORTHODONTICS

PRESENTED BY
DR.SUVARNA GOWDA
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• CONTENTS :
• Introduction
• Development
• Anatomy
• Functions of normal tongue
• Tongue in orthodontics
Swallowing
Examination of the tongue
• Morphological examination
• Functional examination
Functional analysis of Tongue
Tongue Reflexes
Tongue pressure/vloume
• Differential diagnosis of abnormal tongue posture
• Role of tongue in different types of malocclusion
• Tongue thrust Habit and its Treatment
• Conclusion
• References
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INTRODUCTION
• Orofacial musculature has strong influence on dental and skeletal
units which makes it necessary for proper understanding of these
structures.
• Dental arches are enveloped on both the sides (lingual and buccal)
by muscular tissues and precise balance between these forces is
utmost important for normal inter and intra-arch relations.

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• Since long time, role of tongue in malocclusion has been remained
controversial.
• Le Foulon (1839) was the first to propose role of tongue in
malocclusion. “When tongue strikes against the upper front teeth, it
pushes teeth forward”.
• Sweet (1948) pointed out that in improper swallowing, tongue thrusts
forward against the anterior teeth and hard palate in order to push
bolus of food into the pharynx. This thrusting force cause
proclination of anterior teeth.
• But recently Proffit, based on his equilibrium theory, proposed that
duration of force is much more important than magnitude of any
force acting on dental or skeletal units.

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• According to this theory, concept of tongue hitting and moving the
anterior teeth forward is not valid but, posture and position of tongue
can definitely lead to malocclusion.

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DEVELOPMENT

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• Begins at 4th wk, 1st ,3rd & 4th brachial arches
• Pharyngeal arches meet in midline below the stomodeum
• Local proliferation of the mesenchyme- 1st arch
Tuberculum impar-in midline
Lingual swellings-laterally
• Lingual swelling enlarge merge with tuberculum impar- ant2/3
tongue .
• Hypobranchial eminence-large midline swelling-from mesenchyme of
3rd brachial arch grows rapidly than 2nd arch
It gives-post 1/3 tongue/root
• Post most part- 4th arch

• Muscles-occipital myotomes
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• Another important developmental aspect of tongue is it’s
contribution for normal development of palate.

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ANATOMY

Root of Tongue

Body of Tongue

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• ORAL PART (ant 2/3) PAPILLARY
- Margins are free and contact gums & teeth
- Sup surface-median furrow & papillae,rough
- Inf surface-smooth & median fold frenulum linguae

- PHARYNGEAL PART (Post 1/3)LYMPHOID

- - Post surface,
- no papillae-lymphoids& mucous glands

- Seperated by V-shaped sulcus-sulcus terminalis

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MUSCLES (Extrinsic)

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Extrinsic muscles
Muscle Action
Genioglossus depresses tongue, its
posterior fibers protrude tongue
Hyoglossus depresses and retract tongue
Styloglossus retracts tongue
Palatoglossus retracts tongue and draws it up
MUSCLES(Intrinsic)

Intrinsic muscles
Superior longitudinal
Inferior longitudinal
Transverse
Vertical

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Intrinsic muscles
Muscle Action
superior longitudinal makes the dorsum concave
Inferior longitudinal makes the dorsum convex
Transverse decreases the width of tongue
Vertical flattens the tongue
NERVE SUPPLY

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• Blood supply: -
• Lingual artery (branch of ECA) & Lingual vein

• Nerve supply:
• Motor
• All muscles are innervated by hypogossal n. except
• Palatoglossus - Vagus n.
• Sensory- ant 2/3-lingual n (gen sensation)
• - Chorda tympani (taste)
• - Post 1/3-glossopharyngeal n (both general and taste )
• - Post most –vagus ( through int laryngeal n )

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• Papillae of tongue
• They are 4 varieties
• Filiform
• Fungiform
• Foliate
• Circumvallate

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• TASTE : Basic tastes: Salt
• Sour (acidic)
• Sweet (sugar)
• Bitter (vallate papillae)
• Umami- new taste to
a.a like gluatamate,aspatate

Taste sensation –taste buds (4600),in

papillae
Taste buds-sensory,neuro epi cells
Seen in tongue,soft palate & pharynx
Circum vallate-large, numerous taste
buds- sour/bitter
Foliate -numerous taste buds – sour
Fungiform-ant part
Filiform- mechanical, NO TASTE BUDS 18
Normal structural relationship

Note - proximity of tongue and

palate; tip of tongue away from
upper and lower incisors, gentle,
un-strained lip contact; normal
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overbite and overjet
• FUNCTIONS OF NORMAL TONGUE
• Tongue has several imp function of interest to the orthodontist
- Mastication, deglutition, speech, breathing.

• Mastication : - placing food in position (ant & lateral portions of

body) - Pushing food buccally during Mastication .

• Deglutition: - Forming & propelling bolus in to pharynx(1st stg of

swallowing)
- After swallowing tongue contact hard palate while soft palate is
pulled away downward against the posterior portion of the tongue.

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 • Speech: - Formation of sounds - s,z,t,d,sh,
• e,g,is - Elevation of tongue tip behind maxi incisors as in ‘s’ .

Speech difficulty related to Malocclusion

s,z (sibilants) - Ant. Open bite, large gap b/w incisors

t,d (Linguoalveolar stops) - Irregular incisors
f,v (Labiodental fricatives) - Skeletal class III
th,sh,ch(lin.dental fricatives) - Anterior open bite

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• Breathing :
• Nasal breathing- tongue in rest position
• In forced mouth breathing- habit,exertion
- Mandible is depressed,lips are opened
- Tongue contacts laterally with lingual surfaces of mandibular teeth
dropping away from maxilla
• -The ant portion is lowered, lies on lingual surfaces of mandibular
anterior teeth.

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• EQUILIBRIUM & DEVELOPMENT OF THE DENTAL OCCLUSION
EQUILIBRIUM THEORY:
• As applied in engg “An object subjected to unequal forces will be
accelerated & there by will move to a different position in space” It follows
that if any object is subjected to a set of forces but remains in the same
position, those forces must be in balance or equilibrium.
• From this perspective, dentition is in equilibrium as they do not move to a
new location under usual circumstances (mastication,swallowin g,speaking)
• ‘Tooth movement occurs only when the equilibrium against dentition is
unbalanced’ .
• Contributors to the dental equilibrium: Various factors-effect of
pressures,magnitude & its duration
• Masticatory forces
• Soft tissue pressures from the lips,cheeks & TONGUE
• External pressures- habits & orthodontic forces
• Intrinsic pressures-gingival & PDL fibers.
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• Soft tissue pressures from the lips,cheeks & TONGUE:
• Seen during Rest, swallowing, speaking
• Though pressure are much lighter than masticatory but longer
duration
• Studies show that very light forces are successful in moving teeth if
the force is of longer duration.
• So light sustained pressures from the lips,cheeks & TONGUE at rest
are important determinants of tooth position .

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• Injury to soft tissue of lips scarring &contracture
• Incisors moved lingually as lips tightens against them- altered
equilibrium.

• No lip/cheeks (tropical infection)

• Teeth move labially/buccally in
response to unopposed pressure
from the tongue.

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• Pressure from the tongue -macroglossia/patho /abnormal posture

• labial displacement of teeth though lips

& cheeks are intact-altered equilibrium

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• From this equilibrium theory;
• light sustained pressure by the tongue against teeth has significant
role in development of Open bite (proffit).

• If a patient has a forward resting posture of the tongue the duration

of the pressure even light could affect tooth position(vertical & H/Z)

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• SWALLOWING
• Acc T.M Graber 1200-2000/day,4pb of pr/swallow
(cl-II div1,openbite-more)
• Normal swallowing
• Abnormal Swallowing

• Acc to Moyers
- Infantile (visceral) swallowing
- Mature (somatic) swallowing
- Simple -tongue thrust swallowing
- Complex-tongue thrust swallowing
- Retained Infantile swallowing.

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• Normal swallowing
• Teeth are in contact, lips are closed
• Dorsum of tongue closely touch
the palate
• Tip of the tongue lies behind
interdental papillae of maxi incisors
• No tongue thrust seen.

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• Infantile(visceral) swallowing
• According to Moyers
•

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• Transitional swallow occurs during transition from semi solid -solid
food and
the eruption of teeth causes mature swallow (1yr/18mos)
• The normal appearance of feature of both the infantile and mature
swallow

• TRANSITIONAL SWALLOW
• - Diminishing of buccinator activity
• - Appearance of contraction of mandibular elevators
• -stabilised occlusion is seen.

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• Mature (somatic) swallowing
• Teeth together swallow
• Mandible stabilized
contraction of elevators
• Tongue tip touch palate
lightly above behind incisors
• Minimal contraction of the lips

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In mature
swallowing, there is
no abnormal force on
dentoalveolar unit.

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• RETAINED INFANTILE SWALLOW
• Defined as predominant persistance of the infantile swallowing reflex
after the eruption of permanent teeth.
• - Rare,may be associated with
• craniofacial developmental syndromes/neural defects.

• ClinicalFeatures:
• Tongue thrust type ant lateral
• Contraction of buccinator muscle
• Expression less face(facial muscles used for stabilising mandible)
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• Difficulty in mastication(as occlusion only on last molar of quadrant)
• Poor Occlusion
• Gag threshold is low
• Anterior facial height is increased
• severe Anterior open bite

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• Adaptive features to OpenBite:
• Tooth apart swallow with Tongue.Thrust
• Infra eruption of incisors and alveolar development
• Hyperactive mentalis m and lips
• Mandible stabilized by facial muscles

• Treatment : should differentiate this with skeletal Openbite

- If required- orthodontic treatment combined with surgery.

• Poor prognosis

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• TONGUE IN ORTHODONTICS

• By examining the tongue of the patient ,”physicians find out the

diseases of the body ,philosophers the diseases of the mind “- St Justin

• Examination of the tongue

• Role of tongue in malocclusion
• Tongue thrust

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• Examination of the tongue –
• From an orthodontic point of view other than color,texture
• Morphologic examination (size , shape)
• Functional examination (tongue posture)-imp
• Differential Diagnosis of abnormal tongue posture

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• Morphologic examination
• size & shape of Tongue
subjective observation, related to patient ,
Tongue Position is important than size
Length- long tongue can touch tip of nose(not confirmed method)
- Microglossia-rare
– Macroglossia - scalloping on lateral borders of Tongue

• Asymmetry- placing tongue out

– Functional asymmetry- change from one position to other.

- Morphological asymmetry- persists in draped position

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• Clinical implications of asymmetry:

• Tongue asymmetry is important in

dental arch symmetry and dental midlines
• Maintenance of treated incisal relationships
• Open bite
• Not easily corrected, as treatment involve some compromise

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• Functional examination
- Important clinical examination,
- important than size
- Tongue and lips often integrated
- Examine normal tongue function without displacing it or the lips .

• Posture of the tongue while mandible in its postural position

– Clinically- upright position
– Cephalometry- METRIC EVALUATION
–In normal position -Dorsum of the tongue touches the palate lightly,
tip rest in the lingual fossae/crevices of mandibular incisors.

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• Tongue during mastication: -
Difficult test – Associated with neurological problems .

Tongue during swallow :

• Normal -Tip touches interdental papillae just behind the maxi incisors
The unconscious swallow -most imp
command swallow of saliva
command swallow of water
unconscious swallow during mastication

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• Observe the tongue in various swallows
• Patient should be in upright position with the vertebral column
vertical & FHP parallel to the plane
• unconscious swallows
-Place small amount of water beneath the patients tongue tip & ask
him to swallow & note mandibular movements .

• Mature swallow – mandible rises, lips touch lightly with very minimal
contraction

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• Place the hand over the temporal muscle
-pressing lightly with finger tips
-Give the patient more water & ask for a repeat swallow & feel for
temporal muscle contraction

Place a tongue depressor or mouth mirror on the lower lip & ask the
patient to swallow .

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• During speech :
-Is abnormal tongue activity adaptive/etiologic/unrelated to
malocclusion
– Usually- adaptive
– Ask pt to count 1-10,check for tongue adaptivity, consonants sound
-“S”-sound (lisping) most affected

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• FUNTIONAL ANALYSIS:
• Metric evaluation- lateral ceph
• Palatography
• Cineflourography

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• Metric evaluation of tongue posture

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• Tranparent plastic template in mm
• Mark-contours of bony palate & dorsum of tongue

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• Palatography
• Recording the contact areas of the tongue with the palate and
teeth during speech/certain tongue functions
• A thin layer of contrasting impression material is applied on tongue
• Tongue movement are obsevrved-speech/swallowing
• Palatogram records photographically
eg:lisping-defect S sound, TongueThrust
• Evaluation of the influence of functional orthodontic appliance
therapy .

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• Speech assessment is also desirable from an orthodontic point of
view
• In malocclusions with malposed teeth, there can also be a
malposition of the tongue, which can impair normal speech .
• An important diagnostic tool as the clinician establishes a treatment
plan and a probable prognosis for functional appliance therapy.

• Cineflourography
• -tongue movements using camera and film is made during
swallowing .

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• Here the patient is asked to swallow and the camera is started.
• A cineflurographic film is made of the movements of the tongue from
the beginning of the swallowing,regarding backward and downward
movements of the tip of tongue until the tongue moves back to its
original position at the end of swallowing which will be in a matter of
few seconds.

• After the cineflourographic film had been developed,the tracing

technique consisted of drawing a straight line from the labial surface
of the upper central incisor down ward until extends past the lower
incisor. Then ,measurement can be made to know how far tongue has
extended past this line.

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• DIFFERENTIAL DIAGNOSIS OF ABNORMAL TONGUE POSTURE

• Proffit ;-
“Tongue posture is far more adapt to cause of an Open bite than
Tongue thrust, because the tongue is always there exerting a mild ,continuous
force”.
• Abnormal tongue posture is more frequent problem than abnormal size .
• Tongue posture is Related to skeletal morphology

• There are 2 significant variations:

• The retracted tongue posture
• The protracted tongue posture

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• The retracted tongue posture/COCKED TONGUE:
• Tongue tip is withdrawn from all ant teeth

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• A)Retracted posture seen-10% children
• Associated with lateral Openbite
• Most commonly seen in Edentulous adults/pt with bilateral loss of
several post teeth
• Due to positional sense it retract itself to establish tactile contact
laterally with alveolarmucosa for better seal during swallowing.
• Complication :unsettling of mandibular denture .
• B) Protracted tongue posture:
• Tongue lies between incisors
• Serious condition which results in anterior openbite
• Types-
• Endogenous
• acquired adaptive

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• a)Endogenous protracted tongue posture:
• Retention of the infantile postural pattern
• Not esthetic, unstable incisor relationship
• Mild Anterior Openbite
• Protracted tongue is adaptation to increased AFH
• Is Endogenous protracted tongue posture caused OB?
• Or increased AFH/skeletal dysplasias predispose to tongue
protraction?
• Treatment :
Surgery might cause relapse
• poor prognosis

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• b)Acquired adaptive protracted tongue posture:
• Transient-adaptation to tonsilitis/pharyngitis
• Treatment :removal of cause(tonsillectomy)
• Correctable - good prognosis

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• Neonatal posture
• In neonate more forward placement of tongue.
• Abnomal posture with Generalised spacing,proclination
• Prognosis-depends on cause
• -good in respiratory problems

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• ROLE OF TONGUE IN DIFFERENT MALOCCLUSIONS

• Class I malocclusion:
• Most common type of tongue abnormality seen in class I cases is
tongue thrust habit causing anterior openbite.
• Occasionally bimaxillary protrusion is partly attributed to tongue
abnormality being large or posture forward causing forward
positioning of both arches

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In class-II Div I malocclusion

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• Class II, Division 2 malocclusion
• There is some evidence to support the contention that the tongue
tends to accentuate the excessive curve of Spee as it interferes with
the eruption of the posterior teeth by occupying the interocclusal
space.

Class II, Division 2

malocclusion showing
lateral tongue-thrust

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• Tongue and lip adaptation to Class III malocclusion.
• Relatively functionless lower lip is in marked contrast to excessive
activity associated with Class II, Division 1 malocclusion.
• Tongue position is further Low, but with no anterior thrust on
deglutition.

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• SIZE OF TONGUE CAUSING MALOCCLUSIONS

• Microglossia: small tongue ,

Congenital,piere-robin syndrome
• Clinical features:
- tongue tip is at lower level
- Floor of the mouth is elevated and visible
- Dental arch-collapsed & reduced
- Extreme crowding in premolar area
-Severe class-II relation

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• Macroglossia :
• Congenital, increased GH, amyloidosis, tumo rs, edentulous pt
• Difficult diagnosis
• ceph,cineradiography
•
• CLINICAL FEATURES
• Scalloping of lateral borders
• Mandi prognathism
• keeping mandible forwards always

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• Wide,broad flat tongue
• Open Bite
• Mandi prognathism / Class III
• Chronic positioning tongue b/w teeth at rest
• Buccal tipping of post teeth
• Increased tranverse width of dental arch
• Difficult diagnosis
• tongue some times adapt to contracted narrower space after ortho
treatment

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Spacing in upper
anterior region due
to large tongue

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• Consequences of tongue posture
• functional abnormalities on
skeletal pattern:
• In HGP: -
• Forward position/T.T-
• Bimaxillary dental protrusion
• (as tongue pressing on lingual
surfaces of both U/L incisors) –
• Spacing(incisors), Anterior openbite.
• tipped

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• In VGP: -
• T.T- tip the upper incisors to labial

• & Lower incisors-lingually

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• TONGUE REFLEXES
• Most significant is the posture of Tongue which is important for the
maintenance of the phayrngeal airway .
• Base of the tongue forms ant wall of the pharynx .
• Maintenance of phayrngeal airway cause base of the tongue to not to
intrude into airway .
• Genioglossus muscle performs this reflex function.
• The genioglossus reflex may be initiated by a large tongue or large
tonsils or by jaw opening.
• sustained Tongue protraction such as forward posturing of the tongue
may force incisor teeth basically or prevent eruption of incisors if the
tongue rests over the incisal edges.
• large tongue may spill over the buccal teeth preventing their eruption
and produce an posterior open bite or deepbite.
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• ANKYLOGLOSSIA:
• Complete ankyloglossia: fusion of tongue and floor of mouth
• Partial ankyloglossia / tongue tie:
Short lingual frenum /attachment of lingual frenum to the floor of
the mouth near the tip of tongue

Tongue tie :
is most common ,Restricted tongue movements
Speech difficulties (consonants)
Some cases are self corrective
Majority : surgical correction (frenectomy)

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• Measurement of tongue volume
• True FISP- true fast imaging with steady precession
• MRI
• CT scan
• Measuring tongue vol :using true FISP 2D-study,in healthy and
acromegaly pts
• In healthy pts- 140ml - 90ml
• Acromegaly pts -180ml -145ml
• After treatment of acromegaly
154ml -125 ml

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• MRI:
• In 19 adults- coronal and sagittal sections
• Series of images
• multiplying the thickness of each slice and the gap b/w each slice in
the series .
• Avg vol 72.1cc (coronal) 79.3cc (sagittal)
• Results-reproducible
• -Well definable anatomy of tongue

• CT scan: reliable method of measuring vol

- Used in measuring vol of tumours in Ca of tongue
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• Tongue presssure
• EMG
• cineradiography
• Palatograpic
EMG- activity of extrinsic and intrinsic muscles of the tongue are
Measured for potraction,retraction
Genioglossus most imp Protrusion
maintaining shape
maintaining pharyngeal airway

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• TONGUE THRUSTING
• Defin: Proffit-
placement of the tongue tip forward b/w the incisors during
swallowing (1950&60s) OR
It is the habit of thrusting tongue forward against teeth in between
swallowing
• Misnomer-implies tongue is forcibly thrust forward
• Tongue thrust-an adaptive mechanism to maintain Openbite caused
by something else eg. thumbsucking
• TongueThrust term-1958 ,force teeth out of alignment

• Associated with or contributing to an orthodontic/speech problem

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• Etiology -
• Acc to Fletcher
• 1.Genetic factors -anatomic/neruomuscular
eg:hypertonic orbicularis oris activity

• 2.Learned behavior (habit)- acquired as habit

- prolonged thumb sucking,tonsillitis , URTI,improper bottle feeding

• 3.Maturational infantile swallow persists in adulthood

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• 4.Mechanical restriction - macroglossia, constricted dental
arches,enlarged adenoids

• 5.Neurological disturbances -hypersensitive palate,

motor disability of tongue

• 6.Psyhcogenic factors -forced discontinuation of thumbsucking

• 7.Younger children with reasonably normal occlusion-trasitional stage

in physiologic maturation

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• Classification
• According to Moyers (1970)
a. simple tongue thrust swallow
b. complex tongue thrust swallow
• Backlund (1963)
a. Ant tongue thrust
b. Post tongue thrust
• Pickett (1966)
• a. Adaptive-missing teeth/thumb sucking
• b. Trasitory (mixed dentition phase)
• c. Habitual-postural problem,habit or Openbite

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• James S.Braner and Holt
• Type I: Non-deforming tongue thrust

• Type II: Deforming ant tongue thrust

sub group 1- associated with anterior openbite
sub group 2- anterior proclination
sub group 3- posterior cross bite

• Type III: Deforming lateral tongue thrust

sub group 1- posterior open bite
sub group 2- posterior cross bite
sub group 3- deep overbite
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• Type IV- Deforming and lateral tongue thrust
sub group 1- anterior and posterior open bite
sub group 2- anterior proclination
sub group 3- posterior cross bite

• Non-deforming:
occlusion and profile within normal range and acceptable

• Deforming: dentoalveolar defect

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• Clinical features
• Seen from birth
• School age children
• 67-95%(5-8yrs)
• If retained after 4yr- cause of concern and need orthodontic
intervention
• Proclination of ant teeth
• Anterior Openbite
• Bimaxillary dental protrusion
• Posterior cross bite
• Posterior open bite in lateral Tonguethrust

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• Simple T.T
•
Complex T.T

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 Simple Tongue Thrust
• Teeth together swallow-T.T to seal
openbite
• Well circumscribed Openbite
• Precise occlusion-reinforced
by teeth together swallow
• Contraction of lips,mentalis and
mandibular elevator muscles
• H/O Thumb sucking-T.T as adaptive
mechanism to openbite
• Not asscd with respiratory problems
• Diminishes with Age
• Prognosis- Good
Complex Tongue Thrust
• Teeth apart swallow
• Diffuse Openbite
• Poor occlusion-No reinforcing
• Contraction of lips ,mentalis and
facial muscles.no mandibular
elevator muscles.
• H/O breathing/chronic
URTI,Allergies
• Asscd with respiratory problems
• Do not diminishes with Age
• Prognosis -poor 87
• Diagnosis
• Extra oral-facial profile ,-Openbite,increased anterior facial height
• Examination of- tongue posture - tongue function
• Careful differentiation should be made of
Simple tongue thrust
Complex tongue thrust
Retention of infantile swallowing pattern
Faulty tongue posture
Tests for diagnosis
1. swallowing: jaw drops- lips,mentalis muscle contracts strongly-
tongue thrust
2.Seperate the lips while swallowing to watch tongue thrust,and in
doing so,strong muscle contractions can be felt
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• Methods of examination tongue dysfunction:
• Position and size- Lateral ceph
• Tongue pressure- EMG,
• Cineradiography,
• Palatograpic,
• Neurolophysiologic examination

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• Treatment
• Simple tongue thrust:
• 3 phases
• 1.Conscious learning of the new reflex
• 2.Transferal of control of the new swallow pattern to the
subconscious level
• 3.Reinforcement of the new reflex –
If proclination is severe- correct the habit after retraction
Simple T.T-correct by itself during ortho treatment

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• A)Conscious learning of the new reflex:
• Teaching correct tongue position by tactile signals (index finger)
• Tip of tongue to touch palate
• Put tongue tip-close teeth and lip
• -swallow 40times/day
• With little water/food
• Small ortho intraoral elastics-held by tip of tongue against palate
during swallowing
• If correct swallow- elastic will be retained
• Incorrect swallow- elastic will be swallowed
• 2-3times /day

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• B)Reinforcing the new swallow subconsciously:
• To avoid abnormal unconscious swallow-2nd visit
• Flat sugarless fruit drops-citric flavoured(lemon)
• Fruit drop placed on Tip of tongue-hold against palate until it dissolves
• Record timing
Initialy-less time, later more time
Distraction
• self competition emphasized
• Ones/day
• Timing distraction-Best technique

•
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• C)Reinforcing the new reflex:
• Appliance therapyTongue crib
• Should not be given as the 1st step of treatment
• As it is traumatic to pt/ do not wear properly
• Tongue crib:
• Ni-cr/S.S, 3-4 projections (spurs)
• Follow the palatal contour
• Forms barrier/picket fence just behind cingulum of mandi incisors
• Duration:depends on severity of OB(4-9mos)

93
• Method of action:
• Eliminate the strong T.T and
• plunger like action during swallowing
• Reeducate the tongue posture –Dorsum-to touch palate vault
Tip - palatal rugae
• Effects: as tongue confines with in dentition-rests on occlusal
surfaces of post teeth-maintains intraoral distance
-supra eruption and
narrowing of max post teeth prevented
No Openbite

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• After habit interception
• Treat malocclusion associated with T.T,
with removable / fixed ortho appliances
• By these above 3 sequential therapy simple T.T is correctable
• Prognosis - good

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• Complex tongue thrust :
• Occlusion treatment
• 1st Muscle exercises similar to simple T.T with minor modification -
Swallowing with teeth together –
Prolonged appliance therapy
• Prognosis -Poor
• More relapses

96
• Management of tongue thrust
•
• Factors to be considered:
• Diagnosis done by GDP,orthodontist,pedodontist/pediatri cians
• Majority byOrthodontist - when child displays dental/speech problem

• 1. Type of malocclusion: The common types of malocclusion associated with

tongue thrust habits area.
• A.Class I malocclusion with increased over jet.
• b.Angle Class II division I malocclusion with increased over jet.
• c. Deep bite
• d. Marked open bite.

• 2. Degree of malocclusion
• 3. Scope of the problem: habitual,
severe tongue thrusting-needs immediate attention.
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• 4. Maturity of the child.
• 5. Attitude and the degree of cooperation-from the patient as well
as parents.
• 6. Progressive malocclusions should be considered for immediate
treatment.
• 7. Structural considerations to be eliminated are
• a. Nasal air blockage.
• b. Extremely narrow palatal arch.
• c. Maxillary posterior teeth in extremely, lingual position
• d. Macroglossia.

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• Probability of correction:
• Sincere commitment and cooperation of patient and parents

• No neuromuscular problems- successful

• 70%- successful
• 25%- unsuccessful (poor cooperation of pt , parents/both)
• 5%- unsuccessful (factors that make treatment impossible)

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• Case reports Tongue muscle activity after ortho treatm of AOB-
AJODO1999;
• Class I with AOB
• bimaxillary dental protrusion-T.T,lisping
• Prior to treat- increased EMG activity of Genioglossus (protrusion)
• After treatment decreased activity of EMG

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• Severe dental OB with tongue reduction after ortho treat
AO2010:71:228-36
• 21yr,Class III with OB,macroglossia
• Edgewise with crib with begg retainer
• Relapse -mandi arch-spacing,flaring of ant teeth,increased mobility
• Partial glossectomy-1/3 middle dorsum
• Improvement itself w/o further appliance after surgery in 4months
• Shows - EQUILIBRIUM

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• A cineradiographic study of deglutive tongue movement
• nasopharyngeal closure in pt with AOB AO 2007:70:284-89

• Results-tongue tip protrusion

• Slow movement of post part of dorsum
• Suggest compensatory coordination of tongue

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• Chia fen, AJO-2002 Examined the relationship between tongue
movements during swallowing & dentofacial morphology with
Ultrasonography
• Cephalometric radiography
• Dental casts
• Movements of tongue during swallowing are related to dentofacial
morphology
• Arch length increased with prolonged duration of swallowing
• Size, posture,& function of the tongue are significantly correlated
with dentofacial morphology, including jaw relations, abnormality of
dental arch form & abnormal tooth position or malocclusion.

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• CONCLUSION
• Hence position of tongue and its function plays an important role or a
contributing factor in dental malocclusion (T.T,macroglossia)
• Tongue thrust troubled orthodontic treatment, discouraged
orthodontists as there is more relapses due to continuous force by
tongue (protrusion) .
• Accomplishment of successful orthodontic treatment is possible
through proper diagnosis
• Treatment plan taking into consideration of all the surrounding oral
structures.

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• REFERENCES
• Hand book of orthodontics,4th edition,Robert E.Moyers
• Contemporary orthodontics,3rd edition,William R.Proffit
• Color atlas of dental medicine-ortho diagnosis,Thomas Rakosi
• Human anatomy vol3 head & neck,3rdedition, B.D Chaurasias
• Tencate’s Oral histology,6th edition
• The 3M’s –Muscles ,Mastication,Malformation
T.M.Graber D.D.S,MSD,Ph.D.
• Text book of Orthodontics 3rd edition by Gurukeerat singh
• . Lip and tongue pressure in orthodontic patients
Heleen Lambrechts , Evelyne De Baets , Steffen Fieuws , Guy
Willems-ejo/cjp137 466-471 First published online: 20 January
2010
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