 Definitions

 Classifications

 Incidence and Prevalence

 Diagnosis

 Management
 Tully (1969) : movement of the tongue tip between the teeth to
meet the lower lip during deglutition and in sounds of speech, so
that the tongue becomes interdental.

 Profitt (1972): It is the placement of the tongue tip forward

between incisors during swallowing.

 Norton and Gellin (1978):Tongue thrust is the condition in

which the tongue protrudes between anterior and posterior teeth
during swallowing with or without affecting tooth position.
 Barber (1975):A tongue thrust is an oral habit pattern related
to the persistence of an infantile swallow during childhood and
adolescence and thereby produces an open bite and protrusion
of anterior tooth segment.

 Schneider(1982):Tongue thrust is a forward placement of

tongue between the anterior teeth and against the lower lip
during swallowing.
  Physiological : This comprises of the normal tongue thrust
swallow of infancy.

 Habitual: The tongue thrust swallow is present as a habit

even after the correction of the malocclusion.

 Functional : When the tongue thrust mechanism is an

adaptive behaviour developed to achieve an oral seal, it
can be grouped as functional.

 Anatomic : Persons having enlarged tongue can have an

anterior tongue posture.
Reference: Brauer, Townsend V. Holt. Tongue Thrust Classification. The Angle Orthodontist,1965: 35(2):106- 112. PMid:14280960

Maguire JA. The evaluation and treatment of pediatric oral habits. Dent Clin North Am. 2000 Jul;44(3):659-69, PMid:10925776
Classification of tongue thrust by
James s. Braner and Holt-1965

 Type I Non deforming tongue thrust

 Type II Deforming anterior tongue thrust

 Sub group 1: anterior open bite
 Sub group 2 : associated pro-cumbency of anterior teeth
 Sub group 3: associated 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

 Type IV Deforming anterior and lateral tongue thrust

 Sub group 1: Anterior and posterior open bite
 Sub group 2 : proclination of anterior teeth
 Sub group 3: posterior cross-bite References: Tongue Thrust Habit – A Review
Article · January 2009
SIMPLE TONGUE THRUST (Anterior tongue thrusting): It is defined as tongue thrust with a teeth
together swallow. It is usually associated with the history of digit sucking. The features observed
depends upon the duration, intensity and frequency of the habit.

Etiology: The simple tongue thrust swallow usually relates to the

finger sucking habit and this pattern still persists when the habit
has been resolved.

Intra oral features :

1.Proclined, spaced and some times flared

upper anteriors resulting in increased over-jet.

2.Retroclined or proclined lower anteriors

3.Presence of an anterior open bite.

5.The simple tongue thrust is characterized by a normal tooth

contact during the swallowing act. They exhibit good inter-cuspation

of posterior teeth in contrast to complex tongue thrust.

6.The tongue is thrust forward during swallowing to help establish an anterior lip seal. At rest the
tongue tip lies at a lower level.
 Complex tongue thrust : It is defined as tongue thrust with a teeth apart swallow. It is usually
associated with chronic naso-respiratory distress, mouth breathing, tonsillitis, and pharyngitis.

 Etiology :

 Pain and lessening of space in the throat precipitate a new forward tongue posture and swallowing
reflex. Because maintenance of airway patency is a more primitive and demanding reflex than the
mature swallow, the later is conditioned to the necessity for mouth breathing.

 The jaws are thus held apart during swallow in order that the tongue can remain in a protruded
position
 Proclination of anterior teeth
 Bimaxillary protrusion
 This kind of tongue thrust is characterized by a
 teeth apart swallow.
 The anterior open bite can be diffuse or absent.
 Absence of temporal muscle constriction during
swallowing.
 Patients with a complex tongue thrust combine
contractions of the lip, facial and mentalis muscle.
 The occlusion of teeth may be poor. Poor occlusal fit,
no firm inter-cuspation.
 Posterior open bite in case of lateral tongue thrust
 Posterior cross-bite
TONGUE THRUST HABIT - A review. *Gowri sankar singaraju **Chetan kumar ,vol 1 issue 2 ,2009
 Group1: Diastema between upper central
incisors.

 Group 2:Open bite seen not only between

anterior teeth but in posterior teeth as well ,

usually from first molar (forward).

• Group 3 Side thrust: non-occlusion in the

premolar and canine area has been created
by the lateral displacement of tongue
 Anterior tongue thrust
 Posterior tongue thrust
 Forceful tongue thrust
 Lateral tongue thrust in case of missing teeth

Classification : Tulley (1969)

• As a habit
• Innate
• Adaptive behavior

Classification: Moyer’s
• Normal swallow
• Simple tongue thrust
• Complex tongue thrust
• Retained infantile swallow
  According to Fletcher:
 Genetic or heredity factor : They are specific anatomic or neuromuscular
variations in the orofacial region that can precipitate tongue thrust. E.g.
hypertonic orbicularis oris activity.

 Learned behavior ( habit ) : Tongue thrust can be acquired as a habit. The

following are some of the predisposing factors that can lead to tongue
thrusting ;

 1. Improper bottle feeding

 2. Prolonged thumb sucking

 3. Prolonged tonsillar and upper respiratory tract infections.

 4.Prolonged duration of tenderness of gum or teeth can result in a change in

swallowing pattern to avoid pressure on the tender zone

Pannbacker J Speech. Comment on Hanson's "Tongue Thrust: A Point of View"

Hear Disord.1976; 41: 559
  Feeding practices: Prolonged bottle feeding and improper
swallowing pattern has been attributed as one of the etiological
factors of tongue thrusting.

 Maturational:

 Retained infantile swallow: The infantile swallow changes to a

mature swallow once the posterior deciduous teeth start erupting.
Sometimes the maturation is delayed and thus infantile swallow
persists for a longer duration of time. The tongue thrust resulting
from the retained infantile swallow has poorest prognosis.

Maguire JA. The evaluation and treatment of pediatric oral habits. Dent Clin
North Am. 2000 Jul;44(3):659-69.
1.lley WJ. A clinical appraisal of tongue-
thrusting. Am J Orthod 1969;55:640-50
doi:10.1016/0002-9416(69)90040-2