Tongue Thrust

There are many reasons you might be referred to seek an evaluation with a speech language pathologist (SLP). A common referral we get from dentists and orthodontists relates to the presence of a “tongue thrust.” But what is a tongue thrust and how does that relate to what we do as speech language pathologists?

What is a tongue thrust?

A tongue thrust is a pattern of movement where the tongue visibly pushes forward or sideways during swallowing, speaking, or at rest. This forward rest posture of the tongue against or between the teeth can cause an “open bite.” This is where the tongue creates a gap in the alignment of the front (anterior) or sides (lateral) of the teeth when the teeth are closed. An open bite may also be caused by the presence of thumb sucking or prolonged pacifier use. Tongue thrust is often the most recognized symptom of an Orofacial Myofunctional Disorder (OMD).

What is an Orofacial Myofunctional Disorder?

An OMD is the presence of functional and structural alterations in the mouth (oro), face (facial) and regions of the neck (oropharyngeal area). Problems related to OMDs can lead to alterations in breathing, sucking, chewing, swallowing and speech, as well the position of the lips, tongue (oral rest posture), and cheeks. A tongue thrust is just one type of OMD.

What causes a tongue thrust?

This question is often likened to the chicken or the egg causality dilemma. While many say a tongue thrust is what causes an open bite, others believe an open bite causes the tongue thrust. Either way, the cause of Orofacial Myofunctional Disorders is multi-factorial:

• Presence of oral habits including prolonged pacifier use, or thumb sucking – any sucking or chewing pattern lasting past the age of 3 years.
• Allergies causing swollen tonsils or adenoids which create crowding in the back of the throat and may encourage a more forward resting posture of the tongue due to limited space.
• Ankyloglossia, or “tongue tie,” where the band of tissue beneath the tongue restricts the range of movement of the tongue.

Is a tongue thrust ever typical?

Yes! A tongue thrust is often referred to as an “immature swallow” or a “reverse swallow”. Nursing or bottle-fed children will exhibit tongue protrusion to swallow food/liquid. The following developmental milestones are typically observed in a child’s feeding pattern relating to tongue protrusion:

• By 16-18 months, there is an increase in the dissociation of movement between the jaw, lips and tongue. In other words, their ability to move separately from one another increases. Tongue protrusion reduces at this point to support swallowing.
• By 19-24 months, tongue retraction for swallowing occurs
• By 36 months, tongue thrusting with a swallow is typically resolved when a mature swallow pattern develops.

Seeking Help

The success of a treatment program for tongue thrust and/or other related OMDs is highly dependent upon coordinated care between a multidisciplinary team, including but not limited to:

• An orthodontist or dentist: to examine the teeth and jaw.
• A doctor such as an otolaryngologist (ENT): to test for allergies, check tonsils and adenoids, and possible diagnosis or treatment options for tongue tie.
• A speech language pathologist with specific training in orofacial myofunctional treatment to evaluate speech, eating, drinking, and breathing.
• Specialists such as orthodontists or dentists with specific training in evaluation and treatment of Temporomandibular Joint Disorder (TMD) if relevant.

What would treatment look like?

Treatment with a speech language pathologist will generally occur once any associated breathing problems are evaluated and treated by a multidisciplinary team. For evaluation and treatment of orofacial myofunctional disorders, it is important to find a therapist who has had postgraduate training as an Orofacial Myologist. Treatment with an SLP with this training might include:

• Feeding/Swallowing: Changing the chewing and swallowing pattern
• Articulation: Learning how to say sounds differently or more clearly
• Rest Posture: Understanding what tongue, mouth, and face muscles should be doing when speaking, eating, and breathing.
• Breathing: Learning and practicing different breathing patterns.

To learn more about Tongue Thrust and other Orofacial Myofunctional Disorders, visit:

The American Speech Hearing Association’s page on OMDs

The International Association of Orofacial Myology

To find a registered Orofacial Myofunctional Therapist, reach out to Parkwood Clinic for a complementary consultation or visit https://www.myofunctionaltherapists.com/