Speech, Chewing & Swallowing

TONGUE THRUST

ALSO KNOWN AS A REVERSE SWALLOW/IMMATURE SWALLOW

Refers to the improper function of the tongue thrusting/pushing against or between the teeth during swallowing. A tongue thrust usually goes hand in hand with a low and forward tongue resting position.

signs and symptoms of a tongue thrust

  • An Openbite (where the front teeth don’t meet together when the back teeth are closed)

  • Visualisation of the tongue during/after food or drink has been swallowed

  • Speech where the tongue is often visible, coming out in front of the teeth

  • Lisp

  • The tongue visible between the teeth at rest

Possible causes of a tongue thrust

  • Prolonged bottle feeding

  • Pacifier/Dummy sucking after 6 months of age

  • Thumb/Finger sucking

  • Airway obstruction (enlarged tonsils/adenoids/allergies)

  • Tongue tie

Establishing the correct oral rest posture of the tongue and lips, and eliminating a tongue thrust swallow pattern, can greatly assist the Orthodontist/Dentist in aligning the teeth and jaws correctly.

The tongue is a very powerful muscle. With constant pressure on the teeth from a low and forward tongue position, and the forward thrusting with swallow and speech, we are much more likely to see an Openbite and orthodontic issues.

Correcting the swallow and rest patterns leads to a more stable occlusion, with less chance of orthodontic relapse (where the teeth move once the braces/aligners are removed).

Orofacial Myofunctional Therapy (OMT) works to strengthen the tongue and retrain it it stay back behind the front teeth during rest, swallowing and speech. OMT prior to Speech Therapy is very beneficial, as it lays the foundations and ensures that the child has the control, coordination and strength of the orofacial muscles related to speech.

Whilst OMT is not Speech Therapy, we regularly see improvements in speech.

Research…

Relapse of anterior open bites treated with orthodontic appliances with and without orofacial myofunctional therapy: This study demonstrated that OMT in conjunction with orthodontic treatment was highly effective in maintaining closure of anterior open bites compared with orthodontic treatment alone.

Orofacial Myofunctional Therapy in Tongue Thrust Habit: A Narrative Review: Orofacial myofunctional therapy has provided a dramatic and positive influence on patients treated for tongue thrust. The joy of eating, speaking, and correct breathing can be regained along with confidence, self-esteem, and improved quality of life. Clinically, OMT plays a positive role by not only improving swallow but also the posture of tongue, improper muscle function, and reduces relapse of previous orthodontic treatments.

Open bite and atypical swallowing: orthodontic treatment, speech therapy or both? A literature review: The most effective treatment in cases of anterior open bite associated with atypical swallowing is a combination of the traditional orthodontic therapy and myofunctional therapy.

articulation errors in speech

When the tongue rests low and forward in the mouth (rather than behind the front teeth and sealed in the palate), we often see speech errors that involve anterior (frontal) placement of the tongue.

A lisp occurs when the tongue does not make a clear ‘s’ or ‘z’ sound due to the tongue protruding forward or between the teeth (tongue thrust).

Alveolar sounds are affected when the tongue is unable to elevate to the ‘spot’ on the palate. This ‘spot’ is located behind the top front teeth. The tongue should make contact with the spot, but not move forward against the teeth, or out of the mouth between the teeth. The sounds ‘l’ ‘t' ‘d’ and ‘n’ can be affected when this occurs.

Palatal sounds can also be affected when the tongue is not functioning correctly, these being the ‘sh’ ‘ch’ ‘j’ and ‘zh’ sounds.

we need to

start at the start

and create a functional foundation

This means that rather than jumping into speech therapy, for some children a course of Orofacial Myofunctional Therapy is the best place to start. Correct oral resting postures need to be established early, as they carry us through life.

Children who struggle with speech articulation are more likely to withdraw socially, can have reduced self confidence, may be less independent, and easily frustrated due to not being understood. They are also more likely to reduce the length of their sentences and use a smaller range of familiar words to help with being understood.

If the tongue is weak, we need to strengthen it.

If the lips are unable to pout or spread, it needs to be learnt.

If the tongue is restricted due to tongue-tie, it needs to be released.

If the tongue is unable to move independently of the jaw, then we need to teach dissociation.

Humans are great at compensating when we can’t do something, but it usually comes at a cost. If a child is unable to make a sound due to a functional limitation in their orofacial muscles, we may see jaw sliding, jaw fixing, overactive neck muscles, and exaggerated lip movement. This can lead to TMJ (jaw joint) dysfunction, headaches and postural issues.

So if speech is a concern, its best to start at the start and assess for tongue-ties, develop correct oral resting posture, nasal breathing, lip seal, correct chewing and strengthen the orofacial musculature complex. Time then spent in Speech Therapy can be drastically reduced when the orofacial complex is functioning optimally.

NB: Orofacial Myofunctional Therapy is not Speech Therapy, though some Speech Therapists are trained in Orofacial Myology.

If you would like a Speech and Language Assessment, please contact your local Speech and Language Therapy Services.

chewing and swallowing

Chewing

Correct chewing involves the lips together, nasal breathing, manageable bite size, and chewing on both sides.

Chewing on one side the majority of the time can cause:

  • Pain to the masticatory (chewing) muscles

  • TMJ dysfunction/pain

  • Broken/worn teeth

  • Changes in the growth of the jaw bones.

swallowing

When swallowing, the food needs to be sufficiently chewed and lips sealed. The back teeth then need to come together to lightly touch. The tongue then elevates up to the palate, from the front to the back. The tongue must always stay behind the front teeth during the swallow. The tongue coming forward, is known as a tongue thrust swallow.

During a correct swallow there should be no excessive movement of the lips, chin or cheek muscles.

A note for all parents!

If your child is a slow eater, and is still at the table eating when the dishes are done and everyone else has left…WHY?

If your child is a selective eater, refuses to eat meat and chewy foods, pockets food in their cheeks or chews food and spits it out…WHY?

If your child eats with their mouth open regardless how many times you tell them to close it, and no matter what you offer as a reward for dessert they still eat with their mouth open…WHY?

If your child can’t eat without getting food all over their face, the table or their clothing…WHY?

There are numerous reasons for these issues, with the most common being:

  • Low tone of the orofacial muscles, particularly the tongue

  • Tongue-tie

  • Airway obstruction, and the inability to nasal breathe

  • Malocclusion (where the teeth don’t bite together correctly)