In continuation of my posts the next one in the series is on Tongue Thrust Habit (TTH) and its harmful effects on teeth and facial development and its treatment
What is a Tongue Thrust Habit (TTH) ?
It is a habit in which the tongue is thrust between the upper and lower teeth during the act of swallowing. The normal position of the tongue during swallowing is behind the upper teeth and at the beginning of the palate.
Why does it happen ?
Many factors are responsible for it, to list a few
- Inability of the tongue to transition from an infant swallow to a mature swallow.
- A thumb/digit sucking habit as a child which has resulted in an open bite and the tongue needs to be placed between teeth to be able to swallow. On many occasions even an extended use of a dummy can cause the same problem.
- A tongue tie, a condition characterised by a soft tissue, which binds the tongue to the floor of the mouth, being placed more towards the tip of the tongue and thereby restricts the tongue’s range of movement.
How does it present itself ?
It would cause an open bite where the upper and lower teeth do not meet in the front and a gap forms. The back teeth meet but the front teeth do not, difficult to bite down into sandwiches etc. In all probability the person may have a lisp while pronouncing a few alphabets due to the lower position of the tongue.
What is the treatment ?
Due to the constant push of the tongue on the front teeth they would be proclined forward. To start of with, a habit reminder appliance (picture attached) needs to be placed to prevent the tongue from pushing the teeth forward which would also re-train the tongue to some extent. This is followed by treatment with braces to correct the mal aligned teeth. Post braces the retainers should incorporate a component to continue to remind/train the tongue of its new position.
Below is a before and after result of a patient with Tongue thrust which had led to an open bite and who needed a tongue crib and Braces for 18 months (No teeth were extracted in the treatment of this case)
Anterior open bite with tongue thrust and severe crowding (Before)
After treatment, open bite closed
Upper arch aligned after removal of braces
Lower arch after treatment with braces and fixed retainer placed
habit breaker appliance for tongue thrust and digit sucking