Most tongue thrust referrals come from orthodontists because the tongue is interfering with the growth pattern of the teeth. Some view this as a cosmetic problem and will use appliances such as baskets, spikes or even braces and retainers to discourage the tongue thrust. However, what often happens is that as soon as the appliances come off the teeth begin to move back to the starting point because the underlying cause of the movement was not addressed.
The lesser known danger of tongue thrust isn’t discovered until much later in life. Why not? Well, in my personal professional opinion it is because we have few tongue thrust providers who work with all ages as I do. Orthodontists don’t usually see geriatric patients. Speech therapists who treat geriatric disease and disorders don’t usually have a specialization in tongue thrust.
In fact, for me, it was quite by accident that I ended up having this unique birth to death perspective of tongue thrust. As a new graduate clinician I had exposure to tongue thrust complicating the oral and pharyngeal phase of the swallow as I viewed videofluoroscopy swallow studies of patients who were aspirating on all textures. I remember one that was so severe it sticks in my memory even today. Her thrust was very evident as her tongue would come out to meet the food or drink. Her tongue would work excessively as she tried to move the food to the back of her throat to swallow. Her tongue would pump trying to initiate a swallow trigger that was weak and dis-coordinated. She was an aspiration risk on all foods and liquids according to the swallow study. The recommendation was a feeding tube because of her aspiration risk and failure to thrive. There were no therapy interventions that could help her at that time due to the severity of her reverse swallow and her advanced age.
Fast forward about 5 years when I was no longer working with this geriatric population but rather in an outpatient setting with a varied caseload of all ages. This was when I began treating tongue thrust for the typical orthodontic referrals I spoke of earlier. My treatment focused on the placement of the tongue during the resting posture and during the swallow. I honed in on specific muscles of isolation and retraining to balance the tongue into proper placement and movement. You can not expect the complex tongue (which is actually 8 muscles working in synchrony) to just change because you show it a new place to rest. It just doesn’t happen.
After refining my approach and developing the Stone Tongue Thrust Protocol: A Protocol for the Assessment & Treatment of Tongue Thrust the connection happened. I realized the connection of an untreated tongue thrust throughout the lifespan. It was more than teenagers and parents who were frustrated because their teeth were moving back to pre-orthodontia status, despite investment in massive amounts of time and money. I saw adults who were suffering from severe TMJ pain who thought they were sentenced to wear a mouth guard for the rest of their lives. I saw geriatric patients who were experiencing severe swallowing disorders because the body slows and weakens as it ages and they were no longer able to compensate for the reverse swallow inefficiencies.
At Idaho State University, Tony Seikel, PhD et al. researched whether there is in fact a causal relationship between OMD (oromyofunctional disorders/tongue thrust) and OPD (oropharyngeal dysphagia) and his findings support what I have witnessed clinically over the past 20 years. The reverse swallow of tongue thrust (an oral phase dysphagia) can advance into a much more insidious oropharyneal dysphagia resulting in choking and/or aspiration pneumonia.
As with anything, early intervention and prevention is far more effective and preferred. Spending a fraction of time and money on eliminating the tongue thrust now may in fact save you more than additional orthodontia but in fact it may save your life.
For more information on tongue thrust or how to identify a qualified tongue thrust provider visit StoneTongueThrustProtocol.com for information and resources.