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Brace Face?

This may be a controversial topic I’m writing about today, but my intention with this blog is to foster cooperation and education not defensive territorialism.  There are many reasons that children and teens get braces and I am not an orthodontist so I am referring only to those who I have extensive experience with and where I have the privilege of collaborating with orthodontists…tongue thrusters!

More often than not, tongue thrusters require orthodontic braces at some point to make up for what the tongue did not do naturally during development. Teeth are often misaligned due to a narrow palate that doesn’t have enough room for the teeth as well as an overbite or overjet because the tongue is pushing on or through the teeth.

I have never seen a tongue thruster that does not have a high narrow palate. Why? Because the tongue didn’t learn to rest on the palate and spread it naturally during development. There can be a myriad of reasons why: pacifier, thumb sucking and mouth breathing are common influences.

If you look at an infant their face is very small and round with a prominent tongue as they are nursing and sucking as the primary feeding pattern. As an infant develops and begins erupting teeth the natural transition is to easy to swallow “baby food” which is usually a pureed consistency. Any parent can tell you that initially as much of it comes out as goes in! This is because the baby is transitioning from a sucking pattern to a more advanced swallow pattern in which the tongue learns to move backward to swallow instead of forward.

 

mikayla bdays

Still developing and having more space in the mouth as the face elongates and more teeth erupt the toddler begins simple chewables such as soft fruit, cereal or crackers that are manipulated with the synchrony of the tongue and the teeth. It is around this time that the posterior swallow becomes dominant and the reverse swallow is left behind, unless it isn’t.

For any number of reasons, tongue thrusters continue to demonstrate the forward, tongue dominant swallow pattern often using the molars to bite and tear food rather than the front teeth. The tongue posture remains forward in the mouth both at rest and when in motion.

So what does this have to do with braces? Well just about everything because if the tongue hasn’t spread the palate and the jaw by resting and hinging properly the end result is the need for restructuring the mouth by external means to align the teeth for effective alignment for chewing, articulation and aesthetics. This is where palate spreader, braces, and retainers of all sorts come in.

Jessica brace face

I will leave the orthodontic details to the orthodontic experts but will address when, why and how tongue thrust therapy should be integrated into any orthodontic treatment plan for an individual that demonstrates tongue thrust.

WHEN?

In my opinion, tongue thrust elimination should precede orthodontic appliances. I am seeing appliances earlier and earlier on kiddos. I understand that the reason is to facilitate space for the eruption of the teeth but too often the tongue is not considered in the early intervention program of the orthodontist. It should be!

As children begin to lose the “baby teeth” and have permanent teeth emerging is the perfect time to eliminate the tongue thrust, around age 8. Tongue thrust can be eliminated at any age and it’s never “too late” however, just as with any early intervention the process is often easier when younger because they learn so quickly and honestly schedules are a bit more flexible before they hit those full on teenage years!

WHY?

Why not have development on your side? Clearly the need for orthodontics is the result of something gone wrong in the development of the mouth, so why not train the tongue to do what it is supposed to do naturally to facilitate optimal oral development and function?

The reasons that many orthodontists don’t consider tongue thrust therapy is because they don’t know about it or haven’t had a good experience working with a speech therapist that specializes in tongue thrust. Just like most general dentists refer to an orthodontist specialist most orthodontists should refer to a tongue thrust specialist.

The tongue is a dynamic and complex group of 8 muscles! No other muscle group in your body is as specialized as the tongue with much of the function being automatic yet still having voluntary control as well! Understanding the anatomy, physiology, form and function of the tongue requires specialized training to effectively and permanently retrain.

Even within the field of Speech Language Pathology, specialized training is necessary to understand tongue thrust. Yes, all SLPs have training in the anatomy and physiology of the tongue but not all understand the form and function of tongue thrust and how to effectively retrain both the voluntary and automatic, resting and active nature of a tongue thrust.

HOW?

Do your homework! Just like you seek out a competent doctor that meets your needs you should seek out an orthodontist that meets your needs. If any of these “red flags” seem familiar to you or your dental provider has mentioned tongue thrust, the next question to ask is “Who do you recommend I see to eliminate the tongue thrust?”

If you are told that they address it in the office through placement exercises or appliances, they are not addressing the tongue thrust and it will eventually resurface and unfortunately often with undesirable compensatory posture that result in a disorder swallow instead of just a reverse swallow.

If you are told the braces will address it and the tongue thrust will go away, you may want to ask for references from other individuals who had tongue thrust and what their experience was. These are the situations with multiple rounds of braces and permanent retainers that “just keep moving”.

If they refer to an SLP find out if they have specialized training in tongue thrust. What does the program look like? How long does it take and what are the outcomes? A comprehensive program should address not only the “spot” but generalized habituated resting posture of the blade on the palate. It should also address training of a generalized habituated posterior swallow. It should collaborate with other professionals who may support optimal structure and function of the oral and nasal areas such as an ENT and orthodontists.

It’s important that the SLP and orthodontist work together to achieve optimal long term outcomes. The tongue and the teeth can be working on separate programs simultaneously as long as they are in communication and not conflicting with each other. For example, orthodontic spikes would not be helpful for tongue placement if an SLP is retraining the correct tongue posture, however a palate spreader (although uncomfortable and awkward) does not interfere with correct tongue posture and even swallow training.

STIGMA!

frustration

The elephant in the room is the stigma around tongue thrust therapy. I’m not sure if it’s because it has “therapy” in the referral or if it is just the unfamiliarity of the process, but I can tell you that more often than not clients don’t want to say that they are receiving “tongue thrust therapy”.

silly braces

It’s interesting to me that it has become a “cool social status” to have braces (younger and younger) but to address the underlying cause of the braces (for many but not all) is completely ignored and even avoided. I’m sure it’s because this is my world and my clients are thrilled with the elimination of the tongue thrust and the fact that it is more cost effective and permanent than repeated orthodontics and braces, but I just don’t understand why people are embarrassed to have “tongue thrust therapy”.

Maybe we should change the terminology and refer for “tongue thrust elimination”. Yes! Let’s do that! Call it what it is and maybe we can educate the masses and reduce the stigma.

Instead of putting braces on 10 year olds, let’s eliminate the tongue thrust that is contributing to the problem so that the tongue can support the correct structure and function of the mouth while the child’s mouth is changing at a crazy rapid rate! Let’s work together to create the best outcomes for 16 year olds instead of putting on a second or third set of braces. Let’s facilitate the correct growth patterns instead of altering them. Let’s look at eliminating tongue thrust as the first line of defense instead of the last!

Kids at Yellowstone

To learn more about tongue thrust elimination please visit stonetonguethrustprotocol.com to find certified practitioners or link to the STTP Training Center for more information.

Tongue Thrust: The Early Years

I am frequently asked about what can be done with the tongue thrust kiddos who are under the age of intervention for the Stone Tongue Thrust Protocol (STTP) because they don’t have the awareness and attention to actively participate in the intensive remediation program. Should you ignore it? Wait for 8?

jenna toothless

Maybe you are in the school setting and the tongue thrust does not have an educational impact and therefore can not be directly addressed on the IEP. What then? Can you ignore it?

I say no to all of the above. Ethically can you ignore a disorder if you know it is having a detrimental impact and can be eliminated? I can’t.

So what does a clinician do in these situations? I recommend foundational training and/or referral. As the clinician it is your responsibility to educate the parents about the potential impact of tongue thrust and the appropriate remediation options given the child’s age and circumstance. Of course, in order to do that YOU need to have an understanding of tongue thrust and appropriate remediation options. The StoneTongueThrustProtocol.com website is a great place to start with educational blogs and courses to help educate both clinicians and families about what tongue thrust is (and isn’t) and where to go from there.

While you are “waiting” to eliminate the tongue thrust there are several things that will set them up for great success early on.

  1. I already mentioned the first and I think most important…educate about tongue thrust at a level that is appropriate.
  2. Eliminate oral habits
  3. Eliminate contributing factors such as airway or sinus issues (refer to appropriate professional)
  4. Engage the base of tongue
  5. Address developmentally appropriate articulation issues

I am almost positive that no matter the age of the child, if they are on your radar now for tongue thrust but they are not ready for tongue thrust elimination, at least one or more of the above will be appropriate. So how do you know? Use your clinical judgment. If you feel like you need some skill training to improve clinical judgment then please consider the STTP Certification Course.

The skills you learn and the clinical insight all develop your clinical judgment that carries over throughout your caseload. Whether it’s pediatric dysphagia/feeding issues in medical settings or developmental articulation in school settings,  I get feedback from certified clinicians that this coursework has changed the way they practice.

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I’m being asked more about the impact of oral habits on tongue thrust. The thumb sucking and extended pacifier use are widely accepted as contributing factors for potential tongue thrust. School SLPs have mentioned to me that they have an increase of  frontal /s/ productions on their caseloads. I don’t believe we have any hard evidence (this would be a great research study for my University colleagues) but we certainly do have an increase of water bottles, sippy cups, food in pouches and tubes, etc. that encourage the ongoing “suckling pattern” of the tongue with forward and depressed placement. Does our convenience, no mess, on the go lifestyle lend itself to developing a reverse swallow or tongue thrust? I don’t know for sure but it is an interesting observation.

I’m anxious to hear your thoughts and ideas of managing tongue thrust and setting the stage for effective elimination when it is developmentally appropriate. What do you do in your setting? What are the barriers? What are the successes?

Join the conversation and help us change the face of tongue thrust! Breaking down misconceptions and barriers is the beginning. Use our resources and join our classes to make a difference in your caseload management and clinical judgment today!

What You Don’t Know About Tongue Thrust: The Hidden Danger

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.

Top 5 Questions to Ask Your Tongue Thrust Provider

Tongue thrust treatment is a specialized skill set that is most often offered by Speech Language Pathologists (SLP) but also can be provided by dental professionals. As with any service you receive, it pays to do a little research to ensure you have the best provider to meet your needs.

One thing to know is that you may not have a choice between providers depending on your area of service because tongue thrust treatment does require specialized training. Regardless of whether you have 1 or 10 providers to choose from, here are the top 5 questions you always want to ask to ensure you have the best experience possible.

1- Is the provider specialized in Tongue Thrust (TT) in addition to being certified or licensed in their field of practice?

Both  SLPs and dental professionals are required to be certified or licensed (depending on the laws where they practice). It is important that you not assume that they are but ask. Foundational training and the code of ethics ensure a baseline competence and compliance but does not ensure competence with tongue thrust.

Both SLP and dental are vast fields with many areas of specialty as well as general practice. As a patient with tongue thrust you are looking for a specialist.

This may be similar to taking your parakeet to a large animal veterinarian. Yes, the veterinarian probably could treat your parakeet because she probably did have some foundational training in medical school about birds. Most likely anatomy and physiology, common diseases, common medications, etc. However, the knowledge and experience would not be the same as choosing a veterinarian that specializes in domestic birds.

The answer you receive from question 1 will lead you naturally into question 2.

2- How long have you been treating tongue thrust?

The answer to this question may take a little more digging and understanding on your part. With most things in life the longer you do something the better you are at it. However, you need to know that tongue thrust has received a lot of controversy and stagnation due to poor outcomes and relapses.

A provider who is still using placement cues, behavior modification or appliances as the foundation of their program is likely taking much longer to remediate the tongue thrust and is less likely to eliminate it completely.

The Stone Tongue Thrust Protocol (STTP) is a revolutionary treatment protocol that when used correctly by a Certified STTP provider eliminates the tongue thrust efficiently.  A provider who has taken the time to specialize and certify with the STTP will have a different perspective of tongue thrust and expectation for timeline of elimination.

Ask about that expectation and timeline!

3- What will my treatment program look like and how long can I expect to be in treatment?

An ethical and responsible clinician will not give you an individual specific answer to this question without a complete diagnostic evaluation because many factors play into your program and timeline. However, there are generalities across any program that you could expect to receive as an answer.

A treatment program using the STTP is an average of 7-10 treatment sessions over a 2-3 month time frame. Treatment can be done in combination with or during orthodontic care, articulation therapy or other co-existing factors and those factors may increase length of remediation. You can expect complete elimination of the tongue thrust with no need for “tune ups” or regression.

Once you have completed an evaluation to diagnose your tongue thrust, your provider should be able to give you a detailed plan of treatment specific to your severity and circumstances.

4- What are the core principles in your plan of treatment?

Again, as alluded to in question #2, be wary of providers who are still taking a placement, behavioral or appliance approach to treating tongue thrust. These approaches definitely do “treat” tongue thrust but often they do not eliminate tongue thrust.

One common example of this is the articulation/placement approach where the provider trains the patient where to put the tongue for proper resting or articulation targets and trains it through practice. Many times this will eliminate the tongue thrust for the error sounds resulting in accurate articulation and rapid identification of where the tongue “should be” but rarely is it found there during resting posture and never is the reverse swallow addressed.

Another example is the orthodontic patient who wears an appliance to treat the tongue thrust. Whether a basket to properly place the tongue or spikes to discourage thrusting, both are not effective often resulting in complicating the dysfunctional compensatory behaviors of the tongue. Again, this approach does not address muscle training or the reverse swallow at all.

Neither of these approaches consistently achieve the desired and anatomically correct placement and physiologically correct functions of the tongue. Because it doesn’t address the underlying cause of the tongue thrust which is a weak base of tongue and reverse swallow.

The Stone Tongue Thrust Protocol focuses on education and awareness, paired with oral muscle isolation and training to eliminate the tongue thrust resting posture and train the posterior swallow. Each aspect is critical to the rapid complete elimination of the tongue thrust and is the reason the outcomes are changing the face of tongue thrust.

5- How much time will I be expected to commit to my tongue thrust treatment?

Because the STTP does eliminate tongue thrust through education and awareness, oral muscle exercises and swallow retraining, you can expect an intensive program especially for the first 4-6 weeks.

You will be required to practice 3 times every day although the practice is usually less than 10 minutes. You will be accountable to your provider at each session with rapid progress and advancement. Most sessions are an average of 45 minutes but this may depend upon your particular treatment plan and provider.

As a consumer with tongue thrust who is unknowingly caught in the middle of divided approaches and differing levels of expertise and training, you need to come to this treatment table having done your due diligence to find the best provider to meet your needs.

If you are looking for a qualified provider, you can start here at stonetonguethrustprotocol.com where you can find the registry of certified providers. Clinicians who have completed the specialized training and demonstrated clinical competence to be Certified STTP providers are listed here. We are confident in referring these clinicians to you and committed to being a resource for you as you find a provider to eliminate your tongue thrust.

Are you frustrated with Tongue Thrust?

Are you the best clinician you can be? Do you avoid treating tongue thrust because you haven’t had good results? Do you want to have confidence in treating tongue thrust? Whether you are a dental professional or a speech language pathologist you have probably realized frustration with tongue thrust because it is different than the typical populations you receive training on.IMG_1043 For SLPs we get a great deal of education on delays and disorders, articulation and language, but not typically developing kids or adults without articulation differences. For dental professionals they get a great deal of education on the structures of the jaw and teeth, but not the tongue.  Tongue thrust is just enough different from our typical caseloads that many clinicians minimize it or ignore it not understanding the potential impact. Others may attempt to treat it but quickly feel frustrated because of poor progress and motivation which ultimately results in poor outcomes (or inconsistent outcomes at best). Some just don’t recognize tongue thrust or understand how it contributes to the other areas they may be treating (articulation or orthodontics).

How would you feel if you were able to offer tongue thrust services that really make a difference? Do you ever wonder if you’re making a difference for your client that has been on caseload for months with minimal progress that really isn’t making a lot of impact on their function? What if you could SEE the progress? What if your client could SEE the progress?solution Would that be motivating? Tongue thrust is not subjective, qualitative, conceptual areas that we are so used to addressing in speech therapy, nor is it the static structure fill it or pull it we are so used to addressing as dental professionals. When they don’t fit the mold, frustration for both the clinician and client can set in.

How would you feel if you were able to not just treat a problem but completely eliminate it? Much of what we do professionally is treating the symptom rather than the cause. We teach new placement and practice for articulation disorders, we provide opportunities and environments to facilitate language development to catch up delays, we teach compensatory strategies to improve independence and communication but how often do we eliminate the cause? IMG_1052Very rarely! Tongue Thrust is a disorder that can be completely eliminated if treated properly. If you eliminate the tongue thrust you eliminate the other symptoms that it may produce such as dental malocclusions, dysphagia, TMJ, and misarticulations that are resistant to traditional therapy.

How long does it take to eliminate tongue thrust? We measure our tongue thrust program in numbers of sessions rather than months or years because clinical data showed a trend. In an average of 10 sessions over an average period of 3 months the tongue thrust is permanently eliminated. These results have been replicated repeatedly over more than 10 years.  This is one of the hardest adjustments for clinicians to make if they are used to working with articulation or braces which are usually programs of 2-3 years.

Why not eliminate your frustration and increase your clinical skill set with tongue thrust? Why not grow your clinical expertise with an under-served niche population? Why not have raving clients who are thrilled to SEE the results and eliminate future complicating factors? You may just find out how rewarding it is to see real results in a very short time that takes your clinical expertise and practice to the next level of specialty!Act now!

If you are a clinician who is frustrated with tongue thrust or maybe just curious, you can find out more about our protocol and online training program at StoneTongueThrustProtocol.com. We are on a mission to change the face of tongue thrust and we’d love to have you join our mission and eliminate your frustration!STTP email logo

Changing the Face of Tongue Thrust

ballet shoes

If you are training for a marathon do you go to a dance studio to find a trainer? Well that seems ridiculous…of course you wouldn’t!  You would find a coach or training partner that has experience with running and not just any running but marathon, endurance running.  You would probably find someone who has expertise with the kind of equipment, nutrition, mindset and training schedule that you will need to commit to if you are going to complete a full marathon. Bottom line, you would find an expert.

marathon

If you are training to eliminate tongue thrust do you go to articulation therapy? Well that seems ridiculous…of course you wouldn’t! You would find a therapist that has experience with tongue thrust and not just any tongue thrust but eliminating tongue thrust permanently.  You would want to train with someone who has expertise with the kind of program that has been clinically proven and replicated across clinicians to be both effective & efficient, not frustrating and incomplete. Bottom line, you would find an expert.

STTP email logo

The Stone Tongue Thrust Protocol is that proven system and the STTP Training Center is the opportunity for you to gain your own expertise from the tongue thrust specialist that created the Protocol. You don’t like to work with tongue thrust? That’s fine. We all have different niches. Have you considered WHY you don’t like tongue thrust? Maybe it’s because you don’t have effective tools to treat it and you’ve been using a smattering of articulation, oral motor and/or behavior techniques and the tongue just won’t behave. Frustrating!

No wonder tongue thrust has a bad rep with so many misunderstandings and poorly trained clinicians. Now don’t get all bent out of shape…I’m not saying you were poorly trained, I’m saying you went to a dance studio to find your marathon trainer! Tongue Thrust is a specific condition that, more often than not, does not respond easily to traditional articulation approaches. Maybe you did find a running coach, someone who has knowledge about tongue thrust, but they didn’t teach you the actual training and techniques you need to run the marathon (eliminate the tongue thrust).  They gave you an exposure or foundation but the rest is up to you to figure out. Frustrating!

If you have any clients with tongue thrust (or have a tongue thrust yourself) you need to go to the expert! The STTP Training Center is an online learning center that specializes in all things tongue thrust. Whether you are an individual who has a tongue thrust and you’re looking for a competent expert and need information about what to look for. Whether you are a professional who sees patients with tongue thrust (dentist, orthodontist, oral myologist, speech therapist) but you want to know how to collaborate and refer to a competent expert. Whether you are a professional who sees patients with tongue thrust and you want to BE the COMPETENT EXPERT. The STTP Training Center has courses for each of you.

STTP Training Center

We are changing the face of tongue thrust! We are training competent experts with a comprehensive series of courses from introductory to advanced. No longer do clinicians have to piece together a program to treat tongue thrust. No longer does tongue thrust therapy take a year. No longer do clinicians have to wonder how and when is the right time to start tongue thrust therapy. No longer do clients have to return for “tune ups”. No longer do dental professionals have to battle the tongue with appliances and orthotics.

We are changing the face of tongue thrust! We are competent experts who specialize in tongue thrust that collaborate with dentists, orthodontists, speech therapists, ENTs and most of all the clients and their families. We eliminate tongue thrust permanently in a very short period of time. We understand the anatomy and physiology of the tongue and phases of the swallow. We understand how the tongue function and resting posture impacts the muscles of the jaw, neck and throat. We understand the long-term implications of a reverse swallow. We understand that it is more than just cosmetic. We understand how and when to intervene to maximize outcomes.

You’ll find the link and information about any of our classes and the next open course at the stonetonguethrustprotocol.com main website. If you want to run the marathon, don’t go to the dance instructor. If you want to treat tongue thrust, get the specialized training. I know you won’t regret it!

STTP Training Center

Here are just a few comments from recent students:

“I really enjoyed learning all of the characteristics of the swallow and have been able to observe them in some patients (i.e. meet/greet the spoon). I also found the correlating factors to be super helpful to give a full picture. I can see this directly in my case load with lots of overlap for oral habits, airway issues/allergies and the avoidance of some complex foods.”

“I can really see the “bullfrog” effect in the reverse swallow after reviewing some of the assessment videos!

“The series of videos following the same client from assessment to final session was extremely beneficial. It was evident when the client did not practice her homework/journal as it was evident when she did practice her exercises consistently. I loved seeing the improvement as she gained strength, ROM, and endurance for the lingual exercises. This video series reinforced how patient compliance is crucial to the success of the protocol.  It was also beneficial to see how each session started with practicing the assigned exercises and then adaptations were made. These videos are very informative and really reinforce the material presented in the lectures.”

Without exception, our STTP Certified Clinicians are expert! They have gone through at least 40 hours of intensive specialized training with hands on clinical demonstration to ensure that they have exactly the right tools and program to effectively eliminate tongue thrust. They are changing the face of tongue thrust and we hope you will join us in our efforts too!

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Do you have TMJ pain?

Everyone knows TMJ pain is caused from teeth grinding and jaw popping right? Well, hold on a minute. Have you ever considered the role of your tongue in TMJ? I ask because I am a speech language pathologist, we are the “tongue specialists” and I never really thought about the connection until I saw first hand what happens when complex TMJ patients who have been through the gamut of treatment options decide to address the tongue and lo and behold, the TMJ pain resolves!

This discovery made me dig a little deeper. Did you know that your tongue is not just one simple muscle? It is in fact 8 muscles working in synchrony to create very unique and dynamic functions such as chewing, swallowing, speaking, singing and just hanging out resting while you breathe. If you look at the muscles of the tongue you realize that the tongue actually hinges through the styloid process just under the temporal mandibular joint (commonly referred to as TMJ). This is the extrinsic lingual muscle known as the styloglossus muscle, which works in tandem with the other 7 muscles for the tongue to have fluid, effortless movement as it goes about its duties.

muscles of the tongue

But what if it doesn’t? What if those 8 muscles are out of balance? What if they aren’t working in tandem? What if 1 or 2 or 4 are working more than they should because others are working less than they should? What if that hinge is out of balance and it creates tension or pressure? Could it cause pain? Would that pain be in the TMJ region? Could it radiate to the neck, shoulders, head? What if you brace it or impede it so that they “have” to work in synchrony? Does it work? Maybe. Until the muscles figure out a way to compensate around it.

What if you train the muscles to work in synchrony? Does that work? Yes! Creating balance of strength and function of the tongue both at rest and in motion can eliminate the need for mouth-guards or appliances worn to prevent contact or misalignment that is likely caused by a tongue that is out of balance. It certainly is preferred over surgery or injections.

This tongue imbalance is common with tongue thrust because the front of the tongue is doing all of the work and pulling in a forward and downward position both at rest and in motion. Over time misalignments can become malformations. Don’t believe me, check out the gait pattern of a person with a chronic knee injury or what about kyphosis of the back? These are larger structures and we know muscles working incorrectly affect posture, development, alignment and function. Why haven’t we made this connection with the smaller more specialized muscles of the tongue that impact the facial structures?

Tongue thrust is not a cosmetic issue. Tongue thrust is not an articulation issue. Tongue thrust is an issue of function and structure and the long-term implications for swallowing disorders and often pain are significant.  It’s time to look at effective tongue thrust therapy, the elimination of the tongue thrust, as a viable treatment option to remediate the potential underlying cause of the TMJ pain and stop the chronic, progressive and debilitating condition.

The Stone Tongue Thrust Protocol is a clinically proven treatment protocol that efficiently eliminates the tongue thrust by targeting the imbalance of the tongue muscles aligning their function at rest and in motion. When the muscles are working properly the condition is eliminated.

Almost always clients are in treatment with orthodontia and/or TMJ when they come to us. It’s no big deal, remember we’re working with the tongue rather than the teeth and the jaw. The tongue is quite resilient and accommodates the environment so our job is to make sure it is not creating a more unnatural or abnormal posture as we work WITH the orthodontist or TMJ specialist to enhance the treatment so that in the end the patient no longer has a tongue thrust and the work done in orthodontia becomes permanent and/or the TMJ issues are relieved.

Wouldn’t you like to eliminate the pain once and for all? Wouldn’t you like an efficient and proven method to retrain the tongue? It’s time to consider the impact of the tongue on the TMJ and utilize the Stone Tongue Thrust Protocol to eliminate the imbalance in the tongue once and for all.

Breaking Down Barriers

Dilemma

In 1999, I was working on a trauma team in a local hospital outpatient clinic when my first tongue thrust patient landed in my clinic chair. He bore little to no resemblance to the patients I was used to treating that had medical diagnoses like TBI, stroke, Parkinson Disease, ALS etc. This 15-year-old young man was healthy, athletic, and academically talented (that’s the fancy way to say smart!). He had no disease, no paralysis, no articulation errors, no visible oral malformations, no developmental delays.

His orthodontist had referred him to a speech therapist for tongue thrust therapy because he had his braces taken off a year or so earlier and his teeth had moved back where they started. Not something anyone wants to see after that type of time and financial commitment. The orthodontist had determined that he was tongue thrusting and it was contributing to the drift and wanted to have it corrected. Because I was the only in network speech therapist for their insurance plan he ended up coming to me, but honestly I was NOT prepared. I was skilled with disease and disorders…not “normal”. What to do?

Well of course I did what any responsible clinician does when you are faced with a population that is within your scope of practice and related to what you do but not within your skill set. You reach out to the colleagues that do work with that population. You get into the literature and research and find out what is standard practice. What is working?

The results of my collaboration and research revealed a standard practice approach that involved retraining tongue placement by focusing on the “spot”. Traditional tongue thrust therapy took on average a year to retrain the tongue placement and often required “tune ups” as regression was quite common. Very little research was available (and very dated…1970s) and when diving deeper it became very controversial with some experts denouncing the diagnosis of tongue thrust stating that it was a behavior and did not require therapy because it was not a disease or disorder.

I proceeded to treat this young man given the tools and mentoring I had, but quickly realized that he was not going to invest his time in therapy every week for a year, nor was his insurance company going to pay for a year of therapy! Cancelled sessions and poor follow through was looming. If I didn’t get some real results quickly and make it stick the whole thing would be a waste of time and resources. This dilemma and my experience with dysphagia, apraxia, articulation disorders, and dysarthria came together as I added my neurogenic and oral motor experience into the mix. We had success! His tongue thrust was improved.

Expansion

Patients often come in clusters. Once the word gets out that you are a good therapist in a particular area they seem to multiply and suddenly you have quite a few who are looking for the same results. That is what happened, and in 2003 when I started a private practice this reputation followed me and before I knew it we had a reputation for treating tongue thrust. It was in 2005 when I started training my employees to do my technique that we started to realize the consistency with our tongue thrust clients. We realized that they never seemed to need tune ups. We realized they were usually in and out in less than 10 sessions. We realized that their tongue thrust didn’t just improve, it was eliminated. We went back through the clinical data and began following up with previous clients and monitoring current clients and found that indeed, NO regression for up to 5 years (after that we stopped asking!). The average length of treatment was 7 sessions.

Honestly, I was pretty humble and sheepish to share these results because they are so remarkable and NOT standard practice. I was skeptical of my own data, so we kept taking it and kept getting the same results across multiple therapists and multiple years until I was so confident in replicating the process that I published the Stone Tongue Thrust Protocol as an Assessment and Treatment tool for the identification, diagnosis and treatment of tongue thrust in 2008.

Solution

Nearly 10 years after that first 15-year-old came into the clinic I had perfected and systematized the elimination of tongue thrust! So now, almost 20 years later, you would think that there would be more understanding of tongue thrust, more awareness, more effective therapies because we have had so many advances in our scope of practice, research, technology, education…right? Wrong!

I still, on a very regular basis, hear from dentists and patients that nothing can be done (or needs to be done) for tongue thrust; that therapy doesn’t work; that you just need to teach them to put their tongue on their spot. I see patients after they are on their second or third set of braces (and a variety of placement appliances specifically tailored to prevent tongue thrust) with everyone frustrated because the teeth just keep moving. I see patients who are facing major jaw surgeries to address misalignment and TMJ issues. I see patients who have serious TMJ issues that have been treated by a variety of disciplines with no relief. Guess what they all have in common? Yup! They HAD tongue thrust and we eliminated it (as well as the other issues that were being caused or exacerbated by the tongue thrust)!

So no longer am I sheepish and quiet about my technique. You can’t argue with 18 years of clinical refining and outcomes.  In our current climate of transparency, clinical outcomes, and managed care there is no space for 1970s practices that take a year and don’t stick. Poor outcomes have perpetuated the myth that tongue thrust therapy doesn’t work or isn’t needed when in fact it is not the therapy it is the skill set of the clinician. The STTP Training Center was created to train professionals in the Stone Tongue Thrust Protocol so that we can change the face of tongue thrust therapy. Eliminate the misconceptions, take down the barriers and create access to unprecedented outcomes through exceptional training and support.

The STTP Training Center is found online at https://www.openlearning.com/sttptrainingcenter and provides education for the general public about tongue thrust what it is and what can be done. Education for professionals who most often identify tongue thrust, dental and speech language pathologists, about how to recognize and refer to a qualified provider. Education for professionals who treat tongue thrust and want to have an effective skill set to eliminate tongue thrust and build a niche service line in their clinic with exceptional outcomes. Together we are committed to changing the face of tongue thrust therapy and breaking down the barriers of access and outcomes.

 

 

 

Cease & Desist

If you are a clinician who is not certified in the use of the Stone Tongue Thrust Protocol you need to read this. It is important.

For those of you who know me, you know that there are few things I enjoy more than teaching. I love it when the light bulb goes on and a new concept is learned or a new skill developed.  I really love it when an individual is able to implement that teaching and do it as well as, or better than, the teacher.  Likewise, I also tend to be very generous in my teaching and keep it positive. I tend to teach by a carrot, not the stick…BUT

The time has come for me to bring out the stick.

You may not be aware that the Stone Tongue Thrust Protocol (STTP) is a copyrighted intellectual property and in order to have rights to use it you must be trained AND certified in both the assessment and treatment aspects of the STTP. I am aware of individuals and clinics who claim to be trained in the STTP who are not. I know that some of this is because of my teaching at the University where we used some of the tenets of the STTP in clinical practice or as you may have been introduced to the niche population of tongue thrust. This does NOT give you the authorization to use the STTP or train using the STTP in your clinical practice.

Now let me tell you why.

The Stone Tongue Thrust Protocol (STTP) is proprietary because of the structure and combination of education, muscle isolation, training sequence, intensity and OUTCOMES. We are consistently able to ELIMINATE tongue thrust in an average of 7-10 sessions with no regression. There is no other treatment method that has clinical data that supports those outcomes and especially in that time frame and the reason is because they do not have the proprietary formula.

I am not trying to be a big shot know it all expert. It is imperative that we maintain the integrity of the outcomes by ensuring that those who are using the STTP are trained in the ENTIRE formula and have the knowledge, expertise and skill to get those same outcomes.  If you have not completed the training and competency skill assessment to demonstrate that you have that knowledge, expertise and skill then you are not certified and you need to cease and desist using the STTP until you are.

I have had certification students validate the value of this certification and training process who were previously “trained” by someone in their clinic who had been exposed to the STTP either by me or by another clinician and they were not doing it correctly. They did not understand the protocol. They were not getting results. If you are going to use the STTP in your clinical toolbox you MUST be certified in the protocol. It is essential to protect the integrity of the protocol as well as the clinicians who are certified.

Consider becoming a Certified STTP Clinician!

I am in no way trying to withhold valuable, effective clinical methods! I WANT everyone to be a Certified STTP Clinician. However, it isn’t for everyone. Not everyone wants to work with the niche tongue thrust population.  But if you do, this certification is the most valuable you can have because…

You will be trained in the identification, assessment, diagnosis and treatment of tongue thrust

You will be able to achieve the unprecedented, duplicateable, efficient and effective outcomes of the STTP

You can freely and openly use the name, reputation, and outcomes of the Stone Tongue Thrust Protocol in your clinical practice and niche marketing

You and your clinic will be listed on the StoneTongueThrustProtocol.com website where clients and referral sources look for the certified experts in tongue thrust

You will have access to ongoing education, mentoring and support offered only to Certified Clinicians

The Certification process is extensive, but every single person who has completed it agrees that it is so valuable and extensive that they couldn’t imagine doing it without (some had tried).

Your first tongue thrust client will pay for your certification! Everything after that is profit and growth! I can’t think of any other certification I have had that pays for itself so immediately.

Finally, you no longer have to schedule a 3 day workshop, travel, and take time off work, in order to become certified. The STTP Training Center is now online and allows 2 months to complete the training, skill development, and competencies. So convenient, so affordable, and YES so effective!

That’s how we roll! There’s not a lot of fluff.  There’s no BS.  Once you are trained and CERTIFIED you are welcome to use the STTP, market with the STTP, share your results with the STTP. In the meantime, please CEASE and DESIST until you have completed the Certification.

Information about STTP Courses can be found at StoneTongueThrustProtocol.com. You can also like and follow us on Facebook at Stone Tongue Thrust Protocol: STTP Training Center for information, announcements and community.

Don’t believe it! Something CAN be done!

Another mind-blowing experience I had the other day. I am going to change the names here to protect the innocent and the ignorant but unfortunately this story hit so close to home that I KNOW it is happening everywhere, all the time.

The situation takes place in a well-respected and highly knowledgeable dental office where the dentists, assistants, and hygienists have all received education about tongue thrust.  A 10 year-old child sitting in the dentist chair is accompanied by his mother and the dentist mentions that the boy has “tongue thrust”. The mother says “What is that?” The dentist briefly explains to the mother that it is the forward pushing of the tongue against the child’s teeth and it is contributing to his dental problems. The mother says “What do we do about it?” The dentist says “Nothing really”. No one else (assistant or hygienist) chimed in and mentioned tongue thrust therapy and that it can eliminate the tongue thrust resting posture and active thrusting. The mother left overwhelmed with a “problem” and no solution. The dentist will likely wait until the boy has all of his adult teeth mostly in and then refer to the orthodontist to have the palate spread, tongue basket or spikes, and braces followed by a permanent retainer.  After a year or so, the boy will be back at the orthodontist for a second set of braces because the teeth have moved again.

When this conversation  was shared with me I was so sad and frustrated. I don’t know why the dentist didn’t share tongue thrust therapy to eliminate the tongue thrust as an option. Was it because he has referred in the past and it wasn’t eliminated? Was it because it was too time consuming and the patient won’t stick with it? Was it because he didn’t know?

Please share this information with families, dental professionals and speech therapists! There IS effective tongue thrust therapy that is clinically proven to eliminate tongue thrust. The Stone Tongue Thrust Protocol has an average remediation time of 10 sessions which is completed in a few short months. Clinicians who are Certified using the Stone Tongue Thrust Protocol are trained to recognize who is and isn’t a good candidate for remediation to maximize participation and accountability. Which sounds like a better option for you as a patient or parent? 3 months of tongue thrust therapy with a clinician trained in the Stone Tongue Thrust Protocol or years of orthodontia, appliances and maybe even surgery?

Let me be clear, the Stone Tongue Thrust Protocol does not REPLACE orthodontia, but the dentists and orthodontists who refer for it tell our patients what a difference it makes, and some won’t even begin orthodontic treatment until the tongue thrust has been eliminated. It’s painless, efficient, and cost-effective. It SUPPORTS the orthodontia because it puts the oral muscles in the correct place to work in synchrony so that the structures stay in optimal position for efficiency and effectiveness when at rest and in motion. What patient wouldn’t want to know they have this option? What dental practitioner wouldn’t want to provide best care to their patients? What therapist wouldn’t want to have the best tools to treat their clients? This is a game changer and more people need to be aware of this option! “Nothing really” should never come out of a dentists mouth when asked what can be done about tongue thrust!

Kudos to the Parents!

I am continually amazed that in 2016 we still have these perpetuated myths about tongue thrust, whether it exists, what to do about it and whether it matters. I guess I’m amazed because I’ve been effectively treating and eliminating tongue thrust for almost 15 years so when I hear these reports from clients, friends, or family I just shake my head in disbelief! Once I get done shaking my head, I get busy educating because that’s what I do!

Here’s the situation I’m going to start with because it just happened yesterday! Completing an evaluation with a 15 year old young man who has had speech therapy not once but twice in the past 10 years because of concerns with tongue thrust  by the PARENTS because of mouth breathing and jumbled dentition. He of course sees an orthodontist who uses appliances not only to spread his palate but also hinge his jaw to aid with dental alignment. The orthodontist agrees there is an issue with tongue thrust and refers to a speech therapist that is close by his office.  Unfortunately, this therapist is not trained in the elimination of tongue thrust so she does an articulation approach (understand that this child had no articulation errors) and no one sees any results or understands what is even to be expected.

Fast forward 5 years or so and the speech therapy is long gone, the braces are off and low and behold the teeth are going right back where they started! Maddening!  Kudos to the PARENTS who know this isn’t ok. Their child has had sinus surgeries and massive orthodontia and 10 years later is still breathing through his mouth and thrusting. He is now old enough that he doesn’t want his teeth to go back to an open bite (which it already has) and his parents are concerned that the open mouth posture is indicative of something else. Well yes it is! It’s tongue thrust and if you understand why his palate needed to be spread and his jaw needed hydraulics, you understand that it all has to do with the oral muscles we use to swallow. If you have a reverse swallow the front of the tongue is doing all of the work and not distributing the tongue where it should be as you mature from an infant to a toddler to a child to an adolescent and finally an adult. Yes, these mouths are changing for many years and if the muscles are not working properly you have all sorts of maladies like jumbled dentition, misalignment of the jaw, TMJ, articulation disorders, and now research is pointing to progressive swallowing problems as we age.

It’s kind of like the toddlers who walk on their tip toes and as they get older they receive physical therapy to release the tight tendons and retrain their gait so that it doesn’t throw off their muscles, spine and posture as they grow. Unfortunately, most people don’t “see” the effects of the reverse swallow and certainly don’t equate it to a tongue thrust so nothing gets done until the structures are set and even then they treat the symptoms with appliances and surgeries rather than fixing the underlying muscle and swallowing issues that are causing it all to begin with.

I have decided that these stories can be used to debunk the myths and bring both professionals and consumers into the reality that tongue thrust most definitely does exist, tongue thrust therapy can be done by a variety of professionals but the important thing is that they have specialized practical training in the elimination of tongue thrust as a swallowing disorder not just a tongue placement issue. I treat very few clients these days as I have changed my focus to educating the professionals with effective tongue thrust identification and elimination using the Stone Tongue Thrust Protocol. Because of this I feel confident that the word is spreading and people are getting it…  Then I have experiences like the one I share from YESTERDAY.  Oh boy! We still have a lot of work to do! Thank goodness for parents who are persistent and trust their gut.