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 thrust!

If not eliminated early, tongue thrust results in 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 person with tongue thrust 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, persons with tongue thrust 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 ! 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 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 interrupted 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 actual tongue thrust and it will eventually resurface and unfortunately often with undesirable compensatory posture that result in a disordered 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.

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 need for 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.

STTP-EIP Encore Presentation April 23

An Encore Presentation of Last Month’s Webinar

Why Is Tongue Thrust On The Rise? How It Can Be Reversed At ANY Age!

It was an introductory launch of a brand new revolutionary program so we started small, but the feedback has been tremendous! For those of you who missed it, we will be doing it again on April 23rd! The LIVE webinar will be presented at various times so that you can adjust to fit your time zone and the schedule that works best for you.

This is not a replay recording. No! Each webinar will be LIVE so that you can participate and get your questions answered during the webinar. Affordable, quality and convenience are hallmarks of the STTP Training Center and we are continuing that commitment outside of the Training Center as well.

Each participant will not only learn about the revolutionary STTP – Early Intervention Program but you will also get a complimentary copy of the STTP-EIP to use in your practice as a thank you for participating in the webinar!  Additionally, those who are interested in becoming an STTP-2 Certified Practitioner will receive a discount code to apply to the purchase of the STTP Advanced Certification Package.

After this Encore Webinar, this presentation will likely become a course in the STTP Training Center and the price will have to go up to cover the costs. Don’t miss this once in a lifetime chance to be at the front end of this revolutionary idea and participate in changing the face of tongue thrust at a ridiculously low price!  Register for your seat now as space is limited and they are expected to go fast.

register-now-button-pilll-red-hi

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Changing The Face of Tongue Thrust (6)

You don’t work with littles? You’ve never heard of the Stone Tongue Thrust Protocol and you are not sure if it’s a tool worth investing in. Check out the STTP Training Center with the Introduction course Changing The Face of Tongue Thrust designed for professionals who are exploring tongue thrust and want to know more about the Stone Tongue Thrust Protocol as the most effective tool for the elimination of tongue thrust.

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Advanced Certification Course

We know that early intervention may mitigate the sticking power of the tongue thrust but there will still be those for whom it is too late and the Stone Tongue Thrust Protocol is required to eliminate the tongue thrust permanently and efficiently. To protect the integrity and outcomes of the STTP, specialized training and competency must be demonstrated to become a certified practitioner. Become an elite practitioner and grow your niche service line!

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Is Your Child At Risk For Developing Tongue Thrust?

I’ve been approached by clinicians around the globe asking if I’ve noticed an increase in the incidence of tongue thrust and my take on it. Although, I can’t say that I’ve noticed an increase in the percentage of tongue thrust rising in a classroom, because I am only treating tongue thrust and I’m not in a classroom. What I can tell you is that the tongue thrust characteristics are changing and some of those changes are what led to the additional considerations and exercises added last year to the Stone Tongue Thrust Protocol-2.

Additionally, as I have worked with tongue thrust elimination over the past 20 years some trends have been noted and generally accepted in this population.

#1- Early intervention is best, usually

Because elimination of tongue thrust involves retraining automatic swallow and resting muscles the recommendation for intensive intervention is held until the child is old enough to actively pay attention and the muscle awareness and control can be taught, generally age 8. Individuals over age 8 can efficiently learn a posterior swallow and elevated resting posture to eliminate tongue thrust with skilled training.

mik innocence

Does this create a conundrum for the clinician and/or parent who sees a tongue thrust at age 5 but is recommended to wait til 8? Is it easier to reverse habits younger? Will earlier intervention potentially reshape the development of the oral cavity and impede further progression of the reverse swallow and tongue thrust posture?

#2- Chewing is changing, generally

Because our diets have changed over the past 50 years, it does make sense that the development of our mouths has changed as well. Because I have only been a practicing clinician for the past 25 years, I will speak to the changes that I have witnessed both personally and professionally and how they overlap.

With the increased marketing of processed and convenience foods there has been a shift away from a cup, plate, and spoon to transition a baby from the breast to the table. Now the transition looks like any variety of spill proof sippy tippy cups and pouches or bags that the baby can self feed as soon as they can hold the cup or bag.

 

Homemade-baby-food-pouches-11

Babies are completely skipping the developmental stage of biting with those adorable first 4 teeth and learn that they chew using their tongue sucking and mashing more than a rotational chew using their teeth and tongue in tandem.  This lack of chewing has altered the developmental swallow reflexes and muscle development of the jaw, lips and tongue.

#3- Breathing is changing, increasingly

Additionally, food and environmental allergies which used to be rare in children, especially under the age of 8, are now the norm. Allergies often result in stuffiness and congestion which results in breathing through the mouth rather than the nose because it is a more open and unrestricted airway.

infant-allergies

Similar to the above example with biting and chewing, altering the way a child holds their mouth in resting posture for breathing has huge implications for the oral cavity development. If the mouth is open to breathe, the tongue naturally rests on the floor of the mouth to create an open airway. If the mouth is always open with the tongue down, the tongue muscles do not develop properly and the palate does not spread naturally because there is no mechanism to hold and expand the face properly.

Hence, small upper dental arches with crowded teeth requiring palate spreaders and orthodontia. Decreased chewing and development of the jaw, tongue, and lip muscles resulting in weak and malformed jaws as the child ages.

So what if we could go back and potentially undo some of these contributing factors at the earliest of ages rather than waiting until they are 8 and already entrenched in the reverse swallow tongue thrust patterns? This idea is so radical and revolutionary it just might change the face of tongue thrust!

Introducing the Stone Tongue Thrust Protocol-Early Intervention Program (STTP-EIP)

As with any early intervention program, earlier is better! The mission here is to eliminate tongue thrust using the natural developmental structure and function of childhood development.

This program is implemented in tandem with parents and early childhood teachers such as day care and preschool programs.  Education is provided for stepping through the developmental eating phases similar to how we step through language development with a communication rich environment.

Children who are identified at risk can be started on the STTP-EIP as soon as they begin to transition from breast or bottle and at any point along the developmental continuum when risk factors are identified.

mikayla bdays

The STTP-EIP is not expected to prevent all tongue thrust nor is it a replacement for the skilled intervention of the STTP-2. What it is designed to do is increase awareness and promote eating, swallowing and resting posture that facilitates effective development of facial and oral muscles that encourage jaw growth, tongue strength and facial posture of normal development.

If you would like to join the conversation about the STTP-EIP and find out how you can use it as a parent, an early intervention provider, or an SLP stay tuned to the https://stonetonguethrustprotocol.com/ as the webinar and training courses are announced.

Tongue Thrust Like Its 1978?

 

There were great things that came about in the 1970s. They are now affectionately referred to as “the classics”. (I’m not sure how I feel about being classic, but anyway…). However, classic treatment approaches should be done away with when better, more effective, more efficient clinical techniques replace them.

I am continually amazed that in 2018 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 20 years; so when I hear these reports from clients, friends, or family I just shake my head in disbelief! Am I time warping back 40 years to 1978?

Situation #1

Completing an evaluation with a 15-year-old young lady 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.

She, of course, sees an orthodontist who uses appliances not only to spread her palate but also hinge her 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.

jaw hinge appliance

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 her mouth and thrusting. She is now old enough that she doesn’t want her teeth to go back to an open bite (which it already has) and her parents are concerned that the open mouth posture is indicative of something else.

YES! She has tongue thrust…

She has tongue thrust and if you understand why her palate needed to be spread and her 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 pain, articulation disorders, and now research is pointing to progressive swallowing problems as we age.

It’s just 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.

Situation #2

Another mind-blowing experience I had the other day.

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”.

tongue thrust

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 refer for 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?

Situation #3

This is taken from a conversation I had with an SLP colleague who stated “I hate tongue thrust. I really don’t know what to do with it so I just avoid those referrals.”

Well, I have to respect her honesty and candor but ethically I’m not ok with avoiding referrals. I am OK with referring to another professional who IS specially trained in tongue thrust.

Tongue thrust both as a condition as well as the treatment to eliminate it, is wildly misunderstood and ignored. Unfortunately, it gets more compounded with age as the misuse of the muscles leads to structural changes and eventually deterioration.

Fortunately, it’s not 1978 and we now know and understand the oral motor musculature and function and how to eliminate tongue thrust completely in a very short period of time.

lingual muscles

Unlike almost every other aspect of speech language pathology, tongue thrust elimination, done properly, is very tangible and predictable. In other words, you can see it changing and you know exactly what to do next. Like many things in life, just because it’s simple doesn’t mean it’s easy…

Welcome to 2018!

These situations should bring both professionals and consumers into the reality that tongue thrust most definitely does exist, tongue thrust elimination should be provided by a professional specially trained in the elimination of tongue thrust as a swallowing disorder not just a tongue placement issue.

I have eliminated tongue thrust for over 15 years and trained many other professionals with the Stone Tongue Thrust Protocol to identify, diagnose and eliminate tongue thrust. Because of this I feel confident that the word is spreading and people are getting it…  Then I have experiences like these! Oh boy! We still have a lot of work to do!

debunking

One of the biggest differences between 1978 and 2018 is the access to knowledge at our fingertips. There is no excuse for professionals to not be able to recognize tongue thrust. There is no excuse to not refer to a competent specially trained professional who has proven to eliminate tongue thrust.

The STTP Training Center provides education to both the public and the professional who are seeking information about the identification, diagnosis, and elimination of tongue thrust. We also have a provider registry listing those providers who have completed the extensive specialized training to eliminate tongue thrust as Certified STTP Practitioners. Visit StoneTongueThrustProtocol.com to learn more and welcome to the future!

STTP -2 tag line

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!