Do You Love Eliminating 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!

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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 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!


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 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 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.

Changing the Face of Tongue Thrust

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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.


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.

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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.

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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 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!

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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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Breaking Down Barriers


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.


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.


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 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.




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!


The Stone Tongue Thrust Protocol (STTP) is a clinically proven effective tool for the elimination of tongue thrust for individuals over the age of 8.  Cally R. Stone MS, CCC-SLP is a state licensed and nationally ASHA certified clinical Speech Language Pathologist who developed and authored the STTP.  Her clinical work with tongue thrust came initially as an outpatient hospital clinician who received referrals for tongue thrust due to the insurance company contract with the hospital providers.  Frustration with traditional tongue thrust resources falling short in the limited time allowed by the payors, as well as poor follow through by patients led to the integration of techniques used with neurogenic patients who demonstrated oral phase dysphagia.

When Cally became a private practice owner in 2003, she was able to further refine her tongue thrust treatment methods and consistently achieved exceptional results in a shorter amount of time that did not require the “tune ups” reported throughout the tongue thrust literature.  Her practice became well known for the Stone Tongue Thrust Protocol (STTP) with patients and practitioners recognizing the value and lasting results of eliminating tongue thrust by training a new resting posture and posterior swallow. The STTP is now available for a second generation of therapists to become certified in the appropriate identification and use of the Protocol for the assessment and treatment of tongue thrust.