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 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!

 

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!

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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!

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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.

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.

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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 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!

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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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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.