Tongue Thrust/Reverse Swallow

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A reverse swallow (or tongue thrust) is an incorrect swallowing pattern that a dentist or speech pathologist will recognize during a dental or feeding/swallow/speech assessment. Dentists are concerned with the effects a tongue thrust has on the teeth, while speech pathologists are focused on how the tongue movement creates speech problems for speech and swallowing. As a speech & myofunctional therapist, my concern is focused on all of the above, as well as the underlying airway issues that usually accompanies a tongue thrust and mouth breathing. A tongue thrust is a big warning sign to me that there’s something bigger going on. Something that Speech Therapy and Dentistry alone can not fully resolve.

Tongue thrusting is the incorrect positioning of the tongue during speech, swallowing, and resting. It can affect the function of the tongue, teeth, and jaw. Tongue thrusting may lead to several dental problems, including:

• Anterior open bite
• Crossbite
• Crooked teeth
• Overbite
• Underbite
• Temporomandibular joint disfunction (TMJ/TMD)
• Snoring/Sleep Apnea
• Mouth breathing

Do I Have a Tongue Thrust?

When the tongue rests low in the mouth, it must push forward to swallow – this is called a tongue thrust. A tongue thrust and mouth breathing always go hand in hand – so if you’re mouth breathing, you also have a tongue thrust swallowing pattern. You should not see the tongue while talking or while eating. During chewing, the tongue should be going up to the spot on the roof of the mouth and then push the food or drink down and back, not forward. GERD (Gastroesophageal reflux disorder) may be related to tongue thrust. When swallowing with a tongue thrust, you can also burp excessively due to swallowing large amounts of air. This is the most recognizable sign that someone may need myofunctional therapy.

The most problematic aspect of this condition is where the tongue rests in the mouth. When someone has this condition, the tip of the tongue rests against or between the front teeth, and the entire tongue is positioned low and forward on the floor of the mouth. Ideally, the tongue should rest in the top of the mouth and provide an internal support system for the palate. When this kind of swallowing pattern is present, it’s almost inevitable that mouth breathing and an open mouth resting posture will also be found.

What Can Be Done to Fix It?

Once structural issues are ruled out, the only way to completely eliminate a tongue thrust is to learn new habits. The only way to learn new habits is to retrains the tongue muscles and swallow patterns. Myofunctional therapy is a targeted retraining of oral muscles related to speech, swallow and breathing patterns.

Below are three of the most common signs to determine if you, or your child, have a tongue thrust:

• Mouth breathing is the most obvious sign. The mouth is open at rest (day or night), and the tongue is often forward or visible.
• Speech Concerns/Articulation Errors
• Sucking habits, especially thumb sucking, can cause a tongue thrust to occur. When the thumb is constantly in the mouth, creating an improper lingual/palatal position, the swallowing pattern of the tongue develops incorrectly. It is important to realize that even when the sucking habit has stopped, the condition usually still remains.

A tongue thrust is a sign that something bigger is going on. It can be a warning sign for mouth breathing, which can develop into sleep apnea. The airway is the most important thing to address with myofunctional therapy. It can make braces more challenging, because it moves the teeth out of alignment and will continue to do so throughout treatment. Orthodontic treatment can take far longer than it should. This is because the orthodontist is basically fighting against the muscular forces that are pushing against the teeth. An individual can swallow up to 1000 times per day. Of course, the orthodontist will eventually win that battle, but as soon as the braces are removed, the teeth will again be under pressure and will begin to shift causing an orthodontic relapse.

In my experience, I often hear patients struggle to make the correct “S” sound. Other specific sounds that are connected with having a tongue thrust and mouth breathing are Dentalized “T”, “D”, “N” and “L” with tongue contact at teeth instead of “spot” alveolar ridge. These sounds require precise movement and placement of the tongue, which makes them challenging for those without fine control of their oral lingual muscles.

If you have concerns related to a tongue thrust, click here to contact me