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Tongue-thrusting patterns and the lower incisors
Tongue-thrusting lower incisors Raymond Massengill, Allen S. Hall, Ph.D.,
Durham,
patterns and the
Jr., MS., Ed.D., Galen and Debbie Boyd, B.A.
Quinn,
D.D.S.,
MS.,
N. C.
0
UP first study dealing with tongue thrusting described our cinefluorographic analysis technique. 1 We basically described a technique which we have utilized to study tongue movements during the swallowing cycle of patients with what has been referred to as tongue thrusting. In the tongue-thrusting pattern it has been indicated that “the tip or sides of the tongue press either against or through the teeth anteriorly or laterally.“‘~ 2 We have also noticed that the tongue, after pressing against the central incisors or going through them, will in many cases move in an upward and backward cycle pattern. This type of pattern is shown in Fig. 1. The orthodontic study model of this patient is the first model on the left shown in Fig. 2. We have noticed a somewhat similar pattern in approximately twenty-seven of thirty patients with tongue thrusting. The three patients with the somewhat different pattern are the subjects of the present article. In these three patients the lingual pattern during swallowing consisted somewhat of the tongue moving downward instead of upward and, to a degree, the tip of the tongue dragging on the lower central incisors. This type of pattern is shown in Fig. 3. The orthodontic study model for this patient is the second model shown in Fig. 2. Fig. 4 presents an anterior view of the relationship between the upper and lower central incisors. Another pattern similar to the one reviewed in Fig. 3, and one of the patients being reviewed in the present study, is that of the patient presented in Fig. 5. The lingual pattern for this patient shows the tongue to move in the same downward fashion, but the tip of the tongue rests to a certain degree on the occlusal surface of the lower central incisors during much of the entire swallowing cycle. The orthodontic study models of this patient are shown in Fig. 2 (third model from the left). Fig. 6 shows a lateral view of the patient’s dental profile. From Duke
the Medical Speech Pathology University Medical Center.
Laboratory
and
the
Division
of
Orthodontics,
287
Am. J. Orthod. September 1974
D.M.
Fig. 1. Cinefluorographic of patients, referred
Fig.
tracing as tongue
2. Orthodontic
analysis thrusting.
study
showing
models
a swallowing
of patients
presented
pattern
in this
seen
in a number
report.
Fig. 7 shows another patient who was visually observed to have a similar type of swallowing pattern, in which the tip of the tongue moved downward and rested against the lower central incisors. Fig. 8 shows the orthodontic study models of this patient. Therapeutic
aspects
The modification of tongue posture problems or deviant swallowing patterns which adversely affect dental structure is a very difficult process. Often poor oral habits involving nail biting, lip biting, frequent licking of lips, gum chewing, and
Tongue
Fig. 3. Swallowing position and rests
pattern against
in which the occlusal
the tip of the tongue surface of the lower
moves central
downward incisors.
from
a higher
Am. J. Orthod. September 1974
Fig.
4. Anterior
view
of the
relationship
between
the
upper
and
lower
central
incisors.
EM.
Fig.
5. Cinefluorographic
tion
on
the
occlusal
analysis surface.
showing
the
tip
of
the
tongue
in
a resting
type
of
posi-
Volume Number
Fig.
Fig. and
66 3
6. Lateral
Tongue-.thrzuting
view
7. Frontal dental rest against the
of patient
profile lower
whose
cinefluorographic
of patient whose central incisors.
tongue
patterns
and lower incisors
tracings
tip was
were
observed
shown
to move
in Fig.
291
5.
downward
putting such objects as pencils, etc. into the oral cavity are also present in persons with deviant swallow patterns. It is also our observation, and it has been reported by others, that there is often a great deal of tension in the mouth area during the actual swallowing process. The therapy plan which has been most successful for one of us (A. S. H.) is based on a IO-week process. The patient and parents (when appropriate) are counseled regarding the nature of the deviant swallow, and the importance of modifying it is emphasized. It is pointed out that the exercises must be done on a daily basis for the duration of the therapy program. Excuses for not doing the exercises, such as going away for the week end, are not acceptable. The patient and parents are told that unless the patient is willing and motivated to do
Am. J. Orthod. Sef&%zber 1974
et trl.
Fig.
8. Orthodontic
study
models
of patient
presented
in Fig.
7.
exercises daily without exception it would be useless to begin the program. Following the initial conference, the patient and parents are asked to return in 1 or 2 weeks for a second appointment, at which time therapy will be initiated. The purpose of delaying therapy is to allow both the parents ant1 the patient time to determine the patient’s ability to do the exercises on a daily basis. It has been found that some patients are involved in so many activities that it would hc burdensome to commit themselves to a therapy program and they fail to begin therapy. This is good, because to begin a program and do the exercises on an inconsistent basis is to invite failure. The patients who have been unable to modify their swallowing patterns havt tended, without, exception, to he those patients who were inconsistent in doing their exercises or who were not motivated for therapy in the first place. When a patient is enrolled in the therapy program, careful attention is paid to grneral oral habits. Any habits, such as nail biting, etc., are worked on along with modification of the swallow. Tt has been found t,hat unless these habits are modified the likclihootl of changing the swallowing pat,tcrn is decreased considerab1.v. program stresses attention to the entire oral area. The The actual therapy patient is taught. to hecomc aware of the position of the tongue in the mouth, to become accustomed to feeling the alveolar ridge and palatal area, etc. The process is very gradual in nature and is accomplished over the IO-week period in most cases. At the end of the IO-week period the patient is given a set of exercises to continue for 3 months at home. If the patient has failed to modify his swallowing pattern, he is asked to continue several of the exercises previously given to him. However, as hc has done them previously, it is not nccessayv for him to return to the clinic on a weekly basis. E’ollow-up study on each patient is on a 3- to 6month recall basis. the
Tongue-thrusting
patterns
md
louver iwisors
293
In summary, the lingual patterns of three patients have been reviewed. These three patients were referred with a diagnosis of tongue thrusting. When their lingual patterns were compared with those of other patients referred because of tongue thrusting, it was noticed that their patterns were somewhat different. This aspect was reviewed with the aid of cinefluorographic tracings, orthodontic study models, and photographs of the relationship between upper and lower central incisors. Different therapeutic aspects were also discussed. REFERENCES
1. Massengill, AM.
2. Garliner, co.,
I attempt
R., Robinson, M., and Quinn, G. : Cinefluorographio
J. ORTHOD. pp.
61:
analysis of tongue thrusting,
402-406,1972.
D.: Myofunctional
therapy in dental practice, Brooklyn,
1971, Bartel
Dental Book
4-5.
to place
before
your
eyes
just
a Kaleidoscopic
view
of
the
horizon
as
I see
it.
Let your minds travel back to the landing of the Pilgrim Fathers upon Plymouth Rock! Crossing at last, that devoted band felt safe, and fell upon their knees in thankfulness to God. Yet were they safe? They were on dry land at last, yes! But what knew they of the vast continent to the west of them; of the savage hordes in their very vicinity? I liken you of this society to that little group of men. You have this society, and you are recognized as specialists in orthodontia. In the one you have landed upon the Plymouth Rock of your faith, and in the other you have reached the dry land of your ambition. Do you recognize the immensity of the work yet ahead for this society? Half a century from now, the dental historian will publish the roster of this society and call you the pioneers in the new movement. (Ottolengui, Rodrigues: President’s Address, Transactions of the Sixth Annual Meeting of the American Society of Orthodontists, New York, December 27 to 29, 1906.)
Durham,
patterns and the
Jr., MS., Ed.D., Galen and Debbie Boyd, B.A.
Quinn,
D.D.S.,
MS.,
N. C.
0
UP first study dealing with tongue thrusting described our cinefluorographic analysis technique. 1 We basically described a technique which we have utilized to study tongue movements during the swallowing cycle of patients with what has been referred to as tongue thrusting. In the tongue-thrusting pattern it has been indicated that “the tip or sides of the tongue press either against or through the teeth anteriorly or laterally.“‘~ 2 We have also noticed that the tongue, after pressing against the central incisors or going through them, will in many cases move in an upward and backward cycle pattern. This type of pattern is shown in Fig. 1. The orthodontic study model of this patient is the first model on the left shown in Fig. 2. We have noticed a somewhat similar pattern in approximately twenty-seven of thirty patients with tongue thrusting. The three patients with the somewhat different pattern are the subjects of the present article. In these three patients the lingual pattern during swallowing consisted somewhat of the tongue moving downward instead of upward and, to a degree, the tip of the tongue dragging on the lower central incisors. This type of pattern is shown in Fig. 3. The orthodontic study model for this patient is the second model shown in Fig. 2. Fig. 4 presents an anterior view of the relationship between the upper and lower central incisors. Another pattern similar to the one reviewed in Fig. 3, and one of the patients being reviewed in the present study, is that of the patient presented in Fig. 5. The lingual pattern for this patient shows the tongue to move in the same downward fashion, but the tip of the tongue rests to a certain degree on the occlusal surface of the lower central incisors during much of the entire swallowing cycle. The orthodontic study models of this patient are shown in Fig. 2 (third model from the left). Fig. 6 shows a lateral view of the patient’s dental profile. From Duke
the Medical Speech Pathology University Medical Center.
Laboratory
and
the
Division
of
Orthodontics,
287
Am. J. Orthod. September 1974
D.M.
Fig. 1. Cinefluorographic of patients, referred
Fig.
tracing as tongue
2. Orthodontic
analysis thrusting.
study
showing
models
a swallowing
of patients
presented
pattern
in this
seen
in a number
report.
Fig. 7 shows another patient who was visually observed to have a similar type of swallowing pattern, in which the tip of the tongue moved downward and rested against the lower central incisors. Fig. 8 shows the orthodontic study models of this patient. Therapeutic
aspects
The modification of tongue posture problems or deviant swallowing patterns which adversely affect dental structure is a very difficult process. Often poor oral habits involving nail biting, lip biting, frequent licking of lips, gum chewing, and
Tongue
Fig. 3. Swallowing position and rests
pattern against
in which the occlusal
the tip of the tongue surface of the lower
moves central
downward incisors.
from
a higher
Am. J. Orthod. September 1974
Fig.
4. Anterior
view
of the
relationship
between
the
upper
and
lower
central
incisors.
EM.
Fig.
5. Cinefluorographic
tion
on
the
occlusal
analysis surface.
showing
the
tip
of
the
tongue
in
a resting
type
of
posi-
Volume Number
Fig.
Fig. and
66 3
6. Lateral
Tongue-.thrzuting
view
7. Frontal dental rest against the
of patient
profile lower
whose
cinefluorographic
of patient whose central incisors.
tongue
patterns
and lower incisors
tracings
tip was
were
observed
shown
to move
in Fig.
291
5.
downward
putting such objects as pencils, etc. into the oral cavity are also present in persons with deviant swallow patterns. It is also our observation, and it has been reported by others, that there is often a great deal of tension in the mouth area during the actual swallowing process. The therapy plan which has been most successful for one of us (A. S. H.) is based on a IO-week process. The patient and parents (when appropriate) are counseled regarding the nature of the deviant swallow, and the importance of modifying it is emphasized. It is pointed out that the exercises must be done on a daily basis for the duration of the therapy program. Excuses for not doing the exercises, such as going away for the week end, are not acceptable. The patient and parents are told that unless the patient is willing and motivated to do
Am. J. Orthod. Sef&%zber 1974
et trl.
Fig.
8. Orthodontic
study
models
of patient
presented
in Fig.
7.
exercises daily without exception it would be useless to begin the program. Following the initial conference, the patient and parents are asked to return in 1 or 2 weeks for a second appointment, at which time therapy will be initiated. The purpose of delaying therapy is to allow both the parents ant1 the patient time to determine the patient’s ability to do the exercises on a daily basis. It has been found that some patients are involved in so many activities that it would hc burdensome to commit themselves to a therapy program and they fail to begin therapy. This is good, because to begin a program and do the exercises on an inconsistent basis is to invite failure. The patients who have been unable to modify their swallowing patterns havt tended, without, exception, to he those patients who were inconsistent in doing their exercises or who were not motivated for therapy in the first place. When a patient is enrolled in the therapy program, careful attention is paid to grneral oral habits. Any habits, such as nail biting, etc., are worked on along with modification of the swallow. Tt has been found t,hat unless these habits are modified the likclihootl of changing the swallowing pat,tcrn is decreased considerab1.v. program stresses attention to the entire oral area. The The actual therapy patient is taught. to hecomc aware of the position of the tongue in the mouth, to become accustomed to feeling the alveolar ridge and palatal area, etc. The process is very gradual in nature and is accomplished over the IO-week period in most cases. At the end of the IO-week period the patient is given a set of exercises to continue for 3 months at home. If the patient has failed to modify his swallowing pattern, he is asked to continue several of the exercises previously given to him. However, as hc has done them previously, it is not nccessayv for him to return to the clinic on a weekly basis. E’ollow-up study on each patient is on a 3- to 6month recall basis. the
Tongue-thrusting
patterns
md
louver iwisors
293
In summary, the lingual patterns of three patients have been reviewed. These three patients were referred with a diagnosis of tongue thrusting. When their lingual patterns were compared with those of other patients referred because of tongue thrusting, it was noticed that their patterns were somewhat different. This aspect was reviewed with the aid of cinefluorographic tracings, orthodontic study models, and photographs of the relationship between upper and lower central incisors. Different therapeutic aspects were also discussed. REFERENCES
1. Massengill, AM.
2. Garliner, co.,
I attempt
R., Robinson, M., and Quinn, G. : Cinefluorographio
J. ORTHOD. pp.
61:
analysis of tongue thrusting,
402-406,1972.
D.: Myofunctional
therapy in dental practice, Brooklyn,
1971, Bartel
Dental Book
4-5.
to place
before
your
eyes
just
a Kaleidoscopic
view
of
the
horizon
as
I see
it.
Let your minds travel back to the landing of the Pilgrim Fathers upon Plymouth Rock! Crossing at last, that devoted band felt safe, and fell upon their knees in thankfulness to God. Yet were they safe? They were on dry land at last, yes! But what knew they of the vast continent to the west of them; of the savage hordes in their very vicinity? I liken you of this society to that little group of men. You have this society, and you are recognized as specialists in orthodontia. In the one you have landed upon the Plymouth Rock of your faith, and in the other you have reached the dry land of your ambition. Do you recognize the immensity of the work yet ahead for this society? Half a century from now, the dental historian will publish the roster of this society and call you the pioneers in the new movement. (Ottolengui, Rodrigues: President’s Address, Transactions of the Sixth Annual Meeting of the American Society of Orthodontists, New York, December 27 to 29, 1906.)