HABIT ( TONGUE THRUST HABIT)
It is defined as condition in which the tongue makes contact with any teeth anterior to the molars during swallowing.
ETIOLOGY
Fletcher has proposed the following factors being the cause for tongue thrusting.
1) Learned behavior
Tongue thrust can be acquired as a habit. The pre disposing factors are-
a) Tenderness of gum or teeth.
b) Improper bottle feeding.
c) Prolonged thumb sucking.
d) Prolonged tonsillar and upper respiratory tract infections.
2) Genetic factors
Some of the anatomic or neuromuscular variations in the oro -facial region that can precipitate tongue thrust. Ex- Hypertonic orbicularis oris activity.
3) Maturational
Infantile swallow changes to maturational swallow, once the posterior deciduous teeth are erupting.
4) Mechanical restrictions
Conditions such as Macroglosssia, constricted dental arches, enlarged adenoids predispose to tongue thrust habit.
5) Neurological disturbance
Such as hyposensitive palate and motor disability can cause tongue thrust.
6) Psychogenic factors
Tongue thrust sometimes occurs as a result of discontinuation of other habits like thumb sucking.
Braner and Holt classification of Tongue thrust
- Type 1- Non deforming tongue thrust
- Type 2- Deforming anterior tongue thrust
Subgroup 1 - Anterior open bite
Subgroup 2- Anterior proclination
Subgroup 3- Posterior crossbite
- Type 3- Deforming lateral tongue thrust
Subgroup 1- Posterior open bite
Subgroup 2- Posterior cross bite
Subgroup 3- Deep over bite.
Simple classification of Tongue thrust
1) Simple tongue thrust-
It is characterized by a normal tooth contact during the swallowing act.
Presence of an anterior open bite.
Abnormal mentalis muscle activity is seen.
Exhibit good intercuspation of teeth.
2) Complex tongue thrust-
It is characterized by a teeth apart swallow.
Anterior open bite can be diffuse or absent.
Contraction of the circumoral muscles during swallowing.
Absence of temporal muscle constriction during swallowing.
Occlusion of teeth may be poor.
Clinical Features
1) Bimaxillary protrusion
2) Anterior open bite
3) Proclination of anterior teeth
4) Posterior crossbite
5) Posterior open bite in case of lateral tongue thrust.
Management of Tongue Thrust
1) Habit Interception
2) Treatment of Malocclusion
1) Habit Interception-
a) Tongue thrust can be intercepted by the use of habit breakers.
b) Child is taught the correct method of swallowing.
c) Exercise of the tongue to adapt to the new swallowing pattern.
2) Treatment of Malocclusion-
Removable orthodontic or fixed orthodontic appliances.
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