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Tongue Thrust

Atypical / Reverse Swallow
 
 

Try to retract your cheeks with your fingers, bite your teeth, and smile - now try to swallow while in this position. Was it difficult? Now try to put a small amount of water in your mouth, bite your teeth, and smile - now try to swallow while in this position. Were you able to do so without closing your lips or using your cheek/neck muscles? If not, you might have a tongue thrust / atypical swallow. This looks and feels different to everyone. 

What are the potential signs / symptoms?

Tongue thrust, or atypical / reverse swallow, is when the tongue pushes against the teeth or between them during swallowing. This may happen when the tongue is tied or it has learned a low posture pattern from non-nutritive sucking (thumb, finger, pacifier) or bottle feeding. The tongue should brace in the space behind your upper front teeth and carry the motion backward when swallowing.

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Signs of a tongue thrust:

  • Lip Licking

  • Inability or difficulty to swallow with a smile/retraction 

  • The tongue visibly comes forward or even out of the mouth when swallowing

  • Misalignment of teeth 

    • Open bite or open spaces 

    • Anterior teeth angled forward and out

  • Speech concerns

    • Lisps

    • Tongue coming past the teeth for words that don't involve "-th"

  • Open mouth posture

  • Mouth breathing 

Below are a few examples of before and during a swallow while retracted with a smile. Notice the tension around the lips and the tongue coming forward. They are in order from mild to severe.

(The fourth example couldn't complete the swallow while retracted as they rely on their facial muscles).

Before retracted swallow
Before retracted swallow and open bite

Before retracted swallow:

Before retracted swallow
Before retracted swallow

During retracted swallow:

After retracted swallow
After retracted swallow
After retracted swallow
After retracted swallow

Unable to swallow retracted 

Someone with a typical/efficient swallow - their before and during a swallow photos would look identical. For example: 

Before retracted swallow
After retracted swallow

What should I do about it?

Let's start with an initial assessment to ensure we know which exact goals we need to meet and how long we need to reach them! If your child is under five years old, it may be recommended to start with a Myo Munchee Mini program until they can withstand a complete myofunctional therapy program. Sometimes a thrust can resolve with the Myo Munchee + mini myo program alone! Sometimes orthodontics is needed to close the spaces but addressing the muscle imbalance and thrust before and during orthodontics is important to create a stable environment. Myofunctional therapy benefits speech therapy for clients with a thrust and/or tongue tie. 

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