Tongue Crib And Tongue Thrusting: 15 Most Important Points To Know

What Is Tongue Crib?

A tongue crib is an appliance that prevents the tongue from pushing towards the front teeth. It prevents tongue-thrusting behavior.

What Is Tongue Thrust?

Tongue thrusting is a habit of repeatedly placing the tongue in the wrong position while swallowing. As per estimation, it is observed that the tongue is pushed towards the front teeth approximately 1500 times per day with a pressure of 4 to 5 pounds every time. It causes very bad effects on front teeth alignment and development.

A. Causes of Tongue Thrusting

1. Thumb-sucking habit: Prolonged thumb-sucking or consistent pacifier use can contribute to tongue-thrusting behavior.
2. Physiological abnormalities: Tongue thrusting can result from muscle and physiological issues affecting the tongue’s posture and function.
3. Use of some artificial nipples to feed infants: The use of certain artificial nipples during infant feeding may encourage tongue thrusting habits.
4. Macroglossia: An oversized tongue can be a cause of tongue thrusting, affecting tongue placement and swallowing patterns.
5. Hereditary factors: Genetic factors, including the angle of the jawline, can play a role in the development of tongue thrusting.
6. Infections and Associated Factors: Difficulty swallowing due to conditions such as frequent sore throats, large adenoids, and tonsils, recurrent sore throats, enlarged adenoids, and tonsils can lead to difficulty swallowing and contribute to tongue thrusting.
7. Nasal congestion and allergies: Nasal congestion and allergies can affect breathing, potentially leading to tongue thrusting as individuals compensate for restricted airflow through their noses.

B. Types Of Tongue Thrusting

1. Anterior Open Bite
   • Common form of tongue thrust.
   • Lips do not close properly.
   • Open mouth with tongue protruding beyond the lips.
   • Often associated with a large tongue.
2. Anterior Thrust
   • Lower lip pulls in.
   • Lower and upper incisors protrude significantly from their normal position.
   • Overexertion of chin muscles (mentalis).
3. Unilateral Thrust
   • Bite is typically open on one side.
4. Bilateral Thrust
   • Posterior teeth from the first bicuspid through the back molars can be open on both sides.
   • The anterior bite is closed.
   • The most challenging type to correct.
5. Bilateral Anterior Open Bite
   • Only molars touch; frontal teeth never touch.
   • Both sides of the bite are entirely open.
   • Often accompanied by large tongues.
6. Closed Bite Thrust
   • Both upper and lower teeth are spread apart and flared out.
   • Typically, it results in a double protrusion.

C. Effects of Tongue Thrust

Tongue thrusting places repetitive pressure on a child’s teeth, which can have significant repercussions on their oral health and overall oral functionality as they mature.

1. Dental Misalignment:
   • Persistent pressure against the rear of a child’s teeth can gradually push them out of their proper positions. As the child’s mouth continues to develop, the tongue’s pressure may cause the front teeth to protrude or crowd adjacent teeth, resulting in irregularly spaced and crooked teeth. These misalignments can pose challenges for biting and speaking.
2. Bite Irregularities:
   • Tongue thrusting can also contribute to bite problems, where the upper and lower teeth fail to meet correctly during biting and chewing. Common bite issues include overbites, underbites, or crossbites, all of which can hinder normal mouth functioning.
3. Speech Impairments:
   • The coordinated action of a child’s teeth and tongue is crucial for clear speech formation. However, tongue thrusting disrupts this coordination and can lead to speech delays. Children with tongue thrusting issues may struggle with certain speech sounds and may even develop a permanent lisp.
4. Facial Profile Alterations:
   • The dental misalignments and bite problems stemming from tongue thrusting can influence a child’s overall facial shape. If left untreated, persistent tongue thrusting may contribute to an elongated facial profile. Additionally, children may develop the habit of resting with their mouths open or with their tongues positioned beyond their teeth.

D. Onset of Tongue Thrusting Behavior

Tongue thrusting behavior typically emerges as children explore their oral environment, engaging in activities like thumb-sucking, pacifier use, and grasping at various objects.

This instinctual habit initiates in infancy, persisting until around age four, when most youngsters naturally transition to more mature swallowing patterns.

However, if this behavior lingers beyond this stage, it can solidify and prove challenging to address without intervention, such as specialized training or the application of a tongue crib.

E. Consequences of Tongue Thrusting Habits

1. Tongue Thrust’s Impact on Bite and Aesthetics:
   • Tongue thrust can significantly impact both the appearance and function of the teeth, often resulting in an open bite and protrusion of both jaws.
2. Variety of Tongue Thrust Forms:
   • Tongue thrust manifests in various forms, each causing distinct teeth and jaw deviations that affect individuals differently.
3. Anterior Open Bite – A Common Presentation:
   • The most typical form of tongue thrust leads to an anterior open bite, where the upper and lower jaws cannot fully close. This condition is often observed when the tongue rests between the front teeth, hindering normal tooth eruption.
4. One-Sided and Bilateral Tongue Thrust:
   • Tongue thrust can also be one-sided, resulting in an open bite on a single side, or bilateral, affecting both sides of the mouth, particularly the posterior teeth. Bilateral tongue thrust can be particularly challenging to treat.
5. Tongue Positioning Effects on Tooth Alignment:
   • Depending on the tongue’s positioning, tongue thrust can lead to various dental issues, such as the protrusion of upper incisors, inward leaning of lower incisors due to chin muscle tension, or tilting of front teeth in both upper and lower jaws.

F. Who Diagnose Tongue Thrust

General practitioners, pediatricians, dentists, and orthodontics can diagnose tongue thrust

G. How Does A Tongue Thrust Treat?

1. Consistency in Treatment Approach:
   • Treatment for tongue thrust typically follows a similar approach for both children and adults, aiming to correct the issue and improve oral function.
2. Tongue Crib for Children’s Open Bites:
   • In children, a specialized orthodontic device called a “tongue crib” may be employed to address open bites by modifying the roof of the mouth. However, this method is unique to pediatric cases.
3. Orthodontic Solutions for All Ages:
   • Orthodontic devices can be effective in treating tongue thrust, and they are suitable for both children and adults. It’s essential to collaborate with dental professionals to determine the most suitable treatment.
4. Orofacial Myology for Comprehensive Therapy:
   • Orofacial myology is an ongoing therapy that not only corrects lip, jaw, and tongue placement but also addresses swallowing habits. This comprehensive approach is beneficial for individuals of all ages.
5. Addressing Underlying Factors:
   • To ensure the success of swallowing therapy, it’s crucial to identify and resolve any underlying nasal, allergy, or breathing issues that may contribute to or result from tongue thrust. Additionally, speech therapy may be recommended to address speech impediments that could arise from tongue thrusting.

Tongue Cribs

A. How does a tongue crib work?

• A tongue crib is an effective solution for halting thumb-sucking behavior.
• By preventing the thumb from reaching the roof of the mouth, it eliminates the gratification associated with tongue sucking, prompting the child to cease the habit.
• Furthermore, a tongue crib helps to close the open bite gap, allowing the child’s teeth to align properly and preventing front teeth protrusion.

B.Appropriate Timing for Tongue Crib Placement

• Obtaining Tongue Cribs for Correcting Tongue Thrusting
  • In children, tongue thrusting issues typically arise when their permanent teeth start to develop.
  • If your child continues thumb-sucking at the age of four or older, consult your dentist for an evaluation to determine if a tongue crib is necessary to correct the behavior and its associated effects.
• Addressing Tongue-Thrusting Habits in Adults
  • Adults struggling with persistent tongue-thrusting habits should seek advice from their dentist to assess the need for a tongue crib.
  • Dentists can guide when and if a tongue crib should be employed to address the issue effectively.
  • The duration of tongue crib usage typically ranges from 6 to 12 months, depending on the severity of the individual’s tongue thrusting problem.

C. Expectations with a Tongue Crib

1. Initial Discomfort & Mealtime

Mealtimes can be uncomfortable initially. Stick to soft foods and liquids to ease awkwardness. Apply wax to prevent tongue soreness.

2. Gums Irritation

Improper brushing can irritate gums. Check tongue crib after brushing to avoid gum pressure.

3. Cleaning

Tongue cribs gather plaque and tartar. Brush after meals or rinse with water if needed. Proper molar cleaning maintains gum health.

4. Tongue Crib Damage

For any damage or loosening, consult your dentist. Avoid DIY adjustments to prevent complications.

Additional reading: For more in-depth knowledge, one can go through the authorized website of the Journal Of American Dental Association here. For more inputs about teeth cleaning and gum diseases, you can visit the articles by the same authors here.

D.Assessing the Effectiveness of Tongue Cribs

To assess this condition, a simple method involves placing a small quantity of water in the mouth and then gently parting the lips while swallowing. During this observation, if a tongue thrust occurs, you will notice that the tongue forcefully pushes forward while the water is being swallowed.

E. Modification of Tongue Behavior by a Tongue Crib

A tongue crib is a personalized orthodontic device designed to be placed within the mouth. This device features a metal lattice structure and is anchored to the rear molars using two rings, commonly referred to as bands. It is typically recommended for children who exhibit the habit of tongue thrusting.

FAQs