The Tongue Thrust Habit: Why It Ruins Braces and How to Fix It
By Dr. Mohamed Hasab — Specialist Orthodontist, myPediaclinic Dubai
A mother brought her daughter back to my clinic six months after finishing braces treatment. Her teeth were drifting back — specifically, the front teeth were protruding outward again, despite her daughter wearing her retainer religiously. The mother was frustrated. How could this be happening?
I asked her daughter to swallow while I watched. Her tongue pushed forward against the front teeth every single time.
That was the answer. Tongue thrust. A simple muscle habit, largely subconscious, that pushes teeth out of position with every swallow — and a child swallows 500–1,000 times per day. Against that kind of constant pressure, even the best orthodontic work can fail.
Tongue thrust is one of the most underrecognised causes of orthodontic relapse. It’s also one of the most underrecognised contributors to open bite, spacing issues, and lisping in children. This article explains what tongue thrust is, why it matters, and what can be done about it.
What Is Tongue Thrust?
Tongue thrust (also called “orofacial myofunctional disorder” or “tongue protrusion swallow”) is a pattern where the tongue pushes forward or sideways during swallowing, speaking, or at rest — instead of staying positioned correctly against the roof of the mouth.
Normal tongue position at rest:
- Tip of tongue resting gently behind upper front teeth
- Body of tongue pressing gently against roof of mouth (palate)
- Lips closed comfortably
- Breathing through nose
Tongue thrust pattern:
- Tongue rests between upper and lower teeth
- Tongue pushes forward against teeth during swallowing
- Often associated with mouth breathing
- Lip incompetence (unable to close lips comfortably)
Why This Matters
A child swallows approximately 500–1,000 times per day. With tongue thrust, each swallow pushes the front teeth slightly forward. Over years, this creates:
Dental Problems
- Protruding upper front teeth
- Open bite (space between upper and lower teeth)
- Gaps between teeth
- Difficulty retaining results after braces
Speech Problems
- Lisps (particularly “s” and “z” sounds)
- Unclear articulation
- Some children can’t produce certain sounds properly
Orthodontic Treatment Complications
- Slower progress during treatment
- Difficulty closing open bites
- Relapse after treatment ends (teeth drifting back)
- Retainers ineffective against tongue pressure
Airway Consequences
- Often associated with mouth breathing
- Contributes to narrow jaw development
- Poor oral posture affects breathing
What Causes Tongue Thrust?
Tongue thrust often has multiple contributing factors:
- Prolonged thumb sucking or pacifier use — creates a learned abnormal swallow pattern
- Mouth breathing — child develops tongue position to breathe around
- Enlarged tonsils — force tongue forward in mouth
- Restricted lingual frenum (tongue tie) — limits tongue’s ability to reach palate
- Bottle feeding patterns in infancy (some research suggests link)
- Genetic factors affecting oral anatomy
- Allergies causing chronic nasal congestion
- Certain neurological conditions
- Unknown or idiopathic in some children
How to Recognise Tongue Thrust
Signs to watch for:
At Rest
- Mouth slightly open with tongue visible between teeth
- Lips held apart without strain
- Tongue rests low in mouth
During Swallowing
- Tongue pushes forward visibly
- Lower lip tucks behind upper teeth
- Facial muscles tense during swallow
- Child visibly “pushes” to swallow
During Speech
- Lisp, especially on “s” and “z” sounds
- Tongue visible during speech
- “Th” sound difficulty
Physical Signs
- Open bite (gap between upper and lower front teeth)
- Protruding upper front teeth
- Large gaps between teeth
- Mouth breathing
- Long narrow face
Related Habits
Tongue thrust often coexists with:
- Mouth breathing: Forces tongue forward
- Lip incompetence: Unable to close lips without effort
- Persistent thumb sucking: Reinforces abnormal swallow pattern
- Nail biting or pen chewing: Oral fixation behaviours
Often all these need to be addressed together, not just the tongue thrust alone.
Assessment: How We Diagnose
In consultation, I evaluate:
- Visual examination at rest and during activities
- Watching the child swallow water — tongue thrust becomes obvious
- Speech assessment — specific sounds that indicate tongue position
- Tongue strength and mobility — can they lift it to the palate?
- Frenum assessment — is tongue tie restricting movement?
- Airway examination — are tonsils/adenoids affecting tongue position?
- Lip closure assessment — can they close lips without strain?
- Breathing pattern — nose or mouth breather?
- Dental examination — signs of tongue-related malocclusion?
All of this takes 15–20 minutes and gives a clear picture of whether tongue thrust is contributing to orthodontic issues.
Treatment: Multi-Disciplinary Approach
Effective tongue thrust treatment usually involves several elements:
1. Address Underlying Causes
Before trying to change the tongue habit, identify and address:
- Enlarged tonsils (ENT evaluation/surgery if indicated)
- Chronic allergies (paediatric evaluation)
- Tongue tie (frenectomy if restrictive)
- Thumb sucking habit (behavioural approaches)
- Nasal obstruction (ENT, allergy treatment)
Without addressing causes, tongue thrust correction often fails.
2. Myofunctional Therapy
This is targeted exercise therapy for the tongue, lips, and facial muscles. It:
- Teaches proper tongue position at rest
- Retrains the swallowing pattern
- Strengthens lip muscles for closure
- Establishes nasal breathing patterns
- Creates new muscle memory over months of practice
Myofunctional therapy is provided by specially trained therapists — often speech-language pathologists with additional training. In Dubai, qualified myofunctional therapists are available, and I refer to them regularly.
Typical Myofunctional Therapy Program
- Initial evaluation (1–2 sessions)
- Weekly or bi-weekly sessions (10–20 sessions total)
- Home exercises daily between sessions
- Follow-up over 6–12 months
Exercises include:
- Tongue elevation (pressing tongue against palate)
- Swallowing drills (using ball technique or button method)
- Lip strength exercises
- Nasal breathing training
3. Habit Appliances (Orthodontic)
When tongue thrust is severe or myofunctional therapy alone isn’t enough, orthodontic appliances can help:
Tongue Crib
- A fixed appliance with metal loops or mesh behind upper teeth
- Prevents tongue from thrusting forward between teeth
- Effective but can feel awkward initially
- Often worn 6–12 months
Palatal Crib
- Similar concept but positioned in palate
- Creates physical barrier while allowing tongue to reposition
Combined with Myofunctional Therapy
Appliances alone don’t typically retrain the muscle habit — they prevent the damage while therapy rebuilds the pattern. Used together, results are much better than either alone.
4. Orthodontic Correction of Tooth Position
Once the tongue thrust is being addressed, actual tooth alignment is corrected with:
- Traditional braces
- Clear aligners
- Functional appliances if jaw positioning is affected
Critical point: treating teeth without addressing tongue thrust leads to relapse. The teeth move where the tongue pushes them.
5. Retention With Tongue Pattern in Mind
Retention after orthodontic treatment needs to account for tongue thrust:
- Longer retention period
- Both upper and lower retainers
- Fixed retainers often preferred
- Continued myofunctional work if needed
The Thumb-Sucking Connection
Prolonged thumb sucking (beyond age 4–5) often creates tongue thrust. The reasons:
- Thumb in mouth forces tongue to alter its position
- Open bite develops, making normal swallow impossible
- Muscle patterns established while sucking persist after stopping
Children who stop thumb sucking at age 4–5 often have their tongue pattern and open bite resolve spontaneously. Children who continue beyond age 6 typically need active intervention to break both habits.
If your child still sucks their thumb past age 5, addressing both thumb sucking and its consequences becomes important. Habit-breaking approaches include:
- Gentle behavioural strategies
- Thumb-sucking appliances
- Reward systems
- Addressing underlying anxiety or comfort needs
Tongue Tie Connection
A restrictive lingual frenum (tongue tie) prevents the tongue from reaching the palate. If the tongue can’t reach where it should rest, it ends up somewhere else — often forward against teeth. This creates tongue thrust.
Children with significant tongue tie often benefit from frenectomy (simple release procedure) combined with myofunctional therapy. Addressing tongue tie without subsequent therapy often fails to change established habits.
Evaluation for tongue tie should be part of tongue thrust assessment — especially for children with open bites or speech issues.
Age Considerations
Tongue thrust treatment effectiveness varies by age:
- Ages 4–7: Some spontaneous resolution if thumb sucking stops. Early myofunctional therapy highly effective.
- Ages 7–12: Active treatment most effective. Habits not yet fully entrenched.
- Ages 12+: Harder to change but still achievable. Requires strong motivation.
- Adults: Possible but challenging. Often requires extensive therapy.
How Long Does Correction Take?
Realistic timelines:
- Myofunctional therapy alone: 6–12 months
- With habit appliance: 12–18 months total
- Combined with orthodontic correction: 18–36 months total
- Retention phase: ongoing (often lifelong nighttime retainers)
This is a significant commitment but pays off in lasting results.
What Happens If We Don’t Treat It?
Untreated tongue thrust leads to:
- Continued tooth displacement
- Progressive open bite
- Worsening speech issues
- Orthodontic relapse after any treatment
- Need for retreatment later (more expensive)
- Sometimes surgical correction needed in adulthood
Early intervention prevents these cascading problems.
Signs of Successful Treatment
Indicators that treatment is working:
- Tongue rests correctly at palate
- Normal adult swallow pattern established
- Lips close comfortably at rest
- Open bite closing
- Improved speech clarity
- Switch to nasal breathing
- Stable orthodontic results
Frequently Asked Questions
Q: How can I tell if my child has tongue thrust?
Watch them swallow water. If their tongue visibly pushes forward between their teeth, that’s tongue thrust. Also watch their tongue at rest — it should be against the roof of the mouth, not resting between teeth.
Q: Will orthodontic treatment fix tongue thrust?
No — orthodontic treatment can correct tooth position, but without addressing the tongue thrust itself, relapse is likely. Combined approach is needed for lasting results.
Q: What causes tongue thrust in the first place?
Multiple causes: prolonged thumb sucking, mouth breathing, enlarged tonsils, tongue tie, chronic allergies. Often multiple factors combine.
Q: At what age should tongue thrust be treated?
Assessment can happen as early as age 3–4 if there’s concerning pattern. Active treatment most effective ages 6–12. Not too late at any age, but easier earlier.
Q: Is myofunctional therapy available in Dubai?
Yes. Several speech-language pathologists with myofunctional training practice in Dubai. I regularly refer patients and coordinate care.
Q: How much does myofunctional therapy cost?
Typical programs of 10–20 sessions cost AED 5,000–12,000 depending on provider and duration. Often partially covered by insurance.
Q: Can tongue thrust be fixed in adults?
Yes, with commitment and proper therapy. More challenging than in children because habits are more entrenched. Requires motivated patient and consistent home practice.
Q: What if my child doesn’t cooperate with exercises?
Cooperation is essential for myofunctional therapy. Therapists use age-appropriate, engaging techniques. For very young or non-cooperative children, we may wait until they’re more ready or use appliances in the interim.
Q: Will my child always need to wear a retainer?
After tongue thrust is fully corrected and habits are established, normal retention protocols apply. For those who don’t fully eliminate the habit, longer or permanent retention may be needed.
Q: My child has a lisp — is that always tongue thrust?
Often but not always. A speech therapist can evaluate whether the lisp is due to tongue thrust, tongue tie, other factors, or just developmental speech variation. Many 4–5 year olds lisp and outgrow it.
The Bottom Line
Tongue thrust is a common, overlooked habit with significant orthodontic and speech consequences. It ruins otherwise successful orthodontic treatment. It causes relapse. It persists into adulthood if unaddressed.
Treatment works — but it requires a multi-disciplinary approach: addressing underlying causes (tonsils, allergies, tongue tie), retraining muscle habits (myofunctional therapy), preventing harmful patterns (habit appliances), and correcting resulting tooth positions (orthodontics).
At myPediaclinic Dubai, I assess children for tongue thrust as part of comprehensive orthodontic evaluation. When identified, I coordinate with myofunctional therapists and ENT specialists for complete care. Book a consultation if you’re concerned about your child’s swallowing pattern, speech, or orthodontic treatment results.
Dr. Mohamed Hasab is a Specialist Orthodontist at myPediaclinic Dubai. He works regularly with children whose orthodontic issues involve tongue thrust, habit patterns, and airway concerns — integrating orthodontic treatment with myofunctional therapy and medical collaboration.
