Tongue Thrust Research Articles

An Incredible 50-Year Journey: The Application of What We’ve Learned

If all of the past IAOM officers and staff, members, and allied professionals gathered to attend this celebration, no doubt, they would be amazed and proud. What started as “tongue thrust therapy” has expanded into the broad and beneficial scope of cranio-facial, oral, and respiratory health. Those that have gone before continue to inspire us and provide a foundation on which to build over the next 50 years.

Lip-closing strength in children is enhanced by lip and facial muscle training.

ObjectivesWeakening of lip‐closing strength (LCS) associated with an incompetent lip seal (ILS) may affect the oral balance between the lip and tongue pressures. The purpose of this study was to evaluate the effects of lip‐closing training in children with lower LCS and/or abnormal habits across different age groups and to compare its effects on increasing LCS in children with malocclusion and/or oral habits.Material and MethodsLip‐closing training was performed by 154 Japanese children aged 3–12 years using a specialized training device at home for 3 months. Children with oral habits and/or exhibiting less than standard LCS were included. LCS was measured using a digital strain force gauge at a dental clinic at the beginning (T0) and after each month (after 3 months: T3).ResultsChildren had higher LCS responses after lip‐closing training. The first month of lip‐closing training was more effective than the subsequent months. With lip‐closing training, the LCS increased from an average of 6.2 N (T0) to 11.4 N (T3) in Group I, 7.9 N (T0) to 12.8 N (T3) in Group II, and 6.8 N to 11.4 N in Group III. Anterior cross bite, including reverse bite, open bite, and tongue thrusting, significantly reduced training effects.ConclusionOur findings showed that lower LCS in children with ILS resulted in greater responses to lip‐closing training in a short period, but oral dysfunction, such as abnormal habits, inhibited the positive effects of training. Our results suggest that less detrimental effects of malocclusion and abnormal oral habits lip‐closing training enhances LCS in younger children.

Full Mouth Rehabilitation of Early Childhood Caries: A Case Report

Early childhood caries (ECC) is a major health concern that affects the oral health of infants and children negatively. This leads to reduced vertical dimension, masticatory insufficiency, esthetics, development of parafunctional habits such as tongue thrusting and psychological problems. The following case report of ECC documents the restoration ofdecayed primary teeth to improve the oral and general health and help the child to gain the self-confidence. The treatment described is simple and effective and it represents a promising alternative for rehabilitation of decayed primary teeth. Keywords: Early Childhood Caries, Full Mouth Rehabilitation, Pulpectomy, Strip Crowns, Stainless Steel Crowns.

Orofacial Myofunctional Therapy in Tongue Thrust Habit: A Narrative Review.

Aim and objectiveThe respective review article is to provide an overview of the various exercises in orofacial myofunctional therapy (OMT) as a treatment modality for tongue thrust habit. Tongue thrust is the persistence of an infantile swallow pattern during late childhood. This leads to breathing and speech difficulties, open bite, and protruded teeth. During formative years, most children successfully transition from an infantile to a mature swallowing pattern. However, a few develop a retained infantile swallow and tongue thrust habit which could be due to abnormal habit like thumb sucking or an underlying cause like enlarged adenoids. Adverse effects of these habits can be avoided by early detection and intervention in a growing child. Tongue thrust can be treated in different ways with early diagnosis, removal of underlying causes, correcting tongue posture, and breaking of habit with the use of orthodontic appliances. This review article is focused on the various OMT techniques employed for the correction of tongue thrust. There are several exercises in OMT which can help a child with tongue thrust. These can be performed at home under the supervision of the child's parents. Orofacial myofunctional therapy has provided a dramatic and positive influence on patients treated for tongue thrust. The joy of eating, speaking, and correct breathing can be regained along with confidence, self-esteem, and improved quality of life. Clinically, OMT plays a positive role by not only improving swallow but also the posture of tongue, improper muscle function, and reduces relapse of previous orthodontic treatments.How to cite this articleShah SS, Nankar MY, Bendgude VD, et al. Orofacial Myofunctional Therapy in Tongue Thrust Habit: A Narrative Review. Int J Clin Pediatr Dent 2021;14(2):298–303.

Clinical Management of Infant Anaphylaxis.

Anaphylaxis is a condition that is likely increasing in prevalence and commonly treated by allergists as well as other first responders and emergency room providers. Although a relatively rare event, anaphylaxis can occur in infants, with the most common cause attributed to foods. Infant anaphylaxis can present with unique diagnostic challenges and treatment considerations. While infants can present with classic signs and symptoms of anaphylaxis (eg, urticaria, angioedema, dyspnea, wheeze, and vomiting) they can also present with non-classical signs. Non-classical signs of infant anaphylaxis can include ear pulling, tongue thrusting, fussiness, and increase clinginess to the caregiver. These non-classic signs of infant anaphylaxis can often mimic normal infant behavior further complicating the diagnosis. Additionally, when treating infant anaphylaxis, there are special considerations regarding the use of epinephrine. These include determining appropriate needle length, dosages appropriate to administer depending on the weight of the infant, and the availability of different epinephrine auto-injectors. In this article, we aim to review the clinical management of infant anaphylaxis including diagnosis, recognition, treatment, strategies for follow-up and special considerations regarding epinephrine administration in this demographics.

Prevalence of Anterior Open Bite and Its Etiological Factors among a Group of Egyptian Children: A Cross Sectional Study

Background: Anterior open bite (AOB) is the vertical separation between upper and lower teeth when all other teeth are in maximum intercuspation. It is considered abnormal when it affects patient’s function, speech, mastication, future dental health risks and aesthetics. Aim: The current study was conducted to determine the prevalence of anterior open bite and its etiological factors in a group of Egyptian children aged 8 years and above. Methods: The sample comprised 115 participants aged between 8 and 10 years, attending the Outpatients’ Clinic of Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University. AOB was assessed on study cast models using digital caliper. Increased overjet, abnormal oral habits, and parents’ educational level were checked. A close ended questionnaire was answered by patients’ guardians. Data were statistically analyzed with SPSS software package (version 21 SPSS Inc., Chicago, USA). Results: About 24(20.9%) of the 115 participants had AOB, 82 (71.2%) had normal overbite, 9 (7.8%) had increased overbite. Overjet relationship was increased in 51(44.4%). The most common etiological factor was mouth breathing 13(11.3%). Abnormal oral habits revealed higher percentages of tongue thrust 5 (7.2%), thumb sucking 4(5.8%) and lip biting 6(8.7%) in girls. Boys revealed higher percentages regarding mouth breathing 7(15.2%) and nail biting 1(2.2%). There was significant low positive correlation between parents’ educational level and the amount of AOB (r < 0.5, P-value < 0.05). Conclusions: Prevalence of AOB is relatively low, with no sex predilection. Abnormal oral habit may be a causative factor of AOB.

Cerebral palsy

Cerebral palsy is one of the most severely handicapping conditions affecting irregular gait childhood. This condition manifests itself as a number of neuromuscular dysfunctions and involves muscle weakness, stiffness, paralysis, poor balance irregular gait, and uncoordinated or involuntary movement. These children may have higher risk of caries due to their inability to maintain good oral hygiene, intake of soft and cariogenic food, increased prevalence of enamel hypoplasic defects on the teeth. Periodontal diseases occur with great frequency, as they are unable to brush and floss adequately, they may also be on phenytoin to control seizure activity which is a cause of some degree of gingival hyperplasia. Malocclusion occurs twice, bruxism is commonly seen in athetoid type, and due to the nature of disorder, these children are more susceptible to trauma, especially of the maxillary anteriors. They have excessive drooling and difficulty in swallowing. Spastic children present with spastic tongue thrust, Class II DIV 2 malocclusion with unilateral crossbite. Athetoid patients presents with mouth breathing and anterior open bite. Many patients prefer to be treated in the wheel chair, which may be tipped back into the dentist's lap, head should be stabilized throughout the procedure, use physical restraints for control of failing extremities, mouth props, and finger splints can be used for control of involuntary jaw movements, avoid abrupt movements, lights and noises to minimize startle reflex reactions. Local anesthetic can be used with care, rubber dam can be used to protect the working area from hyper active tongue movements, and gauge shield should be used during extraction to avoid aspiration. Premedication can be used to reduce hypertonicity, involuntary movement, and anxiety; general anesthesia can be used as a last resort. This article discusses about etiology, clinical features along with management of children with cerebral palsy.

English

Complex crown root fracture has been reported to be 5 % among the traumatic injuries to permanent teeth. In children, when fracture line extended sub gingivally, the treatment option remained was the extraction of tooth. This extraction led to alveolar bone loss and compromised the outcome of final prosthesis. Root submergence is one of the treatments options which can prevent bone loss and prepare future pontic site in a better way. In children, this technique can prevent not only bone loss but also the occurrence of space loss and development of tongue thrusting habit. Crown-root fracture is defined as a fracture involving enamel, dentin and cementum. It is reported in about 5 % of dental trauma to young children where root completion has not occurred.1 Treatment of these complex tooth fractures in aesthetic zone in growing age is always challenging for the paedodontists. The treatment should not interfere with the growth and development. Depending upon the extension of the fracture line which can result in exposure of the pulpal tissue, the crown-root fracture can be divided into two groups: complicated and uncomplicated. 2 Treatment options in cases of complicated crownroot fractures are complex, and require a multidisciplinary approach. Dental traumatology guideline and American Academy of Paediatric Dentistry has suggested fragment reattachment, orthodontic or surgical extrusion of apical portion followed by post placement, root submergence and extraction. 3 Factors like extension and direction of fracture line, pulpal involvement, tooth maturity and the length of root remaining in the alveolus govern the treatment choice. 4,5 Among above mentioned factors, position of facture line is the most important. As in case of subgingival facture line, risk of bacterial contamination is present and further this may result in gingival inflammation.6 When crown root fracture to permanent tooth occurs in mixed dentition period, goals of treatment are to preserve the tooth in arch without disturbing the growth &amp; development of root and arch. But in case of complicated crown root fracture, when extraction is the only choice of treatment, future complications like space loss, crowding, habits like tongue thrusting and importantly loss of alveolar bone height should be kept in mind. Goals of treatment plan in such cases should be elimination of space loss, development of deleterious habit and maintenance of alveolar ridge for future pontic or implant site. Root submergence is the technique with which we can achieve these goals, keeping this in mind this case was planned and reported.

Strange Behavior in a Transgender Teenager.

1. Salvador R. Maffei, MD* 2. Andrea Dean, MD* 1. *Baylor College of Medicine, Texas Children’s Hospital, Houston, TX A 12-year-old transmale ( transgender male or transmale is the term used for a person who is assigned female at birth [and is, usually, XX genotype] but who identifies as male) presents to the emergency department (ED) from an inpatient psychiatric facility for evaluation of new gait abnormalities and decreased oral intake. He initially presented to the ED 2 weeks earlier with acute onset of confusion, agitation, and suicidal ideation in the setting of a recent disclosure of his gender identity to family and classmates without their acceptance. After medical evaluation for toxic ingestion and intracranial abnormality, he was referred for inpatient psychiatric evaluation and was admitted for 2 weeks. While hospitalized he was started on chlorpromazine, haloperidol, risperidone, and escitalopram. Over the next 2 weeks he developed slowing and stiffening of movements, with progressively impaired motor function and cognitive abilities. For the past 3 days he has demonstrated mutism, minimal oral intake, tongue thrusting, and refusal to walk. At times he would hit himself in the forehead repeatedly. Symptoms did not improve with benztropine, amantadine, and lorazepam use, so he was transferred back to the ED for further evaluation. On presentation he is alert but nonverbal and does not follow commands. He is afebrile, his heart rate is 129 beats/min, and his blood pressure is 136/83 mm Hg. He has dry mucous membranes. There is an ecchymosis on his forehead, consistent with described self-injurious behavior. Cranial nerves, strength, and coordination cannot be assessed, but global hypertonia and lower extremity clonus are elicited. Laboratory evaluation demonstrates a serum sodium level of 151 mEq/L (151 mmol/L) (reference range, 135–145 mEq/L [135–145 mmol/L]) …

Anterior open bite and its relationship with dental arch dimensions and tongue position during swallowing and phonation in individuals aged 8–16 years: A retrospective case–control study

To determine the relationship between AOB and factors such as dental arch dimensions and tongue position during swallowing and phonation. A case-control study was performed in two groups: 132 children with Anterior Open Bite (AOB) and 132 with normal vertical overbite (NVO), aged 8-16 years selected from the records taken by a previous study from five public schools. Dental arch dimensions were assessed through digitalized study models. Swallowing was evaluated using the Payne technique, and phoniatric assessment included an adaptation of the articulation test used to describe phonemes. Chi-Square or Fisher's exact test for comparisons between qualitative variables and the Mann Whitney or T-student were applied to compare the dental arch dimensions according to bite type. A logistic regression model was applied to control the effect of confusion between independent variables and to describe its simultaneous effect on the type of bite. Intercanine, interpremolar and intermolar widths showed higher values in AOB patients with a mean deviation (MD) of 0.536 (P=0.031), 0.60 (P=0.043) and 1.15, (P<0.001) respectively. Distortions caused by tongue interposition and thrust, tongue protrusion during swallowing, mandibular arch intermolar width, total maxillary arch length, maxillary arch perimeter, and posterior arch depth accounted for 64.6% of AOB and allowed for correct predictions in 83.8% of the cases observed in the study population. A significant association between tongue position and function, as well as alterations such as tongue interposition and thrust during swallowing and phonation in individuals with AOB, were observed. There is a relationship between AOB and the presence of a wider mandibular arch and a narrower, longer, and deeper maxillary arch.

Oral Manifestations of Rett Syndrome-A Systematic Review.

Rett Syndrome is an x linked developmental disorder which becomes apparent in females after 6 to 18 months of age. It leads to severe impairments including loss of speech, loss of hand movements/manual dexterity, characteristic hand movements such as hang wringing and intellectual disability/learning problems. This systematic review was carried out to identify the dental manifestation of Rett syndrome and to shed light on treatment options available for oral health problems associated with Rett syndrome. A systematic literature search was conducted on the PubMed, Scopus, Biomed, Web of Science, Embase, Google Scholars, Cochrane and CINAHL using the following entries: Rett syndrome (n = 3790), Oral health and Rett syndrome (n = 17), dental health of Rett syndrome patients (n = 13), and the MeSH terms listed below: Rett syndrome and Oral Health (n = 17), Rett syndrome and dentistry (n = 29). The final review included 22 search articles. The most common oral findings was bruxism. Masseteric hypertrophy was also reported. Anterior open bite and non-physiological tooth wear was observed. Other oral manifestations of Rett syndrome included mouth breathing, tongue thrusting, digit/thumb sucking, high arch palate. Increased awareness and dental education amongst dentists and assistants regarding the dental manifestations of Rett syndrome and similar neurodevelopmental disorders is required to improve the level of care and empathy they can provide to these differently able patients. Research on dental aspects of Rett is scarce and this remains a neglected topic.

A Comparative Analysis of Chewing Function and Feeding Behaviors in Children with Autism

The present study was aimed to compare chewing performance level and feeding behaviors of children with autism to their typically developing peers. A total of 56 children (37 children with autism, 19 typically developing children) participated in the study. Feeding-related characteristics and observational oral-motor characteristics of children were recorded. The Karaduman Chewing Performance Scale (KCPS) was used to assess chewing performance level, the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used to assess feeding behaviors of children, and the Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) was used to evaluate the effect of the child's feeding and swallowing problem on their parents. Results showed that transition time to solid food intake for children with autism was later than typically developing children (p = 0.014), and they had more tongue thrusting (p = 0.009). There were differences between groups in terms of KCPS (p = 0.002), BPFAS (Total frequency score, p = 0.008; Child frequency score, p = 0.017; Parent frequency score, p = 0.021; Restriction score, p = 0.004), and T-FS-IS (Daily activities, p = 0.004; Worry, p = 009; Feeding difficulties, p = 0.031; Total score, p = 0.001). The present study shows that children with autism had worse chewing function and worse mealtime functioning compared to typically developing children. Their parents perceived mealtime behavior as more problematic, and parents' quality of life related to feeding/swallowing disorders was worse compared to parents of typically developing children. The study results reveal the importance of early assessment and intervention of chewing function and feeding behaviors in children with autism.

Endogenous Tongue Thrust – Myth?

Anterior open bite cases are very challenging to manage due to the high relapse potential associated with this feature of malocclusion. It is helpful if the aetiology is established before embarking on treatment to ensure that the appropriate treatment modalities are carried out. Determining whether the aetiology of an anterior open bite is caused by an ‘endogenous tongue thrust’ is extremely difficult. In particular, differentiating between an adaptive and endogenous tongue thrust can be extremely challenging. The case study presented explores the clinical considerations when diagnosing and treating anterior open bites. CPD/Clinical Relevance: This report raises the question: is it possible to diagnose an endogenous tongue thrust?

Analyzing the contribution of the dental components and abnormal habits in the development of dental open bite in growing children: A cross sectional study

Dental Open bite malocclusion could be caused by either aberrant dental development or abnormal oral habits. Aim: The current study aimed at analyzing the causative factors of dental open bite in a group of growing female subjects having normal vertical growth pattern. Materials and methods: Dental measurements were performed on lateral cephalometric radiographs and study models of 176 growing females with an age range of 9-12 years and average vertical skeletal growth pattern. They were divided into 2 equal groups; group 1 consisted of subjects with dental open bite and group 2 consisted of subjects with normal overbite. The existence of oral habits was also recorded for each patient in the 2 groups Results: The flattened curve of Spee and the proclination of the upper incisors were statistically higher in the open bite group. The ratios of occurrence of thumb sucking, tongue thrusting and mouth breathing habits in the open bite group were statistically higher than in the control group. Conclusions: The flattened curve of Spee, and the proclination of upper incisors, together with some oral habits should be cautiously addressed by the orthodontic clinician during the treatment planning process of open bite malocclusions. This could help in resolving the causative factor of the malocclusion.

An interdisciplinary approach to management of diastemas: A novel classification and a case report

Diastema between the teeth negatively affects the patients' smile, psychology and daily activities by creating a disharmony in the patients' face. The development of diastema has been attributed to several factors such as labial frenulum, microdontia, mesiodens, peg-shaped lateral incisors, agenesis, cysts, habits such as finger sucking, tongue thrusting, or lip sucking, dental malformations, genetics, proclinations, dental-skeletal discrepancies, and imperfect coalescence of interdental septum. Patients often present with complex problems that require a multidisciplinary treatment approach which includes determination of the aetiological factors, soft tissue morphology, occlusion, patient demands and aesthetic consideration to achieve satisfactory outcomes. Lack of current literature on classification of diastemas and multi-disciplinary approach of management led to the proposal of a new classification the ATAC (Anatomic and Therapeutic Classification) for management of the diastema. This case report highlights the use of the proposed classification for management of diastemas, requiring a perio-restorative intervention using a Chu's proportion gauge to achieve ideal aesthetics.

Managing an extrusive luxation secondary to tongue thrust in an immature young permanent tooth. A case report and discussion

Managing an extrusive luxation secondary to tongue thrust in an immature young permanent tooth. A case report and discussion

Prevalence Of Different Types Of Oral Habits Among School-Children Aged 6-12 Years In Alexandria (A Survey Study)

Objective: The purpose of this study is to identify the prevalence of parafunctional oral habits among schoolchildren aged 6 to 12 years in Alexandria, Egypt. Materials and methods: A total of 255 Egyptian children, consisting of 158 males and 94 females were randomly examined. The examination included 1-Tongue thrusting: masseteric palpation 2-Thumb sucking: finger examination and intra-oral examination. 3-Mouth breathing: a. medical history. b. Mirror test (fog test) c. Jwemen’s Butterfly test. d. Water Holding Test (Masslers test). 4-Nail biting: fingers, nails examination and intraoral examination. Questionnaires were handed out to the parents to obtain information about the child’s gender, age, medical and dental history and any noticeable oral habits and collected a week later. Data was collected, sorted and registered. The subjects were assigned to different groups according to the habit. Percentile distribution of the subjects was calculated for different habit and their relation to each other, Categorical variables were analyzed using the chi-square test and Student t-test. Significance of the obtained results was judged at the 5% level (P ≤ 0.05). Results: the majority of subjects shows with 41.07% of the subjects had nail biting followed by tongue thrust with 29.4% then mouth breathing with 15.9% and the least prevalent oral habit was thumb sucking with 14.73%. 32.1% of the subjects had no habits at all and 67.9% had at least one habit. conclusion: Nail biting was the most dominant oral habit and the least common was thumb sucking, no patients were found practicing more than 3 habits.

Impact of Oral Myofunctional Therapy on Orofacial Myofunctional Status and Tongue Strength in Patients with Tongue Thrust

Introduction: Tongue thrust is a frequent clinical condition characterized by abnormal patterns of movements and altered tongue posture on the mouth floor. It might contribute to determining alterations in the maxillofacial morphology and in the development of malocclusion. Several therapeutic options are available for treatment. In particular, the orofacial myofunctional therapy (OMT) is frequently adopted even if only few studies have analyzed its efficacy using validated instruments and no information is available regarding the effect of dentition on the results obtained with OMT. Objective: To evaluate the effect of OMT through a validated instrument and explore the role of dentition on its efficacy. Methods: A total of 22 consecutive patients with tongue thrust were enrolled. According to the presence of mixed or complete dentition, the cohort of patients was divided into 2 groups. Each patient underwent OMT according to the Garliner method (10 weekly sessions of 45 min each in hospital and daily exercises at home). The efficacy of OMT was evaluated using the Orofacial Myofunctional Evaluation with Scores (OMES), a validated protocol developed for the assessment of orofacial myofunctional disorders, and the Iowa Oral Performance Instrument (IOPI) to measure the peak isometric pressure exerted by the anterior and posterior part of the tongue. Both OMES and IOPI were administered before and at the end of the treatment. Results: A significant improvement in the OMES scores was demonstrated after OMT. No significant differences between the patients with intermediate and mixed dentition obtained in both the pre- and post-treatment conditions were demonstrated in the OMES scores. Similarly, a significant increase in the peak isometric tongue pressure in both the anterior and posterior parts of the tongue was demonstrated after OMT in the groups. No differences between the two groups in both the pre- and post-treatment conditions were demonstrated in the IOPI scores. Conclusions: OMT improves orofacial motricity and tongue strength in patients with tongue thrust regardless of the type of dentition.

Treating the tongue thrusting: A case report

Presence of an infantile swallow during childhood and adolescence often leads to tongue thrusting which clinically presents a picture of an anterior open bite with protruted of anterior tooth segment. Tongue thrusting habit is the primary etiological factor in the development of an anterior open bite. Management of such abnormal habit includes removal of the underlying etiology, retraining exercises along with the support of mechanical restrictive orthodontic appliances. Palatal crib or palatal spurs are the most commonly used habit-breaking appliances. This case report discusses a case with anterior open bite caused due to tongue thrusting with dental proclination and spacing which was treated by a fixed tongue appliance in the form of a palatal crib for three months, which was followed up regularly in subsequent months.

Single phase correction of tongue thrust habit alongside fixed orthodontic treatment for closure of spaced dentition and midline diastema in a male patient with class I malocclusion without need for a two phase appliance therapy - A case report

Maxillary midline diastema is one of the most frequently encountered esthetic problems in mixed and permanent dentition. Several causes have been attributed to the midline diastema, including developmental, pathologic or iatrogenic. It can also be seen as a transient malocclusion in which case any intervention is contraindicated. A wide range of possible treatments like restorative procedures, composite build up, surgeries (frenectomies) can be done, based on etiology. Thus, correct diagnosis of etiology and specific early intervention plays a major role in deciding the treatment plan.Class I malocclusion is one of the most common problems around the globe affecting around one-third of the patients who come for orthodontic treatment. This case report evaluates the management of Class I malocclusion with spaced dentition and a tongue thrusting habit in a male patient with the help of a single phase appliance therapy without the need for 2 phase correction, i.e, 1st the correction of tongue thrusting with the help of a habit breaking appliance followed by Fixed appliance therapy with braces. This modality not only saves time, but also promotes faster habit breaking as intervention is done in the earlier stages of life when the patient is still growing. Severe maxillar incisor proclination with a convex Orthognthic facial profile, increased mandibular plane angle, incompetent lips and increased overjet was observed on clinical and cephalometric analysis. Orthodontic treatment resulted in a marked improvement of the patient’s smile and a remarkable increase in self-confidence and quality of life. The profile changes and treatment results were demonstrated with proper case selection and good patient cooperation with fixed appliance therapy.