Tongue thrust: a problem that needs a team approach
Tongue thrust (or tongue thrusting) affects how the teeth and jaws develop, and it rarely has a purely dental solution. Treating it well means combining orthodontics, an understanding of how the mouth functions, and conservative dental care. In clinical experience, recognizing the habit early leads to better results and helps prevent later complications.
At Dr Haim Aseriel's dental clinic in Jerusalem, the dental team treats orthodontic problems and functional disorders of the chewing system, and refers patients to other professionals — most often a speech-language pathologist — when needed. Each treatment plan is built around the patient's age, needs and the specific way the tongue pushes on the teeth.
What is tongue thrust?
Tongue thrust is an abnormal functional habit in which the tongue pushes forward and presses against the front teeth during swallowing, speaking or at rest.
The American Association of Orthodontists (AAO) describes it as a habit where the tongue pushes against the teeth when swallowing. In a normal swallow, the tip of the tongue rests on the front of the palate, just behind the upper front teeth, and does not push against or between the teeth. Repeated pressure from the tongue can move the teeth, create gaps between the front teeth (diastema) and, in some cases, affect speech.
Causes include prolonged sucking habits (thumb, pacifier), chronic mouth breathing, the anatomy of the mouth and tongue, and other problems in the structure of the chewing system. Tongue thrust is more common in children, but it also exists in adults, where it may lead to more complex problems. An early and accurate diagnosis is key to successful treatment. Treating it in time helps prevent secondary problems such as crooked teeth, protruding front teeth or jaw joint issues.
Tongue thrust in children
In babies and young children, thumb or pacifier sucking is normal, but long-term sucking is associated with an anterior open bite and a crossbite; the American Academy of Pediatric Dentistry (AAPD) therefore suggests helping children stop sucking habits by age 3 (AAPD, 2024).
According to the same guidelines, what moves the teeth is mainly the tongue's resting position: when the tongue rests forward, the front teeth are likely to shift, whereas if the resting position is normal, a tongue thrust swallow has no clinical significance. Mouth breathing may contribute to an open bite and a narrow palate, but it is not the only cause. Have your child checked if a sucking habit continues after age 3, if gaps or an open bite appear, or if your child breathes through the mouth, snores or sleeps restlessly; the dentist may then refer you to your pediatrician or an ENT specialist.
Tongue thrust in adults
Tongue thrust in adults is often more complex than in children: it may be a habit ingrained over many years, or appear after anatomical changes in the mouth.
Contrary to a common belief, tongue thrust can be treated at any age, although treatment in adults may take longer and combine several approaches. In adults it may occur alongside other problems such as bruxism (teeth grinding, in Hebrew), jaw joint (TMJ) disorders or breathing problems during sleep.
Treatment typically combines targeted tongue exercises, guided by an experienced speech-language pathologist, with custom orthodontic appliances to correct the position of the teeth.
Beyond the teeth themselves, treating tongue thrust in adults can also improve speech clarity and chewing efficiency. Sometimes restorative dental work is needed afterward to repair damage the teeth have accumulated over the years.
Signs and symptoms of tongue thrust: how it is diagnosed
Tongue thrust is diagnosed with a clinical assessment of swallowing patterns, tongue position at rest and during speech, and the structure of the teeth and jaws. The examination focuses on where the tongue sits during different functions, to identify the abnormal patterns typical of tongue thrusting. X-rays, such as a panoramic or lateral image, are taken only when the information is expected to change the treatment plan.
The main signs of tongue thrust, in children and in adults, are:
- The tongue visibly pushing forward when swallowing
- Gaps between the front teeth (diastema)
- An anterior open bite: the upper and lower front teeth do not meet
- Speech problems, especially a lisp on "s", "z", "sh" and "ts" sounds
- Excess saliva, or a tendency to drool while speaking
- A tongue that seems too large for the mouth
Not every patient shows all of these signs, and they vary with age, severity and other factors. Tongue thrust may also be linked to upper airway obstruction, chronic allergies or developmental issues. Identifying the underlying cause is essential to plan effective treatment, so anyone who suspects tongue thrusting — in themselves or in their child — should have a professional assessment.
Examination, treatment plan and price quote
detailed and personalized
During the consultation, Dr Haim Aseriel examines your teeth, explains all the options and gives you a transparent price quote, with no obligation. The clinic is at 12 HaTnufa Street, Jerusalem.
Tongue thrust treatment: how to stop tongue thrusting
Because the tongue presses on the front teeth with every swallow, it creates a constant force that shifts the teeth and can lead to an anterior open bite. Effective tongue thrust treatment therefore addresses both the position of the teeth and the habit itself.
Many cases call for an orthodontist experienced in complex tongue and tooth position problems. Treatment may include dedicated appliances such as a tongue crib — defined by the AAO as a fixed orthodontic appliance used to help a patient stop habits or undesirable tongue forces on the teeth — or a tongue guard attached to a removable or fixed appliance.
In complex cases, orthodontic treatment is combined with a referral to a speech-language pathologist who works on tongue muscles and correct swallowing patterns. This combination can improve success and reduce the risk of the problem returning once the appliances are removed.
Invisalign and clear aligners for patients with tongue thrust
For adults who want a discreet option, Invisalign and other clear aligners can correct the tooth position damaged by tongue thrust, such as gaps between the front teeth or an open bite. The aligners move the teeth, but they do not treat the tongue habit itself.
Small tooth-colored bumps called attachments are bonded to some teeth so the aligners can apply more precise forces. Aligners allow teeth straightening for adults without visible brackets.
Aligners alone are not enough to fully resolve tongue thrust. Success depends on the patient: according to the American Association of Orthodontists (AAO), aligners must be worn at least 22 hours a day and removed only to eat, drink anything other than water and brush; at the same time, the tongue exercises must be done and every follow-up visit kept.
Aligner treatment can last many months, depending on the complexity of the case, and retainers are needed afterward to keep the result over time.
When to see a speech-language pathologist
Speech-language pathologists (speech therapists) are an essential part of the team treating tongue thrust. An assessment by a speech-language pathologist experienced in orofacial problems is recommended when clear signs of tongue thrust affect the bite, or when the problem came back after previous orthodontic treatment.
Common warning signs
Gaps between the front teeth that become more visible when swallowing, chronic mouth breathing or difficulty pronouncing certain sounds all call for a professional assessment.
Personalized exercises
The therapist complements orthodontic treatment by training the tongue and facial muscles. With personalized exercises, the patient learns the correct resting position of the tongue, a normal swallowing technique, and strengthens the tongue and lips for better control.
At the consultation, Dr Haim Aseriel examines the teeth and bite, analyzes tooth position and, when needed, takes X-rays. The resulting plan combines orthodontic treatment with a referral to a speech-language pathologist when needed.
For English-speaking families, the consultation and all explanations are given in English, with a written treatment plan and itemized quote; detailed receipts can be submitted to your insurer (coverage depends on your policy). The clinic is at 12 HaTnufa Street in Talpiot, south Jerusalem, open Sun 8:00–19:00 · Mon 9:00–19:00 · Tue–Wed 9:00–21:00 · Thu 8:30–21:00 · Fri 8:00–14:00.
Tongue thrust: frequently asked questions
Tongue thrust is a habit in which the tongue pushes forward against or between the front teeth when swallowing, speaking or at rest. In a normal swallow, the tip of the tongue rests on the palate just behind the upper front teeth and does not press against the teeth. Over time, tongue thrusting can contribute to gaps between the front teeth and an anterior open bite.
Signs of tongue thrust in adults include the tongue visibly pushing forward when swallowing, gaps between the front teeth, an open bite where the upper and lower front teeth do not meet, a lisp on sounds such as "s" and "z", and excess saliva when speaking. Not every patient shows every sign, so a dental and speech assessment is needed to confirm it.
Tongue thrust can result from prolonged sucking habits (thumb or pacifier), chronic mouth breathing, the anatomy of the mouth and tongue, or other problems in the structure of the chewing system. Upper airway obstruction or chronic allergies that encourage mouth breathing may also play a role.
Stopping tongue thrusting usually combines two approaches: orthodontic treatment to correct the position of the teeth, sometimes with a tongue crib (a fixed appliance that discourages the tongue from pushing on the teeth), and exercises with a speech-language pathologist to retrain tongue posture and swallowing. Treatment is possible in adults too, though it may take longer.
Clear aligners such as Invisalign can correct the gaps or open bite caused by tongue thrust, but they move the teeth and do not treat the tongue habit itself. Without tongue exercises, the problem can come back. According to the American Association of Orthodontists, aligners must be worn at least 22 hours a day.
Sources
- American Association of Orthodontists, Glossary of Orthodontic Terms (tongue thrust, tongue crib, open bite) – View source
- American Association of Orthodontists, Clear Aligners – View source
- ADA / U.S. Food and Drug Administration, The Selection of Patients for Dental Radiographic Examinations, 2012 – View source
- American Academy of Pediatric Dentistry, Management of the Developing Dentition and Occlusion in Pediatric Dentistry, 2024 – View source
