Tongue Thrust and Orthodontics UK — What You Need to Know

What is tongue thrust and how does it affect the teeth?

Tongue thrust is a swallowing pattern in which the tongue pushes forward against, or protrudes between, the upper and lower front teeth rather than resting against the hard palate. In a normal adult swallow, the tongue tip contacts the palate just behind the upper incisors and the teeth come together lightly. In a tongue thrust swallow, the tongue creates pressure against the front teeth on every swallow — and the average person swallows around 500 to 1,000 times per day. That repeated low-grade pressure, sustained over months and years, is sufficient to move teeth. The result is typically proclination (forward tipping) of the upper or lower front teeth, spacing between the front teeth, or an anterior open bite where the front teeth do not overlap vertically even when the back teeth are together.

The link between tongue thrust and open bite

Anterior open bite — where a gap remains between the upper and lower front teeth when biting together — is the most common dental consequence of tongue thrust. The tongue occupies the space that the teeth would otherwise close into. Not all open bites are caused by tongue thrust; thumb sucking and dummy habits during development, skeletal vertical growth patterns, and other factors can produce open bites independently. However, tongue thrust is both a potential cause of open bite and a consequence of it: children with an open bite from any cause may develop an adaptive tongue thrust to seal the gap during swallowing, which then perpetuates the open bite. This cycle makes diagnosis and early intervention important.

How orthodontists identify tongue thrust patterns

An experienced orthodontist will assess tongue posture and swallowing pattern as part of a comprehensive records appointment. Observation of a rest swallow — asking the patient to swallow naturally while watching the lip and tongue — can reveal whether the tongue protrudes. Resting tongue posture is also assessed: if the tongue sits low and forward rather than against the palate, this is a risk factor. In some cases, clinical photographs or video are used. Referral to a speech and language therapist or a myofunctional therapist for a more detailed swallowing assessment may be recommended before orthodontic treatment begins, particularly where a significant open bite is present.

Myofunctional therapy (MFT) in the UK

Myofunctional therapy — sometimes called orofacial myofunctional therapy (OMT) — is a programme of exercises designed to retrain the muscles of the tongue, lips, cheeks, and face to adopt correct posture and function. It addresses tongue rest posture, the swallowing pattern, lip competence, and nasal breathing. In the UK, MFT is provided by some speech and language therapists, specialist dental therapists, and a small number of dedicated orofacial myofunctional therapists. It typically involves weekly or fortnightly sessions over several months combined with daily home exercises. Evidence supports MFT as an effective adjunct to orthodontic treatment for tongue thrust: when combined with orthodontics, open bite relapse rates are significantly lower than with orthodontics alone.

Tongue cribs and habit-breaking appliances

A tongue crib is a fixed orthodontic appliance — usually a wire cage or grid cemented to the upper molars — that physically prevents the tongue from resting between the teeth. It does not teach a correct swallowing pattern but breaks the habit and removes the mechanical pressure on the teeth. Tongue cribs are most commonly used in younger patients, typically aged 8 to 12, where the habit is clearly contributing to an open bite. They are generally worn for 6 to 12 months. Some orthodontists use removable versions. A tongue crib alone is rarely a complete solution: once removed, relapse is possible if the underlying muscle pattern has not changed, which is why combination with MFT is often recommended.

Orthodontic treatment outcomes when tongue thrust is not addressed

Orthodontic treatment alone — without addressing tongue thrust — has a significantly higher relapse rate for anterior open bite than treatment where the functional cause is also corrected. Studies show open bite relapse rates of 25 to 40% or more when tongue thrust is not treated, compared to much lower rates when MFT is combined with orthodontics and good retention. Orthodontists will therefore commonly decline to begin open bite treatment, or will strongly recommend MFT first, if tongue thrust is present. Where open bite has a significant skeletal component in addition to tongue thrust, orthognathic (jaw) surgery combined with orthodontics and MFT may give the most stable result.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.