The Tongue: A Powerful Force in Facial Development
By Dr. Emily Watson
Perhaps you don’t think about your tongue all that much.
That would not be unusual. The tongue plays a big role in our lives — helping us talk, helping us taste, helping us swallow and process our food — but most of the time, all of these things are automatic and not something we pay attention to.
This is why many people don’t know and would never consider that how their tongue rests in their mouth can make a significant difference in jaw development and tooth growth, potentially leading to breathing difficulties and other problems.
Wait, you may be thinking. There’s actually a proper way for the tongue to rest in the mouth — and I may be getting it wrong?
In short, yes. The resting position for the tongue should be at the roof of the mouth, not the bottom of the mouth. Take a moment, relax, and pay attention to what your tongue naturally does. Is it, when at rest, in the proper place? Before trying this exercise, could you have even answered that question?
Quite a few of my orthodontic patients could not have done so. I know because I ask them. When I’m examining them, though, I can pretty much tell whether or not their tongue is usually in the right resting position.
How so? By looking at the structure of the mouth. When the tongue isn’t in its proper place at the roof of the mouth, I will typically see a higher, narrower palate and crowding of teeth.
Mouth breathing, which comes with its own set of problems, can cause the tongue to be in the wrong position. When you breathe through your nose, your tongue naturally should rest at the roof of the mouth, which is where it belongs when you aren’t talking or eating. But when you breathe through your mouth, the tongue gravitates to the bottom of your mouth.
Experiment. Try breathing each way, and you will see what I mean. Habitual mouth breathing over time also affects facial growth and development, as well as the position of the teeth.
This is how poor breathing habits, along with improper tongue placement, can combine to create numerous problems that eventually will need to be addressed.
What is tongue thrust?
Before we delve into some of the ways to correct these problems caused by tongue placement, let’s look at another tongue issue: a tongue thrust. A tongue thrust occurs when someone is swallowing. With a frontal tongue thrust, the tongue moves forward against or between the teeth. With a lateral tongue thrust, the tongue moves to the side. Both of these dysfunctional swallows can affect how the teeth look. For example, a child can end up with an open bite where their front or back teeth don’t touch. Braces can help correct bite problems, but the tongue thrust habit also needs to be addressed because, as I often tell parents, the tongue is a muscle and a strong one. Despite my best efforts, braces are not as strong as the tongue, so if an abnormal swallow is present, it may be difficult to get the teeth to actually come together and touch properly.
There are devices you can use that help with this by keeping the tongue away from the teeth. For example, there are tongue cribs or spurs. A crib is an uncomfortable-looking mechanism that resembles a cage. The crib is placed behind the top front teeth to keep the tongue from pressing against the teeth. Spurs are sharp little spikes that are bonded to the back of the teeth to again keep the tongue away from the teeth.
I’m not a fan of either mechanism, though. Beyond the concerns about looks and comfort, I’m less inclined to use them because I don’t think they address the underlying cause of the problem. The way a child swallows is a habit, and once the device is removed and no longer blocks the tongue from thrusting forward, the chance of a relapse to that old habit is likely. Some practitioners even keep tongue spurs on long after the orthodontic treatment is complete.
Exercises That Can Help
The alternative is to attack the habit directly. Both tongue thrust and tongue placement can be corrected through myofunctional therapy, which is a sort of physical therapy for the mouth where we retrain the child on proper breathing, swallowing, and where to rest the tongue. A therapist can lead the child through several exercises, some of which are fun for the child and involve fairly common activities. Examples given in a tongue-thrust article in the International Journal of Clinical Pediatric Dentistry include blowing up a balloon, whistling, drinking from a straw, and placing the tongue at a specific spot on the roof of the mouth, then snapping it down to create a clicking or popping noise.
Another reason I’ve moved away from tongue cribs is that in using them, I risked missing other potential underlying causes for tongue thrust. Perhaps the child had enlarged tonsils or adenoids, and a tongue resting more forward was a way to breathe better. The child already had breathing troubles. Forcing them to wear an appliance that forces the tongue back just makes those troubles even worse and more uncomfortable for the child.
What are other reasons children develop the habit of tongue thrust? In some cases, it may go back to when they are infants. When babies are breastfeeding, to get their mother’s milk, they are forced to properly place the tongue and use their facial muscles to extract the milk, which in turn is the basis for proper swallowing.
Bottle feeding is different, though. The nipple of a bottle forces the tongue down rather than up, and the milk essentially drips out of the bottle with little force. This can lead to an abnormal swallow and affect the muscle and bone development of the face. This isn’t to say parents should always avoid bottle feeding. There are a host of reasons someone might choose to or need to bottle feed on occasion or even routinely. Working mothers, for example, can’t breastfeed with the regularity they might like.
But the connection to tongue thrust is worth knowing so that the parent can be aware and have some understanding in case the habit develops and leads to problems later.
The most important thing to remember is that a tongue thrust and abnormal swallow are treatable, as is the improper resting position for the tongue. But the sooner they are recognized, the quicker you can try to prevent the other problems they lead to.