[Dysphagia] Tongue Thrust Question

[bddeming@hotmail.com (Brian and Dea Deming)]

Thanks for the info Julie, and to everyone else who responded.  i'll keep 
you all posted.  Dea


>From: "Speech-Huffman" <SpeechHuffman@nc.rr.com>
>To: "Brian and Dea Deming" <bddeming@hotmail.com>, 
><dysphagia@medonline.com>
>Subject: Re: [Dysphagia] Tongue Thrust Question
>Date: Thu, 27 Jun 2002 23:52:35 -0400
>
>I have a fairly identical patient, although she is now 25.  She was 
>referred
>by the orthodontist and oral surgeon.  Our plan after discussion is to for
>me to address tongue placement for speech and swallowing for a few 
>sessions,
>then she will undergo surgery, followed by additional therapy to reinforce
>tongue placement given a corrected bite and absence of skeletal deformity.
>Here is some information that may be helpful:
>-an open bite or bite that consists of molars touching, but front teeth not
>touching is caused by tongue thrusting or anterior placement of tongue for
>speech and swallowing.  It is termed mandibular and maxillary hyperplasia.
>(There are various forms and etiologies, but this one in particular sounds
>related to tongue thrust.)  During development (she is certainly still in
>this stage), the maxilla and mandible are free to grow posteriorally, but
>anterior growth is restricted by the constant pressure of the tongue.  
>Thus,
>it results in a skeletal deformity that (may) worsen as growth continues.
>-speech sounds may be adequate, but the person may overall have speech that
>'looks' and sounds "tonguey" (yes, a formal speech term!!?).  In other 
>words
>the sounds are not as crisp, although placement may look fair and
>productions sound functional.  My patient's articulatory precision is
>adequate, but does not sound "perfect".
>-when a person is a mouth breather, they may not always demonstrate an open
>mouth posture.  What you will notice is a dimpling in the chin when mouth 
>is
>closed as they have to physically close the mouth with muscle contraction,
>rather than ease of anatomic position.  Lips are often flaccid due to the
>lack of closure most of the time.
>-If the tongue posture is not corrected, despite surgery, the condition can
>represent itself over time.  There are numerous cases of individual's in
>orthodontic literature that demonstrate this.
>-Therapy to address tongue position without tactile feedback for a more
>posterior tongue placement are not usually effective.  This is mostly due 
>to
>inability to control this for swallowing.
>-One of the things that may be tried in conjunction with your therapy may 
>be
>an orthodontic appliance such as a tongue crib.  This is an appliance that
>is positioned along the alveolar ridge (attaches to molars) and has a
>cup-shape to hold the tongue.  I would inquire with the orthodontist if 
>this
>is a possibility.
>-If this is not a possibility, I would consider giving tactile feedback
>frequently with a tongue depressor and to give guidelines (like the tongue
>should never touch the teeth during the swallow).  But, alot of this 
>posture
>is at night at times when not being conscious of it...
>
>Now I am rambling!  Hope this helps!!  Julie H
>----- Original Message -----
>From: "Brian and Dea Deming" <bddeming@hotmail.com>
>To: <dysphagia@medonline.com>
>Sent: Tuesday, June 25, 2002 8:39 PM
>Subject: [Dysphagia] Tongue Thrust Question
>
>
> > Hi all,
> >
> > Just eval'd a 12 year old female referred for orofacial/myology therapy
> > secondary to "an anterior open bite and constricted palate accompanied 
>by
>an
> > anterior tongue thrust upon swallowing."  Referral made by her
>orthodontist.
> >   Oral motor exam revealed structures intact and functional for speech 
>and
> > nonspeech purposes.  Dental bite did find top dentition to align 
>directly
>on
> > top of mandibular dentition.  Upper palate appeared more narrow than
> > mandibular structure.  Articulation eval was unremarkable with no
> > distortions of sibilants noted.  Language skills WNL.  Upon gathering
> > background info. mother reported patient to be an open mouth breather 
>with
> > frequent open mouth posturing.  This was not observed during the
>evaluation.
> >   Patient did report, with questioning, her tongue resting against the 
>top
> > teeth at rest and when swallowing.  Any suggestions with this patient?
> > Orthodontist will not proceed with braces until tongue thrust is 
>treated.
> > We discussed "normal" tongue posturing and started a cueing system.  Any
> > other suggestions would be greatly appreciated.  Sincerely, Dea Deming
> >
> >
> >
> > Brian & Dea Deming
> >
> >
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>




Brian & Dea Deming


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