TONGUE-THRUST SWALLOWING

To distinguish between correct and incorrect swallowing, we first need to understand the process of proper swallowing. Correct swallowing begins from an appropriate resting position. In this case, the teeth and lips are gently closed, the body of the tongue rests against the palate, the tip of the tongue is positioned behind the upper teeth without touching them. When swallowing saliva, the tongue moves upward and backward. When swallowing liquids or food, the tongue takes on a spoon-like shape, using this form to lift and press the sip or bite toward the palate and then propel it toward the esophagus.

Incorrect swallowing begins from an improper resting position. In this case, the tongue is positioned on the floor of the mouth, pressing against the lower teeth, or in the upper part of the oral cavity near the palate, but pressing against the upper teeth or “floating” in the middle of the oral cavity. Even in this resting position, the tongue may exert pressure on the lower teeth, the upper teeth, or both. Tongue thrust swallowing is when the tongue makes a forward movement during swallowing, pressing against the teeth or appearing between the upper and lower dental arches. In cases of tongue thrust, the teeth do not close properly during swallowing, causing the tongue tip to slip out between the teeth at the front or the sides.

It is important to emphasize that tongue thrust swallowing is considered physiological in infancy and early childhood. It becomes pathological from the stage of mixed dentition. Through breastfeeding and the proper intake of liquids and solid foods, the facial and tongue muscles strengthen and develop, allowing the swallowing pattern to mature into a correct one.

The need for tongue thrust swallowing therapy is determined by a speech therapist based on the information collected during the assessment. The following signs may indicate that an evaluation for tongue thrust swallowing is recommended:

• eating in large bites, smacking sounds while eating
• mouth breathing instead of nasal breathing
• irregularly positioned teeth
• unsuccessful orthodontic treatment over several years
• speech sound errors with the following sounds: s, zs, cs, sz, z, c, t, d, n, l
• the tongue protrudes from the mouth during speech
• the tongue tip touches the teeth while at rest

• irregular dentition
• bite disorders
• mouth breathing
• feeding, chewing, and swallowing difficulties
• temporomandibular joint problems, clicking, pain
• reduced facial and tongue muscle tone
• articulation disorders (commonly known as lisping)
• teeth grinding and clenching

The irregular functioning of the tongue—whether at rest, during swallowing, or during speech—has a negative impact on the teeth, the lips, and the temporomandibular joint alike. In tongue thrust swallowing, the forward pushing movement of the tongue affects not only the position of the teeth but also the jaw. Depending on the direction of the tongue’s movement, during swallowing and speech it may push against the upper teeth (and therefore the upper jaw), the lower teeth (and therefore the lower jaw), or press between the dental arches, exerting its negative effect either at the front or laterally.

Under physiological conditions, people generally breathe through their nose, which is referred to as nasal breathing. As a result of allergies, excessive nasal spray use, cluster headaches, reflux, or certain medications—e.g. antidepressants or oral contraceptives—the nasal mucosa may swell, causing narrowing in the nasopharynx, which can lead to long-term mouth breathing. During mouth breathing, the tongue sinks down from the palate and rests on the lower teeth. In this lowered position, the tongue cannot counteract the pressure exerted by the cheeks during swallowing, causing the U-shaped upper dental arch to become V-shaped.

As a result of this process, the temporomandibular joint shifts backward and downward, pushing the joint disc forward and causing clicking in the jaw joint. This abnormal joint position leads to disc wear and increased tension in the chewing muscles, which manifests as pain. Prolonged, continuous pressure on the jaw and displacement of the temporomandibular joint may also result in bite disorders (anterior or posterior crossbite, overbite, open bite).

To open the narrowed airways, the head shifts forward. The muscles at the base of the skull tense and tilt the head upward. In this position, the temporomandibular joint slides even further backward, the chewing muscles tighten, and the joint experiences significant strain. Forward head posture places increased load on the TMJ, the chewing muscles, and the suboccipital muscles.

Accordingly, tongue thrust swallowing can be a sustaining factor in temporomandibular joint disorders. To achieve lasting improvement, speech therapy is essential alongside TMJ physiotherapy.

The result of successful tongue thrust swallowing therapy is the development of proper facial and tongue musculature, as well as the acquisition and automatization of correct swallowing, breathing, and articulation patterns. As a result of therapy, chewing and swallowing difficulties can be resolved, temporomandibular joint pain caused by tense chewing muscles can diminish, and both body awareness and overall well-being can improve. Based on these improvements, any necessary orthodontic treatment can also be more successful in the long term.

Tongue thrust swallowing therapy begins with an assessment, during which the speech therapist creates a personalized treatment plan. The therapy requires a high level of attention and awareness from both the therapist and the patient. The first step (if mouth breathing is present) is establishing correct resting and speech breathing. In connection with this, the facial and tongue muscles are strengthened using various preparatory exercises. Speech sound correction may also take place during therapy. (In cases of tongue thrust swallowing, the sounds most commonly affected are: t, d, n, l, sz, z, c, s, zs, cs.)

It is especially important that the patient learns to consciously use their speech organs during swallowing and speaking, and that their articulatory movements become refined. For successful therapy and long-lasting results, weekly or biweekly sessions are required at the beginning, along with regular home practice. After the automatization processes are established, several follow-up control sessions are still necessary. The duration of therapy depends on the severity and complexity of the problem. Ideally, lasting improvement can be achieved within 7–12 months.

In the case of complex temporomandibular joint problems, a comprehensive, multidisciplinary therapy approach is required. After the initial assessment, tongue thrust swallowing therapy involves individual consultation sessions. After a few treatment sessions, the patient becomes able to perform the prescribed exercises independently at home, without the therapist’s assistance. As a result, they will be able to influence their symptoms and alleviate their temporomandibular complaints. The outcome of successful therapy includes correct breathing, proper swallowing, clear articulation, becoming a conscious speaker, and the reduction or elimination of TMJ pain. It may also shorten the duration of orthodontic treatment and help maintain its long-term results.

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During the assessment and treatment of tongue thrust swallowing, the speech therapist may perform a painless intraoral examination while wearing gloves. Carrying out the speech therapy exercises may occasionally cause muscle soreness, as these tasks involve movements that differ from the usual temporomandibular joint motions.

This therapy requires awareness, motivation, and discipline. The patient must understand when, why, and how to perform each task or exercise, and how these will help them acquire correct swallowing and the proper resting position of the tongue. The therapy involves a significant amount of home practice, which must be done regularly and precisely according to the therapist’s instructions. This can be challenging for many, but those who begin the process with sufficient internal motivation will succeed with the support of the speech therapist.

During the initial TMJ consultation, if the examining physiotherapist observes signs of tongue thrust swallowing, they will refer you to our speech therapist partner, Etelka Szalai.