Question
At what point do you not treat tongue thrust? I saw a 10 year old who was referred because her orthodontist does not want to put braces on her because of a tongue thrust. Her background includes no history of thumbsucking/pacfiier/tubes/ear infections/sw
Answer
Oral myofunctional disorders or tongue thrust has been associated with articulation disorders, increased sore throats, and upper respiratory problems. It also is connected with prolonged orthodontia and problems wearing dentures in older adults. Therefore, there are many reasons why we should be involved in the remediation of myofunctional disorders. According to ASHA's (1991) practice guidelines this disorder is within in our scope of practice to treat, and we have evidence to support the efficacy of such treatment. Furthermore, treatment does not require the presence of articulation problems. I am sure you are aware; there are wonderful treatment protocols on the market that will help with both the mechanical components of a "correct swallow" and the behavioral components retraining the tongue and lips.
So at what point to we not treat this disorder? As I read your question, I could not help but wonder if your client has ever been in myofunctional treatment before, especially since her outward symptoms are negligible? If she has, then I would probably provide her with treatment, but would be sure to use a different program than the one previously tried. If she has not, then I would start treatment with her. The reason I would provide treatment is because the orthodontist thinks that the presence of a tongue thrust will have a negative impact on the dental corrections that are planned. Based on the description of the client you provided I would say that she does need work with maintaining proper position. I provided a link to the ASHA's practice guidelines on the ASHA website.
American Speech-Language-Hearing Association. (1991). The role of the speech-language pathologist in management of oral myofunctional disorders. ASHA, 33(Suppl. 5), 7.
Dee M. Lance is an associate professor at the University of Central Arkansas. She has worked with school-age children for 18 years and teaches courses in the areas of child language and phonology.
Dee Lance, Ph.D
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