The Tongue Thrust Epidemic: What It Is, Why It Matters, and What to Do

Between 33% and 50% of children display some degree of tongue thrust — a pattern where the tongue pushes forward against or between the teeth during swallowing, speaking, or at rest. It is one of the most common and least discussed oral habits in childhood. And because it happens hundreds of times per day, quietly and invisibly, it can shape teeth, bite, and speech over months and years before anyone notices.

Understanding tongue thrust — what it looks like, why it happens, and what evidence-based exercises can address it — is the first step toward doing something about it.

What Exactly Is Tongue Thrust?

In a correct swallow, the tongue tip rises to touch the alveolar ridge (the bony bump just behind your upper front teeth), the tongue body seals against the roof of the mouth, and the teeth come lightly together. The whole motion propels food or saliva backward without any forward pressure on the teeth.

In a tongue thrust swallow, the tongue moves forward instead — pressing against the back of the front teeth, or visibly pushing between the upper and lower teeth as they remain apart. This forward thrust can also occur at rest, where the tongue sits low in the mouth and forward rather than resting against the palate.

How Common Is It?

Prevalence figures vary by age group and measurement method, but research consistently finds tongue thrust affects a substantial proportion of children. Studies of Italian school-age children found high rates of open bite and dental protrusion correlated with oral breathing and forward tongue posture. Research on Indian preschoolers aged 3–5 identified tongue thrusting among the most prevalent oral habits, appearing ahead of digit sucking in some cohorts.

The habit often co-occurs with mouth breathing, enlarged tonsils or adenoids, and prolonged bottle or pacifier use. These factors reinforce each other, making tongue thrust both a symptom and a contributing cause of broader orofacial myofunctional challenges.

Effects on Teeth and Bite

The tongue is remarkably powerful for its size. With roughly 600 swallows per day, even a modest forward thrust adds up to an enormous cumulative force on developing dental arches. When that force is consistently directed forward, the effect on growing teeth and jawbone is significant and progressive.

The two most common dental consequences are:

• Open bite: A gap between the upper and lower front teeth even when the back teeth are together — the space created by the tongue habitually resting or pressing between them.
• Dental protrusion ("buck teeth"): Forward flaring of the upper incisors caused by persistent tongue pressure against their backs over months and years.

Orthodontic correction of tongue-thrust-related malocclusion carries significantly higher relapse rates when the underlying habit is not addressed simultaneously. This is why many orthodontists now refer patients to orofacial myofunctional therapists before or alongside braces treatment.

Effects on Speech

When the tongue habitually rests forward, it tends to produce forward airflow during speech sounds that require a tight seal behind the teeth. The most common result is a frontal lisp on /s/ and /z/ — where these sounds come out resembling "th" because the tongue tip is pressing through the gap between the teeth. A lateral lisp, where air escapes from the sides of the mouth, can also occur and is harder to self-correct without professional guidance.

Importantly, the lisp associated with tongue thrust is structurally driven: even if a child consciously knows the correct tongue position, the habitual resting posture keeps pulling the tongue forward. This is why articulation-only therapy for a tongue-thrust lisp often has limited success without also addressing the underlying myofunctional pattern.

4 Signs Your Child May Have Tongue Thrust

• You can see their tongue between or behind the front teeth when they swallow — observe during a normal drink of water, not a staged test sip.
• Their mouth is open at rest — lips parted even when they're not talking or eating; often associated with habitual mouth breathing.
• A frontal lisp on /s/ and /z/ that hasn't resolved by age 5, or a lateral lisp at any age that isn't improving.
• An open bite or noticeably protruding front teeth that a dentist or orthodontist has mentioned — especially with concerns about post-treatment relapse.

The Role of the SLP and Orthodontist

Tongue thrust treatment typically involves two professionals working in parallel. An orofacial myofunctional therapist — often an SLP with specialized training — addresses the tongue posture and swallowing pattern through structured exercise programs. A typical course of therapy runs three to six months of weekly or biweekly sessions, with significant daily home practice in between. An orthodontist manages the dental consequences and may use a palatal crib appliance to physically interrupt the thrust pattern during the habit correction phase.

Research by Villa et al. (2017) on orofacial myofunctional therapy in children with sleep-disordered breathing found significant improvements in tongue posture, airway tone, and sleep quality — suggesting the benefits of correcting these habits extend well beyond the mouth.

What Home Exercises Can Do

Home practice is the backbone of myofunctional therapy. The clinic visit sets the target; the daily repetitions build the new habit. Core exercises typically focus on four areas:

• Training the tongue to rest against the palate rather than the teeth (the "tongue spot" or "dot" resting position).
• Strengthening tongue elevation to prepare for a correct swallow sequence.
• Practicing the correct swallow in a stepwise, conscious way until it becomes automatic and generalized.
• Lip seal exercises to support nasal breathing, which reduces the open-mouth rest posture that reinforces tongue thrust.

Grimasso brings these exercise categories into a structured, gamified format that children find motivating enough to practice every day — which is precisely where the real change happens. Consistent daily repetition is the mechanism; fun is what makes repetition stick.

References

1. Maspero, C., Defraia, E., Nieri, M., & Giannini, L. (2014). Prevalence of malocclusion in 6- to 15-year-old Italian children with oral breathing. European Journal of Paediatric Dentistry, 15(1), 85–88.
2. Bhayya, D. P., Shyagali, T. R., Dixit, U. B., & Bhayya, D. (2012). Study of occlusal characteristics of primary dentition and the prevalence of tongue thrusting habit and its effects in 3- to 5-year-old children in India. Dental Research Journal, 9(6), 751–757.
3. Villa, M. P., Evangelisti, M., Martella, S., Barreto, M., & Rizzoli, A. (2017). Orofacial myofunctional therapy in children with obstructive sleep apnea. Sleep Medicine, 36, 84–88. PMC8343673.
4. Johns Hopkins All Children's Hospital. Tongue Thrust Care Guide. (2024).