崇愛牙醫診所(資料重建中,歡迎新舊朋友)

Tongue thrusting, simply defined, is the habit of thrusting the tongue forward against the teeth or in between while swallowing. It is an infantile pattern of swallowing that has been retained by an individual.
According to Dr. T. M. Graber, we swallow a total of 1,200 to 2,000 times every 24 hours with about four pounds of pressure per swallow. This constant pressure of the tongue will force the teeth out of alignment its an individual with a tongue thrust problem. Besides the pressure exerted while swallowing, nervous thrusting also pushes the tongue against the teeth while it is at rest. This is an involuntary, subconscious habit that is difficult to correct.

A)甚麼是TONGUE THRUSTING?

弄舌癖,簡單來定義,就是舌頭在吞嚥時向前往牙齒舞弄的一個習慣,個別案例有可能持續且可能源自於嬰兒時期的吞嚥動作

根據DR.T.M. GRABER所研究,我們人類每天24小時當中總共會有1200~2000次左右的吞嚥動作,且會產生每次吞嚥約有4磅的壓力,這個舌頭持續性的壓力會因為持續性弄舌癖而產生壓迫牙齒的正常排列,除此之外,這個表現在吞嚥的壓力,也就是神經性的舞弄也會把舌頭往前扳弄牙齒當處於休息的狀態下,這是一個不隨意的無意識的習慣,通常不容易改正

What causes tongue thrust?
No one specific cause has actually been determined for the tongue thrust problem. Any of the following may cause tongue thrust:

• Certain types of artificial nipples used in feeding infants
• Thumbsucking
• Allergies, nasal congestion or obstructions contributing to mouth breathing causing the posture of the tongue to be very low in the mouth
• Large tonsils, adenoids, or many sore throats which cause difficulty in swallowing
• An abnormally large tongue
• Hereditary factors within the family, such as the angle of the jaw line
• Neurological, muscular, or other physiological abnormalities
• Short lingual frenum (tongue tied)

B)引起TONGUE THRUSTING的因素?

沒有一個特定的因素來正確引起TONGUE THRUSTING的問題,下列的因素的任何之一都可能引起TONGUE THRUST

1)某些形式的哺育嬰兒的奶嘴

2)吸吮手指

3)過敏,鼻子的阻塞引起口呼吸,導致舌的位置異常處於口腔中非常低的位置

4)大的扁桃體,腺樣體,或是喉嚨痛,會引起吞嚥上的困難

5)不正常的大舌頭

6)遺傳上的因素有家族傾向,例如下顎角

7)神經,肌肉,或其它生理上的不正常

8)繫帶過短(舌繫帶)

Is there more than one type of tongue thrusting?
There are several different types of tongue thrust and resultant orthodontic problems:

• Anterior open bite - the most common and typical type of tongue thrust. In this case, the front lips do not close and the child often has his mouth open with the tongue protruding beyond the lips. In general, it has been noted that a large tongue usually accompanies this type of tongue thrust.
• Anterior thrust - upper incisors are extremely protruded and the lower incisors are pulled in by the lower lip. This particular type of thrust is most generally accompanied by a strong mentalis (muscle of the chin).
• Unilateral thrust - the bite is characteristically open on either side.
• Bilateral thrust - the anterior bite is closed; however the posterior teeth from the first bicuspid to the back molars may be open on both sides. This is the most difficult thrust to correct.
• Bilateral anterior open bite - the only teeth that touch are the molars with the bite completely open on both sides including the anterior teeth. Once again a large tongue is also noted.
• Closed bite thrust - typically shows a double protrusion meaning that both the upper and lower teeth are flared out and spread apart.

• C)TONGUE THRUSTING不只一種嗎?

• TONGUE THRUST通常有許多不同的形式,也是許多引起矯正上的問題的因素
• 1)前牙開咬,這是最常見到也是最典型的類別,有此狀況,唇無法閉合,且嘴巴老是開開的,舌頭就這樣前伸在嘴唇中間,通常你會看到此類的TONGUE THRUST有一個大舌頭的特徵
• 2)向前舞弄,上門牙呈現相當前突的狀態,而下顎切牙會被下唇往內拉進去,這個類別通常會伴隨著一個強壯的MENTALIS肌肉(下頦肌)
• 3)單邊舞弄,典型的咬合也是開開的
• 4)雙邊舞弄,前方的咬合是緊閉的,但是後方齒群從第一小臼齒開始一直到大臼齒可能是兩邊都開開的,這一類是最難矯治的TONGUE THRUST
• 5)雙邊前方開咬,口腔中唯一接觸的是大臼齒,其它的兩邊的咬合全都是開開的,包括前牙都是,這一類也是有一個大舌頭的特徵
• 6)閉鎖咬合舞弄,典型的外觀顯示雙前突,也就是上下排前牙往外突出去且是分開的

Is tongue thrust very prevalent?

Since 1958 the term "tongue thrust" has been described and discussed in speech and dental publications by many writers. Authorities have noted that a significant number of school-age children have tongue thrust. For example, according to recent literature, as many as 67 to 95 percent of the children 5 to 8 years old exhibit tongue thrust which may be associated with or contributing to an orthodontic or speech problem. Throughout the country, from 20 to 80 percent of orthodontic patients have some form of tongue thrust.

                   D)弄舌癖盛行嗎?

 自從1958年這個弄舌癖的名詞被引述且被提出討論並在牙醫出版物被許多作者編寫出來後,權威文獻指出一個有意義的數據學齡的兒童有弄舌癖,例如,根據最近的文獻,約有67~95%的5-8歲兒童出現tongue thrust會伴隨著可能引起的矯正或是語言上的問題,全國顯示,有20-80%的矯正病人,也有某些形式的tongue thrust出現

 
What are the consequences?
The force of the tongue against the teeth is an important factor in contributing to malformation ("bad bites"). Many orthodontists have had the discouraging experience of completing dental treatment, with what appeared to be good results, only to discover that the case had relapsed because the patient had a tongue thrust swallowing pattern. If the tongue is allowed to continue its pushing action against the teeth, it will continue to push the teeth forward and reverse the orthodontic work.

E)影響力為何?

舌頭對抗牙齒的力量是導致異常咬合的一個重要因子,許多矯正醫師對於治療過程產生沮喪,剛剛治療結束產生好的結果時,卻發現病例出現復發的情形,因為病人的tongue thrust毛病仍存在,若是舌頭老是對牙齒持續它的推進力量,最後還是會對牙齒產生推向前的狀況,而導致矯正的不良結果

Is speech affected by tongue thrusting?
Speech is not frequently affected by the tongue thrust swallowing pattern. The "S" sound (lisping) is the one most affected. The lateral lisp (air forced on the side of the tongue rather than forward) shows dramatic improvement when the tongue thrust is also corrected. However, one problem is not always associated with the other.

F)說話會不會受tongue thrust的影響?

說話是不會經常受到tongue thrust的影響的,尤其是吞嚥的形式,發S聲(口齒不清)是最常受到影響的一個,側向的口齒不清(空氣壓迫舌頭的側邊而不是前方),顯示出戲劇性的改正當TONGUE THRUST也被改正,不過,兩者並沒有正相關

At what age does a child usually exhibit a tongue thrust swallowing pattern?
A child exhibits a tongue thrust pattern from birth. Up to the age of four, there is a possibility that the child will outgrow the tongue thrust pattern and develop the mature pattern of swallowing. However, statistics have shown that if the tongue thrust swallowing pattern is retained, it may be strengthened beyond the age of four. In all probability, the child will need some type of training program to develop the mature swallowing pattern.

G)兒童在甚麼年齡會出現TONGUE THRUST SWALLOWING的形式?

兒童自出生就會出現TONGUE THRUST的形式,直到4歲小孩都有可能持續有著TONGUE THRUST的毛病,同時也會產生吞嚥的成熟形式,不過,統計顯示如果弄舌癖的吞嚥形態持續著,可能會持續超過4歲以上會加劇,有可能小孩必需進行某些訓練的過程,來發展成熟的吞嚥模式

Who diagnoses tongue thrust?
The most difficult problem of all is the diagnosis. As a rule, orthodontists, general dentists, pedodontists, some pediatricians, and speech therapists detect the problem. In many cases, tongue thrust may not be detected until the child is under orthodontic care. However, diagnosis usually is made when the child displays a dental or speech problem that needs correction.

H)誰來診斷TONGUE THRUST?

最困難的就是診斷,常規來看,矯正醫師,開業醫,牙周病醫師,小兒牙科醫師,語言治療師等可能檢查出問題來,在某些案例當中,TONGUE THRUST不見得可以檢查出來直到小孩在進行矯正治療,不過,診斷通常會被確認在小孩已經產生牙科或是語言上的問題而必須治療

Generally, the tongue thrust swallowing pattern may be handled in two ways:An appliance that is placed in the mouth by the dentist (mechanical method)

語言治療技術

• Correction by oral habit training - an exercise technique that re-educates the muscles associated with swallowing by changing the swallowing pattern. This method must be taught by a trained therapist. Therapy has proven to give the highest percentage of favorable results, however the appliance is still used and is successful in some cases.
   
• I)普通,TONGUE THRUST的吞嚥形式可以由兩種途徑處理
• (機械的方法)由牙醫在口腔中放入某種裝置
• 藉由口腔習慣的訓練來改正,運動的技術經由訓練肌肉吞嚥動作伴隨著吞嚥形式的改變,這種方法必須由訓練師來做,已有經驗證明成功率還滿高的,不過,裝置可能僅適合在某些案例上                      
• tongue thrust therapy(請點入)

What Is the probability of correction?
With sincere commitment and cooperation of the child and parent and if there is no neuromuscular involvement, correction is possible in most cases. At the present time, successful correction of T.T. appears to be:

• 70% of the treated cases are successful
• 25% of the treated cases are unsuccessful due to poor cooperation and lack of commitment of the parent, patient, or both.
• 5% of the treated cases are unsuccessful due to factors that make correction impossible.

I'd have to say that one half (or more) of the patients we see in our office have some form of Tongue Thrust, therefore, you can see how important this subject is in diagnosis and treatment planning.

Should you have any questions regarding this or any other matter, please don't hesitate to call the office.

J)矯治好的或然率有多高?

有著小孩與家長真誠的實行與合作,同時沒有神經肌肉系統的介入,矯治在大多數的案例都是可行的,目前為止,T.T的成功治療機率顯示為

70%的案例是成功的

25%的治療案例是不成功的,這個是起因於不合作,與及病人家長,病人,或是兩者的實行

5%的治療案例是不成功的 ,這是歸因於給治療不可能的因子

我不得不說我們診所一半(或以上)的病人有著某種形式的TONGUE THRUST,因此,你可以了解到這個在診斷與治療計畫的擬定是多麼重要

您若是有任何關於這一方面的問題,或是相關的問題,請不要客氣的迅速的與我們聯繫,謝謝!!

(FROM:http://www.bracessandiego.com/tongue_thrust.htm)
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