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American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
Treatment of Tongue Thrust with Hypnosis: Two Case Histories Harold P. Golan D.M.D.
a
a
Boston City Hospital , USA Published online: 21 Sep 2011.
To cite this article: Harold P. Golan D.M.D. (1991) Treatment of Tongue Thrust with Hypnosis: Two Case Histories, American Journal of Clinical Hypnosis, 33:4, 235-240, DOI: 10.1080/00029157.1991.10402940 To link to this article: http://dx.doi.org/10.1080/00029157.1991.10402940
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
AMERICAN JOURNAL OF CLINICAL HYPNOSIS VOLUME
33,
NUMBER 4, APRIL 1991
Treatment of Tongue Thrust with Hypnosis: Two Case Histories
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Harold P. Golan Boston City Hospital Tongue thrust is a relatively infrequent habit which can result in disruptive, permanent oral malocclusion, bone changes, and facial disharmony. The use of hypnotic phenomena can augment myofunctional therapy. Temperature control, glove anesthesia, relaxation, and imagery enhance demonstration of the proper way to swallow. The cornerstone of having the patient actually feel the contraction at the insertion of the masseter muscles provides an inner biofeedback which provides a very positive signal that the improper habit is being corrected. Hypnosis can then be used in the manner described to achieve a good clinical result.
There are three stages of normal swallowing. The first is a willful act when the food or liquid is thrown back to the pharynx and esophagus. Then the tongue creates a tight seal for the last two stages, which are the pharyngeal and esophageal reflexes. Tongue thrust or reverse swallowing refers to a condition during swallowing in which portions of the tongue rest or press against the teeth, the movement of the tongue being from the posterior to the anterior. In normal swallowing the tip of the tongue rests behind the an-
For reprints write to Harold P. Golan D.M.D., 23 Ridge Ave., Natick, MA 01760. Received August 3, 1990; revised October 26, 1990; accepted for publication December 20, 1990.
terior maxillary teeth; the dorsum of the tongue is against the palate, and the movement is from anterior to posterior. Ricketts (1968) states that the tongue and the facial muscles determine the size of the dental arches and the crowding or spacing of the teeth. The tongue has two activities, to assist speech and to assist swallowing (Goda, 1968). A normal person swallows 1500 times daily; 63 times during nighttime sleep; 50 times during a lO-minute meal; 34 times per hour while sitting and reading; and 12 times per hour lying supine and awake (Straub, 1960). There are four kinds of tongue thrust: (1) against the upper and lower anterior teeth, (2) against the anterior and posterior regions, (3) either unilaterally or bilaterally, and (4) between the teeth with spaces up to one inch becoming permanent. In a controlled study of 28 tongue thrusters versus 28 normal swallowers,
235
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236
Lundeen, Kurtz, and Stanley (1974) found that the former had 98.8% more decayed/ filled teeth surfaces and 84.1 % more decayed teeth. The tongue thrusters frequently pushed food into the vestibules where the saliva cannot cleanse the area. The food is then held against the teeth, causing more cavities. Severe cases of tongue thrust can cause malocclusion (Ricketts, 1968). Spiedel, Isaacson, and Worms (1972) in their study of 1500 11year-olds found that of the 2.7% who had tongue thrust, half had malocclusions. Adrianopulos and Hanson (1987) state that one half of all orthodontically treated patients relapse to "unacceptable" occlusion in 12 years. One of the many factors contributing to this relapse phenomenon is tongue thrust. Periodontal conditions (Fitzpatrick, 1969) and bone loss around teeth (Chaiken, 1972) may occur. Open bites and speech difficulties occur when people cannot place their tongue in a normal position. Fogel (1974) states that when people cannot place their tongue in a normal position they develop lisps and have trouble pronouncing T, D, L, N, and Z. Harden and Rydell (1984) describe three ways of changing swallowing habits: (1) mechanical, (2) modification of the oral environment (orthodontia), and (3) myofunctiona 1 therapy. Williams and Kecocq (1980) describe a rake-like appliance, but many orthodontists use this ineffectively and appliances have little effect once they are removed (Subtelny & Sakuda, 1964). Barrett, quoted in Harden and Rydell (1984), believes that the primary goal of therapy is behavior modification. I believe one of the important and effective factors in habit control for adults is the combination of myofunctional therapy and habit control. Speech therapists currently treat most of the tongue thrust problems with varying degrees of success (Mason
& Profitt, 1974; Profitt & Mason, 1975; Hanson, 1967, 1969, 1976, 1981; Hanson & Adrianopoulos, 1982, 1987; Tepper, 1986). The addition of hypnosis enhances therapy. Therapists who have used hypnosis include Secter (1961) who describes a case of tongue thrust in a 14-year-old in which he used a theater technique and behavior modification for treatment. Crowder (1965) used a conscious and unconscious (hypnosis) series of visits to create imagery of being in a movie and eating a snack correctly. Barrett and Von Dedenroth (1967), in their study of 25 patients (21 of whom were orthodontically relapsed), describe a successful technique using eye fixation, progressive relaxation, visual imagery, and arm levitation. Finkelstein (1984) states that hypnosis helps make the attitude for the exercises better, facilitates learning by focusing attention, and enhances rapport. Varying authorities differ as to the etiology of tongue thrust. Straub (1951,1960) believes the cause of reverse swallowing is bottle feeding babies too rapidly. Mason and Profitt (1974) state that tongue thrust is a normal adaptation to pharyngeal airspace. Whatever the reason, about 1% of the adult dental population have problems related to reverse swallowing.
Case Reports
Case 1 The first patient is a married 37-yearold female psychiatric social worker who is the director of a small agency. Her chief complaints were a lisp and an enlarging anterior space between her maxillary and mandibular teeth. The anterior maxillary teeth were becoming mobile and starting to shift. After taking an emotional history
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TREATMENT OF TONGUE TIIRUST
(Golan, 1987), hypnosis was explained, questions were answered, and a short, eyes-closed, relaxation induction was used effectively. After being told how to practice self-hypnosis and to use a sense of humor approach both externally and internally, glove anesthesia was produced in the right hand. After a 25-gauge needle was placed through the skin on the back of the right hand, she was asked to open her eyes while remaining in this state of relaxation, smile at what she saw there, close her eyes, and go even deeper (Golan, 1989). I pointed out to her that she had learned to control one part of her body in a relatively short time, and I then explained what physical structures were involved, such as muscles, nerves, temperature, skin, and blood-vessel control. The implication was that if she could learn to control one part of her body, she could learn to control any part of her body, especially the tongue within her mouth. Correct swallowingwas explained. "Let your body remember what to do. It did when you were first born. You may be very pleasantlysurprisedat how well things will go." A sugarless mint was placed on the middle of the dorsum of her tongue. She was told to hold it firmly against the roof of her mouth, to close her lips, to put the tip of her tongue against the back of her upper front teeth, and to swallow. This is the correct way to swallow; it may be verified by having the patient place the finger tips of the forefinger and middle finger of each hand lightly on the masseter muscle on each side of the face just under the temporomandibular joint and in front of the tragus of the ear. With correct swallowing the muscle will bulge out noticeably to touch. This serves as an inner biofeedback so that the patient, after practicing both in the waking state and the hypnotic state, can make proper swallow-
237
ing part of his/her daily life. Given the statistic of 1500 swallows daily, it is easy to see how the tongue can force the space between the anterior teeth to increase and the teeth to actually move position further unless the pernicious habit is corrected. Further verbiage included: "Keep the anesthesia in your right hand following the termination of this state of relaxation for 5 full minutes as a further sign that something can happen from that marvelous mental process of yours. Take a longer time eating. A Chinese proverb states that a great journey starts with a single step. You have taken that step." When the trance was terminated, the patient opened her eyes and said that both hands were freezing. On the second visit a week later, our patient was speaking more clearly, was swallowing properly on request, and actually was hearing herself swallow (eustachian tubes uncovering properly). "Progress has been made. You have learned how strong the tongue is by holding the sugarless mint against the palate. The pressure was so great that over the years it moved the teeth. Now the pressure is shifted to the palate so that the muscles of your lips will keep the teeth where they are and perhaps even push them back somewhat into proper position. As time goes by you will be doing this in a subconscious, unconscious way as well as in a conscious manner." Ego strengthening is incorporated into treatment in the following manner. "Not only should it be gratifying to you to realize how well you have done to protect the integrity of your body, but also as a mark of strong will and intelligence, both of which are needed to change a strong habit which is deleterious. This realization has been beneficial. Notice how good you feel right now. You can associate this feeling with the
238
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success of what you are accomplishing whenever you need it or want it." The third visit, a month later, saw her swallowing successfully and quite pleased with herself and her response to treatment. She has been seen at 6-month intervals for 2 years with no complaints of further tooth movement or any other oral problems.
Case 2 The second patient is a 28-year-old, white, single female musician, who teaches and plays in an orchestra and a quartet. She likes reading, jogging, hiking, and music. Her chief complaints were earaches and her teeth feeling loose in the morning. Because of her bruxism, she had a splint made by her local dentist to increase the vertical dimension, but her earaches continued. He did not notice her tongue thrust which was covering her eustachian tubes when she swallowed. The increased pressure on her ears was creating the pain. There were no lisps or spaces between the teeth as yet. The protocol used for the first patient was used for the induction and treatment of the tongue thrust. She also felt her masseter muscles pop out on correct swallowing. "Practice this until it becomes part of your life style. Chew or drink more slowly. Look forward to helping yourself." Glove anesthesia was used in the same manner described previously. "Won't it be great to wake up in the morning without having your jaw muscles tired and your teeth feeling loose?" Because this was a compound situation of tongue thrust and bruxism, the protocol for bruxism was used also (Golan, 1989). The treatment is predicated on the assumption that bruxism is caused by stress. The patient is taught how to relax during the day stresses by relaxation with words such as these:
GOLAN
"Whenever one of these situations occur, relax and say something like this to yourself: 'Nothing is important enough for me to get too uptight about.' Keep just enough nervous energy to do whatever you are doing superbly well and spill off the excess in the distance. When you go to sleep at night, practice and say something like this: 'Nothing is important enough for me to eat myself up about.'" This is gut language which is employed by patients who have bruxism. "If during the night some of the stressful periods of the day break out of your subconscious and cause you to grind your teeth, the hard touch of your teeth will wake you. You will smile, realizing that your subconscious is protecting you, turn over, and go right back to sleep." In both patients we had them eat and drink in and out of trance so that they could be observed and actually feel the masseters pop out. This was done with their eyes open and closed during trance and open in the waking state. The following week she reported that she had no earaches. We continued treatment with music imagery. You know how hard it is to learn a difficult new piece-memorizing, bowing, phrasing, and practicingagain and again until there is an unconscious flowing as everything finally comes together to produce a result that is almost subconscious. In the same way we can change physiology. Somehow you will find a way to consciously and subconsciously tell your muscles within your mouth what to do; the tongue is a muscle which is the only one in the body to have fibers in three directions at one time-vertical, horizontal, and transverse-and is one of the most powerful muscles in the body. You can even relax your tongue and mouth with your eyes wide open, be perfectly wide awake, but the inside of your mouth, including your tongue, will be relaxed enough to swallow correctly
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TREATMENT OF TONGUE THRUST
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even with food and drink. Take the time to do this. You have the intelligence, wherewithal, and determination to do this.
Right after this, she ate a piece of food properly. The final visit the next week provided an excellent opportunity for me to show the patient what she was capable of doing with pain control. The patient stated that she had a slight earache. Trance was produced and the following suggestions were given. Notice how much better you feel right now. It's extremely important that you notice this because you now have a way of taking away pain whenever it occurs. Needless to say, your body will protect itself if there is something really wrong. Congratulations on your progress on swallowing correctly, the most difficult part of treatment. It's gratifying for me to see that you have accomplished so much in a short time. The goal is now attainable without ache or pain, but with patience, determination, and relaxation in the same kind of effortless way which you demonstrated in your eating here during this visit.
The patient remarked in trance, "It's exciting. " About a year after treatment ended, I attended a recital in which she performed. She reported comfort most of the time with an occasional problem during periods of great stress. She now is able to handle her previously untenable situation. Discussion The problems of tongue thrust can evolve into quite serious situations as these two case histories demonstrate. Unfortunately many cases of tongue thrust are not diagnosed because of unfamiliarity with the syndrome or are treated ineffectively with physical appliances (Subtelny & Sekuda, 1964). Hypnosis has been used successfully by some clinicians as stated
previously. The author has added some methods which enhance myofunctional therapy by giving the patient a method of control. Use has been made especially of glove anesthesia, relaxation, temperature change, imagery, and ego enhancement. Perhaps the most important additional factor has been the patient's use of inner biofeedback by actually having a method of knowing when proper swallowing has taken place, something which is difficult to know because improper swallowing has been a habit since early childhood. Tongue thrust is not an easy habit to overcome. However, adults who have had the habit for many years can be helped with hypnosis as an important adjunct to therapy. References Adrianapoulos, M. V. & Hanson, M. L. (1987). Tongue thrust and the stability of overjet correction. Angle Orthodontist, 52, 121-125. Barrett, R. H. & Von Dedenroth, T. E. A. (1967). Problems of deglutition. American Journal of Clinical Hypnosis, 9, 121-125. Chaikin, B. S. (1972). Analysis of the therapy of an open bite. Journalof Periodontology, 42, 362-366. Crowder, H. M. (1965). Hypnosis in the control of tongue thrust. American Journal of
Clinical Hypnosis, 8, 10-13. Fitzpatrick, J. A. (1969). Periodontal problems and tongue thrusting habits. Journal of Maxillofacial Orthopedics, 2,29. Finkelstein, S. (1984). Hypnosis and dentistry.In W. C. Wester & A. H. Smith (Eds.)
Clinical hypnosis: A multidisciplinary approach, pp. 343-344, Philadelphia: Lippincott. Fogel, B. (1974). Therapy can curb tongue thrust swallowing. Journalof TheAmerican Dental Association, 89, 1038-1045. Goda, S. (1968). The role of the speech pathologist in the correction of tongue thrust. AmericanJournalofOrthodontics, 54,852859.
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Golan, H. P.(1987). Hypnosis in the treatment of pain. In W. C. Wester (Ed.), Clinical hypnosis: A case management approach, pp. 122-142, Cincinnati: Behavioral Science Center, Inc. Publications. Golan, H. P.(1989). Temporomandibular joint disease treated with hypnosis. American Journal of Clinical Hypnosis, 31, 269-274. Hanson, M. L.(1967). Some suggestions for more effective therapy for tongue thrust. Journal of Speech and Hearing Disorders, 32, 75-79. Hanson, M. L.(1969). Tongue thrust in preschool children. American Journal of Orthodontics, 56, 160-169. Hanson, M. L.(1976). Tongue thrust; A point of view. Journal of Speech and Hearing Disorders, 41, 172-184. Hanson, M. L.(1981). Toward a more effective therapy for tongue thrust. International Journal of Orthodontics, 19, 7-12. Hanson, M. L. & Adrianopoulos, M. V. (1982). Tongue thrust and malocclusion: A longitudinal study. International Journal of Orthodontics, 20,9-18. Hanson M. L. & Adrianopoulos, M. V. (1987). Tongue thrust, occlusion and dental health in middle aged subjects: A pilot study. International Journal of Orofacial Myology,
13,3-9. Harden, J. & RydelI, C. M. (1984). A study of changes in swalIowinghabit resulting from tongue thrust therapy recommended by R. H. Barrett. International Journal of Orthodontics, 22, 12-17. Lundeen, D. J., Kurtz, D. D., & Stanley, E. O. (1974). Clinical study of dental caries
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and tongue thrust. Journal of the American Dental Association, 88, 1018-1022. Mason, R. M. & Profitt, W. R. (1974). The tongue thrust controversy: Background and recommendations. Journal of Speech and Hearing Disorders, 39, 115-132. Profitt, W. R. & Mason, R. M. (1975). Myofunctional therapy for tongue thrusting: Background and recommendations. Journal of the American Dental Association, 80, 403411. Ricketts, R. M. (1968). Esthetics, environment and the law of lip relation. American Journal of Orthodontics, 54,272- 289. Secter, I. I. (1961). Tongue thrust and nail biting simultaneously treated during hypnosis: A case report. American Journal of Clinical Hypnosis, 4,51-53. Speidel, T. M., Isaacson, R. J., & Worms, F. W. (1972). Tongue thrust therapy and anterior open bite: A review of new facial growth data. American Journal of Orthodontics, 62, 287-295. Straub, W. J. (1951). The etiology of the perverted swallowing habit. American Journal of Orthodontics, 35, 603-610. Straub, W. J.(196O). Malfunctionof the tongue. American Journal ofOrthodontics, 46,404424. Subtelny, H. & Sekuda, M. (1964). Open bite: Diagnosis and treatment. American Journal of Orthodontics, 50, 337-358. Tepper, H. W. (1986). Tongue thrust correction in one easy lesson. Functional Orthodontics, 3, 40-43. Williams T. R. & Kekocq, K. R. (1980). A simple tongue thrust appliance. Journal of Pedodontics, 4,299-308.
American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20
Treatment of Tongue Thrust with Hypnosis: Two Case Histories Harold P. Golan D.M.D.
a
a
Boston City Hospital , USA Published online: 21 Sep 2011.
To cite this article: Harold P. Golan D.M.D. (1991) Treatment of Tongue Thrust with Hypnosis: Two Case Histories, American Journal of Clinical Hypnosis, 33:4, 235-240, DOI: 10.1080/00029157.1991.10402940 To link to this article: http://dx.doi.org/10.1080/00029157.1991.10402940
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions
AMERICAN JOURNAL OF CLINICAL HYPNOSIS VOLUME
33,
NUMBER 4, APRIL 1991
Treatment of Tongue Thrust with Hypnosis: Two Case Histories
Downloaded by [University of Toronto Libraries] at 07:37 11 February 2015
Harold P. Golan Boston City Hospital Tongue thrust is a relatively infrequent habit which can result in disruptive, permanent oral malocclusion, bone changes, and facial disharmony. The use of hypnotic phenomena can augment myofunctional therapy. Temperature control, glove anesthesia, relaxation, and imagery enhance demonstration of the proper way to swallow. The cornerstone of having the patient actually feel the contraction at the insertion of the masseter muscles provides an inner biofeedback which provides a very positive signal that the improper habit is being corrected. Hypnosis can then be used in the manner described to achieve a good clinical result.
There are three stages of normal swallowing. The first is a willful act when the food or liquid is thrown back to the pharynx and esophagus. Then the tongue creates a tight seal for the last two stages, which are the pharyngeal and esophageal reflexes. Tongue thrust or reverse swallowing refers to a condition during swallowing in which portions of the tongue rest or press against the teeth, the movement of the tongue being from the posterior to the anterior. In normal swallowing the tip of the tongue rests behind the an-
For reprints write to Harold P. Golan D.M.D., 23 Ridge Ave., Natick, MA 01760. Received August 3, 1990; revised October 26, 1990; accepted for publication December 20, 1990.
terior maxillary teeth; the dorsum of the tongue is against the palate, and the movement is from anterior to posterior. Ricketts (1968) states that the tongue and the facial muscles determine the size of the dental arches and the crowding or spacing of the teeth. The tongue has two activities, to assist speech and to assist swallowing (Goda, 1968). A normal person swallows 1500 times daily; 63 times during nighttime sleep; 50 times during a lO-minute meal; 34 times per hour while sitting and reading; and 12 times per hour lying supine and awake (Straub, 1960). There are four kinds of tongue thrust: (1) against the upper and lower anterior teeth, (2) against the anterior and posterior regions, (3) either unilaterally or bilaterally, and (4) between the teeth with spaces up to one inch becoming permanent. In a controlled study of 28 tongue thrusters versus 28 normal swallowers,
235
GOLAN
Downloaded by [University of Toronto Libraries] at 07:37 11 February 2015
236
Lundeen, Kurtz, and Stanley (1974) found that the former had 98.8% more decayed/ filled teeth surfaces and 84.1 % more decayed teeth. The tongue thrusters frequently pushed food into the vestibules where the saliva cannot cleanse the area. The food is then held against the teeth, causing more cavities. Severe cases of tongue thrust can cause malocclusion (Ricketts, 1968). Spiedel, Isaacson, and Worms (1972) in their study of 1500 11year-olds found that of the 2.7% who had tongue thrust, half had malocclusions. Adrianopulos and Hanson (1987) state that one half of all orthodontically treated patients relapse to "unacceptable" occlusion in 12 years. One of the many factors contributing to this relapse phenomenon is tongue thrust. Periodontal conditions (Fitzpatrick, 1969) and bone loss around teeth (Chaiken, 1972) may occur. Open bites and speech difficulties occur when people cannot place their tongue in a normal position. Fogel (1974) states that when people cannot place their tongue in a normal position they develop lisps and have trouble pronouncing T, D, L, N, and Z. Harden and Rydell (1984) describe three ways of changing swallowing habits: (1) mechanical, (2) modification of the oral environment (orthodontia), and (3) myofunctiona 1 therapy. Williams and Kecocq (1980) describe a rake-like appliance, but many orthodontists use this ineffectively and appliances have little effect once they are removed (Subtelny & Sakuda, 1964). Barrett, quoted in Harden and Rydell (1984), believes that the primary goal of therapy is behavior modification. I believe one of the important and effective factors in habit control for adults is the combination of myofunctional therapy and habit control. Speech therapists currently treat most of the tongue thrust problems with varying degrees of success (Mason
& Profitt, 1974; Profitt & Mason, 1975; Hanson, 1967, 1969, 1976, 1981; Hanson & Adrianopoulos, 1982, 1987; Tepper, 1986). The addition of hypnosis enhances therapy. Therapists who have used hypnosis include Secter (1961) who describes a case of tongue thrust in a 14-year-old in which he used a theater technique and behavior modification for treatment. Crowder (1965) used a conscious and unconscious (hypnosis) series of visits to create imagery of being in a movie and eating a snack correctly. Barrett and Von Dedenroth (1967), in their study of 25 patients (21 of whom were orthodontically relapsed), describe a successful technique using eye fixation, progressive relaxation, visual imagery, and arm levitation. Finkelstein (1984) states that hypnosis helps make the attitude for the exercises better, facilitates learning by focusing attention, and enhances rapport. Varying authorities differ as to the etiology of tongue thrust. Straub (1951,1960) believes the cause of reverse swallowing is bottle feeding babies too rapidly. Mason and Profitt (1974) state that tongue thrust is a normal adaptation to pharyngeal airspace. Whatever the reason, about 1% of the adult dental population have problems related to reverse swallowing.
Case Reports
Case 1 The first patient is a married 37-yearold female psychiatric social worker who is the director of a small agency. Her chief complaints were a lisp and an enlarging anterior space between her maxillary and mandibular teeth. The anterior maxillary teeth were becoming mobile and starting to shift. After taking an emotional history
Downloaded by [University of Toronto Libraries] at 07:37 11 February 2015
TREATMENT OF TONGUE TIIRUST
(Golan, 1987), hypnosis was explained, questions were answered, and a short, eyes-closed, relaxation induction was used effectively. After being told how to practice self-hypnosis and to use a sense of humor approach both externally and internally, glove anesthesia was produced in the right hand. After a 25-gauge needle was placed through the skin on the back of the right hand, she was asked to open her eyes while remaining in this state of relaxation, smile at what she saw there, close her eyes, and go even deeper (Golan, 1989). I pointed out to her that she had learned to control one part of her body in a relatively short time, and I then explained what physical structures were involved, such as muscles, nerves, temperature, skin, and blood-vessel control. The implication was that if she could learn to control one part of her body, she could learn to control any part of her body, especially the tongue within her mouth. Correct swallowingwas explained. "Let your body remember what to do. It did when you were first born. You may be very pleasantlysurprisedat how well things will go." A sugarless mint was placed on the middle of the dorsum of her tongue. She was told to hold it firmly against the roof of her mouth, to close her lips, to put the tip of her tongue against the back of her upper front teeth, and to swallow. This is the correct way to swallow; it may be verified by having the patient place the finger tips of the forefinger and middle finger of each hand lightly on the masseter muscle on each side of the face just under the temporomandibular joint and in front of the tragus of the ear. With correct swallowing the muscle will bulge out noticeably to touch. This serves as an inner biofeedback so that the patient, after practicing both in the waking state and the hypnotic state, can make proper swallow-
237
ing part of his/her daily life. Given the statistic of 1500 swallows daily, it is easy to see how the tongue can force the space between the anterior teeth to increase and the teeth to actually move position further unless the pernicious habit is corrected. Further verbiage included: "Keep the anesthesia in your right hand following the termination of this state of relaxation for 5 full minutes as a further sign that something can happen from that marvelous mental process of yours. Take a longer time eating. A Chinese proverb states that a great journey starts with a single step. You have taken that step." When the trance was terminated, the patient opened her eyes and said that both hands were freezing. On the second visit a week later, our patient was speaking more clearly, was swallowing properly on request, and actually was hearing herself swallow (eustachian tubes uncovering properly). "Progress has been made. You have learned how strong the tongue is by holding the sugarless mint against the palate. The pressure was so great that over the years it moved the teeth. Now the pressure is shifted to the palate so that the muscles of your lips will keep the teeth where they are and perhaps even push them back somewhat into proper position. As time goes by you will be doing this in a subconscious, unconscious way as well as in a conscious manner." Ego strengthening is incorporated into treatment in the following manner. "Not only should it be gratifying to you to realize how well you have done to protect the integrity of your body, but also as a mark of strong will and intelligence, both of which are needed to change a strong habit which is deleterious. This realization has been beneficial. Notice how good you feel right now. You can associate this feeling with the
238
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success of what you are accomplishing whenever you need it or want it." The third visit, a month later, saw her swallowing successfully and quite pleased with herself and her response to treatment. She has been seen at 6-month intervals for 2 years with no complaints of further tooth movement or any other oral problems.
Case 2 The second patient is a 28-year-old, white, single female musician, who teaches and plays in an orchestra and a quartet. She likes reading, jogging, hiking, and music. Her chief complaints were earaches and her teeth feeling loose in the morning. Because of her bruxism, she had a splint made by her local dentist to increase the vertical dimension, but her earaches continued. He did not notice her tongue thrust which was covering her eustachian tubes when she swallowed. The increased pressure on her ears was creating the pain. There were no lisps or spaces between the teeth as yet. The protocol used for the first patient was used for the induction and treatment of the tongue thrust. She also felt her masseter muscles pop out on correct swallowing. "Practice this until it becomes part of your life style. Chew or drink more slowly. Look forward to helping yourself." Glove anesthesia was used in the same manner described previously. "Won't it be great to wake up in the morning without having your jaw muscles tired and your teeth feeling loose?" Because this was a compound situation of tongue thrust and bruxism, the protocol for bruxism was used also (Golan, 1989). The treatment is predicated on the assumption that bruxism is caused by stress. The patient is taught how to relax during the day stresses by relaxation with words such as these:
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"Whenever one of these situations occur, relax and say something like this to yourself: 'Nothing is important enough for me to get too uptight about.' Keep just enough nervous energy to do whatever you are doing superbly well and spill off the excess in the distance. When you go to sleep at night, practice and say something like this: 'Nothing is important enough for me to eat myself up about.'" This is gut language which is employed by patients who have bruxism. "If during the night some of the stressful periods of the day break out of your subconscious and cause you to grind your teeth, the hard touch of your teeth will wake you. You will smile, realizing that your subconscious is protecting you, turn over, and go right back to sleep." In both patients we had them eat and drink in and out of trance so that they could be observed and actually feel the masseters pop out. This was done with their eyes open and closed during trance and open in the waking state. The following week she reported that she had no earaches. We continued treatment with music imagery. You know how hard it is to learn a difficult new piece-memorizing, bowing, phrasing, and practicingagain and again until there is an unconscious flowing as everything finally comes together to produce a result that is almost subconscious. In the same way we can change physiology. Somehow you will find a way to consciously and subconsciously tell your muscles within your mouth what to do; the tongue is a muscle which is the only one in the body to have fibers in three directions at one time-vertical, horizontal, and transverse-and is one of the most powerful muscles in the body. You can even relax your tongue and mouth with your eyes wide open, be perfectly wide awake, but the inside of your mouth, including your tongue, will be relaxed enough to swallow correctly
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even with food and drink. Take the time to do this. You have the intelligence, wherewithal, and determination to do this.
Right after this, she ate a piece of food properly. The final visit the next week provided an excellent opportunity for me to show the patient what she was capable of doing with pain control. The patient stated that she had a slight earache. Trance was produced and the following suggestions were given. Notice how much better you feel right now. It's extremely important that you notice this because you now have a way of taking away pain whenever it occurs. Needless to say, your body will protect itself if there is something really wrong. Congratulations on your progress on swallowing correctly, the most difficult part of treatment. It's gratifying for me to see that you have accomplished so much in a short time. The goal is now attainable without ache or pain, but with patience, determination, and relaxation in the same kind of effortless way which you demonstrated in your eating here during this visit.
The patient remarked in trance, "It's exciting. " About a year after treatment ended, I attended a recital in which she performed. She reported comfort most of the time with an occasional problem during periods of great stress. She now is able to handle her previously untenable situation. Discussion The problems of tongue thrust can evolve into quite serious situations as these two case histories demonstrate. Unfortunately many cases of tongue thrust are not diagnosed because of unfamiliarity with the syndrome or are treated ineffectively with physical appliances (Subtelny & Sekuda, 1964). Hypnosis has been used successfully by some clinicians as stated
previously. The author has added some methods which enhance myofunctional therapy by giving the patient a method of control. Use has been made especially of glove anesthesia, relaxation, temperature change, imagery, and ego enhancement. Perhaps the most important additional factor has been the patient's use of inner biofeedback by actually having a method of knowing when proper swallowing has taken place, something which is difficult to know because improper swallowing has been a habit since early childhood. Tongue thrust is not an easy habit to overcome. However, adults who have had the habit for many years can be helped with hypnosis as an important adjunct to therapy. References Adrianapoulos, M. V. & Hanson, M. L. (1987). Tongue thrust and the stability of overjet correction. Angle Orthodontist, 52, 121-125. Barrett, R. H. & Von Dedenroth, T. E. A. (1967). Problems of deglutition. American Journal of Clinical Hypnosis, 9, 121-125. Chaikin, B. S. (1972). Analysis of the therapy of an open bite. Journalof Periodontology, 42, 362-366. Crowder, H. M. (1965). Hypnosis in the control of tongue thrust. American Journal of
Clinical Hypnosis, 8, 10-13. Fitzpatrick, J. A. (1969). Periodontal problems and tongue thrusting habits. Journal of Maxillofacial Orthopedics, 2,29. Finkelstein, S. (1984). Hypnosis and dentistry.In W. C. Wester & A. H. Smith (Eds.)
Clinical hypnosis: A multidisciplinary approach, pp. 343-344, Philadelphia: Lippincott. Fogel, B. (1974). Therapy can curb tongue thrust swallowing. Journalof TheAmerican Dental Association, 89, 1038-1045. Goda, S. (1968). The role of the speech pathologist in the correction of tongue thrust. AmericanJournalofOrthodontics, 54,852859.
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Golan, H. P.(1987). Hypnosis in the treatment of pain. In W. C. Wester (Ed.), Clinical hypnosis: A case management approach, pp. 122-142, Cincinnati: Behavioral Science Center, Inc. Publications. Golan, H. P.(1989). Temporomandibular joint disease treated with hypnosis. American Journal of Clinical Hypnosis, 31, 269-274. Hanson, M. L.(1967). Some suggestions for more effective therapy for tongue thrust. Journal of Speech and Hearing Disorders, 32, 75-79. Hanson, M. L.(1969). Tongue thrust in preschool children. American Journal of Orthodontics, 56, 160-169. Hanson, M. L.(1976). Tongue thrust; A point of view. Journal of Speech and Hearing Disorders, 41, 172-184. Hanson, M. L.(1981). Toward a more effective therapy for tongue thrust. International Journal of Orthodontics, 19, 7-12. Hanson, M. L. & Adrianopoulos, M. V. (1982). Tongue thrust and malocclusion: A longitudinal study. International Journal of Orthodontics, 20,9-18. Hanson M. L. & Adrianopoulos, M. V. (1987). Tongue thrust, occlusion and dental health in middle aged subjects: A pilot study. International Journal of Orofacial Myology,
13,3-9. Harden, J. & RydelI, C. M. (1984). A study of changes in swalIowinghabit resulting from tongue thrust therapy recommended by R. H. Barrett. International Journal of Orthodontics, 22, 12-17. Lundeen, D. J., Kurtz, D. D., & Stanley, E. O. (1974). Clinical study of dental caries
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and tongue thrust. Journal of the American Dental Association, 88, 1018-1022. Mason, R. M. & Profitt, W. R. (1974). The tongue thrust controversy: Background and recommendations. Journal of Speech and Hearing Disorders, 39, 115-132. Profitt, W. R. & Mason, R. M. (1975). Myofunctional therapy for tongue thrusting: Background and recommendations. Journal of the American Dental Association, 80, 403411. Ricketts, R. M. (1968). Esthetics, environment and the law of lip relation. American Journal of Orthodontics, 54,272- 289. Secter, I. I. (1961). Tongue thrust and nail biting simultaneously treated during hypnosis: A case report. American Journal of Clinical Hypnosis, 4,51-53. Speidel, T. M., Isaacson, R. J., & Worms, F. W. (1972). Tongue thrust therapy and anterior open bite: A review of new facial growth data. American Journal of Orthodontics, 62, 287-295. Straub, W. J. (1951). The etiology of the perverted swallowing habit. American Journal of Orthodontics, 35, 603-610. Straub, W. J.(196O). Malfunctionof the tongue. American Journal ofOrthodontics, 46,404424. Subtelny, H. & Sekuda, M. (1964). Open bite: Diagnosis and treatment. American Journal of Orthodontics, 50, 337-358. Tepper, H. W. (1986). Tongue thrust correction in one easy lesson. Functional Orthodontics, 3, 40-43. Williams T. R. & Kekocq, K. R. (1980). A simple tongue thrust appliance. Journal of Pedodontics, 4,299-308.
