Nine years old, forward tongue thrust

Sandra, I had a patient yesterday.  Nine years old, forward tongue thrust. Severe allergies and asthma.  These are under control as much as they are going to be. Age 9. To see orthodontist soon.  So, is this one that I take as far as possible knowing it will not correct totally?  Do I go ahead with therapy making adjustments with goals? 


Hi K,

It is a difficult question because “it depends”…

You say the asthma and severe allergies are as under control as they are going to be.  I’m not sure what that means.  Is he able to breathe consistently through his nose.  Is at least one nare patent at all times?  Are the allergies seasonal?  We have to always be certain not to ask of the patient what cannot possibly be done.  If you have ruled out all obstacles to treatment, then go ahead and initiate it.

You should not have to make any adjustments as long as he can do the above.


Swallow Right manual

Posted by | Feb 28, 2015 | No Comments

I just ordered the Swallow Right manual. Do you think it will help with this feeling that I have that I do not know how frequent and long to have the patients work each exercise?


Must I wait until a palatal expander is taken out to begin therapy?

Posted by | Feb 15, 2015 | No Comments

I used to take kids who could suction flat with the expander, but there are too many other considerations.


RDH not too sure about charges

Posted by | Jan 30, 2015 | No Comments

I’m not too sure about charges. So far I’m thinking of working these cases without charging.


Can adult undergo expansion?

For adult expansion, longer periods of retention are needed to maintain the expansion.



at times her tongue was in and her lisp were together (which suggests to me that there are no nasal breathing issues). Her tonsils were not visible (small???). She seemed to easily be able to breathe through her nose. Parents report that she does snore a little. Her cheeks were pretty “puffy” looking, but she is a young child so it seemed like it could be just a baby face. On the inside of her mouth, her cheeks seemed really “thick”.


It is fair to start patients when I will be leaving in 3-6 months.

Posted by | Dec 15, 2014 | Tags:
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“Because you know Phase One, most especially proficiency exam #1, you can build a decent foundation for a patient and then, even if they move or you move, they have the most important basic skills.


When apraxia rules all… it explains many of the OM symptoms we see

Hi Sandra, So glad that you were able to meet with my patient. I have been perplexed about him. His OM issues seem to be compounded by his difficulty with nasal breathing (polyps), poor motor planning, and weak sensation around his lips and tongue. For sure…at the very least! My basic results from exam: 1. […]


8-year old girl with a pretty severe tongue thrust and speech errors on all the sibilants plus /r/.

I recommended a lingual frenectomy, which was done last week. She is coming back to therapy Wednesday, and I was wondering if there are specific exercises that should be done post-frenectomy to avoid scar tissue from forming.


Little girl who got her tonsils out unable to say “H”

Posted by | Oct 30, 2014 | Tags: ,
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A nice “flow” of conversation will help to embed that “h” sound within words and phrases rather than just saying it at the beginning.

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