Tongue thrust is referred to as a habit in dentistry and a phenomenon in psychiatry. There is, however, no clear dividing line between the two fields.
In dentistry, tongue thrust is identified as a cause of apertognathia. In addition, tongue thrust patients use the tongue in a compensatory action to close the gap between the front teeth during articulation and swallowing.
In psychiatry, tongue thrust is characterized as a somatic expression of brain wave irregularity or functional disability.
We report a rare case in which prominent tongue thrust, a condition of the oral cavity, was treated on a psychiatric basis.
The patient was a female aged 24 years and 7 months. She developed frequent tongue thrust when speaking after having received dental treatment. She had difficulty speaking fluently and the dentist, suspecting apertognathia, introduced her to the department of orthodontics.
The tongue thrust was evident during the first examination to the extent that the tongue protruded visibly beyond the front teeth. The tongue thrust did not appear to be dependent on the situation.
The orthodontic examination found mild skeletal apertognathia but, judging from our own clinical experience, the tongue thrust exceeded the requirements of compensatory action.
As the tongue thrust did not appear to be due to the occlusion, an examination at our department of psychiatry was also requested on the same day. The psychiatric department found an unusual brain wave pattern and ameliorated the tongue thrust and brain disorder by drug prescription.
In this case, the particular symptoms of the oral cavity enabled us to judge that the patient might need psychiatric assistance. The orthodontist was able to recommend a course of action, on the basis of the state of occlusion and patient's main complaint, which led to improvement.
It is, however, extremely difficult for dentists, who have little knowledge of methods of psychiatric examination and testing, to identify such patients with confidence. We believe that it is important for dental treatment to be considered in a comprehensive manner that includes the psychosomatic perspective.
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