Can Aligners Fix an Open Bite Caused by Adult Tongue Thrust?

An anterior open bite caused by tongue thrust is one of the more challenging orthodontic problems because the underlying cause — tongue posture — must be addressed alongside tooth movement, or the bite will reopen. Modern clear aligners combined with myofunctional therapy can effectively close adult tongue-thrust open bites with results that remain stable. This guide explains the comprehensive approach needed for lasting success.

Aligners for Tongue-Thrust Open Bite: Quick Guide

Modern clear aligners can effectively close adult tongue-thrust open bites when combined with myofunctional therapy to retrain tongue posture. Without addressing the tongue habit, results relapse. Treatment typically takes 12-24 months with myofunctional therapy continuing afterward. Success rates good when patient commits to both components.

Understanding Tongue-Thrust Open Bite

What it is:

Anterior open bite:

• Front teeth don't touch when biting back teeth together.
• Gap between upper and lower front teeth.
• Visible with bite closed.
• Various severities.

Tongue thrust:

• Tongue pushes between teeth during swallowing.
• Tongue rests between teeth.
• Pressure prevents teeth meeting.
• Continuous force opens bite.

Connection:

• Tongue position prevents normal eruption.
• Pressure keeps teeth apart.
• Bite stays open.
• Self-perpetuating cycle.

Other causes of open bite:

• Skeletal patterns.
• Thumb sucking (childhood).
• Mouth breathing.
• Habits (pencil chewing, etc.).

Why It's Challenging

Particular difficulties:

Active force opposing treatment:

• Tongue continuously pushes teeth apart.
• Treatment moves teeth together.
• Tongue undoes work.
• Cycle continues.

Without addressing cause:

• Treatment fails.
• Bite reopens.
• Frustration for patient.
• Wasted investment.

Habit modification difficult:

• Tongue posture unconscious.
• Lifelong patterns.
• Requires conscious retraining.
• Slow progress.

Comprehensive approach essential:

• Tooth movement (aligners).
• Habit modification (myofunctional therapy).
• Sometimes surgery.
• Long-term retention.

Aligner Treatment

How they help:

Tooth movement:

• Extrude front teeth (bring down/up).
• Sometimes intrude back teeth.
• Close the open bite.
• Achieve contact.

With attachments:

• Specifically designed for vertical movements.
• Force application controlled.
• Effective for many cases.

Treatment planning:

• 3D simulation showing movements.
• Sequence of aligners.
• Realistic expectations.

Compliance critical:

• 22 hours daily wear.
• Without wear: no progress.
• Patient compliance essential.

For aligner options, see adult braces.

Myofunctional Therapy

The essential complement:

What it is:

• Exercises to retrain tongue posture.
• Therapist-guided programme.
• Specific exercises for tongue, lips.
• Daily practice required.

Goals:

• Tongue rests on palate (correct position).
• Tongue swallows correctly (without pushing teeth).
• Mouth closed at rest.
• Nose breathing primarily.

Programme typical:

• Weekly sessions with therapist.
• Daily home exercises.
• 6-12 months programme.
• Lifelong habits.

Without it:

• Treatment fails typically.
• Relapse within months/years.
• Bite reopens.
• Frustration.

With it:

• Stable results.
• Tongue retrains.
• Teeth stay together.
• Long-term success.

When Aligners Work Best

Suitable cases:

Excellent candidates:

• Mild-moderate open bite (2-4mm).
• Tongue-thrust primary cause.
• No skeletal component.
• Compliant patient.
• Committed to myofunctional therapy.

Good candidates:

• Moderate open bites.
• Combined habit and dental.
• Comprehensive treatment plan.

Limited suitability:

• Severe skeletal open bite.
• Wide open bites (5mm+).
• Often need surgery.
• Very non-compliant patients.

Treatment Process

What to expect:

Initial assessment:

• Comprehensive examination.
• Bite analysis.
• Tongue posture evaluation.
• Myofunctional therapy referral.
• Photographs.
• 3D scans.
• Sometimes lateral cephalometric X-ray.

Phase 1: Myofunctional therapy:

• Often starts before aligners.
• 6-12 weeks initial training.
• Establish tongue posture.
• Foundation for treatment.

Phase 2: Aligners + continued therapy:

• Aligners begin with retrained tongue.
• Therapy continues throughout.
• Coordinated care.

Phase 3: Retention:

• Lifelong retention.
• Continued myofunctional habits.
• Monitoring for relapse.
• Address issues promptly.

Treatment Time

Typical durations:

Mild cases:

• 12-18 months aligners.
• 6-12 months myofunctional therapy.
• Coordinated treatment.

Moderate cases:

• 18-24 months aligners.
• Often entire treatment.
• Comprehensive approach.

Complex cases:

• 24+ months.
• Sometimes combined with surgery.
• Specialist care.

For relapse prevention:

• Lifelong habit maintenance.
• Periodic monitoring.

Cost Considerations

Investment perspective:

Aligner treatment: £4,000-£7,000 for open bite cases.

Myofunctional therapy: £800-£2,500 for full programme.

Combined treatment: £5,000-£10,000.

For comparison:

• Surgical correction: £10,000-£20,000+.
• Failed orthodontics without therapy: cost without benefit.

Long-term value:

• Stable results worth investment.
• Functional improvement lasting.
• Better than repeated failed treatment.

For ongoing care, see dental membership.

Surgical Options

When needed:

For severe skeletal open bite:

• Orthognathic surgery required.
• Major undertaking.
• Best results for severe cases.
• Combined with orthodontics.

Procedure:

• Upper jaw surgically repositioned.
• Sometimes lower jaw too.
• Aligners before and after surgery.
• Total treatment: 18-30 months.

For most adult cases:

• Aligners + myofunctional: sufficient.
• Surgery: only severe cases.
• Discussion of options.

Special Considerations

For patients with TMJ issues:

• Open bite affects TMJ.
• Treatment often improves symptoms.
• Comprehensive approach.

For patients with speech issues:

• Tongue thrust can affect speech.
• Speech therapy sometimes alongside.
• Improvement with treatment often.

For mouth breathers:

• Address nasal obstruction.
• ENT consultation sometimes.
• Allergies treatment.
• Habit modification.

For long-term thumb suckers:

• Even after stopping habit.
• Open bite persists.
• Same treatment approach.
• Often good outcomes.

Combined Treatments

For comprehensive care:

Aligners + myofunctional + restorative:

• Cosmetic improvements after — see cosmetic dentistry.
• Comprehensive smile design.

Aligners + myofunctional + ENT:

• Address breathing issues.
• Comprehensive approach.

Aligners + myofunctional + speech therapy:

• For speech-affected patients.
• Coordinated care.

Aligners + general dentistry care:

• Address other dental needs — see general dentistry.
• Comprehensive oral health.

Long-term Stability

Critical considerations:

With proper protocol:

• Stable long-term.
• Tongue retrained.
• Habits established.
• Retention maintained.

Without proper protocol:

• Relapse common.
• Often complete relapse.
• Wasted investment.
• Frustration.

Lifelong commitments:

• Tongue posture awareness.
• Mouth closed at rest.
• Retention wear.
• Periodic check-ups.

Address contributing factors:

• Allergies affecting nasal breathing.
• Adenoid issues.
• Restorative needs affecting tongue position.

Key Points to Remember

• Aligners alone don't fix tongue-thrust open bites.
• Myofunctional therapy essential to address underlying cause.
• Treatment typically 12-24 months combined.
• Without addressing tongue: bite reopens.
• Severe skeletal cases may need surgery.
• Lifelong habits and retention essential for stability.

Frequently Asked Questions

How do I know if I have a tongue thrust?

Several signs:

Visual signs:

• Open bite (front teeth don't touch)
• Tongue visible at front when speaking
• Tongue protrudes when swallowing
• Spaced teeth sometimes

Functional signs:

• Difficulty with certain sounds (s, z, sh, ch)
• Lisp sometimes
• Difficulty swallowing pills
• Front teeth wear unusual

Habits:

• Mouth breathing often
• Open mouth at rest
• Allergies chronic
• Nasal congestion

Self-assessment:

• Look in mirror: where is your tongue?
• Should rest on palate
• Often rests between teeth in tongue-thrusters
• Watch yourself swallow water

Professional assessment:

• Dental examination: open bite signs
• Speech therapist: pattern analysis
• Myofunctional therapist: comprehensive evaluation
• Sometimes: video swallow study

Common scenarios:

• Childhood thumb sucking
• Tongue-tie (sometimes)
• Allergies causing mouth breathing
• Inherited patterns
• Combination factors

For your case:

• Mention to dentist
• Describe symptoms
• Ask about myofunctional referral
• Comprehensive assessment

If you have open bite and suspect tongue thrust, mention to dentist for specific evaluation. Earlier addressing leads to better outcomes.

Why is myofunctional therapy so important?

The underlying cause:

The fundamental problem:

• Tongue thrust caused open bite
• Tongue position keeps it open
• Without changing tongue: bite reopens
• Treatment addresses symptom, not cause

What myofunctional therapy does:

• Retrains tongue posture
• Establishes correct swallowing
• Develops mouth-closed rest position
• Promotes nose breathing
• Lifelong habit changes

Without it:

• Aligners close the bite
• Tongue continues thrusting
• Bite reopens within months/years
• Wasted investment
• Frustration

With it:

• Tongue retrained
• Stable results
• Long-term success
• Worth investment

Programme typical:

• Weekly sessions with therapist
• 6-12 months programme
• Daily home exercises (15-30 minutes)
• Lifelong habit awareness

Patient commitment:

• Significant time investment
• Daily practice
• Patience with slow progress
• Long-term thinking

Why people skip it:

• Cost consideration
• Time commitment
• Don't understand importance
• Frustration with slow progress
• Discomfort with exercises

Consequences of skipping:

• Treatment failure likely
• Relapse typical
• Repeat treatment needed
• Often worse long-term
• Money wasted

Realistic perspective:

Myofunctional therapy isn't optional for tongue-thrust open bites — it's essential. Discussion of importance with practitioner before starting treatment. Better not to start than to skip the essential component.

Will treatment help my speech if I have a lisp?

Often yes:

The connection:

• Tongue position affects speech
• Open bite allows tongue to protrude
• 'S' sounds distorted (lisp)
• Other sounds affected sometimes

With treatment improvements:

• Closed bite = tongue stays in
• Better sound production
• Lisp often improves
• Sometimes dramatic improvement

Combined with speech therapy:

• Faster speech improvement
• Better outcomes
• Long-term results
• Coordinated care

Realistic expectations:

• Often significant improvement
• Sometimes complete resolution
• Sometimes mild lisp persists
• Better than no treatment

For severe lisps:

• Speech therapy alongside
• Myofunctional therapy helps
• Comprehensive approach
• Often good outcomes

Patient experiences:

• "My lisp is so much better"
• "People understand me clearly now"
• "I'm not self-conscious anymore"
• "Worth treatment for speech alone"

Adults vs children:

• Children: Easier improvement
• Adults: Slower but possible
• Both: Worth treatment
• Adults: Often surprised by improvement

For professionals:

• Public speaking improvement
• Career confidence
• Worth investment
• Quality of life improvement

For your case:

• Discuss speech concerns with dentist
• Consider speech therapy referral
• Comprehensive approach
• Realistic expectations

If lisp is significant concern, comprehensive treatment including speech therapy alongside aligners and myofunctional therapy provides best outcomes. Many adults are pleased with speech improvements.

Can I just have surgery instead of aligners and therapy?

Sometimes yes, often no:

When surgery indicated:

• Severe skeletal open bite (5mm+)
• Significant facial imbalance
• Conservative treatment unlikely to succeed
• Combined with orthodontics

Surgical procedure:

• Orthognathic surgery: jaw repositioning
• Major undertaking
• Recovery: months
• General anaesthetic
• Hospital stay

Pros of surgery:

• Faster transformation (after recovery)
• Severe cases treatable
• Skeletal correction
• Sometimes dramatic improvement

Cons of surgery:

• Risks: infection, nerve damage, anaesthesia
• Cost: £15,000-£30,000+
• Recovery: months of dietary restriction
• Tongue thrust may continue (still need myofunctional)

Combined approach often:

• Aligners before surgery
• Surgery for skeletal correction
• Aligners after for fine-tuning
• Myofunctional throughout
• Total time: 18-36 months

For most adult cases:

• Aligners + myofunctional: sufficient
• Surgery for severe cases only
• Discussion of options
• Realistic assessment

Surgical pathway involves:

• Specialist orthodontist consultation
• Maxillofacial surgeon consultation
• Comprehensive planning
• Insurance sometimes covers
• NHS sometimes funds

For your case:

• Comprehensive assessment determines need
• Discussion with specialists
• Realistic options presented
• Personal preferences considered

Realistic perspective:

For mild-moderate open bites, conservative treatment usually preferred. For severe skeletal cases, surgery often necessary. Comprehensive consultation provides specific recommendation for your case.

Will my children inherit this if I have tongue thrust?

Mixed answer:

Genetic component:

• Some inherited tendency
• Skeletal patterns inherited
• Tongue size inherited
• Family history common

Environmental factors:

• Pacifier use prolonged
• Thumb sucking habits
• Mouth breathing (allergies)
• Bottle feeding patterns
• Modifiable factors

For your children:

• Watch for habits
• Address thumb sucking by age 3-4
• Treat allergies
• Encourage nose breathing
• Limit pacifier use after age 2

Early intervention:

• Pediatric dentist by age 1
• Address habits early
• Myofunctional therapy for children effective
• Better outcomes than adult treatment

Signs to watch:

• Open bite developing
• Tongue protrusion when swallowing
• Mouth breathing habit
• Lisp developing
• Speech issues

Prevention strategies:

• Myofunctional therapy prophylactically
• Address allergies promptly
• Limit pacifier/thumb after age 2
• Encourage good habits
• Regular dental care

Treatment if needed:

• Children: Easier treatment
• Better long-term outcomes
• Skeletal modification possible
• Don't wait until adult

For your case:

• Be vigilant with children
• Don't repeat your patterns
• Early intervention
• Better outcomes for them

Realistic perspective:

While there's some inherited tendency, environmental factors are very influential. Vigilance with your children's habits and early intervention if signs develop can prevent the same issues you experienced.

How long until my open bite closes during treatment?

Variable but progressive:

Treatment timeline:

• First 3 months: minor visible change
• Months 3-6: noticeable closing
• Months 6-12: significant closing
• Months 12-24: completion

Visible progress:

• Early: subtle changes
• Mid-treatment: clear progress
• Late: final refinements
• Complete: contact achieved

Photo comparison:

• Before: open bite visible
• 3 months: minor improvement
• 6 months: significant improvement
• 12 months: substantial closing
• 18-24 months: completed

Patient experience:

• "I can see progress monthly"
• "Friends notice changes"
• "My bite feels different"
• "Excited about progress"

Factors affecting speed:

• Severity: greater = longer
• Compliance: poor = slower
• Tongue retraining: progress depends on habit change
• Age: adults slower than children

Sometimes plateaus:

• Tongue thrust continuing
• Insufficient wear time
• Need to reassess
• Address issues

For optimal progress:

• 22 hours daily wear
• Myofunctional therapy consistent
• Regular check-ups
• Address issues promptly
• Patience with process

Final result:

• Functional contact of front teeth
• Improved speech
• Better chewing
• Confidence boost
• Worth the wait

For your case:

• Consultation provides realistic timeline
• 3D simulation shows expected progress
• Regular progress assessments
• Adjustments as needed

For specific timeline, comprehensive consultation provides personalised estimate based on your specific case severity and complexity.

Conclusion

Modern clear aligners can effectively close adult tongue-thrust open bites, but only when combined with myofunctional therapy to address the underlying cause. Without retraining tongue posture, results inevitably relapse. Comprehensive treatment over 12-24 months with continued attention to tongue habits provides stable, long-lasting results.

For specific assessment, comprehensive consultation evaluates open bite severity and treatment options. Dental symptoms and treatment options should always be assessed individually during a clinical examination.

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Disclaimer:

This article is intended for general educational purposes only and does not constitute personalised dental advice. Individual diagnosis and treatment recommendations require a clinical examination by a qualified dental professional.

Written Date: 28th April 2026

Next Review Date: 28th April 2027