Research Article

A Modified Bluegrass Appliance for

Sarabjeet Singh
Sandhu, Taruna Puri, Interception of Tongue Thrust Habit –
Navreet Sandhu,
Manurashmi Sharma A Clinical Innovation
Correspondence to:
Dr Taruna Puri Introduction
E-mail Id: tarunapuri5@ The relationship between form and function of the stomatognathic system has been
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studied extensively by many investigators. It has been suggested that the size,1–3
function,4–6 and posture7–9 of the tongue might have some effects on the surrounding
oral environment. However, it has always been a matter of debate whether tongue
function would lead to malocclusion or it merely adapts to local changes of occlusion.
The tongue thrusts forward to gain anterior valve function in order to prevent the
escape of food or liquids as suggested by Proffit.8 However, the reverse is not always
true. A tongue thrust swallowing is often present in children with good anterior
occlusion.

Palatal crib with or without spurs is commonly used as a habit-breaking appliance for
tongue thrust habit. But there are problems associated with it like difficulty in speech
and mastication, and iatrogenically self-inflicted injuries, which can occur with this type
of appliance. Therefore, this appliance is regarded as a punitive rather than a supportive
appliance. This article describes the use of a modified bluegrass appliance for
interception of tongue thrust habit in a patient with hyper divergent growth pattern.

Fabrication of the Appliance

As hay rake or cage-type of appliances are a form of punitive appliances, it was decided
to intercept the habit with a bluegrass appliance. As the patient who reported to us was
having a hyper divergent growth pattern (Fig. 1), it was decided to modify the bluegrass
appliance. The patient were explained the purpose of the appliance and was positively
motivated regarding the importance of the habit interception.10

In this modified appliance, it was decided to use both an acrylic roller (Fig. 2,a) for habit
interception and a transpalatal arch (Fig. 2,b) kept 3–4 mm away from the palate. As the
transpalatal arch was kept sufficiently away from the palate, it aided in intrusion of
molars because of the tongue pressure. Also as the patient had a vertical growth
pattern, it was desirable to avoid any type of extrusive effect on the molars. As the
patient had a missing maxillary left molar it was decided to solder wire spurs (Fig. 2,c)
distal to maxillary left second premolar and mesial to maxillary left second molar to
prevent their drift into the extraction space of maxillary first molar. Both maxillary right
first and second molars were banded and connected to the appliance to increase the
How to cite this article: anchorage.
Sandhu SS, Puri T, Sandhu
N. A Modified Bluegrass The patient was instructed to turn the roller from front towards back with her tongue 4
Appliance for Interception
of Tongue Thrust Habit-A
times a day for a period of 15 minutes. The patient was comfortable with the roller and
Clinical Innovation. J Adv she was positively motivated for the interception of her tongue thrust habit. The roller
Res Dent Oral Health served as a reminder instead of a hay rake or a cage type of appliance which serve as a
2016; 1(3&4): 1-3. form of punishment.

ISSN: 2456-141X

© ADR Journals 2016. All Rights Reserved.

Sandhu SS et al. J. Adv. Res. Dent. Oral Health 2016; 1(3&4)

Figure1.20-Year-Old Female Patient with Convex Soft Tissue Profile, Tongue Thrust
Habit and High FMA before Treatment

A modified bluegrass appliance (Fig. 2) can be used for habit interception.

Figure 2.Modified Bluegrass Appliance. a: Acrylic Roller for Habit Interception, b: Transpalatal
Arch Kept 3–4 mm Away from Palate, c: Soldered Wire Spurs

Figure 3.Appliance Cemented into Patient’s Mouth

ISSN: 2456-141X 2
J. Adv. Res. Dent. Oral Health 2016; 1(3&4)
Advantages
a. The blue grass appliance as given by Haskell and
Mink10 is easy to wear, and did not pose problems
such as difficulty in speech and eating,
iatrogenically self-inflicted wounds, tendency to get
mutilated or destroyed which are associated with
traditional palatal cribs.
b. Modified bluegrass with a transpalatal arch
component kept 3-4 mm away from the palate
avoided the extrusive effect on the molars.
c. Neuromuscular activity was modified to normalize
the tongue position. Within a few days, the tongue
established a new non-harmful habit of playing with
the roller. Hence, this appliance worked through
counter conditioning response to the original
conditioned stimulus.
d. The roller did not obstruct while eating, presented
minimum disturbances with speech, and stimulated
tongue movement.
Conclusion
Hence, modified blue grass appliance is a non-punitive
appliance and esthetic, and patient can wear it
comfortably. It can be given as a supportive therapy as it
requires no reminding or bribing, and parents can be
freed of anxiety and frustration. It does not interfere
with patient’s growth and eliminates the habit with
limited complications.
Conflict of Interest: Nil
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Date of Submission: 09th Jul. 2015
Date of Acceptance: 11th Feb. 2016