Lisp Remediation With Anterior Open Bite

By Pam Marshalla

anterior_open_biteQ: I have a student with a frontal lisp and an anterior open bite. Can you suggest compensatory strategies to help him?

If he is going to get his teeth fixed I might wait to do anything until after he teeth are fixed.

If he is not going to get his teeth fixed, then the compensation simply involves getting him to produce the best sibilants he can given his dental structure.

He needs to stabilize the tongue at the back-lateral margins.  This will draw the tongue in behind the front teeth.

Then you have to experiment with where to place the tongue-tip to obtain the best sound you can.  Most therapists tell me that the best sounds that can be obtained with an anterior open bite are one of two––

  1. Position the tongue-tip so that it points toward (but does not touch) the upper central incisors.
  2. Position the tongue-tip down so that it anchors against the lower central incisors and arches upward to create a  narrow groove between the body of the tongue and the upper front teeth.

5 thoughts on “Lisp Remediation With Anterior Open Bite”

    1. An anterior open bite may or may not be related to a tongue thrust. Sometimes these things co-occur, and sometimes they don’t.

      If an anterior open bite is noticed, and if there is a tongue thrust (I assume you mean a reverse or infantile swallow pattern), then it would be my personal approach to address both simultaneously.
      Have the orthodontist put the braces on AND enroll him in a program to correct his swallow.

      Not everyone agrees with this approach, however. Some prefer to do them in sequence as you suggested, and many clients receive the opposite sequence.

  1. I have 4.5 year old with an open bite and interdental lisp. If a few sessions trialling a clear /s/ sound does not work with the above methods, do you recommend waiting until they’re a bit older/waiting to see what happens when they get their new teeth?

    I am finding it challenging getting an /s/ with the tongue back, he’s trying but I’m finding that because of the open bit his tongue is always coming out and if it’s not interdental it’s dentalised.

    1. I know this above comment was a long time ago, but I have a similar question. I have been working with a 4, now 5 year old for one year and she is still only able to achieve approximations for /s/ with her open bite. She was still using a paci when I started seeing her at 4 but apparently not any more. but the child told me she still sucks her thumb. Should I discharge now? or keep plugging along?

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