Ask A Therapist: Bite Block & Tongue Depressor Questions

Posted by Deborah Grauzam on

I have a student who is using the red bite blocks. He just started. When I put the bite block #2 between his teeth he slides them over. Is this normal or should I reposition them?

I have another student who is having a very hard time holding the tongue depressor between his lips. He has a hard time dissociating between his lips and his tongue and jaw. His tongue is retroflex for l. He is currently working in l in the final positing of words and is having a hard time bringing the tongue forward and not back. Any advice?




Hi Rebecca

I would definitely reposition. I often have to have the patient bite a couple of times until it is positioned correctly especially with patients with severe weakness. You may even want to practice the biting without the bite block for correct position first and then go in with the bite block. Sometimes that helps as well. 

As far as the second part of the question, I would make sure that I have addressed any jaw weakness first. That is typically the foundation of the issue. As far as the tongue placement I would work on stimulating with the toothette the forward placement of the tongue. I would touch with the toothette on the alveolar ridge where you want the tongue tip to touch and then I would touch the tip of the tongue with the toothette. You can use vibration with the toothette if your client will accept that. This has helped many patients I have worked with find the appropriate placement. 

Please let me know if you have any other questions. We are always here and happy to help.




Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 11 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy.  She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

bite block exercises bite block hierarchy Bite Blocks dissociation jaw grading bite blocks jaw weakness Liz Smithson OPT OPT exercises oral motor exercises retroflex tongue depressor tongue depressor exercise Toothettes

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  • Georgia,

    Jaw sliding is a sign of jaw weakness. I would revisit bite blocks and try to work through those again because the progression may have been too quick. Look for subtle cues of weakness with bite blocks such as leaning forward, shoulder movement or jaw movement.

    Technically, tongue protrusion is acceptable in straw hierarchy until straw #4, however I would continue to work on other things that work on tongue retraction. I would work on open cup drinking with the cutout cup and any other activity where the client finds tongue retraction, and then reoffer straws. Encourage tongue retraction before placement of the straw in the mouth to increase use of the appropriate motor plan.

    Let us know if there is anything else we can do for you! We are always happy to help.


    TalkTools on
  • Hi Georgia,

    Thank you for your question. I need to forward this to a therapist and will email you back with an answer.


    TalkTools on
  • If a client has a jaw slide, and has successfully worked through all of the bite blocks, would you still carry on using them? I am also using chewy tubes, and using bite block #1 during the production fo /t/.
    If a client is protruding the tongue during a swallow, would you still progress with the straw program, or would you stay on straw #1 until he could swallow without protruding?

    Georgia Jammine on

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