Health Center » Healthy Dentistry

 
By: Stephen R. Goldberg D.D.S., C.C.N.

"Of course I swallow the right way," you might say, "what a ridiculous question to ask!" But about 20% of all people swallow the wrong way. Even if you think that you know how to swallow-you've been doing it all your life and nobody has ever told you that you were doing it wrong-don't be so sure.

A wise man once said that "you see what you know." The diagnosis or discovery of a deviant or incorrect swallowing pattern is not obvious, and so is often overlooked. There are varying degrees of deviation in swallowing patterns; deviations associated with an oro-facial muscle imbalance.

Do you ever see people whose upper front teeth protrude so much that they resemble cartoon characters like Bugs Bunny or Goofy? Have you ever noticed people whose mouths are almost always open, their lips and front teeth separated? About 2-3% of the population has overt facial and or dental deformities, often resulting from a so-called "tongue thrust" or reverse swallow.

The problem with the term "tongue thrust" is that it indicates that the tongue is the only culprit. In addition to the tongue, our swallowing mechanism involves the lips, cheeks, chin, neck, teeth hydroid (neck) bone and pharynx (throat). The tongue, lips, cheeks and throat muscles all touch the teeth during swallowing, chewing, talking, singing, whistling, kissing and playing a wind instrument. If those four muscle groups are properly aligned before the age of twenty, the result will be an even, well-contoured dental arch-form for the upper and lower teeth.

What causes an incorrect or deviant swallowing pattern? Most swallowing patterns are formed before, during or soon after birth. For example, if a baby is fed incorrectly, or given a hard bulbous pacifier, an incorrect swallowing habit may result. Infants or children given to such activities as thumb or finger-sucking, lip or cheek biting, or mouth breathing, is also at risk of developing this same imbalance.

 

 

 

Try this experiment: Place your thumb in your mouth and swallow. The tip of your tongue can only go straight forward, toward your front teeth and lips. Infants usually suck their thumbs while they sleep, subconsciously training their tongue to move forward instead of upward.

 

In a contest of strength between muscle and bone, muscle will win every time. This is why orthodontic braces work so well. Intermittent pressure on the teeth transmits force to the ligaments and then to the bones that surround the teeth. Likewise, if the tip and/or sides of the tongue touch the teeth during deglutition (swallowing), shifting or tilting of the teeth can result. Don't forget, we all subconsciously swallow about 2,000 times every 24 hours.

 

What characterizes a correct swallowing pattern? During correct swallowing, the tip and middle part of the tongue press on the top of the mouth (palate). Then the back of the tongue contacts the throat muscles, pushing the food backward and down into the esophagus.

 

In a deviant, swallowing pattern, the tip of the tongue presses against the front teeth, the middle part drops down and the back arches up. The lips usually purse and the chin flexes in an effort to help the weak throat muscles to push the food backward. This is called a "reverse swallow" as all the forces for swallowing come from the tip of the tongue, the lips and the chin.

 

Oral Myofunctional Therapy deals with swallowing patterns, and other oral habits including thumb sucking nail biting, lip biting, cheek biting and bruxism (grinding he teeth during sleep). It has been effective in correcting deviant swallowing patterns and/or oro-facial muscle imbalances. In fact, when myofunctional therapy is correctly administered, many orthodontic and periodontal treatment failures can be virtually eliminated.

 

 

A major problem of deviate swallowing is that it often causes orthodontic relapses and periodontal treatment failures. If a person's swallowing habits go uncorrected they can wind up undergoing the same orthodontic treatment again and again. If after periodontal or gingival (gum) surgery has been performed someone's teeth keep shifting and spreading, it is probably the result of abnormal forces placed on the teeth via the tongue. Not only can this excessive pressure against the teeth loosen them, it can also force food particles against and between the teeth, a leading cause of periodontal disease.

 

Oro-facial muscle imbalance can also cause something called "globus hystericus" (a lump in the throat). It appears that most people who choke to death swallow the wrong way. This is due to the flaccid and poorly developed throat and other posterior and other posterior swallowing muscles caused by deviant swallowing.
Swallowing problems can cause a condition called "aerophagia" (swallowing air). Children who often suffer from "tummy-aches" after eating may be accumulating air in their stomachs. When the middle part of the tongue drops down during swallowing, the air bubble between the palate and the tongue is swallowed. The resulting accumulation of air in the stomach can cause severe abdominal pain. This pain symptom may be incorrectly interpreted as a "spastic stomach."

 

Myofunctional therapy has also been shown to shorten the amount of time a patient needs to wear braces, can help tighten the teeth, and help patients retain their previously loose dentures.

 

Swallowing is a habit, and habits can be broken. We stop biting our nails. We stop smoking. We can also stop swallowing incorrectly. But breaking a habit requires a great deal of motivation and desire. The patient must do his or her homework consistently.

 

Myofunctional therapy consists of a series of resistance exercises, word training exercises and subconscious training. The myofunctional therapist merely leads the way for the patient's self-correction. The therapy was developed about thirty years ago, but not taught in any dental college.

 

While the diagnostic, motivational, and counseling techniques of Myofunctional Therapy are vital for preventive dentistry, it is often unavailable. Current dental educational discourages non-mechanical treatments, and so most dentists are not comfortable with motivational therapies that require patients to participate in their own treatment.