Atypical swallowing

Atypical swallowing is a disorder characterized by an abnormal swallowing pattern, most often due to improper tongue positioning. It is a normal condition during the first years of life; however, it becomes problematic if it persists beyond four or five years of age.

During swallowing, food (liquids, solids, and semi-solids) is prepared and transported from the mouth to the stomach through a sequence of voluntary and involuntary movements involving the muscles of the mouth, head, and neck.

In a correct swallowing pattern, the lips remain closed and the teeth are aligned, while the tip of the tongue presses against the hard palate and the body of the tongue elevates toward the central portion of the superior oral cavity. In contrast, patients with atypical swallowing push the tongue against the teeth. In some cases, chin contraction, lip tightening, interposition of the lower lip between the teeth, or head movement may also occur.

The prognosis of atypical swallowing is generally good. Although the learning process may last up to a year, patients usually learn to swallow properly without sequelae or complications. Furthermore, correct swallowing prevents future problems such as speech disorders, dental issues, or digestive conditions.

Symptoms

The symptoms commonly associated with atypical swallowing include:

• Tongue interposition between the teeth during swallowing.
• Mouth breathing.
• Protrusion of the upper or lower jaw.
• Retrusion of the upper or lower jaw.
• Atypical movements during swallowing: head elevation, lip contraction, facial grimacing.
• Noises during swallowing.
• Food leakage during intake.

Causes

Atypical swallowing is caused by multiple independent factors which, when combined, prevent proper swallowing. The most relevant include:

• Chronic oral breathing: the tongue lowers to open the airway and therefore does not elevate to facilitate swallowing.
• Adenoid or tonsillar hypertrophy: enlarged adenoids or tonsils promote oral breathing.
• Ankyloglossia: a short lingual frenulum that limits tongue mobility.
• Orofacial hypotonia: reduced muscle strength in the tongue, lips, and cheeks.
• Malocclusion: initially a consequence that later becomes a causative factor, creating a vicious cycle that perpetuates the abnormal swallowing pattern.
• Loss of anterior teeth or spacing between anterior teeth.

Risk factors

The risk of atypical swallowing increases in the following situations:

• Prolonged use of a pacifier or bottle.
• Thumb sucking, which favors malocclusion.
• Excessive use of puréed or overly soft foods without timely introduction of solid foods.
• Ogival (narrow and high-arched) palate.
• Maxillary malformation.
• Family history of malocclusion or atypical swallowing.

Complications

Persistent atypical swallowing in adulthood may lead to:

• Dental misalignment.
• Diastema: spacing between teeth.
• Abnormal development of the palate and jaws.
• Malocclusion: defective occlusion of the dental arches.
• Narrowing of the palate.
• Difficulty pronouncing certain phonemes (/r/, /n/, /d/, /t/, /f/, /s/).
• Digestive disorders resulting from improper mastication.
• Oral dryness.
• Increased risk of snoring.
• Possible entry of food into the airway, with risk of choking.
• Alteration of facial aesthetics.

Prevention

Prevention should focus on ensuring nasal breathing and promoting appropriate swallowing development during early childhood, when children transition out of infancy.

Additionally, the following recommendations should be observed:

• Avoid bottle and pacifier use after two years of age.
• Prevent thumb sucking.
• Encourage the transition to solid foods by promoting bilateral chewing from six months of age.
• Promote adequate lip closure.

Which physician treats atypical swallowing?

Atypical swallowing is diagnosed and treated collaboratively by specialists in Speech-language therapy, Otorhinolaryngology, and Dentistry.