What is atypical swallowing?

A person is said to have “atypical swallowing” when they position their tongue or swallow erroneously. In fact, these people tend to swallow while exerting forward pressure with their tongue and on their teeth. Moreover, the tongue in resting position (whenever the person is not speaking, eating, etc.) is also in contact with the lower teeth instead of being positioned on the hard palate (behind the upper incisors).

However, it is to be noted that atypical swallowing is considered normal for babies and young children. It is only with growth that the swallowing of the individual reaches a certain maturity, thus implying a natural positioning of the tongue on the hard palate, behind the upper incisors. However, in some cases, this transition is not completed which manifests in the individual’s swallowing and speech (example: lisping).   

What are the main causes and the clinical signs?

Certain factors can cause or maintain atypical swallowing:

• Mouth breathing which may come from several factors such as nasal congestion, a chronic cold rhinitis, allergies, large tonsils, etc.
• Bad habits such as thumb sucking or sucking other objects (example: nail biting, lip licking, or teeth grinding, etc).
• Certain anomalies of the oral-facial zone such as having a short frenum, a high-arched palate, or malocclusion which may prevent the tongue from adequately positioning itself.
• The lack of adaptation of the tongue to new oral structures in the case of orthodontic treatment.

Thus, the signs or symptoms of atypical swallowing relating to pressure from the tongue on the teeth would be:

• The need to have an open mouth when in resting position or when the person swallows.
• Cracked lips.
• A protruding tongue during speech, swallowing or even in resting position.
• Excessive drooling.
• When swallowing, a tongue held between the teeth, contracted lips and a downward movement of the head may be observed.
• Difficulty in chewing and swallowing certain foods in an effective manner (example: swallowing pills).
• The development of dental malocclusion or bad positioning of the teeth.
• The deceleration of the orthodontic treatment and possible recurrences after cessation of treatment.
• The presence of articulation disorders relative to the production of sounds with the tongue, notably the sounds « s, z, ch, and j ».

How to act?

In the majority of cases, patients which consult with a speech therapist are referred by a dentist or an orthodontist. The speech therapist will thus have the job of evaluating the oral-facial structures and their function as well as the position of the tongue when resting, swallowing and articulating. During the examination, the speech therapist also looks for possible causes to atypical swallowing (example: mouth breathing, bad habits, etc.). This global and thorough examination thus helps the speech therapist choose the modality of the follow-up. The age of the patient is imperative, given that patients must be conscious and invested in the treatment. Moreover, in some cases, the intervention of a speech therapist must firstly be centered on the elimination of factors that exacerbate atypical swallowing (example: bad habits, respiratory issues, etc.). A good control of these factors would help the speech therapist put in place new mechanisms with regards to the positioning of the tongue when resting, speaking and swallowing.