Why we should reeducate Atypical Swallowing ?
Primary swallowing is physiological until the age of 3-4 years, but it becomes atypical if it persists once chewing has been established. This persistence causes the orofacial muscles, and particularly the tongue, to apply pathogenic forces to the jaws and teeth.
Such dysfunctions must therefore be treated as soon as they are diagnosed since they greatly influence our orthodontic practice and the results obtained.
From dysfunction to dysmorphia
If the dental arches are not in contact during swallowing, the tongue finds its place between the maxilla and mandible, to come into contact with the labial or jugal mucosa, causing anterior or lateral open bites.
Contraction of the labial and chin muscles holds the mandible in a retrusive position. This is the classic history of functional mandibular retrusion which will become mandibular retrognathism in adolescence. In a similar way, a habitually low tongue position, caused by mouth breathing, a too short frenum, or an anomalous tongue mass, causes projection of the mandible, which will become prognathism.
This low tongue position also leads to a lack of elevation of the lingual dome against the palatal arch to stimulate its growth. The upper arch will not develop physiologically, which will lead to a narrowing of the maxilla: endo-alveolus, or worse: endognathism.
Incorrect tooth position is therefore just a visual indication of a functional problem.
Incorrect tooth position is therefore just a visual indication of a functional problem.
Dysfunction: the force that resists the mechanics of your treatment
Mechanical treatments aim to realign the dentition through application of a constant force. The forces generated by the dysfunction slow down your treatment. Once these are corrected, they will speed up your treatment
From dysfuction to relapse
A source of dread for both practitioners and patients, relapse, even partial, occurs far too often.
« 90% of treatments relapse within 20 years »
Dr R.Little, American Journal of Orthodontics, Mai 1988.
Once the misalignment is corrected, stability can only be obtained if the causes are also removed.
The dysfunctional force that resisted mechanical treatment will lead to further deformations when the resistance is removed.
Ending treatment without reestablishing a functional balance is a sure sign that relapse will occur.
Case of relapse with fix contentions
“Yes, but I can also reach stability with fixed braces retainers”
It’s true that the dentition is held in the ideal position with fixed retainers. This means they have to be worn for life and changed as soon as they fall off so they continue to be effective, which in practice is never the case.
Fixed retainers added to lingual dysfunction can be harmful
Moreover, the constant battle between the forces exerted by the dysfunction and the resistance offered by the fixed retainers will never end. With the teeth no longer able to move, the supporting tissues will suffer the consequences.
Don’t let dysfunctions bring the quality of your work into doubt.
Use the swallowing mechanism as part of your interceptive and preventive treatment.
In 2002, the French National Authority for Health (called the ANAES at the time) issued the following recommendations for our profession:
“An initial checkup should take place before the age of 6 years, during which several anomalies, including functional anomalies, should trigger interceptive treatment.”
Gugino said: “The earlier we treat, the better the patient’s face adapts to our plan; the later we treat, the more we have to adapt to fit the patient’s face.”
Dr. Fellus, a specialist in early treatment, goes further:
“Why will 50% of children never need orthodontic treatment? Let’s try to understand this and act on these factors as early as possible: let’s eliminate the cause before deformations appear.”
Swallowing: to orthodontics and beyond
The consequences of atypical swallowing are not limited to orthodontics. They affect a number of disciplines:
- Speech therapists: Poor lingual positioning often leads to complications in communication or speaking in patients.
- Osteopaths and Physiotherapists: Since the mandible is one of the six postural sensors, their patients often need functional retraining. Atypical swallowing and resultant dysmorphia often affect the body’s overall balance.
- Somnologists and ENT specialists will also be interested in how atypical swallowing affects their patients’ breathing. These patients are also more likely to suffer from infectious diseases, snoring, and sleep apnea.
