The right to socializing and enjoying food takes a new and significant step forward. The “Oltre la Pizza” project, born from the collaboration between the Salvatore Nigrelli Association, Io Sano, and Antica Pizzeria Da Michele, officially announces its expansion to locations in Rimini and Genoa.

Following its success at previous locations in Campania, the initiative aimed at breaking down dietary barriers for people with dysphagia is now being rolled out in Emilia-Romagna and Liguria as well. At the Rimini and Genoa locations of Antica Pizzeria Da Michele, it is now possible to order a complete meal for people with dysphagia—offered free of charge—including pizza, a beverage, and dessert, to be enjoyed comfortably at a table with loved ones or picked up as takeout.

“Oltre la Pizza” is not just a nutritional solution, but an act of social inclusion. Thanks to the technology and products provided by Io Sano, patients with swallowing difficulties can enjoy meals—in this case, pizzas—that retain their full sensory and nutritional qualities while ensuring maximum safety. The goal is to allow anyone, regardless of their medical condition, to enjoy the experience of dining out at one of the world’s most iconic pizzerias.

Alessandro Condurro and Francesco De Luca, Directors of Michele in the World, say: “After Aversa, Pompeii, Caserta, Salerno, and our historic location in Naples, we are proud to bring ‘Oltre la Pizza’ to Rimini and Genoa. Our philosophy has always been to make everyone feel at home. With this initiative, our pizza and the atmosphere of our restaurants truly become universal. It’s not just about offering a meal, but about restoring the joy of sharing to those who are often excluded from it for health reasons. Seeing all members of a family eat together, without anyone having to give up the pleasure of dining out, is the most beautiful achievement for our brand.”
Renata and Nadia Nigrelli, respectively president and vice president of the Salvatore Nigrelli Association, continue: “This initiative stems from a personal experience, linked to the story of Salvatore Nigrelli and his life with ALS, which allowed us to understand firsthand what it means to face dysphagia every day. For this reason, the expansion of the project represents for us not only an important milestone, but a concrete commitment to transforming a difficult experience into an opportunity for inclusion and sharing for many families.”
Giovan Battista Varoli, Sole Director of Io Sano – solutions for dysphagia, concludes: “The goal of creating a product for people with dysphagia that evokes the traditional flavors of Neapolitan pizza stems from the desire to reconcile the health of those who are most vulnerable with tradition and, therefore, gastronomic quality. The homogenized Neapolitan pizza combines a safe texture with the assurance of nutritional value, but above all with the taste and experience of pizza. Pizza—and we do not use capital letters by chance—is identity, history, goodness, beauty. Being called upon to collaborate on a project that celebrates it to help vulnerable people is a source of pride for us, but above all of deep and genuine gratification. It is important that those suffering from dysphagia can once again enjoy pizza, without their condition posing a limitation or causing discomfort. Thank you to Antica Pizzeria Da Michele and the Salvatore Nigrelli Foundation for involving us. A heartfelt and lasting thank you.”
The service is available immediately at the participating locations and remains available at the locations in Naples, Aversa, Pompeii, and Salerno.

L’Antica Pizzeria Da Michele Rimini: 6 Via Mentana

L’Antica Pizzeria Da Michele Genoa: 120 Via XII Ottobre

The IDDSI (International Dysphagia Diet Standardisation Initiative) framework remains a benchmark for healthcare and food service professionals involved in the nutritional management of patients with dysphagia.

Several years after one of the most significant international conferences on dysphagia, the IDDSI continues to play a central role in clinical practice. The International Dysphagia Diet Standardization Initiative, launched in 2013, was established with the goal of developing a shared and universally applicable terminology for defining the texture of thickened foods and liquids intended for individuals with swallowing disorders. After approximately three years of work, the international scientific committee developed a structured classification system in the form of a diagram, which is still widely used in various care settings. The IDDSI Framework categorizes foods and beverages into eight texture levels (0 to 7), identified by sequential numbering, textual descriptions, and standardized color codes.

The document also includes a description of simple, reproducible assessment methods that enable healthcare professionals to accurately and consistently classify each food or liquid based on its safety and suitability for patients with dysphagia.

Beverages

Although many national classifications rely primarily on viscosity to categorize beverages and liquids, this parameter is insufficient to fully describe the behavior of fluids during oral ingestion. Variables such as density, yield stress, temperature, propulsion pressure, and lipid content significantly influence flow characteristics and swallowing safety. Given the difficulty, especially in a care setting, of measuring viscosity using laboratory instruments, the IDDSI Framework recommends the use of the Syringe Gravity Flow Test (IDDSI Flow Test) as a practical and standardized method for evaluating liquids.

Food

The assessment of solid foods requires a combined analysis of mechanical properties—such as hardness, cohesiveness, and adhesiveness—and the geometric and dimensional characteristics of the food bolus. The IDDSI has introduced texture descriptions that take into account not only the physical properties of the food but also the risk of aspiration. For an accurate classification, it may be necessary to use multiple assessment tests from among those described in the IDDSI Framework, including: the Fork Drip Test, the Spoon Tilt Test, the Fork or Spoon Pressure Test, the Chopstick Test, and the Finger Test.

December 12 – World Dysphagia Day

On this day dedicated to those who live with swallowing difficulties, we want to offer a small gesture to make the holiday season more peaceful and inclusive.

GET A FREE RESCIGNO PANETTONE!
Starting today, inthe "Oltre la Pizza" Box, you’ll also find apackage of Rescigno Panettone (made in collaboration with the Salvatore Nigrelli Association): the taste of Christmas in a safe texture suitable for those with dysphagia.

CHRISTMAS2025 DISCOUNT – 20%
Just for the holidays, use the codeNATALE2025to get20% off.

Valid fromDecember 12(World Dysphagia Day) throughJanuary 15, 2026. Cannot be combined with other codes or offers.

BOX: MORE THAN JUST PIZZA

€ 29,00

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The "Oltre la Pizza" project has captured the attention of the media and the public, demonstrating how innovation can blend with solidarity and tradition.
Created through a collaboration between the Salvatore Nigrelli Association, Io Sano – Solutions for Dysphagia, and Antica Pizzeria da Michele in the World, Oltre la Pizza brings a completely free menu of pizza, desserts, and beverages to locations in Aversa, Caserta, Naples, Pompeii, and Salerno (see here for a list of locations), designed specifically for those living with dysphagia.

The initiative and the people involved
The project was officially presented on September 23, 2025, at the headquarters of the Archconfraternity of the Holy Trinity of Pilgrims in Naples and received extensive media coverage in numerous publications:
NAPOLI TODAY, IL DENARO, NAPOLI FACTORY, IL MEZZOGIORNO, IL CONFRONTO, NAPOLI VILLAGE, SUD NOTIZIE, IL MATTINO, IL CORRIERE DELLA SERA

The following speakers took the floor during the project presentation: Renata Nigrelli ( president of the Salvatore Nigrelli Association) and Nadia Nigrelli (vice president), Giovan Battista Varoli (sole director of Io Sano), Sergio Condurro (CEO of Antica Pizzeria da Michele), Alessandro Condurro and Francesco De Luca ( CEO of Antica Pizzeria da Michele in the World), along with Antonio Maddalena ( Director of the Home Care Unit, ASL Napoli 1). The discussion was moderated by journalist Brunella Chiozzini.

The project draws inspiration from the history of the Nigrelli family. In particular, the tragic experience of losing Salvatore Nigrelli, who suffered from ALS, inspired the desire to create something that went beyond—something that could restore hope and dignity. (Eroica Fenice)

Where can you find the “Beyond Pizza” menus?
Starting this September, at select locations of Antica Pizzeria da Michele in the World (Aversa, Caserta, Naples, Pompeii, and Salerno), you can order a menu specially designed for people with dysphagia, which includes:
• pizza (Margherita, Marinara, and Cosacca varieties)
• beverage
• dessert
All menu items will be offered in modified, safe textures, while maintaining the quality and authentic flavors of the Neapolitan tradition. The service will be free of charge, and a takeout option is also available for those with mobility difficulties. (Io Sano®)

An open invitation
This initiative is a concrete gesture of hospitality, a step toward the right to enjoy food—even for those who have difficulty swallowing.
We look forward to seeing you at our pizzerias in Aversa, Caserta, Pompeii, and Salerno: join us, bring whoever you like, and share this experience.

If you’d like to try the flavors of our menu beyond pizza at home, you can also purchase them from our website at a special price!

BOX: MORE THAN JUST PIZZA

€ 29,00

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The IDDSI funnel is a device designed to measure the viscosity of liquids intended for patients with dysphagia in a standardized manner, in accordance with the IDDSI (International Dysphagia Diet Standardization Initiative) framework. It replaces the previous syringe method and significantly simplifies the clinical assessment of consistency levels, making the tests more accessible, faster, and repeatable
A validation study from 2024, on 73 different samples, showed that the funnel’s results correspond to 92% of those obtained using a syringe (model BD 303134), with a negligible average difference of 0.2 mL. This demonstrates that the funnel is a reliable and accurate system.

How to Use the IDDSI Funnel Correctly

Preparing the liquid and the funnel

• Make sure the liquid is thoroughly mixed and at the right temperature.
• Use the official IDDSI funnel, which includes a 10-mL syringe and a funnel, eliminating the need for additional tools

Funnel conversion

• Slowly fill the syringe to the 10 mL mark.
• Start the test: hold the funnel syringe upright and allow the liquid to flow by gravity alone.

Timing and Measurement

• Let it run for exactly 10 seconds, then close the lower outlet.
• Measure how much fluid remains.
  If it takes between 6.5 and 7.2 seconds for the tank to empty completely, the level is acceptable

Interpretation of the results

The residual volume corresponds to the IDDSI level:
Residual volume (mL) IDDSI level Description
0–1 Liquid Water / non-viscous
1–4 Slightly viscous Behaves like a slightly viscous liquid
4–8 Nectar Nectar-like viscosity
8 Honey Honey-like viscosity
Note: These are approximate values; always refer to the official IDDSI tables.

Repeatability and quality control

Repeat the test at least three times to confirm the consistency.
If the results fall outside the standard range in more than three tests, investigate using a micro-densitometer or reject the liquid

Hands-on demonstration

This video provides a step-by-step demonstration of the flow test using the IDDSI funnel.

Benefits for healthcare facilities and nursing homes

1. Standardization and Safety
   Thanks to the Funnel, it is possible to accurately determine the viscosity level, thereby reducing the risk of suction and increasing feeding safety.
2. 
   Operational EfficiencyFaster and easier to use than a syringe, the funnel supports the work of staff in the kitchen or on the ward.
3. 
   Hands-On TrainingThe funnel is an excellent tool for training professionals—from kitchen staff to caregivers—using a straightforward and intuitive method.
4. Quality of Care
   The Funnel helps ensure consistency between meal ordering, preparation, and serving; it promotes a multidisciplinary approach and improves patient compliance.

Buy the funnel and download the instructions!

Would you like to learn how to use it step by step or try it out at your facility?
Download the instructions and order the funnel here:

IDDSI Funnel for the IDDSI Flow Test

€ 28,00

The IDDSI Funnel isthe only funnel designed to properly perform the IDDSI Flow Test. Simply pour the liquid into the funnel and read the test result. The funnel is reusable and recyclable after being washed according to the provided instructions.
Io Sano | Solutions for Dysphagia is an authorized distributor of IDDSI Funnels in Italy and the European Union.

The Funnel is sold in boxes of 10 pieces each. Once your order is complete, you will receive a confirmation email, and your order will then be processed and shipped (you will receive a separate email with the tracking information). Delivery takes approximately 7–10 days.

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IDDSI Funnel for IDDSI Flow Test Quantity

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Add to cart

Category: FUNNEL

Would you like to learn more or train your staff? Io Sano is the authorized European distributor for IDDSI funnels. Contact us for consultation, purchases, targeted training, and access to official guidelines.

The mouth is a potential breeding ground for pathogens. Failing to thoroughly clean your teeth, tongue, and palate makes it easier for bacteria to enter the body.

Oral hygiene should always be an integral part of one’s daily routine, not only for reasons of comfort but above all to protect one’s health. In fact, the oral cavity, in addition to being the main gateway to the digestive and respiratory systems, is also a potential reservoir of pathogens (approximately 300 species of bacteria) that could cause various types of health issues. First and foremost, oral diseases, which, in addition to being a serious aesthetic problem, are a cause of dehydration and malnutrition as well as a risk factor for heart disease, diabetes, and stroke. Secondly, poor oral hygiene in dysphagic patients is linked to aspiration pneumonia. Failing to thoroughly clean the teeth, tongue, and palate exposes one to excessive bacterial proliferation; these bacteria, remaining in the oral cavity, are likely to spread throughout the body. In fact, these pathogens can enter the body along with food, drinks, or saliva and reach the respiratory tract instead of the esophagus. 

Oral hygiene as a daily preventive measure

For the reasons listed above, oral hygiene should be a fundamental part of care for people with dysphagia, especially for those who are unable to manage it on their own due to motor or cognitive impairments. However, this is not always the case, and all too often oral care is not viewed as an integral part of patient care. The same applies to oral examinations, which are often not performed as frequently or with the appropriate tools as they should be.

The greatest risk involved in feeding a patient with swallowing difficulties is that food may enter the airways.

Penetration is defined as the passage of a bolus into the airways above the vocal cords. Normally, this penetration is prevented by the protective cough reflex. 

Aspiration refers to the passage of food particles below the vocal cords. In this case, the cough reflex is not strong enough to expel these particles, which can have serious consequences for the respiratory system.

Aspiration pneumonia is the most common cause of death in patients with dysphagia resulting from neurological disorders. Aspiration is defined as the inhalation of oropharyngeal or gastric contents into the larynx and lower respiratory tract. The risk of aspiration is relatively higher in older adults due to the increased incidence of dysphagia and gastroesophageal reflux. Following aspiration, various pulmonary syndromes may occur, depending on both the quantity and nature of the aspirated material, the frequency of aspiration, and the host’s response to the material itself.

Aspiration pneumonia proper—or Mendelson’s syndrome—is a chemical injury caused by the inhalation of sterile gastric contents, whereas aspiration pneumonia is an infectious process caused by the inhalation of oropharyngeal secretions colonized by pathogenic bacteria; although there is some overlap between the two, they represent two distinct clinical entities.

Aspiration pneumonia is characterized by chemical burns to the tracheobronchial tree and lung parenchyma caused by the acidity of gastric contents, followed by an intense parenchymal inflammatory reaction. Since gastric acidity prevents the growth of microorganisms, microbial infection plays no role in the early stages of aspiration pneumonia but may play a role only at a later stage, although the incidence of this complication is poorly understood. However, it should be noted that when the stomach’s pH rises following the use of antacids or proton pump inhibitors—which are frequently used in the elderly—potentially pathogenic microorganisms may colonize the gastric contents.

The signs and symptoms of patients who have aspirated gastric contents range from gastric regurgitation into the oropharynx to the onset of rales, cough, cyanosis, pulmonary edema, hypotension, and hypoxemia, with rapid progression to acute respiratory distress and death. In most cases, only shortness of breath or coughing is present, while some patients experience what is commonly referred to as silent aspiration, detectable only by radiological examination.

Aspiration pneumonia develops as a result of the aspiration of secretions colonized by microorganisms from the oropharynx; however, it should be noted that this is one of the main mechanisms by which bacteria—such as Haemophilus influenzae and Streptococcus pneumoniae, which colonize the oropharynx—enter the airways. In fact, about half of healthy adults aspirate small amounts of oropharyngeal secretions during sleep, but their microbial content is continuously cleared through active ciliary transport, normal immune mechanisms, and coughing. However, if these mechanisms are compromised or if the amount of aspirated material is substantial, pneumonia may develop.

In elderly patients and in those who have suffered a stroke and have dysphagia, there is a strong correlation between the volume of aspirated material and the development of pneumonia. 

The diagnosis of aspiration pneumonia is based on radiographic evidence of pulmonary infiltrates at the bronchopulmonary level. Factors that increase the risk of oropharyngeal colonization by potentially pathogenic microorganisms and that increase the bacterial load may increase the risk of aspiration pneumonia; for example, this risk is lower in edentulous patients and in elderly patients who receive effective and thorough oral care. In fact, inadequate oral hygiene in the elderly can lead to extensive oropharyngeal colonization by potential respiratory tract pathogens such as Pseudomonas aeruginosa and Staphylococcus in community-acquired pneumonia.

With regard to the microbial agents responsible for aspiration pneumonia, Pseudomonas aeruginosa and other Gram-negative bacteria have been found to predominate in patients with aspiration syndrome acquired in a hospital setting, while Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Enterobacteriaceae are prevalent in community-acquired pneumonia.

It is clear that food often enters the respiratory tract more frequently when feeding patients with dysphagia, even in the early stages. When this occurs and is accompanied by a sensation of choking, persistent coughing, and a red or cyanotic complexion, the problem becomes extremely obvious to the person administering the food

 It can be far more dangerous to overlook the signs of small amounts of food entering the bronchi—silent aspiration—since the patient often does not notice it. Certain symptoms should raise suspicion, including:

• A consistent occurrence of a few involuntary coughs immediately afterward, or at least within 2–3 minutes of swallowing the bite
• A hoarse voice or hoarseness after swallowing a mouthful
• Fluid or food coming out of the nose
• The presence of a fever, even if not high—37.5–38°C—with no obvious cause; the fever may in fact be a sign of inflammation or irritation caused by food entering the airways.

If even one of these symptoms is detected, it is advisable to report them immediately to your doctor and/or to the healthcare professional directly responsible for managing dysphagia.

It is worth noting that the passage of food into the respiratory tract—through the trachea into the bronchi and then into the lungs—even in small amounts but with repeated episodes over time, can lead to a form of pneumonia that begins as inflammation but may progress, especially if food continues to enter the bronchi, to a more severe infectious form. Great care is therefore required when administering meals, both in terms of how they are administered—posture, timing, etc.—and in terms of food selection.

When feeding patients with swallowing difficulties, it is necessary to plan a progression of foods based on the patient’s swallowing ability. The choice of foods, which depends on the type and severity of dysphagia, should be guided primarily by the following criteria:

• Patient safety by reducing the risk of aspiration—the entry of food into the airways—through the selection of foods with appropriate physical properties (consistency, viscosity, cohesion)
• The patient’s nutritional needs, with particular reference to protein, calorie, and fluid intake, as well as any dietary requirements and food preferences.

While it is essential that meals be varied, appetizing, and nutritionally balanced, it is equally important to take all necessary measures to prevent food from entering the airways and the resulting risk of aspiration pneumonia.

Among these measures, we recommend paying attention to posture, following proper feeding techniques, and spreading meals throughout the day (at least 5 times) to reduce the patient’s effort.

Above all, however, we recommend that food selection be made with great care and that the foods’ rheological properties (in particular, homogeneity, absence of two-phase separation, texture, viscosity, viscoelasticity, and cohesion) be appropriate for patients with dysphagia, remaining absolutely consistent throughout the various stages of use, from preparation through to the moment of administration.

There are many studies by researchers on the relationship between people with dementia and food, and how they perceive it. They all agree that eating does not serve merely a biological function, but represents an experience of incredible significance. Wendy Mitchell has clearly explained firsthand the various aspects surrounding food and the act of eating; in her book“What I Wish People Knew About Dementia,”she describes how the disease has changed her relationship with food.

“You can tell me a secret, and I’ll keep it forever because I simply won’t remember it. But one thing I never forget is that food used to mean so much more to me than it does now,” Mitchellsays as he introduces the topic of food in his first-person account of living with dementia.

The Many Meanings of Food

Within any culture, food takes on great significance because it embodies culinary traditions that have evolved and been passed down over time, closely tied to the local area, its flavors, and its community. In other words, food, in addition to being linked to sensory pleasure, plays a very important role on a social level —just consider that mealtime is also a way to mark the passage of time—and on an emotional level. In fact, very often our memories associate flavors, recipes, and foods with specific childhood memories and moments of togetherness.

Mitchell describes it this way:“These days I even have to set alarms on my iPad to remind myself to eat: the part of my brain that senses hunger stopped working a long time ago. Yet, when you no longer derive pleasure from food, you realize it’s so much more than that. It’s how we show love as parents, it’s how we bond with friends, it’s an excuse for saying the wrong thing, it’s a welcome to the neighborhood.”

He adds:“Even when I was diagnosed with early-onset Alzheimer’s in 2014, at the age of 58, I used food to help ease the difficult times that followed.”

Dementia changes not only eating habits but also cooking habits

When someone has dementia, it’s not just their eating habits that change, but their cooking habits as well, because cooking becomes a major challenge. As the disease progresses, it becomes increasingly difficult to remember even the simplest things, such as how to make a cup of tea. Mitchell also explores this aspect, showing how cooking shifts from being an act of love for oneself and others to a moment of frustration, anger, and helplessness, and how those places of color, scent, and creativity become labyrinths of confusion and chaos. Losing the ability to cook can feel like a genuine loss.

In this case, only the love of our loved ones can truly help restore a positive sense of purpose to meal preparation. Mitchell says:“My son-in-law, Stuart, now cooks for me just two or three times a week, so I don’t feel like I’m imposing. But his are the only meals prepared fresh.” What remains is the gesture of love that is now received rather than given, but which nonetheless represents a moment of positively perceived connection. Thus, mealtime can continue to bring pleasure on a relational level, even though the sensory and perceptual aspects are lacking.

Eating out can also become very difficult. Mitchell herself acknowledges this:“Eating out used to be a luxury, but now it’s very stressful,”and then adds:“In restaurants, I choose the first thing I recognize that will be easy to eat. Never meat, because it requires the coordination to cut it into small, manageable pieces, and I lost that a long time ago. The simple task of cutting food requires serious concentration. Even chewing isn’t as easy as it used to be.”

Understanding the actual capabilities of people with dementia is also essential when it comes to choosing foods and the settings in which they are eaten. It is important to adapt to the new rhythms and habits of people with dementia, who are unable to control their behavior or memory.

How to Help People with Dementia Enjoy Their Food More

The best way to help people with dementia enjoy their food is to consider as many factors as possible and be attentive to their needs without overlooking anything, in the hope of making mealtimes as pleasant and worthwhile as possible. This often means simplifying the act of eating or drinking to allow for a certain degree of independence, as much as possible. Therefore, choose meals they can eat on their own or present the dish in a way that allows them to eat it independently.

“We don’t know for sure what causes dementia, and we don’t know what to eat or drink to prevent it. All I know is that every day is a challenge, a game of chess I have to play against this disease in my head, and I’m determined to win for as long as possible.” Wendy Mitchell.

Unlike dysphagia, atypical swallowing is a disorder caused by the failure of the swallowing process to develop properly during early childhood.

Just like dysphagia, atypical swallowing is classified as a swallowing disorder. It results from the failure of the swallowing process to evolve beyond the primary infantile stage, a condition that can occur in children over the age of seven or in adults. Atypical swallowing is therefore caused by the persistence of an infantile swallowing pattern.

This change in swallowing patterns corresponds to the stage of a child’s development when the front teeth emerge, to the transition from liquid to solid foods, to changes in posture that lead to independent walking,and to the development of the temporomandibular joint.

Changes in these stages or excessive reliance on certain habits (bottle-feeding, pacifiers, etc.) can lead to a delay in or failure to develop the adult’s physiological swallowing reflex, with the infantile reflex persisting

Common causes of atypical swallowing in both children and adults include various conditions affecting the nasal passages, such as recurrent or chronic rhinitis, sinusitis, and enlarged adenoids, which lead to mouth breathing, preventing the teeth from closing properly and causing the tongue to drop during swallowing.

It is clear that this is a condition quite different from dysphagia, which is a secondary symptom of much more serious conditions. Atypical swallowing, on the other hand, is a dysfunction of one or more stages of the swallowing mechanism that also causes food to pass improperly through the upper digestive tract.

How do infants swallow?

Given the daily intake of liquid food through breastfeeding or bottle-feeding, infants tend to push their tongues between their gums and press their lips together to generate enough pressure to swallow. As they develop, this swallowing pattern tends to change depending on their diet and feeding methods.

After a phase of so-called infantile swallowing, the child gradually changes the type of swallowing as the front baby teeth emerge and dietary patterns shift (from a completely liquid diet to one that also includes solid foods). Between 18 and 28 months, the child’s swallowing is referred to as mixed.

In the coming months, as the baby begins to eat solid foods, he or she will start to close the mouth after chewing, allowing the tongue to push the food against the roof of the mouth and down the throat, and then into the digestive tract.

Types of atypical swallowing

Now that we have analyzed the swallowing mechanism in infancy, it is easier to describe the different types of atypical swallowing. Among the main ones, we highlight the following:

– Simple tongue-thrust swallowing: This is a relatively minor disorder that is easily corrected, as the individual regularly clenches their teeth during swallowing and does not place their tongue between their teeth. In these cases, the following frequently occur: limited open bite, protrusion of the tongue onto the alveolar arches during swallowing, contraction of the elevator muscles, tendency toward a low tongue posture and risk of mouth breathing, predominantly vertical chewing, and tendency for the palate to take on an ogival shape.

– Complex tongue-thrust swallowing: significantly more severe than the previous condition, it causes various problems. These include: an anterior bite extending to the premolars, significant tongue protrusion between the dental arches, failure to clench the teeth during swallowing, anterior chewing, and frequent dental malocclusions.

• True infantile swallowing: This is the form of atypical dysphagia that most closely resembles the swallowing pattern of a newborn. In these cases, the following occur: persistence of the infantile swallowing reflex, strong tongue thrusting between the dental arches, failure to clench the teeth during swallowing, reduced facial expressions, and frequent mouth breathing even at rest.

Consequences of atypical swallowing

Failure to treat atypical swallowing can lead to problems that are not limited to dental issues. These include:

• protruding teeth (dental overjet);
• pointed arch;
• changes in chewing;
• postural problems;
• speech disorders;
• cosmetic changes;
• aerophagia and globus hystericus.