Category: Dysphagia

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.

Dysphagia is a common condition characterized by difficulty swallowing that can occur at any age, although it is most prevalent among the elderly. This condition can be temporary or permanent and can affect both men and women. But what exactly is it?

What is dysphagia?

The term dysphagia refers to any disorder affecting the passage of food from the mouth to the stomach and can involve any stage of the swallowing process. Swallowing is the ability to transport solid, liquid, gaseous, or mixed substances (food or drink, either alone or together) from the mouth to the stomach.

It is a complex process that involves the rapid coordination of a group of muscles, which on the one hand allows the passage of the bolus —that is, food that has been chewed, mixed, and moistened with saliva—into the digestive tract, and on the other hand protects the airways and lungs from the risk of aspiration and/or foreign body penetration.

Swallowing is a process that is partly voluntary and partly reflexive, as some stages are beyond our control and are therefore involuntary. If complications arise during this process, they can have serious consequences, such as aspiration pneumonia.

Recognizing this condition early is critical to the patient's safety and well-being.

What causes dysphagia?

Dysphagia can have various causes, and according to the American Gastroenterological Association, they can be classified as follows:

• Neurological – brain stem tumors, head trauma, stroke, cerebral palsy, Guillain-Barré syndrome, Huntington’s disease, poliomyelitis, post-polio syndrome, tardive dyskinesia, metabolic encephalopathies, multiple sclerosis, amyotrophic lateral sclerosis, dementia, Parkinson’s disease, and Alzheimer’s disease;
• Structural – cricopharyngeal bar, Zenker’s diverticulum, cervical scarring, oropharyngeal tumors, congenital malformations, osteophytes, and skeletal malformations;
• Myopathies – connective tissue diseases (overlap syndrome), dermatomyositis, myasthenia gravis, sarcoidosis, myotonic dystrophy, oculopharyngeal dystrophy, polymyositis, paraneoplastic syndromes;
• Iatrogenic – side effects of drug therapy, post-surgical muscle or nerve damage, effects of radiation exposure, corrosive (injury caused by pills, intentional);
• Infectious diseases – diphtheria, botulism, Lyme disease, syphilis, mucositis (caused by herpes, cytomegalovirus, Candida, etc.);
• Metabolic disorders – amyloidosis, Cushing's syndrome, thyrotoxicosis, Wilson's disease.

If you suspect you have dysphagia, it is advisable to contact your doctor and follow the necessary steps to diagnose the condition in order to determine its severity and the appropriate course of treatment.