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From the Townsend Letter
December 2007


It's The Bite That Counts
by J.S. Mittelman, DDS

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To be really healthy, you must be aware of the causes of disease and avoid or correct them. One of the most common problems we see in our practice has to do with the way people swallow. Few people, laymen and doctors alike, are aware of the trouble that the abnormal swallow can cause. Yet, studies show that 75% of the population swallows incorrectly.

In the normal swallow, the tip of the tongue should brace itself against the roof of the mouth just behind the upper front teeth. Then the food is dumped back and swallowed. In the abnormal swallow, the bulk of the tongue's muscular forces is asserted against the teeth during the swallow. It can be a forward thrust or sideways – or any combination of directions.

The problem usually starts early in life. During normal breast-feeding, infants have to suck hard to get milk. The tongue aids in the swallowing process. But in about ten percent of cases, the mother has what we call "fast flow." The milk flows so rapidly that the tongue reverses its movement to keep the child from choking. It presses forward to slow down the oncoming milk. In bottle-fed babies, much the same happens. The speedy flow of formula causes the tongue to move abnormally in effort to slow the flow of the fluid. In so doing, faulty neuromuscular patterns are laid down early in life. The brain and nervous system are programmed to send natural messages to the tongue's muscles – and the tongue thrusts forward, sideways, or a combination of directions from then on. In so doing, the infant swallows a lot of air with the milk. This is why we have to remove the bottle and "burp" them so often. As children grow older and eat more solid food, they need to drink abnormal amounts of water during meals in order to get food down.

Another consequence of the reverse swallow is the dry mouth from which these children suffer. They sleep with their mouths open, and this nocturnal mouth breathing dries out their saliva. It becomes ropey and desiccated instead of detergent and cleansing, and this leads to greater amounts of plaque formation. Plaque consists of germ colonies around the necks of the teeth and is responsible for gingival gum inflammation and rampart decay.

In the reverse swallow, we find that other muscles are affected. The lip muscles are flaccid and have poor tone. And so quite often people with the reverse swallow breathe a great deal through the mouth during the day. This perpetuates the dry mouth, and these children, and adults, too, are inclined to combat the parched feeling with candy suckers.

Ingested sugar acts locally on the teeth. Bacterial flora develop speedily because of the sucrose, and this encourages even more plaque formation. The refined sugar is in solution, and so it passes quickly into the plaque – and then the bacteria breed more rapidly. Dental disease follows. Sugar ingestion over a period of time can also lead to hypoglycemia, and this condition is directly related to stress. Hypoglycemic individuals suffer greatly from the effects of tension. They have high irritability. And this results in their common tendency towards bruxism – clenching and grinding of their teeth. It becomes a neuromuscular pattern, and they are often unaware of it.

When one grinds teeth, the jaw jiggles the joint that is located just in front of the ear. It is called the temporomandibular joint. The muscles, tendons, and ligaments associated with the joint become inflamed from the erratic movements, and the area starts to be painful. Headaches result and so do referred aches down the neck, shoulders, and other parts of the body. About 20% of the population have some symptoms of this syndrome, called the temporomandibular joint dysfunction syndrome. Some authorities feel that hypoglycemia should be suspected in cases of this type.

Abnormal swallow patterns and temporomandibular joint dysfunction are also closely related. Unless this is understood and considered in treatment, temporomandibular joint problems will be likely to recur. Indeed, in cases of abnormal swallow, correction of the tongue habit may prevent the possible future development of temporomandibular joint dysfunction.

Adequate treatment always requires removal of the cause. When the tongue presses on the teeth during the act of swallowing instead of pressing on the resistant hard palate, it actually serves as an orthodontic appliance and causes the teeth to move, however imperceptibly at first. Whenever the teeth do move, the occlusion becomes distorted, and the relationships of the biting surfaces of the upper and lower teeth are changed. When the jaws close as in biting, the teeth don't fit together harmoniously. The jaws are then inclined to search for a convenient and comfortable place to close so that the hills and valleys of the opposing teeth do not interfere with one another. When the jaw shifts, the joints of the jaw in front of the ear also shift, and this triggers the temporomandibular joint dysfunction syndrome. If the syndrome is already present, abnormal swallowing can aggravate it. This shifting of the teeth from the pressure of the tongue can occur very slowly. The resulting temporomandibular joint dysfunction syndrome symptoms are at first well within patients' adaptive and resistive capacities, so that they are not aware of the impending trouble.

When teeth don't come together accurately when closing, a tendency to grind the teeth results. The teeth gnash in an unconscious effort to wear down the interfering biting surfaces and to find a comfortable place to rest the teeth together. In these cases, when the dentist adjusts the occlusion, (the biting surfaces), the patient gets only temporary relief. One must consider the functional movements of the tongue in order to prevent recurrence or to prevent temporomandibular joint dysfunction initially. The abnormal swallow continues to change the biting relationship of the upper and lower jaws by causing the teeth to move.

About ten years ago, we successfully treated a young girl's temporomandibular joint problem by, among other things, adjusting her bite. Yet we were all distressed when, in three months, she returned with her headaches. We adjusted her bite again, and again she was relieved of her discomfort. But when several months passed, her headaches returned, and so did she. At that time, we had begun to appreciate the importance of the abnormal swallow, so we incorporated myofunctional therapy into our practice. We found that this young girl had an abnormal swallow. In swallowing, her tongue pressed against her lower right premolars, changing their relationship with the opposing upper premolars when they came together in biting. She was highly motivated when we suggested she learn to correct her abnormal swallow. She worked hard at it. After the initial course of myofunctional therapy, when we were sure that she was swallowing correctly, we adjusted her bite once more. She has been without her symptoms since then.

We have found in the vast majority of temporomandibular joint dysfunction syndrome cases, there is an associated faulty swallowing pattern. Dr. Eugene Dryer has called this reverse swallow by the name, "traumatic swallow" – and with good cause.

We can help prevent the development of this unfortunate tongue problem by convincing mothers that there are many advantages to be expected from proper breast-feeding:

1. Breast-fed children's teeth occlude better. They fit together better when they bite. A great deal of orthodontic problems can be prevented if one can avoid the development of the reverse swallow.
2. Because they receive their mother's milk, there is less likelihood for breast-fed children to develop sensitivities to any allergic ingredients in the formula.
3. The breast-fed child has less tendency to develop an abnormal swallow, and therefore, less thumb sucking can be expected.
4. Because the mouth and face muscles of breast-fed children develop more naturally, these children generally have a better facial appearance. This has the added benefit of affording them a far better self-image psychology.
5. Less mouth-breathing is another characteristic breast-fed child. We discussed the harmful effects of mouth-breathing and the reasons why it should be avoided.
6. The improved nutrition of the breast-fed child increases its host resistance to disease.

No one can argue that it is more sensible to get at the cause of disease than have to deal later with its effects. If you're not preventing disease, you are preventing health. One should try to prevent the reverse swallow. But where it does exist, it makes for a happier and healthier future for the individual if the faulty neuromuscular patterns are relearned correctly.

Reprinted from
The Journal of the International Academy of Nutritional Consultants


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December 2, 2007

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