As speech therapy professionals, we know that atypical swallowing is an oral dysfunction characterized by an incorrect positioning of the tongue during the act of swallowing. When atypical swallowing affects occlusion (bite) causing malocclusion, the diagnostic-therapeutic management is generally a combination of speech therapy and orthodontics for its total rehabilitation. The former will be aimed at normalizing altered oral functions (swallowing, breathing, etc.), while the action of the orthodontic appliances will resolve the bite disorder, that is, the anatomy.
In the sixties, orthodontists, concerned about relapses in the rehabilitation of malocclusions, resorted to working jointly with speech therapists so that the latter would carry out treatment to try to reduce muscle pressures against bone structures.
Atypical swallowing and myofunctional therapy
The speech therapist’s intervention is based on the application of Myofunctional Therapy (MFT), which is defined as “the set of procedures and techniques used for the correction of orofacial muscle imbalance, the creation of new muscular patterns in swallowing, the creation of appropriate patterns for speech articulation, the reduction of harmful habits, and the improvement of the patient’s aesthetics” (Meyer,L. A., 2004, cp. Abello et al., 2005).
Its working basis is the buccomaxillofacial system, which is responsible for vital functions such as breathing, sucking, swallowing, chewing, and speech; and many others such as yawning, crying, vomiting, etc. The speech therapist’s work in cases of atypical swallowing with the inclusion of orthodontics can be developed in three different stages. Training with the Master’s in Myofunctional Therapy will allow you to know which ones:
Prior Intervention
The orthodontist prioritizes myofunctional speech therapy due to causes that motivate the speech therapist’s action on the present swallowing dysfunction:
- patient’s age
- anterior or lateral open bite
- sucking habits
- mixed dentition
Pre-orthodontic Intervention
It is common in daily practice, especially in the case of children who, due to their young age, are not yet ready to begin correcting their bite, but who present some speech therapy treatable disorder. Among these disorders are:
- atypical swallowing,
- mouth breathing,
- bad oral habits (e.g., thumb sucking), etc.
Joint Intervention
When the speech therapist and the orthodontist work together, greater benefits are offered to the patient. This simultaneous work promotes information exchange and interprofessional coordination, shortens treatment times, and guarantees optimal short, medium, and long-term results.
Post-intervention
This is carried out after the removal of the appliances, with the aim of verifying the adequate generalization process of previously learned patterns (prior and/or joint intervention), through scheduled review sessions according to each individual. This period is considered critical for occlusion stability and it must be ensured that there are no muscular and/or functional interferences that affect it and predispose to relapses. These occur when the patient’s dental arches return to the same state they had before undergoing orthodontic treatment.
During this time, the speech therapist’s intervention will consist of review sessions to confirm the maintenance of the new swallowing pattern (day and night). These reviews are usually carried out every 15, 30, or 45 days, a frequency that will depend on the particular characteristics and needs of each individual.
Post-orthodontic intervention is also applicable to any patient with a corrected bite who maintains an “atypical” swallowing pattern, for not having undergone prior or joint myofunctional therapy, a dysfunction that can destabilize occlusion.
Treatment of atypical swallowing
From the experience of experts in the field of speech therapy, to correct atypical swallowing in a patient who also requires orthodontics, the most appropriate procedure is summarized below:
For the treatment of atypical swallowing, eight to ten sessions are recommended before the placement of the appliances, to make the patient aware of their incorrect swallowing pattern and the new way of swallowing, through specific myofunctional therapy exercises selected according to the diagnosis obtained during the evaluation. In this stage, the patient is prepared to begin learning to swallow saliva, liquids, and solids from the five daily meals, in conjunction with orthodontic treatment.
Maintenance of the new swallowing pattern 24 hours a day; a process that will be supervised through spaced sessions until the bite is corrected, that is, until the removal of the orthodontic appliance.
Final review sessions with less frequency, where the speech therapist’s work will be aimed at avoiding possible interferences in occlusion (from the tongue, lips) and also, the ideal moment to give the patient definitive speech therapy discharge.
If the speech therapist’s work ends before the orthodontist’s intervention, a provisional discharge is given, and the case is resumed later, that is, a post-orthodontic intervention is carried out through review sessions with a certain periodicity. Similarly, provisional discharge is given in the opposite case, when the patient has been treated for atypical swallowing prior to the start of the correction of their malocclusion.
Finally, definitive discharge is given once it is observed that the patient has generalized the learned patterns and has their bite corrected.