Atypical / Aberrant swallowing
Types of Swallowing Patterns
Swallowing is something we do hundreds of times each day, yet many people don’t realise that how we swallow can have a significant impact on breathing, speech, facial development, jaw function, and even the position of the teeth.
A healthy swallow relies on the coordinated movement of the tongue, lips, jaw, and throat muscles. When this pattern is disrupted, the body often develops compensatory swallowing habits that may contribute to orthodontic concerns, TMJ pain, mouth breathing, and ongoing muscle tension.
Normal (Mature) Swallow
A mature swallow is considered the ideal swallowing pattern for children (after approximately 4–6 years of age) and adults.
What happens during a normal swallow?
- Lips remain relaxed and gently closed
- Teeth lightly touch or remain slightly apart
- The tongue presses firmly against the roof of the mouth (palate)
- The tongue tip sits just behind the upper front teeth
- Minimal facial muscle activity
- No lip pursing or chin contraction
- Breathing returns easily through the nose afterwards
Why is this important?
A mature swallow:
- Supports proper facial growth
- Helps maintain straight teeth
- Encourages nasal breathing
- Reduces strain on the jaw joints (TMJ)
- Improves speech clarity
- Promotes efficient swallowing with minimal muscle effort
An abnormal swallowing pattern may contribute to:
- Orthodontic relapse
- Crooked teeth or bite changes
- TMJ pain
- Facial muscle tension
- Mouth breathing
- Speech difficulties
- Poor tongue posture
- Inefficient chewing
At Lake View Dental & Wellness, we assess swallowing patterns as part of a comprehensive myofunctional therapy evaluation to identify muscle imbalances and develop an individualised treatment plan.
Anterior Tongue Thrust
A tongue thrust swallow occurs when the tongue pushes forward against or between the teeth during swallowing instead of pressing against the palate.
This is one of the most common dysfunctional swallowing patterns seen in both children and adults.
Common signs
- Tongue visible between the teeth
- Lips tighten during swallowing
- Chin muscles contract
- Difficulty keeping lips together
- Mouth breathing
- Forward resting tongue posture
- Speech differences such as a lisp
Possible effects
- Open bite
- Protruding front teeth
- Orthodontic relapse after braces
- TMJ discomfort
- Difficulty maintaining correct tongue posture
Common causes
- Prolonged dummy use
- Thumb sucking
- Mouth breathing
- Enlarged tonsils or adenoids
- Tongue tie
- Low tongue posture
- Retained primitive reflexes
Bilateral tongue thrust
With a bilateral tongue thrust, the tongue pushes outward against both sides of the upper teeth during swallowing rather than elevating into the palate.
Pressure is applied laterally instead of upward.
Clinical Features
- Tongue presses into both back teeth
- Poor tongue elevation
- Widening force against posterior teeth
- Food may collect in the cheeks
- Reduced tongue stability
Potential Effects
- Posterior open bite
- Dental arch changes
- Cheek biting
- Poor chewing efficiency
- Reduced tongue strength
Unilateral tongue thrust
A unilateral tongue thrust occurs when the tongue consistently pushes toward one side of the mouth during swallowing.
This often develops as a compensation for pain, muscle weakness, airway issues or altered chewing habits.
Clinical Features
- Tongue deviates to one side
- Uneven muscle activation
- One-sided chewing habits
- Facial asymmetry during swallowing
Potential Effects
- Crossbite
- Uneven tooth movement
- TMJ dysfunction
- Muscle imbalance
- Neck tension
- Facial asymmetry
Active Orbicularis Oris Swallow
An active orbicularis oris swallow occurs when the lips work excessively hard to complete a swallow.
Rather than relying on the tongue to stabilise against the palate, the body compensates by overusing the muscles surrounding the mouth.
Clinical Features
- Lips press tightly together
- Visible lip pursing
- Chin dimpling (mentalis activation)
- Facial muscle tension
- Minimal tongue stability
Potential Effects
- Facial muscle fatigue
- Lip incompetence
- Poor tongue posture
- Difficulty transitioning to a mature swallow
- Increased strain on surrounding muscles
Teeth-Clenched Swallow
During a teeth-clenched swallow, excessive force is generated by the jaw muscles to stabilise the swallow.
Although light tooth contact can occur during a normal swallow, forceful clenching is not considered an efficient swallowing pattern.
Clinical Features
- Strong tooth clenching
- Tight jaw muscles
- Limited tongue movement
- Neck muscle recruitment
- Increased muscle tension
Potential Effects
- TMJ pain
- Tooth wear
- Headaches
- Jaw fatigue
- Neck pain
- Muscle overactivity
Dysfunctional Swallow Related to Primitive Reflex Retention
In some individuals, swallowing difficulties are linked to retained primitive reflexes that should have integrated during early childhood.
Reflexes such as the Rooting Reflex, ATNR, STNR and Moro Reflex may continue to influence oral muscle coordination.