Wellness Through the Power of the Tongue
by DP Dental’s Dr Yue Weng Cheu
WELLNESS THROUGH THE POWER OF THE TONGUE
“This eye-opening and detailed explanation about the tongue and its connection to sleep, oral health and posture will convince you that the tongue isn’t just a sensory muscular organ!”
The importance of the oral cavity is apparent from the very first day of our life. It features prominently even when a baby is a foetus. It is astounding how many reflexes we depend on to guide us through early growth and development before our cognitive ability matures. Reflexes such as the rooting reflex and suck-swallow-breathe reflexes ensure that we get fed and survive, if not, thrive.
The basis of these reflexes is grounded in our nervous systems, with cranial nerves playing instrumental roles in driving these movements. A ‘simple’ action of a baby turning and latching on to his mother’s breast to feed is a massive undertaking of multi-department coordination which affects this synchronous activity that happens within a split second.
Let’s understand the complex and intricate activity of the nervous system through the simple action of a baby suckling.
The facial nerve (CN VII), trigeminal nerve (CN V), glossopharyngeal (CN IX) and the vagus nerve (CN X) all work together to feed the trigeminal nucleus sensory information from the face, including touch-position and pain-temperature.
The mere action of an infant feeling the nipple causes the accessory nerve (CN XI) to turn the head and neck towards the breast. The Trigeminal nerve (CN V), which is a massive circuit, gets the jaw working to draw in the milk. This action also requires the facial nerve (CN VII) to close the sides and the Hypoglossal (CN XII) and Glossopharyngeal (CN IX) to activate and proprioceptively move the tongue to work in rhythmic contractions to press the nipple against the palate to extract milk from the mother.
The Vagus nerve then sees to the proper swallowing. It also activates the parasympathetic systems to start the smooth muscles to join in the beat to move the milk from mouth to stomach and beyond. While at it, the Vagus nerve, together with the lungs and heart sequence breathing to the act of swallowing.
The intricacy of such interplay of cranial nerves to bring about our early survival has a lasting effect in the latter part of life as well.
What are the implications when the tongue position isn’t optimal?
There are certain occasions (such as in the presence of a tongue-tie or poor function due to conditioning) where the tongue is not in contact with the palate all the time (except when eating or speaking). These occasions lead the way to a cascade of changes.
Stunted growth of arch of the mouth
As such, the upper arch will not be stimulated to grow to the fullest potential, and the lower jaw will be restricted by the extent of the frontal part of the upper jaw in most cases.
Think about it- the roof of the mouth is the floor of the nose. So if the upper arch does not expand transversely, the palatal arch stays high like a dome in the mouth. A high mouth dome could result in a big bump in the floor of the nose, and it does not spread out as expected with growth.
Poor nasal breathing
The nasal septum then grows down with the flattening of the dome in the mouth, and any restriction curtails the proper extension and deviation occurs. This deviation will be picked up by the ENT later and be attributed to poor nasal breathing.
The reduction in volume in the mouth due to stunted growth means the tongue is getting squeezed out. It will retract backwards to find space, or it might spill over the biting surface of the lower teeth. This tongue position can exert undue pressure on the teeth, causing tipping or less eruption, and translating it into a reverse curve of Spee.
Depending on the worsening degree of an overbite, it will further compromise the support and aggravate the volumetric reduction—more on overbite issues coming up.
Usually, by now, the particular person would already be using their mouth to breathe as nasal breathing becomes more laborious.
Some might become obligate mouth breathers. The nasal passage then becomes more and more congested and sometimes could even become infected. The stagnation of mucous within the warm passages form a breeding ground for bacteria. Sinusitis, rhinitis, middle ear infection and post-nasal drip will become all too common occurrences. It is not an allergic reaction but a functional shift that results in compensation.
Antihistamines, steroid sprays or nasal washes only offer temporary relief. However, if we do not revert to obligate nasal breathing, the whole cycle will recur.
Mouth infections such as tonsillitis
The mucous in the nose helps to filter, warm, humidify and slow down the air as we breathe. The nasal lining also produces nitric oxide (NO) to help improve blood vessel dilations to increase oxygen exchange in the lungs. If we use the mouth for breathing, we will miss out of the goodness of the nasal nourishment. Instead, the air intake directly through the mouth will trigger a major response from the defence centres, and the adenoids and tonsils will swell with excessive duties.
NO is also a potent antimicrobial agent. Its concentration in the nasal passages is high enough to kill bacteria on a petri dish. NO ‘disinfect’ the inside of the nose to reduce the risk of infections.
With the nose blocked, the tongue down and retracted, and throat swelling, getting air in can be a challenging affair.
Of course, the body cannot tolerate a lack of air. It can skip meals or drinks but cannot go even a minute without oxygen. It will contort and distort the body to achieve better air intake.
Implications to head posture
One such adaptation to a breathing issue is the forward head posture. One would raise the head to extend the neck to open up the airway, but it means that the head is tilted up. But to balance and move, one would regain the horizontal gaze with some neck adjustments and end up with the head protruding forward. This posture often results in strained neck muscles from a person having to carry the weight of their head when it is off the axis of the spine.
The upper trapezius and the sternocleidomastoids are the central ‘neck’ muscles engaged in this exercise. The levator scapulae and pectoralis muscles aid them. Tension will cause the upper body to roll in towards the chest, creating a hunch-back look. It is also called kyphosis.
Issues with an overbite and other oral issues
With the tongue not settling with the right amount of force from in-out and the lips are not competent (together) the curtain of force from out-in is lost too.
This situation has a significant impact on the alignment of teeth and the size of the jaws. Using the mouth to breathe also activates the buccinator (trumpet-blowing muscles), and that pushes in from the side and further narrows the jaws. Misalignment of teeth can lead to malocclusion, a poor bite.
The lower jaw can have six-axes of position, namely pitch, yaw, roll, up/down, left/right, front/back. In a perfect case, the jaw is levelled and balanced. This proper alignment will set the head and neck to a balanced alignment too. But most if not all of us do have some degree of mal-positioning.
Implications to the spine
If the mal-positioning is severe, the roll (cant) of the jaw will cause the head to be tilted to the same degree. A high-low shoulder will be the visual ramification of this. If the yaw of one’s bite is off, the body will rotate with the jaw, as the head is linked with muscles from cranium to spine.
These off axes compensation result in a 3D ‘twisting’ of the spine known as scoliosis. The body tries to stay balanced, but with parts going off neutral, muscle strains build up over time and pain is inevitable.
An inability to breathe well may occur and even worsen during sleep. Some will snore or even have an obstructive sleep problem. Sleep-disordered breathing has a significant role in tooth wear, especially with Upper Airway Resistance Syndrome. Inadequate respiration due to resistance in the airway will disturb sleep patterns and cause the oxygen level in the blood to drop drastically.
Body responses to this drop in the level of blood include muscles tightening to jerk the jaw forward in sleep to open the airway. Sometimes this might have a leg kick component. This forceful uncontrolled movement is vital to survival but destructive to dentition, joints and muscles. Further reduction of vertical support due to tooth wear will aggravate the airway issue. A vicious downward spiral will occur.
Earlier on, we mentioned that for some reasons, the tongue might not be in the right position to guide and help with a person’s growth. Changes in feeding such as bottle feeding, use of a pacifier, thumb sucking, tongue-tie all contribute to the tongue ‘malfunction’.
Without the tongue going up to stimulate the palate when we breathe and swallow, we will under-stimulate the parasympathetic nervous systems – our ‘feed-and-breed’ or ‘rest-and-nest’ systems. This under-stimulation will manifest in various intestinal issues such as gastric reflux, irritable bowel syndrome, indigestion etc.
Babies are known to have reflux corrected when they have undergone a tongue-tie release surgery. The act of the tongue returning to stimulate the palatine area rebalances the parasympathetic nervous system.
The act of swallowing takes the cue from the tongue touching the palatal areas to effect the right beat or rhythm for the peristaltic or wave-like motion of the gut to ease the food down.
In conclusion, what we realise is that all this knowledge makes us appreciate the fantastic choreography from the conscious or subconscious control of swallowing to the autonomic nervous system of smooth muscle movement.
The miscommunication between these systems can have dire consequences. The parasympathetic arm of the autonomic nervous system has the antagonistic side, the sympathetic system. This system is responsible for our ‘fight or flight’ responses. It will be stimulated when we cannot breathe well.
If you suffer from any of these symptoms, do not suffer in silence! We are just one call away! To book an appointment with us, please call 62820122 or WhatsApp us at 9012 8562
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