Maspero C, Prevedello C, Giannini L, Galbiati G, Farronato G
Maxillo-Facial and Odontostomatological Unit, Fondazione Ca' Granda IRCCS, Ospedale Maggiore Policlinico, Department of Orthodontics, University of Milan, Milan, Italy -
Minerva Stomatol. 2014 Jun;63(6):217-27.
Atypical swallowing is a myofunctional problem consisting of an altered tongue position during the act of swallowing. High incidence in population, multifactorial etiology and the recurring connection with the presence of malocclusions made it a topic of strong interest and discussion in science. The purpose of this review is to illustrate the current orientation on the topic of atypical swallowing, trying in particular to answer two questions: 1) what kind of connection is there between atypical swallowing and malocclusion; 2) what kind of therapy should be used to solve it.
This review was conducted on the Medline database [www.ncbi.nim.nih.gov/pubmed] searching for the keywords "atypical swallowing" and "tongue thrust". We examined all the documents from the year 1990 onwards, excluding the ones about syndromic cases of the central motor system.
The causal relation between the two problems seems to be biunique: some authors affirm that this oral habit starts as a compensation mechanism for a preexisting malocclusion (especially in case of open-bite); other texts show that it has a tendency to exacerbate cases of malocclusion; it is also proven that a non-physiological tongue thrust can negatively influence the progress of an ongoing orthodontic therapy. Thereby, the best therapeutic approach seems to be a multidisciplinary one: beside orthodontics, which is necessary to correct the malocclusion, it is essential to set up a myofunctional rehabilitation procedure to correct the oral habit, therefore granting long time permanent results. There is also proof of a substantial difference between the results obtained from early (deciduous or primary mixed dentition) or later treatments.
The biunique causal relation between atypical swallowing and malocclusion suggests a multidisciplinary therapeutic approach, orthodontic and myofunctional, to temporarily solve both problems. An early diagnosis and a prompt intervention have a significantly positive influence on the therapy outcome.
非典型吞咽是一种肌功能问题，表现为吞咽过程中舌位改变。其在人群中发病率高、病因多因素且与错牙合畸形的存在反复相关，这使其成为科学界备受关注和讨论的话题。本综述的目的是阐述非典型吞咽这一主题的当前研究方向，尤其试图回答两个问题：1）非典型吞咽与错牙合畸形之间存在何种联系；2）应采用何种治疗方法来解决该问题。
本综述在Medline数据库[www.ncbi.nim.nih.gov/pubmed]上进行，搜索关键词“非典型吞咽”和“吐舌”。我们查阅了1990年以后的所有文献，排除了关于中枢运动系统综合征病例的文献。
这两个问题之间的因果关系似乎是双向的：一些作者认为这种口腔习惯最初是作为对已存在的错牙合畸形（尤其是开牙合情况）的一种补偿机制；其他文献表明它有加重错牙合畸形病例的倾向；还证明非生理性吐舌会对正在进行的正畸治疗进展产生负面影响。因此，最佳的治疗方法似乎是多学科的：除了矫正错牙合畸形所必需的正畸治疗外，建立肌功能康复程序以纠正口腔习惯也至关重要，从而获得长期的永久性效果。也有证据表明早期（乳牙列或乳牙恒牙混合列）或晚期治疗所取得的结果存在显著差异。
非典型吞咽与错牙合畸形之间的双向因果关系表明，应采用正畸和肌功能多学科治疗方法来暂时解决这两个问题。早期诊断和及时干预对治疗结果有显著的积极影响。
