Podcasts


Tonsils – Episode 110

An image of a caucasian child's mouth, open wide with their teeth, tongue, and uvula visible. This is representative of the way one may open wide for a doctor to inspect the tonsils and throat.

Tonsils Basics

Your tonsils can be found in the back of your throat.  You can open your mouth and look in the mirror and see them on each side of your mouth behind your teeth and tongue.  You can also feel them below your earlobes and behind your jaw bone.

Tonsils are composed of lymph tissue since they are a part of your lymph system.  They store white blood cells that help you fight off infection.  Their activation during sickness is why they swell and get sore.

They are covered with the same mucosal membrane as the rest of the inside of your mouth.  This mucosa layer has pits and crevices called crypts.  These crypts increase the surface area of the mucosa that comes in contact with the lymph tissue and allows more opportunity for infectious material to be directly accessed by the immune system.

Infectious Tonsil Issues

Tonsillitis is the inflammation of the tonsils.  It can be classified as acute or chronic.  Acute tonsillitis is directly related to a viral or bacterial infection.  Chronic tonsillitis can be either a persistent, long-lasting infection or multiple consecutive acute episodes that can appear to be one long sickness.

Swollen tonsils can cause simple activities such as swallowing, talking, and breathing very painful.  You can see your swollen tonsils when you look in the mirror.  They will appear red or possibly blistered.

Mono, an infection caused in adolescents and adults by the Epstein-Barr virus, cause severe swelling in all the lymph nodes, including the tonsils.  This is one of the situations where your tonsils will be so inflamed, you can see the swelling on the outside of your face and neck.  Because such a large portion of your lymph system is involved, including your spleen, this is a serious sickness.

Strep throat is probably the first infection you think about when you think of swollen tonsils.  The bacteria, streptococcus, infect the lining of the tonsils and throat.  This is why the doctor will swab your tonsils when they’re testing for strep.

Non-Infectious Tonsil Issues

A non-infectious reason the tonsils will be large is a condition caused hypertrophic tonsils.  The tonsil tissue and/or mucosa overgrow and become oversized without any infection or immune activation being involved.  Overgrown tonsil tissue can lead to snoring or sleep apnea, and that’s bad.

Another non-infectious issue with your tonsils is called tonsilloliths or tonsil stones.  These stones happen when dead bacteria or food debris gets stuck in the crypts and they become calcified.  They cause a sensation many describe as a crumb stuck in your throat.   They can become quite large and can interfere with swallowing and eustachian tube function.  Because the eustachian tubes run from your eardrum into your throat, if the tonsil is swollen enough, it may close off the tube to the ear and cause ear pressure/pain.  Some tonsil stones are large enough to be visible and may have to be manually removed.  Lastly, due to the composition of the stones (dead bacteria and old food), frequent tonsil stones can be the cause of bad breath.

There’s no way to prevent tonsil stones 100%.  Good oral hygiene can certainly help reduce the frequency of stones, and can also help remove them quickly if they occur.  The most common way of trying to remove a tonsil stone involve coughing, clearing your throat, or hissing.  All three of these ways produce vibrations in the lining of the throat and mouth.  So along with the exhalation of these methods, hopefully, the result is the stone coming out of the tonsil and out of your mouth.

PSA:  Please DO NOT scratch your tonsils with your fingernails to remove a tonsil stone!

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Sleep Hygiene
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Metallic Taste – Episode 109

A table covered in pennies with varying luminosity. They will add a metallic taste to your water. Ha ha!

Glossary

Aguesia: no taste

Hypoguesia: reduced ability to taste (no the same as when taste changes due to changes in ability to smell)

Dysgeusia: dysfunctional taste (bad, salty, rotten, or metallic taste).  Metallic is most common.

Causes for Change

Chemotherapy and radiation for cancer causes taste changes because the taste buds are rapid-cycling cells and the goal of chemo and radiation is to kill fast-growing cells (cancer cells are definitely fast-growing).

Head trauma or brain damage may damage the path of taste from the mouth to the brain.

Conditions like GERD, diabetes, urinary retention, and dry mouth can cause dysgeusia.  Zinc deficiencies can too (in case you can’t tell, zinc plays a big role in many processes in your mouth).

Over 250 medications can causes changes in taste.  These include blood pressure medications, antibiotics, chemotherapy, asthma medications, and lithium.  Some of them are secreted in the saliva, so the change in taste is because you actually taste the medicine.  Other changes are because the medication disrupts or alters receptor or signal transport (i.e. ion transport – sodium, calcium, potassium, or chloride).

My Own Metallic Taste

I was taking generic Biaxin, AKA clarithromycin, for a sinus infection.  Clarithromycin is in a class of medication called macrolides.  Macrolides work on infections by disrupting the DNA-copying proteins in the bacteria.  They are known as bacteriostatic antibiotics, which means they stop the bacteria from growing and dividing, but do not kill them.  This allows your own immune system to get rid of the bacteria itself.

It was the worst!  Everything tasted so bad.  I had to take it for 10 days, so I spent those 10 days eating the strongest and spiciest foods I could find to try and cover it up.

Your saliva contains clarithromycin in a concentration of ~2.72 mg/L.  To get an idea of how small this amount is, it takes you 12-24 hours to produce 1 liter of saliva.  Only 3-7% of adults report metallic taste with clarithromycin.

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Diabetes Madlib #2

Clueless About Diabetes Madlib

[source: diabetesduo.com]

With November being National Diabetes Awareness Month, here is another version of the Diabetes Madlibs.  How many of these misconceptions have you held?  Have you ever thought that all types of diabetes are the same?  It may be time to get to know someone with diabetes, they can teach you a lot.

(Answers provided by Ronei, but they are not representative of her knowledge and support of people with diabetes, this is for comic value only.)

“Oh, you have Diahbeedees? So your stomach doesn’t work, right? Well, at least you don’t have emphysema. My Grandmother has it and got it because she ate too much fruit. Last year, she had her toe cut off! I hear you can cure it by drinking water? I feel joyful for you because those fuzzy needles would make me pant. And I could never have someone burp one of those pump things in my knee. My cousin had juvenile diabetes but outgrew it when she turned 54. I was reading in the Enquirer that Helen Mirren had it but reversed it by eating only sushi. And Jimmy Fallon has it and he’s lived a long time with no problems. I also read where lots of people who have it bad travel to Ireland because they have a cure for it there. Don’t get excited, Dr. Who said there will be a cure here in America in 9 years. Then you can start eating kale again!” 

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Taste Buds – Episode 108

An image for your taste buds. A plate of bread and cheese with sliced salmon, a cup of yogurt with berries, a container of fancy crackers, a mug of black coffee, and a plate with red and black grapes, circular orange slices, and a half of grapefruit. It's all laid out on brown parchment paper on a table of raw wood planks.

Review

Smell plays a big part in your ability to taste.  The bumps on your tongue that you can see are actually papillae.

4 Types of Papillae

Filiform

Filiform papillae are the most numerous papillae and are arranged in regular rows running parallel to the median sulcus.  They are cone-shaped – either a single cone (like a volcano shape) or a frill of cones.  These papillae don’t actually taste flavors but they do sense touch.  They work as cleaners, helping your tongue create friction with other parts of your mouth to loosen bits of food from the nooks and crannies.

Foliate

These papillae are located on the sides of the tongue near the back.  They are flat, leaf-like folds, and can be visible in some people.  These papillae contain taste buds for flavors.

Fungiform

These are mushroom-shaped.  They are scattered all over the tongue but seem to be more concentrated on the edges and tip of the tongue.  They contain taste buds for flavor as well as the sense of touch.

Vallate (Circumvallate)

These papillae are dome-shaped with a border.  The best description is that they appear as a circular fort with a mote around it and then a wall on the outside.  Or maybe they look like a bunch of “outie” belly buttons!  They are laid out on the back of the in a V-shaped pattern, pointing towards the back of the throat.  These papillae can be visible in some people, and they contain taste buds for flavors as well.

Each papilla contains many taste buds.  They are called “buds” because, microscopically, they appear as unopened rosebuds. Taste buds have a swirl-like funnel with an opening in the middle that contains fluid.

How You Taste

You put food in your mouth. Your saliva dissolves bits of it to free up molecules.  The molecules that are mixed in your saliva wash into the funnels of each taste bud.  There, the molecules mix into the taste bud fluid and get swirled around to come in contact with as many taste sensors (nerves) as possible.  From here, the chemical signal changes into an electrical signal as the taste messages zoom into your brain.  In the brain, the signal is translated and identified – including details such as flavor, pain, temperature, texture, intensity, and smell (while your saliva mixes with some molecules, other molecules are released into the air as aromatics and contact the olfactory sensors in your nose).

Taste Buds Map Truth

The taste bud map that has been used for years in textbooks was created in 1901.  Even with all the things that we’ve learned about how taste buds work, where they’re located, and what they look like, this map has never been re-written.  The original map identified four basic flavor categories: sweet, sour, salt, bitter.  Yet, just nine years later, the Japanese were able to identify “umami” – that savory flavor that doesn’t quite fit into the other four.  Yet, the map still wasn’t re-written.  Even now, scientists are learning and updating the database on what the tongue can taste and how – including categories like “fatty” and “metal” and even “water”.

So, while the taste buds are not grouped into sections based on the flavor they can taste, some taste buds may have a greater affinity or sensitivity to a certain type of flavor.

It is estimated that we have about 2000-4000 tastebuds, and since the surface of the tongue is like your skin, the tastebuds recycle about every week or two.  This rapid and continuous recycling might be why it is acclaimed that your taste (preference and enjoyment from your taste buds) changes approximately every seven years.

Conclusion

Even though the tastebud categories are still too complicated to rewrite the map, I still plan to use my taste buds to their fullest potential.  Eat up!

Resources

I gathered some of my information from a PubMed article that is actively being updated by real scientists – How Does Our Sense of Taste Work?

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Burning Mouth & Pepto Lips – Episode 107

An image of black lips, partially open to show some of the top and bottom teeth. Maybe the person has a burning mouth, or just had too much Pepto!

 

Burning Mouth Syndrome

Burning Mouth Syndrome is defined as a burning sensation with no underlying cause.  It may include dry mouth sensations with no true symptoms of dry mouth.  BMS is accompanied by unremitting burning or pain but no mucosal changes or signs of injury or swelling.

3 Categories

  • Increases throughout the day after waking
  • Stays the same morning, during the day, and at night
  • Has no pattern

Common Symptoms

  • Bilateral pain of the tongue
  • Chronic pain labeled as moderate to severe, or a 6-10 on the pain scale.
  • Worsened by talking, stress, fatigue, or hot, spicy, or acidic foods.

Subjective Descriptions

  • Dry mouth
  • Change in ability to taste
  • Accompanied by a headache
  • Decreased appetite
  • Improved by cold foods or drinks

Those who suffer from BMS may see temporary relief with topical analgesics (i.e. lidocaine or benzocaine) but see no improvement from systemic medications.  Fifty percent of the cases have no apparent cause but do have some correlation with depression.  This is a case of “the chicken or the egg”.  Are people with depression more likely to have symptoms of BMS?  Or are people with BMS more likely to become depressed?

Before someone can be said to have Burning Mouth Syndrome, many other issues must be ruled out.

  • Deficiencies (iron, folate, B vitamins, zinc)
  • Dry mouth
  • Nerve damage
  • Hypothyroidism
  • Type 2 Diabetes
  • Nocturnal habits (clenching, grinding, tongue-thrusting)
  • Infection (thrush, herpes, HIV)
  • A hiatal hernia (GERD)
  • Medications (ACE inhibitors, anticholinergics)
  • Myeloma (a blood cancer involving plasma cells)

Pepto Lips

Pepto-Bismol, aka Bismuth subsalicylate, has been used for decades for a variety of stomach complaints.

Bismuth is a good binder of toxins, in a similar way that carbon is in activated charcoal.  And yes, bismuth is one of those elements on the periodic table.  Subsacylate activates into salicylic acid (related to aspirin) and works to decrease inflammation of the gastric lining.

When bismuth binds with sulfur that is naturally in your saliva, it becomes bismuth sulfide, which has a black color and can stain your tongues and lips temporarily.  Pepto overuse is the obvious cause of black lips.

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Tongue Issues – Episode 106

Born With…

Ankyloglossia is also known as a tongue tie.  It is a result of a short frenulum.  This issue is easily corrected if it interferes with eating and talking.

Macroglossia is am abnormally large tongue.  This is one of the visible characteristics of Down’s Syndrome.  It is described as the tongue looks and feels to be bigger than space in the mouth.

Infected With…

Strawberry tongue

The tongue can appear extremely red and papillae are swollen to look like seeds on a strawberry.  This is a symptom of several conditions.

  • Kawasaki Disease is a rare but serious childhood disease.  The blood vessels become inflamed, and this includes the blood vessels in the tongue, making it appear red.
  • Scarlet Fever is caused by the same bacteria as strep throat.  The infection goes from being just in the throat to the bacteria toxins spreading in the bloodstream.
  • Toxic Shock Syndrome is when the bacteria called Staph aureus (yes, this is the staph that lives on your skin and can cause wound infections) gets into the bloodstream.  This is a medical emergency and needs to be treated immediately.

Hairy Tongue

White hairy tongue appears as patches on the sides of the tongue.  It can happen when someone who is immunocompromised gets the Epstein-Barr Virus. (Epstein-Barr is a virus that causes mild childhood illness or a disease we know as Mono when teens and adults.)

Black hairy tongue is a little more obscure with several possible root causes.

  • Smoking, excessive coffee or tea consumption, excessive alcohol consumption, or soft diet can lead to the inability to shed dead skin cells.
  • Antibiotic overuse leads to overgrowth of fungus or bacteria.
  • Overuse of peroxide-based mouthwash causes oxidation and discoloration of the skin cells.

Function Lost

Motor Neuron Disease occurs in the later stages of ALS or Lou Gerig’s Disease when the nerves and muscles of the tongue for speech and swallowing become affected.

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Your Tongue – Episode 105

Tongue Basics

Your tongue is made up of eight muscles.  This is why it is called a muscular organ.  It is the most important articulator in speech production. (A brief word dissection:  articulate means to communicate something clearly.  In medicine, articulate means to make a connection.  It all makes sense!)

The tip is called the apex.  The crease down the middle is called the median lingual sulcus.  There is another crease at the back of your tongue and it is called the sulcus terminalis.

Tongue Muscles

The tongue has two types of muscles.  Extrinsic muscles attach to bones boarding the mouth.  Intrinsic muscles are completely contained inside the tongue borders.

Extrinsic Muscles

These muscles are responsible for moving your tongue front to back and side to side.  There are four of them and they are named for the facial bones that they are anchored to.

  • The genioglossus muscle moves it forward so you can stick it out of your mouth.
  • The Hyoglossus muscle pulls it back and presses it down.
  • The Styloglossus muscle raises the sides of it during swallowing.
  • The Palatoglossus muscle raises the back of it during swallowing.  It also presses the soft palate down and squeezes the palatoglossal arch inward during that same step of swallowing.

Intrinsic Muscles

These muscles are responsible for all the shapes and movements your tongue makes when you talk and eat.

  • The superior longitudinal muscle covers the top side.
  • The inferior longitudinal muscle covers the bottom side.
  • The vertical muscle fibers are in the middle and connect the superior to the inferior muscles.
  • The transverse muscle fibers start at the median sulcus and connect to the outer edges.

The Tongue Has Skin?!

The surface of your tongue is known as the masticatory mucosa, which basically means it’s the surface that food comes in contact with.  The surface is made up of epithelial cells just like your skin.  The cells are keratinized (or filled with a toughening protein) so it is tough and does not get damaged by the wide variety of things we eat.

Call Backs

Wrinkly Brain

Skin 101

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Teeth Issues – Episode 104

teething

Teething

Teething is mostly known as the phase of babies growing their first teeth.  Eruption is when the tooth enamel shows through the gum tissue.  A baby’s first teeth grow in between 6 months and 2 years old.  Before any of the teeth show, the gums can be swollen and bumpy.  These symptoms can cause fussiness, sleeplessness, drooling, decreased appetite, excessive chewing, and overall grumpiness.  A few controversial symptoms include fever, diarrhea, and rash. A fever less than 100.4*F can be indicative of inflammation going on, which can be true for some teething babies.  Diarrhea is blamed on excessive saliva ending up in the digestive tract (eh, many things can change the consistency of a baby’s poop, especially in the early stages where they’re only drinking milk or just learning to eat new foods).  A rash is a little more questionable, but can also be a result of inflammation going on.

Treatments

Treatments for teething babies include Infant’s Tylenol or Infant’s Ibuprofen (for children older than 6 months).  Other medications that used to be recommended for teething babies were Teething Tablets and Orajel.  An active ingredient in the Teething Tablets is Belladonna.  This medication can constrict blood vessels, which is good when there’s inflammation (increased blood flow) to an area, but bad when baby’s blood vessels are already tiny and they need to get blood to very important places (i.e. the brain).   The bottom line is that Belladonna can decrease the amount of blood, and therefore oxygen to a baby’s brain, and the outcome can potentially be SIDS.

This is also true of Benzocaine, the ingredient in Orajel.  Benzocaine is a topical numbing agent.  The key word here is topical.  It is not intended to circulate in the body.  The problem comes when you use a TOPICAL product in your mouth, you can’t help but swallow some of it.  When Benzocaine is swallowed, it can cause a serious side effect that involved decreased oxygen in the blood.  Again, if oxygen doesn’t get to important places in the baby’s body, bad things can happen.

PSA: NO Belladonna and NO Benzocaine for babies!

Plaque

Your teeth are covered in a biofilm that is mostly made up of bacteria. That bacteria can compromise the seal that is formed between healthy teeth and healthy gums.  If this seal is breached by bacteria, then infection and gum disease (gingivitis) can occur.

Tartar

Plaque can harden, and when it does, it becomes known as tartar.  Mouth bacteria eat the sugars in the food that gets stuck in the crevices of your teeth.  A waste product of this process is lactic acid, and lactic acid can actually dissolve enamel of your teeth.  Minor erosion can be repaired by your body.  The problem is that saliva cannot break through the plaque.

Cavities

Tooth decay is the result of long-term enamel erosion that can’t be repaired by the body.  If the erosion is deep enough, it can expose the softer parts of the tooth to irritants and injury.  When this happens, the only way to repair and protect the tooth is to get a filling from your dentist. *womp womp*

Discoloration

Extrinsic stains are when substances change the tooth color from the outside. So this is how coffee, tea, wine, and tobacco can make the teeth yellow or brown.  Also, certain bacteria, excessive chlorophyll, or excess copper and nickel can make the teeth look green.

Intrinsic stains are when the building blocks of teeth are altered and changes the color from the inside.  Tetracycline antibiotics have been a common treatment for acne in teenagers for quite a long time.  It is well-documented that these antibiotics can bind up free calcium in the body.  Therefore, it is not recommended for pregnant women or children younger than 8 years old to use these medications.  There are many cases of developing fetuses and children with quickly-developing teeth ending up with grey or brown teeth due to this missing calcium (remember, calcium built into the enamel is what makes it white).

Injuries

A chipped tooth is when a part of the enamel breaks away.  A fractured tooth is when a crack involves the enamel and the dentin.  An abscess is an infection in the gum around the tooth or in the accessible or exposed pulp of a tooth.  Luxation is a dislocated tooth, and may or may not include injury to the periodontal ligaments or jawbones.

Dental Trauma Guidelines

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Teeth – Episode 103

Types of Teeth

Incisors: You have 4 on the top and 4 on the bottom.  Yes, it sounds like “scissors”; they are the teeth and cut and tear food (or the enemy?).  They are in the very front of your mouth.

Canines:  You have 2 on the top and 2 on the bottom.  Yes, canine, like a dog; they are sharp and pointed.  These teeth are good for gripping and tearing.  Also known as cuspids (one point).  They are located at the “corners” of your teeth arch.

Premolars: You have 4 on the top and 4 on the bottom.  These are permanent teeth only.  They have a flatter surface for crushing food.  Also known as bicuspids (two points).

Molars: You have 6 on the top and 6 on the bottom.   They have large flattish surfaces for grinding up food.  Four of these molars are also known as your wisdom teeth.

Parts of a Tooth

Outside In

Enamel: This is the part that you can see.  It is mostly made up of a crystalline structure of calcium phosphate, and that’s what makes them look white.  Enamel all by itself can be very brittle.

Dentin: This layer is made of a softer, yet still strong calcium-containing crystals.  This acts as a tough and supportive scaffold for enamel.

*These two layers together are what make your teeth so hard and strong.

Pulp: The soft connective tissue that contains the nerves and blood vessels that feed the tooth.

Top to Bottom

Crown: This is the part of the tooth that is above the gum line that you can see.  And since you can only see the outside of the tooth, when you look at your teeth, you only see enamel.

Neck:  This is the enameled part of the tooth that is below the gum line.

Root: The part of the tooth that is embedded in the jawbone and provides the openings for the nerves and blood vessels to run up into the pulp.  The roots are covered by a specialized bone structure called cementum (yes, it sounds like cement).

*The roots are actually attached to the jawbone by periodontal ligaments. (Ligaments are connective tissue that connects bone to bone).

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Mouth Issues – Episode 102

open mouth

Mouth Issues

Ulcers

They are uncomfortable and mostly non-serious.  Also known as “canker sores”.  Can take 2-3 weeks to completely heal.  Anything lasting over 3 weeks should be checked out by your doctor or dentist.  Ulcers can appear on the inside of the cheeks or lips, the roof of the mouth, or the tongue.  A minor ulcer versus a major ulcer is determined by the size of the sore and the layers of skin affected.  Any ulcer that is bleeding should be checked out despite the length of time.  The edges are red while the center can be yellow, white, or grey.  And they are PAINFUL!!

Ulcers can be caused by acidic or spicy foods, braces, stress, hormones, and some medications (such as beta-blockers for blood pressure or NSAIDs).  Nutritional deficiencies can increase your risk of ulcers.  Malabsorption due to conditions like celiac or deficiencies in B-vitamins and iron are the most common culprits.  Also, decreased immunity can make the skin inside the mouth more prone to ulcer recurrence.

Thrush

This is a yeast infection the mouth caused by the overgrowth of Candida, known as oral candidiasis.  It appears as white patches on the inside of the cheeks, tongue, or roof of the mouth, and the spots cannot be scraped off.  Candida is normal in the body and is kept in balance by the rest of the body’s normal flora.  Overgrowth can occur after antibiotic treatments, during times of decreased immunity due to treatments or disease states, or from inhaled steroid treatments.

Thrush is treated with a topical antifungal that the doctor directs you to swish around in the mouth to coat the affected areas, usually Nystatin.  If yeast is wide-spread, a systemic antifungal will be used.  Probiotics are a great way to keep your normal flora in balance.

Angular cheilitis (ky-ly-tis)

Cheilitis = inflammation of the lips.  This is the cracking that can occur in the corners of your mouth.  Many sources will tell you this is caused by a vitamin deficiency – like B-vitamins, iron, and zinc.  Other times, it may be a wound caused by contact dermatitis from increases contact with the tongue or your hands, and then they may become infected with normal skin bacteria or other bacteria in saliva.  An infected wound is one that doesn’t ever appear to heal.  Fungal infections, in the same way, cause the skin to crack open and appear overly dry and never-healing.

Lie Bumps

Transient Lingual Papillitis (swollen taste buds).  They can appear to be white or red, and they can be asymptomatic or very bothersome.  Not sure what exactly causes it.  Definitely NOT caused by lying.  *I used to think they were “lye bumps” as in sodium hydroxide that is a strong base and used to be popular as a detergent.*

Cleft lip/palate

A birth defect that has a strong genetic component, but also linked to environmental components that have not been pinpointed yet.  A cleft lip or palate is a result of parts of the mouth and face not fusing together during fetal development, and requires surgical correction after the baby is born.  The oral and nasal cavities are supposed to be separate and when they are not, it can increase the risk of sinus and ear infections.  Ear tubes are usually recommended.

Even after repair, a child may require speech and occupational therapies to develop the muscles needed for normal speech and eating habits.  Many times, a follow-up surgery is required as the child grows, and many other types of mental support are needed.

Bonus

*Mouth Cancers: the most common cause of mouth cancers is tobacco use (smoking, chewing).  It can start out as something that appears minor like a mouth sore, but can develop quickly into something deadly.  In the end, it can result in large areas of the mouth having to be surgically removed.

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Music Credits: Up In My Jam (All Of A Sudden) by – Kubbi https://soundcloud.com/kubbiCreative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 http://creativecommons.org/licenses/b…Music provided by Audio Library https://youtu.be/tDexBj46oNI