mouth


Swallowing – Episode 112

 

A young child with no shirt and light brown hair against a blue sky is swallowing gulps of orange juice from a clear plastic bottle.

The 3 Phases of Swallowing

Oral Phase

This phase includes chewing and saliva mixing with the food to form a bolus (a little glob of mashed up food). Then the tongue moves the bolus towards the back of the mouth.  The tongue starts by pressing against the hard palate behind the front teeth.  Then the sides of the tongue raise up to also press against the hard palate inside the teeth.  At this point, the bolus has nowhere to go except towards the back of the throat.

Pharyngeal Phase

The vocal folds in the larynx close to keep food out. The larynx also moves up as the epiglottis covers it to seal off the airway. Then the soft palate and uvula move up and close off the nasal passage  So now there is only one way out.

Esophageal Phase

The bolus moves into the esophagus (because it is the only open path). The esophageal muscles contract from top to bottom (this waving, rhythmic muscle movement is called peristalsis) to push the bolus into the stomach.

Swallowing Reflex

There are sensory receptors in the pharynx and tongue that receive touch signals.  When they are touched by a bolus, the signals are sent to the brain stem and the return signal results in involuntary and automatic movements of the larynx and epiglottis.  This is a good thing since swallowing is a very rhythmic process and you want food and drink to continue going in the correct direction.

This reflex cannot be triggered by sticking your finger in your throat.  You are more likely to trigger a gag reflex that way.  The voluntary steps of swallowing must be initiated before the involuntary portion of the process takes over.

Weird Swallowing Scenarios

How do you swallow with your mouth open?

At the dentist, you are usually laying in the chair on your back and facing the ceiling.  There are at least three tools and two hands in your mouth.  Things in your mouth trigger saliva production.  Also, generally one of the tools the dentist is using is emitting water.  The natural reflex when you have to hold your mouth open for a long time is to bring the back of the tongue and the soft palate together.  This seals off the throat and allows you to still breathe through your nose.  The liquid in your mouth plus gravity creates a puddle at the seal of your tongue and soft palate.  Because the touch sensors to trigger your swallowing reflex are also in this area, it is likely you begin to panic because if they don’t hurry and use the suctioning straw to remove the liquid, you’re going to swallow!

Do you swallow in your sleep?

A study was done to find that the only times you swallow while sleeping is during arousal and during REM.  My logical deduction regarding why is that when you’re aroused or in one of the more shallow phases of sleep, that is when you can voluntarily move – roll over, adjust the bedding, and swallow.  During REM sleep, most people will experience sleep paralysis, so whatever exciting things are happening in their brain, the body is not likely to act it out.  Because the brain cannot tell if a dream is real or imaginary, the feeling solicited can trigger hormones secretions and saliva production. Increased saliva, just like in the dentist scenario, can trigger swallowing.

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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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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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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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Probiotics

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Mouth Parts – Episode 101

bright red lips in a slight smirk behind a window covered in droplets of water

Mouth Parts

Lips:  They are red due to blood flow.  They have lots of nerve ending so they can be very sensitive.  Our lips are used to manipulate food as we eat and make sounds as part of our speech.
* The Divot above the center of your upper lip is called the philtrum.

Gums:  They are also known as the gingiva.  Even though they are wet and look fleshy, healthy gums are quite resilient.

Teeth: They are used for chewing, and possibly as a tool.  Healthy teeth and gums seal together tightly to keep out invaders.  We will talk about teeth in a separate episode.

Tongue:  It is a muscular organ made up of many muscles and nerve endings.  It just happens to be an organ that we can voluntarily move around.  We use our tongue to manipulate food and to make sounds for speech.  And, of course, it is covered in taste buds.  We will cover all of this in a separate episode.

Hard Palate:  A flesh-covered bone that connects the upper teeth.  Our tongue will smash food against it when we eat and use to make certain sounds in speech.

Soft Palate: It is a muscle behind the hard palate and it moves up to close off the nose when we swallow and sneeze.  It also interacts with the back of the tongue to make certain sounds when we talk.

Palatoglossal arch:  It marks the front edge of the soft palate.

Palatopharyngeal arch: It makes the back edge of the soft palate and the end of the “mouth”.

Salivary Glands

Parotid glands: The largest salivary glands are located by your jaws, below your ears.
Submandibular glands: They are located under the jaw and back molars
Sublingual glands: They are located under the tongue, behind your chin.
~1000 of mini glands: They cover the buccal (cheek) tissue, soft palate, uvula, and tongue to keep everything moist.  This is what allows the inside of the mouth to be known as a mucous membrane.

Sublingual papilla: This is the folds of skin under the tongue.  This area contains many blood vessels close to the surface.  Medicine development has learned this is a great place for medication absorption directly into the bloodstream.

Palatine raphe (ray-fee): This is the seam down the middle of the hard palate.

Frenula: Plural for frenulum.  These are folds of skin that connect one place to the other.  You have three: for your upper lip, lower lip, and tongue.

Uvula: Latin for “small bunch of grapes”.  It is attached to the soft palate and contains a gag reflex trigger.  It is also involved in snoring if it dries out.

 

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Sneezing

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