Then I asked Betty about her coughing. Initially, she said that she coughed more on liquids than food and she coughed all the time. I asked her to drink some water but she didn’t cough. Specifics are so important when trying to diagnose a problem. More questions revealed the truth: Betty gets choked on her saliva, not on food or drinks. Now I needed to find out why…

Betty had pretty teeth and had never had braces. Closer inspection of the left side of her teeth revealed a space between her back upper and lower molars. I asked her to close her mouth, swallow her saliva, and discover whether the side of her tongue protruded through that space when she swallowed. She said that it did. I then asked her to swallow her saliva again and discover what the tip of her tongue pushed against when she swallowed. She said it pushed against the back of her upper front teeth. This confirmed that Betty had a tongue thrust.

It is usually hard for a person with a tongue thrust to swallow quickly because their tongue is probably just laying on the bottom of the mouth. It isn’t making contact with the palate, providing control of the substance being swallowed. Betty allows saliva to build up in her mouth so she doesn’t have to swallow so often. Because of her weak tongue muscles, when her mouth gets full of saliva, gravity jerks the saliva down her throat before her tongue has a chance to try to control it and this causes her to cough. Mystery solved.

Goal #1: Learn how to swallow without pushing the back of her teeth and stop coughing.

Betty was then asked to protrude her tongue and let it be relaxed. This revealed scalloped edges, and indentations all around her tongue, indicating her tongue had been pushing against her teeth when inside her mouth. So what? This meant that her tongue was too wide for that space and what were the chances when she was sleeping, and her muscles were relaxed, that her tongue also relaxed, got wider, and forced her lips to fall apart? This was worth investigating.

Goal #2: Make her tongue skinnier.

Betty’s lips were closed when she wasn’t talking. She was breathing through her nose and said that she was pretty sure that she breathed through her nose while sleeping. More questions would help us discover if she was a mouth breather while sleeping. Did she wake up with a dry mouth and/or sore throat? Yes. Did she wake up with a headache? Yes. Did she have daytime sleepiness? Yes. These are all symptoms of mouth breathing while sleeping. This confirmed my suspicion.

Goal #3: Train her lips to stay closed while sleeping to prevent mouth breathing.

I couldn’t forget Betty’s main complaint of a painful tongue when she swallowed. What was causing that? I still hadn’t heard any hoarseness in her voice, which was the reason she was referred to me. Experience has taught me that a hoarse voice could be a sign of tension in the larynx, which is where the vocal cords are located. Was Betty breathing from her belly or her chest? I told her to put her hand on her belly and inhale and discover whether her belly pushed out or not. No. It did not and Betty found it very strange to try to push her belly out while breathing. She put her other hand on her chest, inhaled, and by using both hands as guides, she was able to redirect her inhalation. Betty said that her hoarseness was very inconsistent and it is suspected that muscle tension, due to improper breathing and/or holding her breath while talking, was the culprit. Read this article to learn more about abdominal breathing

Goal #4: Learn how to breathe properly and consistently.

I asked Betty if she ever accidentally bit the sides of her tongue. She said no, but she said that she does chew on the inside of her cheek on the left side. I then saw Betty do something with her mouth. Her lips puckered up and twisted to the left side. I asked her what she was doing and she said she was chewing on the inside of her cheek. I directed her to look in the mirror and asked her to do it again. I asked her if she knew what she looked like when she was doing that and she said no, that she had never been aware of it. At this point, I asked her to chew on her cheek again and discover if that pain in her tongue that she had initially complained about was present. She said yes. Then I discovered that she has been chewing on her gum for 4-5 years and continues to do it numerous times per day.

Goal #5: Stop chewing on the inside of her cheek to determine if that is the source of her tongue pain.

I believe we have discovered and identified the problems. The rest is easy: make the tongue skinnier and stronger and train it to “live” on the roof of her mouth, forcing her to nasal breathe and swallow in a new way. Wake up feeling refreshed!