Neuroscience and swallowing rehabilitation, Froggymouth: An anoetic approach, 2nd edition

Abstract

This self-published book by Dr Patrick Fellus, an orthodontist and a founding president of the French Pediatric Orthodontic Society and the International Functional Association (IFUNA) gave me an “a-ha” moment in addition to learning what the word anoetic means. I learned that fMRI studies have shown that a tongue thrust “abnormal” swallow occurs with increased brain activity and energy because it activates accessory tongue muscles that involve C1-C3 cervical nerves. Now, I wonder how this “increased brain activity” could be a contributing factor with hyper-neuronal excitability, causing some people to develop apnea, face pain, headache, and neck pain conditions. The literature has studies about “abnormal swallow patterns,” but until recently, the solution seemed tedious. Most patients resist seeing a speech pathologist, and getting them to do a series of exercises is time-consuming for a dental or orthodontist office and the patient. This book presents us with a research-based understanding of the swallow neurological mechanism and provides us with a simple way to change neuromuscular controlled swallow patterns with a device used 15 minutes a day while awake. A review of the neurological mechanisms about habitual learned behaviors like swallow patterns, we are told, does not happen while sleeping, implying that using an oral appliance while sleeping will not change habitual swallow patterns. Could this explain why many patients who stop using post-orthodontic appliances experience bite collapse? This book nicely dovetails with emerging studies that connect the patency of the upper airway with the dynamics of facial growth and development of children. The tongue is often blamed for pathological movement of teeth, and now we are presented with a more nuanced explanation. The book includes a review of embryology and reflex swallow patterns of the fetus and newborns. We are told how, during the first few years of life, swallow patterns change as the brain develops. Use of a pacifier and finger sucking is discussed as well as changes with swallowing while eating chewable food. Several extreme case histories of only using the Froggymouth device are presented. The book has a bibliography but no footnotes. Dr Fellus has contributed to explaining the dynamic relationship of swallowing, upper airway breathing, and the neurobiology that controls it. Multimodality management of most problems is typically the most effective approach; this book explains how this device offers an elegant addition to your armamentarium.