Do you check during the evaluation and during treatment if the client is biting during the swallow?

Q:  Do you check if the client is biting during the swallow?

A:  Perhaps 30 – 40 years ago, checking for the bite during the swallow was part of the standard evaluation.  We used to think that the closure was related to the “balancing” of the masseter muscles.  We believed that the tongue being held between the posterior dentition, and preventing molar closure, contributed to “weak and imbalanced” masseters.  Current understanding is that not every typical swallow involves such biting together of the back teeth.  Sometimes the swallow involves only a very light contact, depending upon what food or liquid is being swallowed.  There are likely many other factors involved as well.  Long before we work on the actual swallow, we have assured ourselves that the patient’s tongue can and does fit well within the palate and that he can collect and suction the bolus correctly.  This, in itself, negates the need to emphasize the actual biting together of the back teeth since it is addressed in steps all along the way long before the swallow is introduced in therapy.