06/28/2025
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Did you know that a white-coated tongue can be a sign of altered swallowing?
A proper swallow should:
âś… Be silent - with no gulping or clicking
âś… Involve no pursing or tightening of the lips, cheeks, or chin
âś… Happen without head bobbing or visible effort
âś… Create a full tongue-to-palate seal (not forward thrust of the tongue)
When the tongue seals correctly against the palate, it helps clear food remnants from the tongue surface, preventing build-up and reducing the appearance of a white coating.
This child had a history of myofunctional and structural issues related to swallowing:
🧩 Palate expansion for a narrow upper jaw
🧩 Persistent open bite, with concerns about orthodontic relapse
🧩 Tongue thrust and lisp
🧩 Breastfeeding cut short on medical advice due to recurrent, severe mastitis
🧩 Picky eating, including avoidance of meat
🧩 Chronic glue ear lasting over two years
🧩 Signs of sleep-disordered breathing including tummy sleeping, restlessness, and bedwetting
At one point, ARFID (Avoidant/Restrictive Food Intake Disorder) was considered.
But before we assign that label, we need to ask:
Could this child be avoiding food because their altered swallow makes some foods feel difficult or unsafe?
In this case, a previously undiagnosed tongue-tie, subtly restricting elevation of the mid-tongue was a key root cause, introducing dysfunctions that have compounded with time.
Visual clues to watch for:
đź“· Image 1: White-Coated Tongue
Without consistent tongue-to-palate contact, the tongue doesn’t self-clean.
đź“· Image 2: Attempted Tongue-to-Palate Suction Hold
The child attempts suction, but the seal is weak. The tongue tip lifts, but the mid and back remain low.
Myofunctional therapy can improve tongue tone and coordination. The extent of any tongue-tie restricting mid-tongue lift can then be more accurately assessed.
đź“· Image 3: Tongue Tip Elevation with Floor of Mouth Stabilised
With the floor of the mouth gently held down, we can see the mid-to-back tongue is tethered and struggles to lift.
This child’s story gives us plenty of clues.
Many children compensate well, but when dysfunction persists, the tongue doesn’t develop the resting posture and tone needed for optimal oral development, breathing, and sleep.
Let’s pay attention to the basics before we assume a complex diagnosis.
Don’t assume your healthcare professional has looked for this. Even as a dentist, or the so-called expert of the mouth, I didn’t learn any of this in dental school.
Often, the tongue is telling the story. We just need to look and learn.
