Swallowing Eating

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Swallowing Eating
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Our mission is to improve the quality of health care and lives of everyone affected by Temporomandibular Disorders.
Eating and drinking are enjoyable activities that positively impact an individual’s quality of life and are also necessary for maintaining good nutrition.
The pain and jaw dysfunction associated with TMJ disorders can make chewing and swallowing food challenging. TMJ patients who also have eating disorders face even more challenges. How and what you are able to eat can influence your nutritional and health status – an aspect that is often overlooked by both patients and health care providers .
The TMJ Association asked patients their opinion on this topic. Here are a few comments:
“…Eating fruits, veggies, and health foods tend to be very hard on my jaw; I can get a headache just from eating an apple or a few carrots. I would much rather eat mashed potatoes and not hurt…”
“…There are days I am so hungry, but I know the price I will pay if I ‘chew’ the wrong foods…”
“…My daily food choices are very limited, due to the possibility of my jaw locking up while chewing crunchy or chewy foods…”
The TMJ Association developed a nutritional guide, TMD Nutrition and You , specifically for people with compromised oral function to help them maintain a healthy diet in spite of their oral disability. Click here to download a free copy of our booklet!
Despite the pain and functional limitations commonly seen in Temporomandibular disorders (TMJ) affecting a person’s ability to chew and swallow, there is very little research on the relationship between TMJ, diet and nutrition. 
“While nutritional modifications are often a consequence of the “soft diet” component of most TMJ self-management programs, little evidence has addressed the benefits and adverse effects of addressing nutritional needs” ( National Academy of Medicine Report on Temporomandibular Disorders ).
To address these questions, a study, Persistent Temporomandibular Disorders and Dietary Changes: A Cross-sectional Survey, was begun in 2019 by a team of researchers at Newcastle University in the United Kingdom in collaboration with The TMJ Association. We thank the TMJ patients who participated and are pleased to share some preliminary results.
The aim of the study was to understand the impact of TMJ on diet and nutrition, which can lead to evidence-based guidelines for making healthy dietary choices. In total, 93 individuals drawn from 11 different countries completed the nutrition study’s patient questionnaire, with 70% from the U.S. Approximately half of those who completed the questionnaire went on to complete daily diet diaries; but only half of these completed diaries over the three consecutive days requested. The mean age of participants was 50.7 years old, most of whom were women. Over 95% had been diagnosed with a TMJ disorder by a healthcare professional.
The results of this study have been published, May 25, 2021 in the Journal of Oral Rehabilitation : Temporomandibular Disorders and Dietary Changes: A Cross‐sectional Survey .

Medically Reviewed by Nayana Ambardekar, MD on January 20, 2021
Swallowing seems simple, but it's actually pretty complicated. It takes your brain , several nerves and muscles, two muscular valves, and an open, unconstricted esophagus , or swallowing tube to work just right.
Your swallowing tract goes from the mouth to the stomach . The act of swallowing normally happens in three phases. In the first phase, food or liquid is contained in the mouth by the tongue and palate (oral cavity). This phase is the only one we can control.
The second phase begins when the brain makes the decision to swallow. At this point, a complex series of reflexes begin. The food is thrust from the oral cavity into the throat (pharynx). At the same time, two other things happen: A muscular valve at the bottom of the pharynx opens, allowing food to enter the esophagus, and other muscles close the airway ( trachea ) to prevent food from entering the airways. This second phase takes less than half a second.
The third phase starts when food enters the esophagus. The esophagus, which is about nine inches long, is a muscular tube that produces waves of coordinated contractions (peristalsis). As the esophagus contracts, a muscular valve at the end of the esophagus opens and food is propelled into the stomach. The third phase of swallowing takes six to eight seconds to complete.
A wide range of diseases can cause swallowing problems, which your doctor may call "dysphagia." These include:
Under normal circumstances, people rarely choke during a meal. Occasionally, food will stick in the esophagus for a few seconds (especially solid foods), but will pass spontaneously or can be washed down easily with liquids. But there are a number of symptoms that you should get checked for a possible swallowing problem, including:
Immediate medical attention is needed when food becomes lodged in the esophagus for more than 15 minutes and doesn't pass spontaneously or with liquids.
Some people don't know that they have swallowing problems, because they compensate unconsciously by choosing foods that are easier to eat, or they eat more slowly. However, untreated swallowing problems raises the risk for choking or having large pieces of solid food lodge in the esophagus.
If you think you have a swallowing problem, talk to your health care provider. You may get tests such as:
Cineradiography: An imaging test in which a camera is used to film internal body structures. During the test, you will be asked to swallow a barium preparation (liquid or other form that lights up under X-ray). An X-ray machine with videotaping capability will be used to view the barium preparations movement through the esophagus. This is often performed under the guidance of a speech pathologist, an expert in swallowing as well as speech.
Upper endoscopy: A flexible, narrow tube (endoscope) is passed into the esophagus and projects images of the inside of the pharynx and esophagus on a screen for evaluation.
Manometry: This test measures the timing and strength of esophageal contractions and muscular valve relaxation.
Impedance and pH test: This test can determine if acid reflux is causing a swallowing problem.
Treatment depends on the type of swallowing problem you have. Sometimes, a swallowing problem will resolve itself without treatment. On other occasions, swallowing problems can be managed easily. Complex swallowing problems may require treatment by a specialist or several specialists.
If you have a chewing or swallowing problem there are several things you can do to make eating and drinking easier and safer, including:
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Difficulty swallowing can be caused by something as simple as not chewing your food enough but can also be a sign of serious conditions, such as a stroke or cancer.
Gasteoenterologist, NYU Langone Health
Gasteoenterologist, NYU Langone Health
Illustration of a person thinking with cross bandaids.
Illustration of a person thinking with cross bandaids.
Illustration of various health care options.
Illustration of various health care options.
Esophageal diverticulum (zenker’s diverticulum)
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I have had GERD since 1981 and it has been controlled with prescription acid blockers over the years and it has helped. About 8 years ago, with a change in diet, I was able to stop taking them. And then a few years later, from stress and a construction accident, my reflux came back and so went back on meds.

But about two months ago I choked on a piece of asparagus and have had troubling trying swallowing since. Went to an ENT and he found nothing wrong. Then just had an endoscopy done 2 days ago and didn't find anything significantly wrong with my stomach or esophagus or throat, although they did dilate my esophagus and took a couple biopsies, but I'm still not swallowing right.
Gasteoenterologist, NYU Langone Health
Dr. Kim is a Gastroenterology Fellow at New York Presbyterian Hospital/Columbia University where she also completed her residency training in Internal Medicine. She received her medical degree at Washington University in St. Louis and earned her BA in Biology at Harvard College. Her specialty is Gastroenterology, with a research interest in gastric cancer and clinical outcomes.
Take a quiz to find out what's causing your trouble swallowing.
Take a quiz to find out what's causing your trouble swallowing.
Difficulty swallowing , or dysphagia, occurs when the muscles and nerves that allow you to swallow become irritated, compressed, or damaged. It is more common with age.
It may feel like food is stuck in your throat or chest, or cause coughing, heartburn, pain when swallowing, regurgitation (food coming back up your throat), and drooling.
Sometimes, difficulty swallowing is caused by something simple, like eating too fast or poor chewing. But it can be caused by physical issues with your esophagus, such as a blockage or swelling. Or it may be a sign of a serious condition, such as cancer or a stroke.
Treatment may include medication, endoscopy, or surgery.
Difficulty swallowing causes a lot of discomfort, but it can also lead to aspiration, which is when food or liquid gets into the airways instead of the esophagus. Everyone aspirates a little bit, but when people have difficulty swallowing, they can aspirate more, which can lead to pneumonia. — Dr. Judy Kim
An esophageal obstruction prevents food, liquid, and saliva from reaching your stomach. The blockage may be caused by food, usually tough items like meat (or objects such as a bone in the meat), that gets stuck in your esophagus. This typically occurs if you don’t chew properly or don’t have enough teeth to break up your food. The symptoms come on suddenly.
Cancer of the esophagus—or less commonly, the stomach—can also cause difficulty swallowing because your esophagus narrows. In this case, you may also have other symptoms, including weight loss, blood in your stool, and anemia .
Go to the ER if you swallowed something sharp (like a bone), the food feels like it’s stuck for a while, or you can’t even swallow saliva. You may need to have an endoscopy to remove the obstruction.
If you have symptoms of esophageal or stomach cancer, see your doctor immediately. Treatment depends on the type of cancer you have and may include surgery and chemotherapy.
Gastroesophageal reflux disease (GERD) occurs when stomach acid flows back into your esophagus, causing a burning sensation in your chest or upper abdomen. GERD is very common, affecting 18% to 28% of people in the U.S, according to a study published in Gut .
GERD can cause ongoing inflammation that may lead to a complication called esophageal strictures, also called peptic strictures. This is an abnormal tightening of the esophagus that can make swallowing even more difficult and prevent food from reaching your stomach.
Treatments for GERD include changing your eating habits to avoid foods that trigger heartburn. Medications can be used to lower the amount of acid your stomach produces, such as antacids, proton pump inhibitors, and H2-blockers.
If you have esophageal strictures, you may need to have them dilated (widened) during an endoscopy to relieve your symptoms.
Take a quiz to find out what's causing your trouble swallowing.
Eosinophilic esophagitis (EoE) occurs when the esophagus becomes inflamed with a type of immune cell called eosinophils. It’s thought to be an immune system disease caused by exposure to certain allergens. People with EoE may also have other allergic disorders, such as asthma , eczema , or food allergies.
The build-up of eosinophils can damage the esophageal tissue, causing difficulty swallowing and increasing your risk of food getting stuck in your throat.
A gastroenterologist will do a biopsy of your esophageal tissue during an endoscopy (through a tube that goes down your throat). EoE is treated with medications such as proton pump inhibitors to reduce inflammation. You may also see a dietitian, who can create a diet for you that helps you avoid certain allergens.
Many people think that difficulty swallowing only affects the elderly. However, there are several diseases that can affect younger people, such as eosinophilic esophagitis. It is important to take symptoms seriously and be evaluated by a physician. — Dr. Kim
Achalasia is a rare disorder in which your esophagus doesn’t move properly when you swallow, making it difficult for food to be propelled down to your stomach. Achalasia also prevents the sphincter muscle at the bottom of your esophagus from relaxing normally, which prevents food from emptying into the stomach properly.
The condition is caused by damaged esophageal nerve cells, which prevent the muscles of the esophagus from functioning as they should. Symptoms appear gradually and worsen over time.
There is no cure for achalasia. Treatment includes medications like calcium channel blockers, muscle relaxants, and Botox injections, though these are less effective. One treatment is a procedure called pneumatic dilation, in which your doctor inserts a balloon in your esophagus and inflates it to widen your esophagus. In some cases, surgery is necessary to cut the end of the esophageal sphincter.
A stroke occurs when blood flow is stopped by a clot in your brain or when there’s a bleed in your brain. A transient ischemic attack (TIA) often called a “mini-stroke” can cause similar symptoms as a stroke, but it lasts for less than 24 hours.
After a stroke or TIA, you may have weakened muscles of the oropharynx (the middle part of your throat) or it may affect your swallowing reflex. These both cause difficulty swallowing.
If you have symptoms of a stroke or TIA, immediately go to the emergency room. TIAs need to be taken as seriously as a stroke because they increase your risk of experiencing a full-blown stroke. Treatment includes anti-clotting medication and possibly surgery.
Myasthenia gravis is an autoimmune disorder that causes muscle weakness in various parts of your body, such as your jaw, eyelids, arms, and legs. It occurs when your immune system mistakenly attacks the proteins that regulate the connection between your nerves and muscles.
This causes weakness in various parts of your body and can interfere with your ability to swallow.
While myasthenia can’t be cured, the condition can be treated with corticosteroids, immunosuppressants, and medications called cholinesterase inhibitors. You may also need surgery to take out the thymus, the gland that produces the antibodies that attack your body in myasthenia gravis.
An esophageal diverticulum is a protruding pouch in the lining of your esophagus. The most common type is a Zenker’s diverticulum (ZD), which develops near the upper sphincter, the muscle that helps keep food and saliva from entering your airway.
ZD is thought to be caused by the thickening of certain throat muscles, which occurs naturally with age. ZD is most common in men over 70.
A small diverticulum may not bother you, but a large one can cause difficulty swallowing. Food and saliva may collect in the diverticulum, causing bad breath or regurgitation.
Your doctor or gastroenterologist can diagnose ZD with a barium swallow test. In this imaging test, you drink a liquid that allows your doctor to see your esophagus on an X-ray. People with moderate to severe ZD may need surgery, or a diverticulotomy, to break apart the muscles.
A number of conditions can cause difficulty swallowing, including:
When there is difficulty even just starting a swallow right as you initiate eating or drinking, then it is more likely an oropharyngeal cause—it may be best to see a neurologist or speech language pathologist. When there is difficulty a few seconds after you swallow and it seems like something is stuck in the throat or chest area, it is more likely esophageal and seeing a gastroenterologist may be most helpful. — Dr. Kim
Take a quiz to find out what's causing your trouble swallowing.
See your doctor if you have any of the following symptoms:
You should go to the ER if you have any of these signs of a more serious problem:
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