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STAGES OF DEGLUTITION
AND TONGUE
THRUSTINGSubmitted by:-Musavvar MansooriRanjeet DhonkalB.D.S. final yr
Department of PedodonticsGovt. College of Dentistry, indore
DEFINITION---THE SERIES OF CO-ORDINATED MUSCLE CONTRACTION THAT MOVES A BOLUS OF FOOD FROM THE ORAL CAVITY THROUGH THE ESOPHAGUS TO THE STOMACH.
IT IS AN IMPORTANT FUNCTION CARRIED OUT BY STOMATOGNATHIC SYSTEM.
DEGLUTIOTION
TYPESINFANTILE SWALLOW PATTERNMATURE OR ADULT SWALLOW
PATTERN
INFANTILE SWALLOWINGInfants swallow food by suckling. This is
an autonomic reflex in human beings.Development of swallowing begins
around 12.5 wks of intrauterine life. Full swallowing and sucking is established by 32-36 wks of IU life.
Sucking and swallowing reflexes are present in a full term baby and their absence would suggest a developmental defect.
MECHANISMBreastfeeding
Infant lips closed around the areola of the breast.
Tongue protrudes to the lower lip and forms a spoon like closure around nipple.
Relaxation of the elevator muscles of the mandible
Mouth is open wide
Milk is directed to the pharynx by the peristaltic movement of the tongue.
MATURE SWALLOWING PATTERN
Mature swallow develops around 4-5 yrs.
Maturation of swallow pattern occurs with the addition of semi-solid and solid food to the diet.
It is characterized by the relaxation of the lips, placement of the tongue behind the maxillary incisors and elevation of the mandible until posterior teeth are in contact.
TONGUE MUSCULATUREEXTRINSIC MUSCLES:- Genioglossus
muscle. Styloglossus
muscle. palatoglossus
muscle. Hyoglossus
muscle.INTRINSIC MUSCLES:- Superior longitudinal muscle Inferior longitudinal muscle Transverse muscle Vertical muscle
As person swallows the of the tongue contact the:-
Tooth surface.Rugae areas.Adjacent to rugae.Vault.Soft palate.And Swallowing of bolus occurs.
STAGES Oral stage/ First stage Pharyngeal stage/ Second stage
Oesophageal stage/Third stage
ORAL STAGEVoluntary stage
Food move into pharynx from mouth.
Positive pressure created at posterior part
Posterior part is elevated and retracted against hard palate.
Anterior part of tongue is retracted and depressed.
Bolus is placed on posterodorsal surface of tongue.
Pharyngeal stageInvoluntary stage
Bolus moves into esophagus
Peristalsis contraction of pharynx
Upper3-4 cm of esophagus relaxes
Stretching of esophagus due to upward movement of larynx
ESOPHAGEAL STAGE
Bolus entered to stomach.
Relaxation of lower esophageal sphincter
Bolus enters the lower part of esophagus
Bolus is propel down
Initiation of peristalsis in esophagus.
TONGUE THRUSTING
DEFINITIONTULLEY (1969):- States tongue thrust as the forward movement of the tongue tip between the teeth to meet the lower lip during deglutition and in sounds of speech, so that the tongue becomes interdental.
BARBER (1975):- Tongue thrust is an oral habit pattern related to the persistence of infantile swallow pattern during childhood and adolescence and thereby produces an open bite and protrusion of the anterior tooth segment.
CLASIFICATION 1By JAMES and HOLT TYPE 1:- Non deforming tongue thrust. TYPE 2:- Deforming anterior tongue
thrust.Anterior open bite.Anterior proclination.Posterior cross bite . TYPE 3:- Deforming lateral tongue
thrust.Posterior open bite.Posterior cross bite.Deep overbite.
TYPE 4:- Deforming anterior and lateral tongue thrust.
Anterior and posterior open bite.Proclination of anterior teeth.Posterior cross bite.
SIMPLE TONGUE THRUST The simple tongue thrust is
characterized by normal tooth contact during swallowing.
Presence of an anterior open bite.
They exhibit good intercuspation of teeth.
The tongue is thrust forward during swallowing to help establish an anterior lip seal.
Abnormal mentalis muscle activity seen.
LATERAL TONGUE THRUST
Posterior open bite with tongue thrusting laterally.
COMPLEX TONGUE THRUST
It is characterized by teeth apart during swallowing.
Anterior open bite can be diffuse or absent.
Absence of temporal muscle contraction during swallowing.
Contraction of circumoral muscle during swallowing.
The occlusion of the teeth may be poor..
CLASSIFICATION 3 PHYSIOLOGICALThis comprises the normal tongue
thrust swallow of infancy. HABITUALThe tongue thrust swallow is present as
a habit even after the correction of the malocclusion.
FUNCTIONALWhen the tongue thrust mechanism is
an adaptive behavior developed to achieve an oral seal.
ANATOMIC Person having enlarged tongue
can have an anterior tongue posture.
ETIOLOGY Retained infantile swallow During infantile swallow the tongue is
placed between the gum pads. After 6 months of age several maturational movements occur that alters the functioning of orofacial musculature. With the arrival of the incisors the tongue assumes a retracted position. If the transition of the infantile swallow to the mature swallow do not take place with the eruption of incisors then tongue thrusting develops.
UPPER RESPIRATORY TRACT INFECTION
Mouth breathing.Chronic tonsillitis.Allergy. NEUROLOGICAL DISTURBANCESHyposensitive palate.Moderate motor disability. Disruption of sensory control and
coordination of swallowing. FUNCTIONAL ADAPTIBLITY TO
TRANSIENT CHANGE IN ANATOMY.Missing incisors.
FEEDING PRACTICESBottle feeding.Consistency of infant diet. INDUCED DUE TO OTHER ORAL HABITSThumb and finger sucking HEREDITARYInherited hyperactivity of orbicularis oris
with specific anatomic configuration and neuromuscular activity.
TONGUE SIZECongenital aglossia.Macroglossia.
EXTRAORAL FINDINGS LIP POSTURE
Greater lip separation. MANDIBULAR MOVEMENTS More erratic movements and no in coordination
between tongue tip and mandible itself. The average path of mandibular movement is upward
and backward with the tongue moving forward. SPEECH Sibilant distortions Lisping Problems in articulation of S, N, T, D, I, Th, Z, V, Ph,
Sh sounds. FACIAL FORM Increase in anterior facial height.
INTRAORAL FINDINGS TONGUE MOVEMENTS:- jerky and
irregular TONGUE POSTURE:- lowered tongue tip. MALOCCLUSION:- Proclination of maxillary anteriors.Generalized spacing between teeth.Maxillary constriction.Retroclination or proclination of mandibular
teeth.Anterior open bitePosterior open bitePosterior cross bite.
ANTERIOR OPEN BITE
POSTERIOR OPEN BITE
POSTERIOR CROSS BITE
ANTERIOR CROSS BITE
DIAGNOSISHistory takingExamination
TREATMENTTRAINING OF CORRECT SWALLOW AND
POSTURE OF THE TONGUE:- {A} Myofunctional exercises
1. Child is asked to place the tip of tongue in rugae area for 5 min and then swallow.
2. Orthodontic elastics and sugar less fruit drop exercise.3. 4S exercise:- includes Identifying the spot Salivating Squeezing the spot Swallowing4 Other exercises:- whistling Reciting the count from 60-69 Gargling yawning
{B} Using appliance as a guide
Preorthodontic trainer Nance palatal arch
SPEECH THERAPY:-It is not indicated before the age of 8
yrs.To pronounce words beginning with s
and repeat s.Multiplication table of 6.
MECHANOTHERAPYFixed and removable appliance- To restrain the anterior tongue
movementsTo force the tongue downward and
backwardTo reeducate the tongue position.Removable appliance therapy-
Hawley's appliance
Removable appliance therapy- Hawley's appliance
Trans palatal arch
Oral screen- modified acrylic plate used to control muscles forces both inside and outside the dental arches
TONGUE CRIB
For posterior open bite modified cribs is used
CORRECTION OF MALOCLUSIONSURGRICAL TREATMENT-
orthognathic surgical procedure for correction of skeletal malformation.
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