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  • 8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx






  • 8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx


    SYSTEM Functions ofstomatognathic sst!m "

    Mastication , swallowing, respiration speech andmaintenance of posture are the various functions ofthe stomatognathic system, they are all intimately

    related and occur simultaneously.

    All the oropharyngeal reex such as mandibularposture, respiration, tongue position, deglutition,sucking, gagging, laughing, sneezing and vomiting are

    present as uncontrolled reexes as they are life savingactivities.

    Tactile sensation is well developed in the new born.

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    Th! D!#!$o%m!nt Of &a'iousR!(!)!s Du'ing Th!

    INTRAUTERINE Lif! a'! asFo$$o*s

    . !y the "thweak of intra#uterine life stimulation of lips

    causes the tongue to move.$. At about the same time, stimulation of upper lip

    causes mouth closure and even deglutition .

    %. &ag reex develops by about '($ weeks.

    ". )espiration by about $* weeks.

    *. +ucking by $*weeks.

    . +ucking and swallowing by %$ weeks.

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    +ensory guidance for all activities including -aw

    Movement, covers a large area and includesmultiple contacts for sensory inputs tongue,lips, soft palate, posterior, pharyngeal wall andtemporomandibular -oint./

    A brief review of the forces acting on the bonystructures to shape them during thedevelopmental stages helps us in understanding

    the changes that pernicious oral habits canbring about in the oral architecture.

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    Som! Antagonistic Fo'c!sActing on th! Masticato'

    A%%a'atus". 0ips# tongue.$. 1heeks#tongue

    %. 2ruption 3f teeth#Masticatory Muscles, Masseter,Medial 4terygoid .

    ". Air pressure on skin and nasal cavity#tongue inclosed mouth, air pressure in open mouth.

    *. Masseter 5 elasticity of periodontal ligamentsuprahyloid muscles.

    . 6nternal pterygoid# same as masseter.7. 2xternal pterygoid in anterior movement#posterior

    one third of temporalis.

    '. +uprahyoid group, digastricus, muscles of neck in

    lateral movement#external pterygoid of other side.

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    Mastication "+Mastication is a complex activity aimed at

    breaking down and insalivation of the food, preparatory toswallowing

    INFANT "+The 8rst food is consumed by suckling . This is an

    unlearned or innate reex in homo#sapiens.

    Th! C$assic ,att!'n is Out$in!- .suc/$! 0 S*a$$o* 1 2Bosma in infant "

    . 9ead is extended, tongue elongated and low in the oor of

    the mouth, -aws a part and lips pursed around the nipple.

    $. Mandible is slightly protruded.

    %. :uring ;unction, i.e. deglutition, the rhythmic contraction ofthe tongue and facial Muscles aids in the +tabilization of the


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    Di3!'!nc! 2!t*!!n Suc/$ing 4Suc/ing


    +uckling consist of small nibbling movements of the lipsaround the mothererent from thesucking process.

    Suc/ing "+

    +ucking consist of drawing a li=uid or other substance/into the mouth by creating a partial vaccum in the mouth.

    9oweverthese two words are often used interchangeably

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    On!s th! chi$- sta'ts ta/ing

    so$i- foo-s". The intensity of the act of satisfying hunger is


    $. !ut most of the muscles of the cheek tongueand oor of the mouth are involved.

    %. There is less activity of lips and Mandibularthrust is reduced.

    ". 6nfant ?uickly learns to use from being forcedout of the mouth during peristaltic action ofthe tongue and the cheeks as the bolus offood is forced towards the pharynx.

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    In An Infant

    !olus is mixed with saliva by the

    action of tongue.

    $ )hythmic action of muscles of the cheek serves to

    force the food back towards the tongue@ which pushesthe food against the hard palate.

    % To permit the food interpose between gum pads orteeth, the mandible is depressed by gravity and hyoidand lateral pterygoid muscles with simultaneousdeection towards the working side.

    " 0ateral +hift of mandible is more apparent whilechewing hard food.

    * Mandible is closed primarily by the temporal and

    masseter muscles activity.

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    Masticatory stroke in an adult Summarized

    by Fletcher using the six phases outlined by

    Murphy:56 ,'!%a'ato' ,has!"+ ;ood is ingested and

    positioned by the tongue with in the oral cavity andmandible is moved towards the chewing side.

    76 Foo- Contact"+ 1haracterized by a momentaryhesitation in movement. This pause is triggered bysensory receptors concerning the apparent viscosity

    of the food and probably transarticular pressureincident of chewing.

    86 Th! C'ushing %has! "+ +tarts with a high velocitythen slows as the food is crushed by a slight change

    in direction but no delay.

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    96 Tooth Contact " Accompanied by a slight

    change in direction but no delay.

    :6 Tooth G'in-ing ,has! " 6t coincides with thetransgression of Mandibular molars acrosstheir maxillary counterparts and is highlyconstant from one cycle to cycle.

    ;6 T!'mina$ ,has! " Messerman %/ termedthis phase as terminal functional orbit.Ahlgren/ noted that during this phase thebilateral muscular discharge becomes une=ualand asynchronous, indicating that the person ischewing unilaterally.

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    S*a$$o*ing < D!g$utition

    :eglutition or swallowing is an important functioncarried out by the stomatognathic system.

    The +wallowing pattern in infants is di>erent fromthat seen in adults.

    Thus two main forms of swallowing are


    I6 Infanti$! S*a$$o*

    II6 Matu'! S*a$$o*

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    56 Infanti$! S*a$$o*

    o Cha'act!'istics "

    . -aws apart with the tongue between the gumpads

    $. Mandible is stabilized by the contraction of themuscles of the 7thcranial nerve and the

    interposed tongue.%. The swallow is guided and to a greater extent

    controlled by interchange between the lips andtongue.

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    =ith Li>ui- Foo-? Immatu'! o'

    #isc!'a$ s*a$$o* in infants"

    &um 4ads are not brought into contact. A clucking isfre=uently heard.

    The 6nstinctive and peristaltic like muscle activitysteers the li=uid or bolus of food back into pharynx

    After is leaves the oral cavity food is then propelledthrough pharynx by superior, middle and inferiorconstrictor muscles or pharynx past the epiglottis

    into the esophagus

    The epiglottis class o> the pharynx as its posteriorperipheral portions are forced backward against thesuperior constricting ring.

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    Chang!s f'om s!miso$i- to so$i-

    foo- an- !'u%tion of t!!th

    . Tongue is no longer forced into space between thegum pads or incisal surfaces of the teeth which

    contact momentarily during swallowing.$. Mandibular thrust diminishes during transitional

    period of to $ months of age

    %. Mandibular elevators stabilize the mandible

    ". 1heek B 0ip muscles reduce the strength of theircontractions

    *. Tip of tongue is positioned near the incisiveforamen during the act of deglutition6

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    76 Matu'! S*a$$o*

    Mature swallowing is seen after a year of life.The infantile swallow gradually disappears witheruption of the buccal teeth in the primarydentition

    Cha'act!'istics "

    . Teeth are together.

    $. Mandible is +tabilized by contraction of

    Mandibular elevators, which are primarily *thcranial nerve muscles.

    %. Tongue tip is held against the palate above andbehind the incisors.

    ". There are minimal 1ontraction of lips in Dature+wallow6

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    ,has!s of s*a$$o*ing o'-!g$utition"

    D!g$utition occu' in fou' %has!s

    .The preparatory swallow

    $.The oral phase

    %.4haryngeal phase".The esophageal phase.

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    56 Th! ,'!%a'ato' S*a$$o*E# The food after mastication is assembled as a

    compact bolus on the dorsum of the tongue Teeth are brought into occlusion to stabilize the Faws

    B to close the oral cavity properly and isolate it fromlabial vestibule.

    4osterior aspect of tongue presses against the soft

    palate to isolate the oral cavity from pharynx.

    76 Th! O'a$ ,has!E# The soft palate is raised to seal o> the nasal cavity

    and the posterior part of the tongue drops down. These movements create a smooth path for the

    bolus as it is pushed into the pharynx by theperistaltic action of the tongue.

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    86 Th! ,ha'ng!a$ ,has!E# !egins as soon as the food passes through the faucial


    As the food reaches the pharyngeal walls, there is areex upward movement of the entire pharyngealcomplex.

    Ghen the pharyngeal wall touches the soft palate a

    peristaltic movement set up to move the food -o*n6

    96 Th! O!so%hag!a$ ,has!E# This phase commences as soon as the food passes

    the cricopharyngeal sphincter. 4eristaltic activity of the oesophageal walls occur to

    pass the food into the stomach

    The tongue B the palate return to their originalposition to start the next cycle.

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    D!nition "+A habits can be de8ned as the tendency towardsan act that has become a repeated performance, relatively8xed, consistent and easy to perform by an individual



    6H+2;H00 9A!6T+

    9A)M;H0 9A!6T+



    M2AD6D&;H0 9A!6T



    D3D 4)2++H)2

    !6T6D& 9A!6T



    D3D 13M4H0+6J2

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    C$assication "+ Ha2its


    This includes habits of normal function suchas,

    Co''!ct tongu! %osition?

    ,'o%!' '!s%i'ation 4 -!g$utition?

    No'ma$ us! of $i%s in s%!a/ing


    This includes all the habits that exertperverted stress against the teeth B dentalarches such as,

    Thumb sucking # Tongue Trusting

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    &a'ious Ha2its a'! "

    . Thumb +ucking

    $. ;inger +ucking%. ;renum +ucking

    ". Tongue thrusting

    *. 4aci8er or dummy sucking

    . 0ip !iting

    7. Dail !iting

    '. 1heek biting

    . 4encil or ;oreign obFect sucking

    K. 0ip +ucking

    . Lnuckle +ucking

    $. Tongue thrusting

    %. Mouth !reathing

    ". 1lenching

    *. !ruxism

    . 3ccupational 9abit

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    Thum2 Suc/ing < Fing!'

    Suc/ing < DigitSuc/ing "+

    D!nition"+ 6t can be de8ned as placement of the thumb or

    one or more 8ngers in varying depths into themouth

    The presence of this habit is considered =uitenormal till the age of %#" years. 4ersistence ofthe habit beyond this age can lead to variousmalocclusions.

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    56 ,hsio$ogica$ ,'o2$!ms!6g6 .51 2nlarged adenoids,

    $/ :eviated septum

    76 Emotiona$ %'o2$!ms

    !6g6 .51 2xcessive parental demand$/ !irth of +ibling

    %/ Teasing, 1riticism physical abuse

    "/ 4rolonged or repeated separation from parents

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    E3!cts of Thum2 Suc/ing

    . 9ypotonic upper lip

    $. 4roclination and spacingof upper anterior

    %. Anterior open bite

    ". 6ncreased over Fet

    *. )etroclined lower anteriorsN

    . 9yperactive lower lip

    7. 1ompensatory tongue thrusting

    '. 6ncreased !uccal Musculature pressure leading on

    to the collapse of maxillary arch, and a highpalatal vault which predisposes to posteriorcrossbite

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    The severity of the malocclusion caused bythumb sucking depends on the trident offactors. They are

    . :uration

    $. ;re=uency

    %. 6ntensity

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    Manag!m!nt of thum2 suc/ing

    56 ,scho$ogica$ a%%'oach

    . The parents should be counseled to providethe child with ade=uate love and a>ection

    $. The parents should also be advised to divertthe child

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    .A1 R!mo#a2$! a%%$ianc!s

    . )eminder appliance# simple acrylic plate

    $. Appliance with tongue spikes

    %. Appliance with tongue guard

    ". 3ral screen

    .B1 Fi)!- A%%$ianc!s

    *. )akes

    . +harpened fork

    7. +oldered grate appliance

    '. upper lingual arch

    .81Ch!mica$ a%%'oach

    Hse of bitter tasting or foul smellingpreparation places on the thumb.

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    .I1 Acco'-ing to mo!'s

    a/Dormal infantile swallow

    b/Dormal Mature swallow

    c/+imple tongue thrust swallow

    d/1omplex tongue trust swallowe/)etained infantile swallow

    D!nition "6t is de8ned as a condition in which the tongue

    makes contact with any teeth anterior to the molars duringswallowing

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    .II1 Acco'-ing to 2'an!' an- ha$t

    Type 6 E Don#deforming tongue thrust

    Type 66E :eforming anterior tongue thrust

    +ub group E Anterior open bite

    +ub group $E Anterior proclination.

    +ub group %E 4osterior 1rossbite

    Type 666 E :eforming 0ateral tongue thrust+ub group E 4osterior open bit

    +ub group $E 4osterior 1rossbite.

    +ub group %E :eep overbite.

    Type 6J E :eforming Anterior B 0ateral tongue thrust

    +ub group E Ant B 4ost. open bit+ub group $E 4roclamation of anterior teeth

    +ub group %E 4osterior 1rossbite

    Eti $ "

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    Etio$og "

    516 G!n!tic Facto's "

    6nherited variation on oro#facial form e.g.hypertonic orbicular is oris activity

    716 L!a'n!- 2!ha#io' .Ha2it1a/ 6mproper bottle feeding

    b/ 4rolonged thumb suckingc/ 4rolonged tonsillar B upper respiratory tract


    d/ 4rolonged duration of tenderness of gum or

    teeth can result in a change in swallowingpatterns to avoid pressure on the tender zone

    e/ Tongue held in open spaces during mixeddentition.

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    816Matu'ationa$ "

    916M!chanica$ R!st'ictions "

    a/ 4resence of certain condition such as

    5 Marcoglossia5 1onstricted dental arches

    5 2nlarged adenoids

    :16N!u'o$ogica$ Distu'2anc!5 9yposensitive palate

    5 Moderate motor disability

    ;16Oth!' Facto'5 Anaesthetic throat

    5 !rain inFury

    5 ;aulty 3rthodontic treatment

    5 Abnormal sleeping habits

    5 +leeping towards one side

    5 3ral +ensory de8ciency.

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    C$inica$ F!atu'!s

    a. 4roclamation of anterior teeth

    b. Anterior 3pen bite

    c. !imaxillary 4rotrusion

    d. 4osterior openbite in case of lateral tongue thrust

    e. 4osterior crossbite

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    $/. :egree of malocclusion

    %/. Maturity of the child

    Manag!m!nt of tongu! th'ust

    Facto's to 2! consi-!'!-"

    /. Type of Malocclusion E 1ommon typesa/ 1lass 6 malocclusion with increased overFetb/ Angle

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    "/. Attitude and the degree of co#operation that canbe

    expected from the parents

    */. 4rogressive malocclusion should be considered

    forimmediate treatmentK

    /. +tructural considerations to be eliminated are

    a/ Dasal air blockage

    b/ 2xtremely narrow palatal archc/ Maxillary posterior teeth in extremely lingual position

    d/ Macroglossia

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    Th! manag!m!nt of tongu! th'ustin#o$#!s int!'c!%tion of th! ha2it

    fo$$o*!- 2 t'!atm!nt of co''!ct th!


    .a1Ha2it int!'c!%tion. 6t can be interception by use of habit breaker

    5 !oth 8xed and removable cribs or rakes are valuable aidsin breaking the habits

    $. 1hild is taught the correct method of swallowing

    %. Jarious muscles exercise of tongue

    .21T'!atm!nt of ma$occ$usion5. 3nce the habit is intercepted the malocclusion

    associated with the tongue thrust is treated using

    5 )emovable or

    5 ;ixed orthodontic appliances

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    D!nition " + Mouth breathing de8ned

    as habitual respiration through the mouthinstead of the nose

    C$assication "

    . Anatomic$. 3bstructive

    %. 9abitual

    f h

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    Caus!s of Mouth2'!athing

    516,a'tia$ o' com%$!t! nasa$o2st'uction ma 2! -u! to

    a/ :eviated septum

    b/ Darrow nasal passage associated withnarrow maxilla

    c/ 6nammatory reaction of nasal mucosawith oedema

    d/ Allergic reaction of nasal mucosa

    e/ 3bstructive adenoids

    716 An Anatomic mouth 2'!ath!'?f/ 4atient having short upper lip

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    C$inica$ F!atu'!s

    The type of malocellusion most often

    associated with mouth breathing is called$ong fac! sn-'om! or th! c$assica-!noi- fac!

    . 0ong and narrow face

    $. Darrow nose and nasal passage

    %. +hort and accid upper lip

    ". 1ontracted upper arch with possibility of posteriorcrossbite

    *. An expressionless face or blank face

    . 6ncreased over Fet as a result of aring of the incisor7. Anterior marginal gingivitis

    '. The dryless of the mouth predisposes to caries

    . Anterior open bite

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    T'!atm!nt of mouth B'!athing

    . 2limination of underlying pathology e.g.. nasal orpharyngeal obstruction

    $. Appliance like vestibular screen

    %. Application or adhesive tape to the lips

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    BRUISM"D!nition" !ruxism de8ned asOgnashing and grindingof the teeth fornon#functional purposesP


    / 4sychological B emotional stresses

    $/ 3cclusal interference or discrepancy betweencentric relation and centric occlusion

    %/ 4ericoronitis B periodontal pain is said to trigger!ruxism.

    "/ +urface irregularities of lips, cheek and tongue

    */ 4ain or discomfort of TM- and Faw muscles.

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    C$inica$ f!atu'!sa/ 3cclusal wear facets can be observed on the

    teethb/ ;ractures of teeth and restorations

    c/ Mobility of teeth

    d/ Tenderness and hypertrophy of masticatory

    musclese/ Muscles pain when the patient wakes up in the


    f/ Temporomandibular Foint pain and discomfort

    can occur

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    T'!atm!nt/ 4sychotherapy

    $/ Autosuggestion and 9ypnosis%/ )elaxing exercise and physiotherapy

    "/ 2limination of oral pain B discomfort

    */ 3cclusal therapy.

    5 e.g. occlusal adFustment of eliminate theprematurities

    / Dight guards or other occlusal splints

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    Li% 2iting 4 Li%

    Suc/ing Ha2it

    0ip biting B 0ip +ucking some times appearafter forced discontinuation of thumb or8nger sucking

    0ip biting most often involves the lower lipwhich is turned inwards and pressure isexerted of the lingual surface of the maxillaryanterior

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    C$assication. Getting the lip with tongue.

    $. 4ulling the lip into the mouth between the teeth

    C$inica$ f!atu'!sa/ 4roclined upper anteriors and retroclined lower


    b/ 9ypertrophic B redundand lower lipc/ 1racking of lips

    T'!atm!nt56 Ha2it can 2! int!'c!%t!- using

    0ip bumper or lip plumper 76 Co''!ction of ma$occ$usion

    5 e.g. 6f there is a class 66 division 6 malocclusion or

    5 excessive over Fet problem

    5The abnormal lip activity

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    Fing!' Nai$ Biting


    Dail !iting is one of the most common habits inchildren B adults

    5 6t is a sign internal tension

    Ag! of occu''!nc! " Dail biting absent before % years of age

    6ncidence rises sharply from "# years andremains at a fairly constant level between 7 andK year rises again to a peak during

    adolescence Etio$og

    Any 2motional 4roblem

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    E3!cts ". :ental e>ects

    51rowding, rotation and

    5Attrition of incisal edges of the incisors


    $. 2>ects on the nails

    56nammation of the nail beds B also of thenails

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    Manag!m!nt E/ Mild cases no treatment is indicated

    $/ Avoid punitive methods such as scolding

    nagging , threats%/ 2ncourage outdoor activities which may help

    in easing tension

    "/ Application of nail polish, light cotton mittens

    as a reminder.

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