ORTHODONTICS & DENTOFACIAL ORTHOPAEDICS 1

Paper – I (Anatomy)

Q.14. Deglutition. (10 M)

CONTENTS/SYNOPSIS

Introduction

Definition

Stages of deglutition

1) Preparatory (stage) phase

2) Oral (stage) phase

3) Pharyngeal (stage) phase

4) Oesophageal (stage) phase

Theories of Deglutition:

1.Theory of constant proportion

2.Theory of oral expulsion:

3.Theory of negative pressure:

4. Theory of integral function:

Clinical application of deglutition in orthodontics

References

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INTRODUCTION

▪ The important physiologic orofacial functions include respiration,

swallowing, mastication, and speech.
▪ The orofacial musculature is relatively the most sophisticated in the
newborn, so that the patency of the airway breathing and nutritional
demands may be met.
▪ Already present as unconditioned reflexes—for there is no time to learn
these life-saving activities—are oropharyngeal reflexes for mandibular
posture, respiration, tongue position, deglutition, suckling, gagging,
coughing, sneezing and vomiting.

DEFINITION

▪ Deglutition is the act or process of swallowing.

▪ Once the respiration is established in an infant, the next important event or
priority is suckling and swallowing. These two maneuvers help the child to
obtain milk and transfer it the gastrointestinal tract.
▪ Both suckling and swallowing movements start developing from 32nd week of
intrauterine life.

▪ Deglutition is influenced by three factors:

1. Degree of fineness of food.

2. Intensity of taste.

3. Degree of lubrication of bolus.

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STAGES OF DEGLUTITION

▪ Fletcher divides the deglutition cycle into four phases, which are highly
integrated and synergistically coordinated.
▪ By average, an individual frequently swallows about once per minute during
meals and nine times per minute during eating. During sleep, swallowing is
done at infrequent intervals

▪ The four phases are preparatory phase, oral phase, pharyngeal phase and the
esophageal phase .

5) Preparatory (stage) phase

6) Oral (stage) phase

7) Pharyngeal (stage) phase

8) Oesophageal (stage) phase

1. Preparatory phase

▪ It starts as soon as liquid is taken in, or after the bolus has been
masticated.
▪ The liquid or bolus then moves to swallowing preparatory position on the
dorsal surface of the tongue.
▪ In the infant, the bolus accumulation may also be seen between the
tongue base and the epiglottis lies posterior to the tongue.
▪ The oral cavity is then sealed by tongue and the lips.

2. Oral phase

▪ During this phase of swallowing, the soft palate moves upward and the
tongue drops downward and backward.
▪ Simultaneously, the hyoid bone and larynx move upward.
▪ These movements in combination create a smooth pathway for the bolus
to be pushed from the oral cavity using the wavy rippling tongue
movements.

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▪ The liquid food flows ahead of the lingual constrictions when the solid
food is pushed by the tongue.
▪ The oral cavity maintains an anterior and lateral seal during this phase
and is stabilized by the muscles of mastication.

4. Pharyngeal phase

▪ This phase of swallowing begins as the bolus passes through the

fauces.
▪ The entire pharyngeal tube is lifted upward and the nasopharynx is
sealed by soft palate closure against posterior pharyngeal wall (i.e.
Passavant ridge).
▪ The hyoid bone and tongue base movesforward as both the pharynx
and the tongue keep progressing their peristalsis of food bolus.

5. Esophageal phase

▪ This phase of swallowing commences as food passes the

cricopharyngeal sphincter.
▪ While peristaltic movement carries the food through the esophagus, the
hyoid bone, palate and tongue return to their original positions.
▪ The hyoid bone, palate and tongue regain their original position when
the food is carried into esophagus by peristaltic movement.

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Theories of Deglutition:

A) Theory of constant proportion:

▪ This theory suggests that the passage of the food through the

upper digestive tract in three phases:

- Oral phase.

- Pharyngeal phase.

- Oesophageal phase.

B) Theory of oral expulsion:

▪ This theory suggests that the bolus of the food is passed to the

stomach by oral expulsion by the contraction of tongue and

mylohyoid muscles.

C) Theory of negative pressure:

▪ This theory holds that the tongue is brought forward to create a

negative pressure and this pressure is accomplished by larynx.

Due to this negative pressure food is sucked from the mouth to the

oesophagus.

D.Theory of integral function:

▪ The concept that the process of deglutition is performed

successively by the contraction of the oral, pharyngeal, and

oesophageal muscles.
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Clinical application of deglutition in orthodontics

As per article ,Hanson ML, Cohen MS. Effects of form and function on
swallowing and the developing dentition. American Journal of Orthodontics.
1973 Jul 1;64(1):63-82.

▪ Much research has verified the presence of lingual pressures against the
teeth during speech, at rest, and during swallowing.
▪ The aggregate of these pressures is significantly greater than the
amounts which Weinstein reports are sufficient to move teeth.
▪ The presence of any one of the following factors to a marked degree, or
of any combination of them, is a potential predictor of a tongue-thrust
pattern likely to persist throughout the mixed dentition:

1. Mouth breathing.

2. Digit-sucking.

3. Enlarged tonsils.

4. A high and/or narrow anterior palatal arch.

5. Marked lip movement during swallowing.

6. Any anterior malocclusion in the deciduous dentition.

7. Dentalization of linguo-alveolar consonants (/s/, /z/, /d/, /t/, /l/, /n/).

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REFERENCES
• Textbook of medical physiology- Guyton (10th edition)
• Textbook of ORTHODONTICS by SRIDHAR PREMKUMAR
• Hanson ML, Cohen MS. Effects of form and function on swallowing and the
developing dentition. American Journal of Orthodontics. 1973 Jul 1;64(1):63-
82.
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