Lecture 5 Ortho

♦The tongue is powerful muscular organ, which exerts pressure at frequent intervals during the day and
night. Pressure exerted by the tongue against the teeth during swallowing lasts for approximately one
second and 1000 times/day.
♦The tongue is functioning mainly in conjunction with the lips and cheeks. It is a guiding force for the
erupting teeth by its size, posture and function.

♦The best clinical sign of a large tongue is the presence of scalloping on the lateral
borders.
♦Pressure of the tongue on the lingual surfaces of the anterior teeth results in open
bite and spacing. On rare occasions, the tongue is too small. The dental arch reflects
the small tongue size and is collapsed and reduced with extreme crowding in the
premolar area.

♦Tongue function is particularly concerned with mastication, swallowing and speech.

♦During the normal infantile swallowing the jaw are apart during swallowing,
the tongue is pouches forward and placed between gum pads (fig 18, a), Fig. (18 a):
the mandible is stabilized by the contraction of the orofacial musculature. tongue position in
infantile swallow
During the transition from an infantile to a mature swallow,
with the eruption of the incisors, the swallow is characterized by
muscular activity to bring the lips together, and the tongue
becomes restrained within the oral cavity proper (fig 18, b).

Fig. (18 b):

♦Effect on occlusion: tongue position in
The tongue thrusting has been evaluated by a number of authors with regard mature swallow
to its role in the etiology of malocclusion. According to one school of thought, tongue
thrust is the consequence of an abnormal morphologic relationship, an adaptive phenomenon. Other
investigators consider the tongue a primary factor as a consequence of retained infantile swallowing or
other abnormal habits.

♦Normally during mandibular posture, the dorsum of the tongue touches the palate
lightly and the tip
rests in the lingual fossae or at the cervices of the mandibular incisors (fig 19a).
♦During normal mature swallow the tongue tip touches the palate just behind the
maxillary incisors.

a b c
Fig. (19): Variation in tongue posture. (a): normal tongue posture. (b): retracted
tongue posture. (c): protracted

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 Lecture 5 Ortho
Abnormal tongue posture:
♦Tongue posture is related to skeletal morphology and it is more able to cause an open bite than tongue
function because the tongue is always there exerting a mild continuous force.

Two significant variations from the normal tongue posture can be seen.
1- Retracted tongue posture; in which the tongue tip is withdrawn from all the anterior teeth (fig 19,
b):
• It is associated with a posterior open bite (fig 20) since the tongue spread laterally and it is
more frequent in edentulous adults and in cases with bilateral loss of several posterior teeth.
• The retracted tongue posture is unsettling to the mandibular artificial dentures.
2. The protracted tongue posture: It may be a serious problem since it usually results in an open bite
(Fig 19, c). It may be endogenous or acquired adaptive.

Endogenous: Fig. (20): retracted tongue

• It is retention of the infantile postural pattern, for reasons not posture after loss of
posterior teeth.
yet clear.
• Adaptation to excessive anterior facial height (fig 21, a) and in
skeletal class III (fig 21, b) which predispose to open bite. The
tongue adapting to enforce an anterior seal during the
swallow.
• Surgical correction of severe skeletal dysplasia is often a
successful. Relapse was found to be the result of failure of the
tongue to adapt to the altered skeletal morphology (the
prognosis is poor).

b
Fig. (21): Protracted
Acquired tongue posture. In severe
• The acquired protracted tongue posture is vertical malocclusion.
a simpler matter since it is an adaptation to Mandibular thrusting
occurs during function (a).
enlarged tonsils (fig 22), pharyngitis or Mandibular
tonsillitis. Prognathism, downward
• Treatment: refer such patients to a and forward displacement
of the tongue causes an
physician for correlative therapy. After anterior tongue thrust (b)
tonsillectomy and /or adenoidectomy
dramatic changes in tongue and
mandibular posture often occur due to
alterations in the growth of the face (good
prognosis) Fig. (22): hyperplastic
toilette mandible is
dropped and the tongue
is positioned forward to
avoid painful sensations
and to keep the oral air
way open.

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 Lecture 5 Ortho

Swallowing behavior:

♦The infantile swallow is closely associated with suckling. During stickling, the nipple is drawn well into
the mouth by negative pressure within. This allows milk to be delivered onto the back of the tongue.
The breast is enveloped by the upper lip, upper gum pad and palate above, and the tongue below. The
tongue will lie over the lower gum pad and protrudes to touch the lower lip. The contraction of the
tongue and facial muscles help to stabilize the mandible.

♦At the moment of swallowing the jaws are together and regular breathing continues. The milk is prevented
from entering the pharynx by the well-formed aryepiglottic folds and high position of larynx.

♦In the neonate the tongue is able to express the milk from the nipple but unable to collect it from the
mouth so any excess milk will dribble down the chin.

♦When the incisors erupt, the tongue changes to the mature position. Mandibular growth downward and
forward increases the intraoral volume and alveolar bone growth vertically aids in the normal change in
the tongue's posture during the first year of life.

:
♦All occlusal functions are learned in stages as the nervous system and the orofacial and jaw musculature
mature. Most children achieve most features of mature swallow at 12 to 15 months of age.
The characteristic-features of mature swallow are:
1- Teeth are together for swallowing food bolus and they may be apart during swallowing of liquids.
2- The mandible is stabilized by contraction of the muscles enervated by the fifth cranial nerve.
3- The tongue is held against the palate above and behind the incisors.
4- Minimal contraction of the lips is seen during swallow.

Stages of swallowing:
(a)Collecting stage.
♦During the first stage of swallowing, the food is collected in the fore- most
part of the mouth in front of the retracted tongue. The posterior part of the Fig. (24): (a) Tongue
tongue is in contact with the soft palate. peristalsis during somatic
swallowing –collecting
♦The lips are not in contact and the teeth are not occluding.
stage.
(b) Transporting stage: 1st part of movement.
♦During the second phase of swallowing, i.e., the transporting stage, the
tip of the tongue first moves upward and the anterior section of the
dorsum is depressed.

(c) Transporting stage: 2nd part of movement. (b) Transporting stage 1st
part of movement.
♦The entire anterior section of the tongue then moves upward
and the central section of the dorsum is depressed. This
peristalsis transports the bolus rearward.

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(c) Transporting stage 2nd
 Lecture 5 Ortho
(d) Transporting stage: 3rd part of movement.
♦At the end of the transporting stage, the soft palate is displaced upward and
rearward.
♦The lip musculature contracts simultaneously, the lips are together, the
mandible is raised and the teeth come into contact and there is a complete
separation between mouth cavity proper and oral vestibule. (c) Transporting stage 2nd
part of movement.
(e) Third swallowing stage.
♦The dorsum of the tongue is depressed even further during the third stage so
that the bolus can pass through the oropharyngeal isthmus: simultaneously
the anterior part of the tongue is pressed against the hard palate, thus forcing
more food rearward.
♦The soft palate forms the oronasal seal and closes the nasopharynx. The teeth (d) Transporting stage 3rd
are in full occlusion, the tongue is placed against the palate and the lingual part of movement.
surface of anterior teeth, the lips contact and breathing stops for a moment.
(f) Fourth swallowing stage.

♦During the fourth stage of the swallowing act, the dorsum of the tongue is
moved further upward and rearward against the soft palate and squeezes the
remaining food bolus out of the oropharyngeal area. (e) Third swallowing stage.
♦Contraction of the constrictor muscles in turn carries the food into the
esophagus. At this moment the opening of the larynx is completely closed
by the sphincter muscles.

(g) Final stage of swallowing cycle. .

(f) Fourth swallowing
♦Once the swallowing act has been completed, the mandible returns to its rest stage.
position and the teeth come apart.

♦Liquids and juicy food are swallowed with the upper and lower teeth
separated, the periphery of the tongue comes in contact with the cheeks and
lips, the muscles of which are contracted.
(g) Final stage of
swallowing cycle.

♦As it has been mentioned before, most children change over from
tooth apart infantile swallowing to the teeth together adult
swallowing after eruption of the first deciduous molars (12-15 ♦Adults and children perform
months of age). periodic idle swallowing of saliva
every few minutes during the day
♦The atypical swallowing behavior would appear to be a persistence and at intervals at night. In idle
of the infantile type. The teeth are not placed into occlusion during swallowing the teeth are normally
swallowing. The tongue is brought between the separated teeth till brought together and the whole
it touches the cheeks and lips. There is an active contraction of the process is the same as the adult
buccinator and orbicularis muscles to provide a firm "box" for the type of swallowing.
tongue action. The mentalis muscle shows active contraction too.