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NORMAL AND

ABNORMAL
FUNCTION
OF
STOMATOGNATHIC
SYSTEM

Functions of
stomatognathic system :

Mastication , swallowing, respiration speech and


maintenance of posture are the various functions of
the stomatognathic system, they are all intimately
related and occur simultaneously.

All the oropharyngeal reflex such as mandibular


posture, respiration, tongue position, deglutition,
sucking, gagging, laughing, sneezing and vomiting are
present as uncontrolled reflexes as they are life saving
activities.

Tactile sensation is well developed in the new born.

The Development Of Various


Reflexes During The
INTRAUTERINE Life are as
Follows
1.

2.

3.
4.
5.
6.

By the 14th weak 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 .
Gag reflex develops by about 181/2 weeks.
Respiration by about 25 weeks.
Sucking by 25weeks.
Sucking and swallowing by 32 weeks.

Sensory guidance for all activities including Jaw


Movement, covers a large area and includes
multiple contacts for sensory inputs (tongue,
lips, soft palate, posterior, pharyngeal wall and
temporomandibular Joint.)

A brief review of the forces acting on the bony


structures
to
shape
them
during
the
developmental stages helps us in understanding
the changes that pernicious oral habits can
bring about in the oral architecture.

Some Antagonistic Forces


Acting on the Masticatory
Apparatus:
1.
2.
3.

4.

5.

6.
7.

8.

Lips- tongue.
Cheeks-tongue
Eruption Of teeth-Masticatory Muscles, Masseter,
Medial Pterygoid .
Air pressure on skin and nasal cavity-tongue in
closed mouth, air pressure in open mouth.
Masseter elasticity of periodontal ligament
suprahyloid muscles.
Internal pterygoid- same as masseter.
External pterygoid in anterior movement-posterior
one third of temporalis.
Suprahyoid group, digastricus, muscles of neck in
lateral movement-external pterygoid of other side.

Mastication :Mastication is a complex activity aimed at


breaking down and insalivation of the food, preparatory to
swallowing
INFANT :- The first food is consumed by suckling . This is an
unlearned or innate reflex in homo-sapiens.

1.

2.
3.

The Classic Pattern is Outlined (suckle Swallow ) by


Bosma in infant :
Head is extended, tongue elongated and low in the floor of
the mouth, Jaws a part and lips pursed around the nipple.
Mandible is slightly protruded.
During Function, i.e. deglutition, the rhythmic contraction of
the tongue and facial Muscles aids in the Stabilization of the
Mandible

Difference between Suckling &


Sucking
Suckling :Suckling consist of small nibbling movements of the lips
around the mothers breast to stimulate the smooth
muscle contraction which causes the squirting of milk
into the mouth.
Thus suckling maneuver is entirely different from the
sucking process.

Sucking :Sucking consist of drawing ( a liquid or other substance)


into the mouth by creating a partial vaccum in the mouth
.
However these two words are often used interchangeably

Ones the child starts taking


solid foods:
1.

2.

3.

4.

The intensity of the act of satisfying hunger is


reduced.
But most of the muscles of the cheek tongue
and floor of the mouth are involved.
There is less activity of lips and Mandibular
thrust is reduced.
Infant Quickly learns to use from being forced
out of the mouth during peristaltic action of
the tongue and the cheeks as the bolus of
food is forced towards the pharynx.

In An Infant
1

4
5

Bolus is mixed with saliva by the


action of tongue.
Rhythmic action of muscles of the cheek serves to
force the food back towards the tongue; which pushes
the food against the hard palate.
To permit the food interpose between gum pads or
teeth, the mandible is depressed by gravity and hyoid
and lateral pterygoid muscles with simultaneous
deflection towards the working side.
Lateral Shift of mandible is more apparent while
chewing hard food.
Mandible is closed primarily by the temporal and
masseter muscles activity.

Masticatory stroke in an adult Summarized


by Fletcher using the six phases outlined by
Murphy:
1.

Preparatory Phase:- Food is ingested and


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

2.

Food Contact:- Characterized by a momentary


hesitation in movement. This pause is triggered by
sensory receptors concerning the apparent viscosity
of the food and probably transarticular pressure
incident of chewing.

3.

The Crushing phase :- Starts with a high velocity


then slows as the food is crushed by a slight change
in direction but no delay.

4.

Tooth Contact : Accompanied by a slight


change in direction but no delay.

5.

Tooth Grinding Phase : It coincides with the


transgression of Mandibular molars across
their maxillary counterparts and is highly
constant from one cycle to cycle.

6.

Terminal Phase : Messerman (1963) termed


this phase as terminal functional orbit.
Ahlgren(1961) noted that during this phase the
bilateral muscular discharge becomes unequal
and asynchronous, indicating that the person is
chewing unilaterally.

Swallowing / Deglutition

Deglutition or swallowing is an important function


carried out by the stomatognathic system.

The Swallowing pattern in infants is different from


that seen in adults.

Thus two main forms of swallowing are


recognized.
I. Infantile Swallow
II. Mature Swallow

1. Infantile Swallow
o

Characteristics :
1.
2.

3.

Jaws apart with the tongue between the gum


pads
Mandible is stabilized by the contraction of the
muscles of the 7th cranial nerve and the
interposed tongue.
The swallow is guided and to a greater extent
controlled by interchange between the lips and
tongue.

With Liquid Food, Immature or


visceral swallow in infants:
Gum

Pads are not brought into contact. A clucking is


frequently heard.
The Instinctive and peristaltic like muscle activity
steers the liquid or bolus of food back into pharynx
After is leaves the oral cavity food is then propelled
through pharynx by superior, middle and inferior
constrictor muscles or pharynx past the epiglottis
into the esophagus
The epiglottis class off the pharynx as its posterior
peripheral portions are forced backward against the
superior constricting ring.

Changes from semisolid to solid


food and eruption of teeth
1.

2.
3.
4.
5.

Tongue is no longer forced into space between the


gum pads or incisal surfaces of the teeth which
contact momentarily during swallowing.
Mandibular thrust diminishes during transitional
period of 6 to 12 months of age
Mandibular elevators stabilize the mandible
Cheek & Lip muscles reduce the strength of their
contractions
Tip of tongue is positioned near the incisive
foramen during the act of deglutition.

2. Mature Swallow

Mature swallowing is seen after a year of life.


The infantile swallow gradually disappears
with
eruption of the buccal teeth in the primary
dentition
Characteristics :
1. Teeth are together.
2. Mandible is Stabilized by contraction of
Mandibular elevators, which are primarily 5th
cranial nerve muscles.
3. Tongue tip is held against the palate above and
behind the incisors.
4. There are minimal Contraction of lips in Nature
Swallow.

Phases of swallowing or
deglutition:
Deglutition occur in four phases
1. The preparatory swallow
2. The oral phase
3. Pharyngeal phase
4. The esophageal phase.

1. The Preparatory Swallow:

The food after mastication is assembled as a


compact bolus on the dorsum of the tongue
Teeth are brought into occlusion to stabilize the jaws
& to close the oral cavity properly and isolate it from
labial vestibule.
Posterior aspect of tongue presses against the soft
palate to isolate the oral cavity from pharynx.

2. The Oral Phase:

The soft palate is raised to seal off 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 the
peristaltic action of the tongue.

3. The Pharyngeal Phase:

Begins as soon as the food passes through the faucial


pillars
As the food reaches the pharyngeal walls, there is a
reflex upward movement of the entire pharyngeal
complex.
When the pharyngeal wall touches the soft palate a
peristaltic movement set up to move the food down.

4. The Oesophageal Phase:

This phase commences as soon as the food passes


the cricopharyngeal sphincter.
Peristaltic activity of the oesophageal walls occur to
pass the food into the stomach
The tongue & the palate return to their original
position to start the next cycle.

HABITS

Definition :- A habits can be defined as the tendency towards


an act that has become a repeated performance, relatively
fixed, consistent and easy to perform by an individual

CLASSIFICATION HABITS :USEFULL HABITS


I
HARMFUL HABITS
EMPTY
II
MEANINGFUL HABIT
HABITS

PRESSURE
III

NON PRESSURE
BITING HABIT
COMPULSIVE

IV
NON COMPULSIVE

Classification :- Habits

USE FUL HABITS :


This includes habits of normal function such
as,
Correct tongue position,
Proper respiration & deglutition,
Normal use of lips in speaking

HARMFUL HABITS :This includes all the habits that exert


perverted stress against the teeth & dental
arches such as,
Thumb sucking - Tongue Trusting

Various Habits are :


1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

Thumb Sucking
Finger Sucking
Frenum Sucking
Tongue thrusting
Pacifier or dummy sucking
Lip Biting
Nail Biting
Cheek biting
Pencil or Foreign object sucking
Lip Sucking
Knuckle Sucking
Tongue thrusting
Mouth Breathing
Clenching
Bruxism
Occupational Habit

Thumb Sucking / Finger


Sucking / Digit
Sucking :

Definition :It can be defined as placement of the thumb or


one or more fingers in varying depths into the
mouth
The presence of this habit is considered quite
normal till the age of 3-4 years. Persistence of
the habit beyond this age can lead to various
malocclusions.


1.

Etiology:
Physiological Problems
e.g. (1) Enlarged adenoids,
(2) Deviated septum

2.

Emotional problems
e.g. (1) Excessive parental demand
(2) Birth of Sibling
(3) Teasing, Criticism physical abuse
(4) Prolonged or repeated separation from parents

Effects of Thumb Sucking


1.
2.
3.
4.
5.
6.
7.
8.

Hypotonic upper lip


Proclination and spacing
of upper anterior
Anterior open bite
Increased over jet
Retroclined lower anteriors\
Hyperactive lower lip
Compensatory tongue thrusting
Increased Buccal Musculature pressure leading on
to the collapse of maxillary arch, and a high
palatal vault which predisposes to posterior
crossbite

The severity of the malocclusion caused by


thumb sucking depends on the trident of
factors. They are

1. Duration
2. Frequency
3. Intensity

Management of thumb sucking


1. Psychological approach
1.
2.

The parents should be counseled to provide


the child with adequate love and affection
The parents should also be advised to divert
the childs attention to other things such as
play and toys.

2. Mechanical aids
Habit breakers can be of two types
A.
B.

Removable appliances
Fixed appliances

(A) Removable appliances


1.
2.
3.
4.

Reminder appliance- simple acrylic plate


Appliance with tongue spikes
Appliance with tongue guard
Oral screen

(B) Fixed Appliances


5.
6.
7.
8.

Rakes
Sharpened fork
Soldered grate appliance
upper lingual arch

(3)Chemical approach
Use of bitter tasting or foul smelling
preparation places on the thumb.

TOUNGE TRUSTING HABIT

Definition :

It is defined as a condition in which the tongue


makes contact with any teeth anterior to the molars during
swallowing

Classification

I) According to moyers
a)Normal infantile swallow
b)Normal Mature swallow
c)Simple tongue thrust swallow
d)Complex tongue trust swallow
e)Retained infantile swallow

II) According to braner and halt

Type I : Non-deforming tongue thrust


Type II: Deforming anterior tongue thrust
Sub group 1: Anterior open bite
Sub group 2: Anterior proclination.
Sub group 3: Posterior Crossbite

Type III : Deforming Lateral tongue thrust


Sub group 1: Posterior open bit
Sub group 2: Posterior Crossbite.
Sub group 3: Deep overbite.

Type IV : Deforming Anterior & Lateral tongue thrust


Sub group 1: Ant & Post. open bit
Sub group 2: Proclamation of anterior teeth
Sub group 3: Posterior Crossbite

Etiology :

1). Genetic Factors :


Inherited variation on oro-facial form e.g.
hypertonic orbicular is oris activity

2). Learned behavior (Habit)


a) Improper bottle feeding
b) Prolonged thumb sucking
c) Prolonged tonsillar & upper respiratory tract

infections.
d) Prolonged duration of tenderness of gum or
teeth can result in a change in swallowing
patterns to avoid pressure on the tender zone
e) Tongue held in open spaces during mixed
dentition.

3).Maturational :
4).Mechanical Restrictions :
(a) Presence of certain condition such as
Marcoglossia
Constricted dental arches
Enlarged adenoids

5).Neurological Disturbance
Hyposensitive palate
Moderate motor disability

6).Other Factor

Anaesthetic throat
Brain injury
Faulty Orthodontic treatment
Abnormal sleeping habits
Sleeping towards one side
Oral Sensory deficiency.

Clinical Features
a.
b.
c.
d.
e.

Proclamation of anterior teeth


Anterior Open bite
Bimaxillary Protrusion
Posterior openbite in case of lateral tongue thrust
Posterior crossbite

Management of tongue thrust


Factors to be considered:
1). Type of Malocclusion : Common types
a) Class I malocclusion with increased overjet
b) Angles Class II division I malocclusion with
increased over jet
c) Deep bite
d) Marked open bite

2). Degree of malocclusion


3). Maturity of the child

4). Attitude and the degree of co-operation that can


be
expected from the parents
5). Progressive malocclusion should be considered
for
immediate treatment0
6). Structural considerations to be eliminated are
a)
b)
c)
d)

Nasal air blockage


Extremely narrow palatal arch
Maxillary posterior teeth in extremely lingual position
Macroglossia

The management of tongue thrust


involves interception of the habit
followed by treatment of correct the
malocclusion

(a)Habit interception
1.

It can be interception by use of habit breaker


Both fixed and removable cribs or rakes are valuable aids

in breaking the habits


2.
3.

Child is taught the correct method of swallowing


Various muscles exercise of tongue

(b)Treatment of malocclusion
.

Once the habit is intercepted the malocclusion


associated with the tongue thrust is treated using

Removable or
Fixed orthodontic appliances

Mouth Breathing

Definition : - Mouth breathing defined


as habitual respiration through the mouth
instead of the nose

Classification :
1.
2.
3.

Anatomic
Obstructive
Habitual

Causes

of Mouth
breathing

1).Partial or complete nasal


obstruction may be due to
a) Deviated septum
b) Narrow nasal passage associated with

narrow maxilla
c) Inflammatory reaction of nasal mucosa
with oedema
d) Allergic reaction of nasal mucosa
e) Obstructive adenoids

2). An Anatomic mouth breather,


f)

Patient having short upper lip

Clinical Features

The type of malocellusion most often


associated with mouth breathing is called
long face syndrome or the classic
adenoid face
1.
2.
3.
4.
5.
6.
7.
8.
9.

Long and narrow face


Narrow nose and nasal passage
Short and flaccid upper lip
Contracted upper arch with possibility of posterior
crossbite
An expressionless face or blank face
Increased over jet as a result of flaring of the incisor
Anterior marginal gingivitis
The dryless of the mouth predisposes to caries
Anterior open bite

CLINICAL FEATURE VESTIBULAR

SCREEN

Treatment of mouth Breathing


1.
2.
3.

Elimination of underlying pathology e.g.. nasal or


pharyngeal obstruction
Appliance like vestibular screen
Application or adhesive tape to the lips

BRUXISM

Definition :

Bruxism defined as
gnashing and grinding of the teeth for
non-functional purposes

Etiology
1)
2)
3)
4)
5)

Psychological & emotional stresses


Occlusal interference or discrepancy between
centric relation and centric occlusion
Pericoronitis & periodontal pain is said to trigger
Bruxism.
Surface irregularities of lips, cheek and tongue
Pain or discomfort of TMJ and jaw muscles.

Clinical features
a)
b)
c)
d)
e)
f)

Occlusal wear facets can be observed on the


teeth
Fractures of teeth and restorations
Mobility of teeth
Tenderness and hypertrophy of masticatory
muscles
Muscles pain when the patient wakes up in the
morning
Temporomandibular joint pain and discomfort
can occur

Treatment
1)
2)
3)
4)
5)

6)

Psychotherapy
Autosuggestion and Hypnosis
Relaxing exercise and physiotherapy
Elimination of oral pain & discomfort
Occlusal therapy.

e.g. occlusal adjustment of eliminate the


prematurities
Night guards or other occlusal splints

Lip biting & Lip


Sucking Habit
Lip biting & Lip Sucking some times appear
after forced discontinuation of thumb or
finger sucking
Lip biting most often involves the lower lip
which is turned inwards and pressure is
exerted of the lingual surface of the maxillary
anterior

Classification
1.
2.

Wetting the lip with tongue.


Pulling the lip into the mouth between the teeth

Clinical features
a) Proclined upper anteriors and retroclined lower

anteriors
b) Hypertrophic & redundand lower lip
c) Cracking of lips

Treatment
1.

Habit can be intercepted using

2.

Lip bumper or lip plumper

Correction of malocclusion
e.g. If there is a class II division I malocclusion or
excessive over jet problem
The abnormal lip activity

Nail Biting is one of the most common habits in


children & adults
It is a sign internal tension

Finger Nail Biting

Age of occurrence

Nail biting absent before 3 years of age


Incidence rises sharply from 4-6 years and
remains at a fairly constant level between 7 and
10 year rises again to a peak during
adolescence

Etiology

Any Emotional Problem

Effects

Dental effects
Crowding, rotation and
Attrition of incisal edges of the incisors
( mandibular)
2. Effects on the nails
1.

Inflammation of the nail beds & also of the


nails

Management :
1)
2)
3)
4)

Mild cases no treatment is indicated


Avoid punitive methods such as scolding
nagging , threats
Encourage outdoor activities which may help
in easing tension
Application of nail polish, light cotton mittens
as a reminder.

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