FACTORS INFLUENCING FUNCTIONAL

DEVELOPMENT OF ARCHES
 CONTENTS

• MASTICATION
• DEGLUTITION
• RESPIRATION
• SPEECH
• PASSIVE MUSCLE FUNCTION
 Mastication
• Patients with severe malocclusion often have difficulty in
normal mastication, not so much in being able to chew their
food but in being able to do so in a socially acceptable manner.

• Unfortunately, there are almost no reasonable diagnostic tests

to evaluate masticatory efficiency, so it is difficult to quantify
the degree of masticatory handicap and difficult to document
functional improvement.
Mastication of food occurs in the six phases.

1. Preparatory phase
2. Food contact
3. Crushing phase
4. Tooth contact
5. Guiding phase
6. Centric occlusion
 Swallowing
• Normal Infantile swallow

• Normal mature swallow

• Simple tongue thrust swallow

• Complex tongue thrust swallow

• Retained infantile swallow

 Phases of swallowing
1. The preparatory swallow
2. The oral phase
3. The pharyngeal phase
4. The oesophaegeal phase.
Phases of swallowing
 Features of Visceral Swallowing
• Triggered by sensory interchange between tongue and lips.
• Jaws apart and tongue pushed between gum pads during
swallowing – tip of tongue protrudes (tongue thrusting).
• Mandible stabilized by contraction of tongue and orofacial
movements.
• Dorsum of tongue – concave and depressed tongue positioned
low.
• As deciduous dentition complete – replaced by somatic
swallow.
• If visceral swallow persists beyond 4th year of life – orofacial
dysfunction.
 Mature Swallowing

• Triggered off by contraction of mandibular elevations

(masseter)
•  No tongue thrust / constant forward positioning
• Tip of the tongue supported on lingual surface of the
dentoalveolar area
• Teeth in momentary contact during swallowing
• Contraction of perioral movements are light
• Dorsum of tongue is less concave and approaches palate.
• Simple tongue thrust swallow: The simple tongue thrust
swallow typically displays contractions of the lips, mentalis
muscle and mandibular elevators and the teeth are in occlusion
as the tongue protrudes into an open bite.
Complex tongue thrust swallow
• Complex tongue thrust swallow is defined as a tongue – thrust
with teeth apart swallow.
• Patients with a complex tongue thrust combine contractions of
the lip, facial and mentalis muscles, lack of contraction of the
mandibular elevators, a tongue thrust between the teeth and a
teeth apart swallow.
Retained infantile swallowing
• Defined as predominant persistence of the infantile
swallowing reflex after the arrival of permanent teeth. Those
who do demonstrate very strong contractions of the lips and
facial musculature. The tongue thrusts strongly between the
teeth in front and on both sides.
• Strong contraction of lip/facial muscles.
 Speech
• Speech problems can be related to malocclusion, but normal
speech is possible in the presence of severe anatomic
distortions.
• Speech difficulties in a child therefore are unlikely to be
solved by orthodontic treatment. If a child has a speech
problem and the type of malocclusion related to it, a
combination of speech therapy and orthodontics may help.
• If the speech problem is not listed as related to malocclusion,
orthodontic treatment may be valuable in its own right but is
unlikely to have any impact on speech.
 Respiration
• Its an inherent reflex activity.
• The new born infants are basically a nasal breather .
• In patients having partial or total nasal obstruction , nasal
breathing may not be possible. These patient breathe through
the mouth.
 Sleep apnea
• Sleep apnea may be related to mandibular deficiency, and
occasionally this functional problem is the reason for seeking
orthodontic consultation.
• Both the diagnosis and management of sleep disorders requires
an interdisciplinary team and should not be attempted without
assessment, documentation, and referral from a qualified
physician.
• Recent research suggests that oral appliances to advance the
mandible can be effective, but only in patients with mild forms
of sleep apnea, which must be established by polysomnography
in a sleep laboratory before treatment in the orthodontic office
begins.
 PASSIVE MUSCLE FUNCTION

• The teeth and supporting structures are blanketed from all

direction by muscles.
• Thus the integrity of the dental arches and the relationship of
the teeth with each other and with teeth of the opposing arch
are to a large extent influenced by muscles.
• There is balance of forces between muscles that is believed to
influence the position and stability of the dentoalveolar
complex.
Buccinator mechanism