STAGES OF DEGLUTITION

AND TONGUE

THRUSTINGSubmitted by:-Musavvar MansooriRanjeet DhonkalB.D.S. final yr

Department of PedodonticsGovt. College of Dentistry, indore

DEFINITION---THE SERIES OF CO-ORDINATED MUSCLE CONTRACTION THAT MOVES A BOLUS OF FOOD FROM THE ORAL CAVITY THROUGH THE ESOPHAGUS TO THE STOMACH.

IT IS AN IMPORTANT FUNCTION CARRIED OUT BY STOMATOGNATHIC SYSTEM.

DEGLUTIOTION

TYPESINFANTILE SWALLOW PATTERNMATURE OR ADULT SWALLOW

PATTERN

INFANTILE SWALLOWINGInfants swallow food by suckling. This is

an autonomic reflex in human beings.Development of swallowing begins

around 12.5 wks of intrauterine life. Full swallowing and sucking is established by 32-36 wks of IU life.

Sucking and swallowing reflexes are present in a full term baby and their absence would suggest a developmental defect.

MECHANISMBreastfeeding

Infant lips closed around the areola of the breast.

Tongue protrudes to the lower lip and forms a spoon like closure around nipple.

Relaxation of the elevator muscles of the mandible

Mouth is open wide

Milk is directed to the pharynx by the peristaltic movement of the tongue.

MATURE SWALLOWING PATTERN

Mature swallow develops around 4-5 yrs.

Maturation of swallow pattern occurs with the addition of semi-solid and solid food to the diet.

It is characterized by the relaxation of the lips, placement of the tongue behind the maxillary incisors and elevation of the mandible until posterior teeth are in contact.

TONGUE MUSCULATUREEXTRINSIC MUSCLES:- Genioglossus

muscle. Styloglossus

muscle. palatoglossus

muscle. Hyoglossus

muscle.INTRINSIC MUSCLES:- Superior longitudinal muscle Inferior longitudinal muscle Transverse muscle Vertical muscle

As person swallows the of the tongue contact the:-

Tooth surface.Rugae areas.Adjacent to rugae.Vault.Soft palate.And Swallowing of bolus occurs.

STAGES Oral stage/ First stage Pharyngeal stage/ Second stage

Oesophageal stage/Third stage

ORAL STAGEVoluntary stage

Food move into pharynx from mouth.

Positive pressure created at posterior part

Posterior part is elevated and retracted against hard palate.

Anterior part of tongue is retracted and depressed.

Bolus is placed on posterodorsal surface of tongue.

Pharyngeal stageInvoluntary stage

Bolus moves into esophagus

Peristalsis contraction of pharynx

Upper3-4 cm of esophagus relaxes

Stretching of esophagus due to upward movement of larynx

ESOPHAGEAL STAGE

Bolus entered to stomach.

Relaxation of lower esophageal sphincter

Bolus enters the lower part of esophagus

Bolus is propel down

Initiation of peristalsis in esophagus.

TONGUE THRUSTING

DEFINITIONTULLEY (1969):- States tongue thrust as the forward movement of the tongue tip between the teeth to meet the lower lip during deglutition and in sounds of speech, so that the tongue becomes interdental.

BARBER (1975):- Tongue thrust is an oral habit pattern related to the persistence of infantile swallow pattern during childhood and adolescence and thereby produces an open bite and protrusion of the anterior tooth segment.

CLASIFICATION 1By JAMES and HOLT TYPE 1:- Non deforming tongue thrust. TYPE 2:- Deforming anterior tongue

thrust.Anterior open bite.Anterior proclination.Posterior cross bite . TYPE 3:- Deforming lateral tongue

thrust.Posterior open bite.Posterior cross bite.Deep overbite.

TYPE 4:- Deforming anterior and lateral tongue thrust.

Anterior and posterior open bite.Proclination of anterior teeth.Posterior cross bite.

SIMPLE TONGUE THRUST The simple tongue thrust is

characterized by normal tooth contact during swallowing.

Presence of an anterior open bite.

They exhibit good intercuspation of teeth.

The tongue is thrust forward during swallowing to help establish an anterior lip seal.

Abnormal mentalis muscle activity seen.

LATERAL TONGUE THRUST

Posterior open bite with tongue thrusting laterally.

COMPLEX TONGUE THRUST

It is characterized by teeth apart during swallowing.

Anterior open bite can be diffuse or absent.

Absence of temporal muscle contraction during swallowing.

Contraction of circumoral muscle during swallowing.

The occlusion of the teeth may be poor..

CLASSIFICATION 3 PHYSIOLOGICALThis comprises the normal tongue

thrust swallow of infancy. HABITUALThe tongue thrust swallow is present as

a habit even after the correction of the malocclusion.

FUNCTIONALWhen the tongue thrust mechanism is

an adaptive behavior developed to achieve an oral seal.

ANATOMIC Person having enlarged tongue

can have an anterior tongue posture.

ETIOLOGY Retained infantile swallow During infantile swallow the tongue is

placed between the gum pads. After 6 months of age several maturational movements occur that alters the functioning of orofacial musculature. With the arrival of the incisors the tongue assumes a retracted position. If the transition of the infantile swallow to the mature swallow do not take place with the eruption of incisors then tongue thrusting develops.

UPPER RESPIRATORY TRACT INFECTION

Mouth breathing.Chronic tonsillitis.Allergy. NEUROLOGICAL DISTURBANCESHyposensitive palate.Moderate motor disability. Disruption of sensory control and

coordination of swallowing. FUNCTIONAL ADAPTIBLITY TO

TRANSIENT CHANGE IN ANATOMY.Missing incisors.

FEEDING PRACTICESBottle feeding.Consistency of infant diet. INDUCED DUE TO OTHER ORAL HABITSThumb and finger sucking HEREDITARYInherited hyperactivity of orbicularis oris

with specific anatomic configuration and neuromuscular activity.

TONGUE SIZECongenital aglossia.Macroglossia.

EXTRAORAL FINDINGS LIP POSTURE

Greater lip separation. MANDIBULAR MOVEMENTS More erratic movements and no in coordination

between tongue tip and mandible itself. The average path of mandibular movement is upward

and backward with the tongue moving forward. SPEECH Sibilant distortions Lisping Problems in articulation of S, N, T, D, I, Th, Z, V, Ph,

Sh sounds. FACIAL FORM Increase in anterior facial height.

INTRAORAL FINDINGS TONGUE MOVEMENTS:- jerky and

irregular TONGUE POSTURE:- lowered tongue tip. MALOCCLUSION:- Proclination of maxillary anteriors.Generalized spacing between teeth.Maxillary constriction.Retroclination or proclination of mandibular

teeth.Anterior open bitePosterior open bitePosterior cross bite.

ANTERIOR OPEN BITE

POSTERIOR OPEN BITE

POSTERIOR CROSS BITE

ANTERIOR CROSS BITE

DIAGNOSISHistory takingExamination

TREATMENTTRAINING OF CORRECT SWALLOW AND

POSTURE OF THE TONGUE:- {A} Myofunctional exercises

1. Child is asked to place the tip of tongue in rugae area for 5 min and then swallow.

2. Orthodontic elastics and sugar less fruit drop exercise.3. 4S exercise:- includes Identifying the spot Salivating Squeezing the spot Swallowing4 Other exercises:- whistling Reciting the count from 60-69 Gargling yawning

{B} Using appliance as a guide

Preorthodontic trainer Nance palatal arch

SPEECH THERAPY:-It is not indicated before the age of 8

yrs.To pronounce words beginning with s

and repeat s.Multiplication table of 6.

MECHANOTHERAPYFixed and removable appliance- To restrain the anterior tongue

movementsTo force the tongue downward and

backwardTo reeducate the tongue position.Removable appliance therapy-

Hawley's appliance

Removable appliance therapy- Hawley's appliance

Trans palatal arch

Oral screen- modified acrylic plate used to control muscles forces both inside and outside the dental arches

TONGUE CRIB

For posterior open bite modified cribs is used

CORRECTION OF MALOCLUSIONSURGRICAL TREATMENT-

orthognathic surgical procedure for correction of skeletal malformation.

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