STOMATOGNATHIC SYSTEM - Copy.pptx
-
Upload
drashishpandey2011 -
Category
Documents
-
view
424 -
download
29
Transcript of STOMATOGNATHIC SYSTEM - Copy.pptx
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
1/51
NORMAL AND
ABNORMALFUNCTION
OFSTOMATOGNATHIC
SYSTEM
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
2/51
SYSTEM Functions ofstomatognathic sst!m "
Mastication , swallowing, respiration speech andmaintenance of posture are the various functions ofthe stomatognathic system, they are all intimately
related and occur simultaneously.
All the oropharyngeal reex such as mandibularposture, respiration, tongue position, deglutition,sucking, gagging, laughing, sneezing and vomiting are
present as uncontrolled reexes as they are life savingactivities.
Tactile sensation is well developed in the new born.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
3/51
Th! D!#!$o%m!nt Of &a'iousR!(!)!s Du'ing Th!
INTRAUTERINE Lif! a'! asFo$$o*s
. !y the "thweak of intra#uterine life stimulation of lips
causes the tongue to move.$. At about the same time, stimulation of upper lip
causes mouth closure and even deglutition .
%. &ag reex develops by about '($ weeks.
". )espiration by about $* weeks.
*. +ucking by $*weeks.
. +ucking and swallowing by %$ weeks.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
4/51
+ensory guidance for all activities including -aw
Movement, covers a large area and includesmultiple contacts for sensory inputs tongue,lips, soft palate, posterior, pharyngeal wall andtemporomandibular -oint./
A brief review of the forces acting on the bonystructures to shape them during thedevelopmental stages helps us in understanding
the changes that pernicious oral habits canbring about in the oral architecture.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
5/51
Som! Antagonistic Fo'c!sActing on th! Masticato'
A%%a'atus". 0ips# tongue.$. 1heeks#tongue
%. 2ruption 3f teeth#Masticatory Muscles, Masseter,Medial 4terygoid .
". Air pressure on skin and nasal cavity#tongue inclosed mouth, air pressure in open mouth.
*. Masseter 5 elasticity of periodontal ligamentsuprahyloid muscles.
. 6nternal pterygoid# same as masseter.7. 2xternal pterygoid in anterior movement#posterior
one third of temporalis.
'. +uprahyoid group, digastricus, muscles of neck in
lateral movement#external pterygoid of other side.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
6/51
Mastication "+Mastication is a complex activity aimed at
breaking down and insalivation of the food, preparatory toswallowing
INFANT "+The 8rst food is consumed by suckling . This is an
unlearned or innate reex in homo#sapiens.
Th! C$assic ,att!'n is Out$in!- .suc/$! 0 S*a$$o* 1 2Bosma in infant "
. 9ead is extended, tongue elongated and low in the oor of
the mouth, -aws a part and lips pursed around the nipple.
$. Mandible is slightly protruded.
%. :uring ;unction, i.e. deglutition, the rhythmic contraction ofthe tongue and facial Muscles aids in the +tabilization of the
Mandible
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
7/51
Di3!'!nc! 2!t*!!n Suc/$ing 4Suc/ing
Suc/$ing"+
+uckling consist of small nibbling movements of the lipsaround the mothererent from thesucking process.
Suc/ing "+
+ucking consist of drawing a li=uid or other substance/into the mouth by creating a partial vaccum in the mouth.
9oweverthese two words are often used interchangeably
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
8/51
On!s th! chi$- sta'ts ta/ing
so$i- foo-s". The intensity of the act of satisfying hunger is
reduced.
$. !ut most of the muscles of the cheek tongueand oor of the mouth are involved.
%. There is less activity of lips and Mandibularthrust is reduced.
". 6nfant ?uickly learns to use from being forcedout of the mouth during peristaltic action ofthe tongue and the cheeks as the bolus offood is forced towards the pharynx.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
9/51
In An Infant
!olus is mixed with saliva by the
action of tongue.
$ )hythmic action of muscles of the cheek serves to
force the food back towards the tongue@ which pushesthe food against the hard palate.
% To permit the food interpose between gum pads orteeth, the mandible is depressed by gravity and hyoidand lateral pterygoid muscles with simultaneousdeection towards the working side.
" 0ateral +hift of mandible is more apparent whilechewing hard food.
* Mandible is closed primarily by the temporal and
masseter muscles activity.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
10/51
Masticatory stroke in an adult Summarized
by Fletcher using the six phases outlined by
Murphy:56 ,'!%a'ato' ,has!"+ ;ood is ingested and
positioned by the tongue with in the oral cavity andmandible is moved towards the chewing side.
76 Foo- Contact"+ 1haracterized by a momentaryhesitation in movement. This pause is triggered bysensory receptors concerning the apparent viscosity
of the food and probably transarticular pressureincident of chewing.
86 Th! C'ushing %has! "+ +tarts with a high velocitythen slows as the food is crushed by a slight change
in direction but no delay.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
11/51
96 Tooth Contact " Accompanied by a slight
change in direction but no delay.
:6 Tooth G'in-ing ,has! " 6t coincides with thetransgression of Mandibular molars acrosstheir maxillary counterparts and is highlyconstant from one cycle to cycle.
;6 T!'mina$ ,has! " Messerman %/ termedthis phase as terminal functional orbit.Ahlgren/ noted that during this phase thebilateral muscular discharge becomes une=ualand asynchronous, indicating that the person ischewing unilaterally.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
12/51
S*a$$o*ing < D!g$utition
:eglutition or swallowing is an important functioncarried out by the stomatognathic system.
The +wallowing pattern in infants is di>erent fromthat seen in adults.
Thus two main forms of swallowing are
recognized.
I6 Infanti$! S*a$$o*
II6 Matu'! S*a$$o*
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
13/51
56 Infanti$! S*a$$o*
o Cha'act!'istics "
. -aws apart with the tongue between the gumpads
$. Mandible is stabilized by the contraction of themuscles of the 7thcranial nerve and the
interposed tongue.%. The swallow is guided and to a greater extent
controlled by interchange between the lips andtongue.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
14/51
=ith Li>ui- Foo-? Immatu'! o'
#isc!'a$ s*a$$o* in infants"
&um 4ads are not brought into contact. A clucking isfre=uently heard.
The 6nstinctive and peristaltic like muscle activitysteers the li=uid or bolus of food back into pharynx
After is leaves the oral cavity food is then propelledthrough pharynx by superior, middle and inferiorconstrictor muscles or pharynx past the epiglottis
into the esophagus
The epiglottis class o> the pharynx as its posteriorperipheral portions are forced backward against thesuperior constricting ring.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
15/51
Chang!s f'om s!miso$i- to so$i-
foo- an- !'u%tion of t!!th
. Tongue is no longer forced into space between thegum pads or incisal surfaces of the teeth which
contact momentarily during swallowing.$. Mandibular thrust diminishes during transitional
period of to $ months of age
%. Mandibular elevators stabilize the mandible
". 1heek B 0ip muscles reduce the strength of theircontractions
*. Tip of tongue is positioned near the incisiveforamen during the act of deglutition6
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
16/51
76 Matu'! S*a$$o*
Mature swallowing is seen after a year of life.The infantile swallow gradually disappears witheruption of the buccal teeth in the primarydentition
Cha'act!'istics "
. Teeth are together.
$. Mandible is +tabilized by contraction of
Mandibular elevators, which are primarily *thcranial nerve muscles.
%. Tongue tip is held against the palate above andbehind the incisors.
". There are minimal 1ontraction of lips in Dature+wallow6
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
17/51
,has!s of s*a$$o*ing o'-!g$utition"
D!g$utition occu' in fou' %has!s
.The preparatory swallow
$.The oral phase
%.4haryngeal phase".The esophageal phase.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
18/51
56 Th! ,'!%a'ato' S*a$$o*E# The food after mastication is assembled as a
compact bolus on the dorsum of the tongue Teeth are brought into occlusion to stabilize the Faws
B to close the oral cavity properly and isolate it fromlabial vestibule.
4osterior aspect of tongue presses against the soft
palate to isolate the oral cavity from pharynx.
76 Th! O'a$ ,has!E# The soft palate is raised to seal o> 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 theperistaltic action of the tongue.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
19/51
86 Th! ,ha'ng!a$ ,has!E# !egins as soon as the food passes through the faucial
pillars
As the food reaches the pharyngeal walls, there is areex upward movement of the entire pharyngealcomplex.
Ghen the pharyngeal wall touches the soft palate a
peristaltic movement set up to move the food -o*n6
96 Th! O!so%hag!a$ ,has!E# This phase commences as soon as the food passes
the cricopharyngeal sphincter. 4eristaltic activity of the oesophageal walls occur to
pass the food into the stomach
The tongue B the palate return to their originalposition to start the next cycle.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
20/51
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
21/51
HABITS
D!nition "+A habits can be de8ned as the tendency towardsan act that has become a repeated performance, relatively8xed, consistent and easy to perform by an individual
CLASSIFICATION HABITS "+
9A!6T+
6H+2;H00 9A!6T+
9A)M;H0 9A!6T+
66
2M4TI
M2AD6D&;H0 9A!6T
666
4)2++H)2
D3D 4)2++H)2
!6T6D& 9A!6T
6J
13M4H0+6J2
D3D 13M4H0+6J2
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
22/51
C$assication "+ Ha2its
USE FUL HABITS "
This includes habits of normal function suchas,
Co''!ct tongu! %osition?
,'o%!' '!s%i'ation 4 -!g$utition?
No'ma$ us! of $i%s in s%!a/ing
HARMFUL HABITS "+
This includes all the habits that exertperverted stress against the teeth B dentalarches such as,
Thumb sucking # Tongue Trusting
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
23/51
&a'ious Ha2its a'! "
. Thumb +ucking
$. ;inger +ucking%. ;renum +ucking
". Tongue thrusting
*. 4aci8er or dummy sucking
. 0ip !iting
7. Dail !iting
'. 1heek biting
. 4encil or ;oreign obFect sucking
K. 0ip +ucking
. Lnuckle +ucking
$. Tongue thrusting
%. Mouth !reathing
". 1lenching
*. !ruxism
. 3ccupational 9abit
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
24/51
Thum2 Suc/ing < Fing!'
Suc/ing < DigitSuc/ing "+
D!nition"+ 6t can be de8ned as placement of the thumb or
one or more 8ngers in varying depths into themouth
The presence of this habit is considered =uitenormal till the age of %#" years. 4ersistence ofthe habit beyond this age can lead to variousmalocclusions.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
25/51
Etio$og"
56 ,hsio$ogica$ ,'o2$!ms!6g6 .51 2nlarged adenoids,
$/ :eviated septum
76 Emotiona$ %'o2$!ms
!6g6 .51 2xcessive parental demand$/ !irth of +ibling
%/ Teasing, 1riticism physical abuse
"/ 4rolonged or repeated separation from parents
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
26/51
E3!cts of Thum2 Suc/ing
. 9ypotonic upper lip
$. 4roclination and spacingof upper anterior
%. Anterior open bite
". 6ncreased over Fet
*. )etroclined lower anteriorsN
. 9yperactive lower lip
7. 1ompensatory tongue thrusting
'. 6ncreased !uccal Musculature pressure leading on
to the collapse of maxillary arch, and a highpalatal vault which predisposes to posteriorcrossbite
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
27/51
The severity of the malocclusion caused bythumb sucking depends on the trident offactors. They are
. :uration
$. ;re=uency
%. 6ntensity
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
28/51
Manag!m!nt of thum2 suc/ing
56 ,scho$ogica$ a%%'oach
. The parents should be counseled to providethe child with ade=uate love and a>ection
$. The parents should also be advised to divertthe child
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
29/51
.A1 R!mo#a2$! a%%$ianc!s
. )eminder appliance# simple acrylic plate
$. Appliance with tongue spikes
%. Appliance with tongue guard
". 3ral screen
.B1 Fi)!- A%%$ianc!s
*. )akes
. +harpened fork
7. +oldered grate appliance
'. upper lingual arch
.81Ch!mica$ a%%'oach
Hse of bitter tasting or foul smellingpreparation places on the thumb.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
30/51
TOUNGE TRUSTING HABIT
C$assication
.I1 Acco'-ing to mo!'s
a/Dormal infantile swallow
b/Dormal Mature swallow
c/+imple tongue thrust swallow
d/1omplex tongue trust swallowe/)etained infantile swallow
D!nition "6t is de8ned as a condition in which the tongue
makes contact with any teeth anterior to the molars duringswallowing
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
31/51
.II1 Acco'-ing to 2'an!' an- ha$t
Type 6 E Don#deforming tongue thrust
Type 66E :eforming anterior tongue thrust
+ub group E Anterior open bite
+ub group $E Anterior proclination.
+ub group %E 4osterior 1rossbite
Type 666 E :eforming 0ateral tongue thrust+ub group E 4osterior open bit
+ub group $E 4osterior 1rossbite.
+ub group %E :eep overbite.
Type 6J E :eforming Anterior B 0ateral tongue thrust
+ub group E Ant B 4ost. open bit+ub group $E 4roclamation of anterior teeth
+ub group %E 4osterior 1rossbite
Eti $ "
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
32/51
Etio$og "
516 G!n!tic Facto's "
6nherited variation on oro#facial form e.g.hypertonic orbicular is oris activity
716 L!a'n!- 2!ha#io' .Ha2it1a/ 6mproper bottle feeding
b/ 4rolonged thumb suckingc/ 4rolonged tonsillar B upper respiratory tract
infections.
d/ 4rolonged duration of tenderness of gum or
teeth can result in a change in swallowingpatterns to avoid pressure on the tender zone
e/ Tongue held in open spaces during mixeddentition.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
33/51
816Matu'ationa$ "
916M!chanica$ R!st'ictions "
a/ 4resence of certain condition such as
5 Marcoglossia5 1onstricted dental arches
5 2nlarged adenoids
:16N!u'o$ogica$ Distu'2anc!5 9yposensitive palate
5 Moderate motor disability
;16Oth!' Facto'5 Anaesthetic throat
5 !rain inFury
5 ;aulty 3rthodontic treatment
5 Abnormal sleeping habits
5 +leeping towards one side
5 3ral +ensory de8ciency.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
34/51
C$inica$ F!atu'!s
a. 4roclamation of anterior teeth
b. Anterior 3pen bite
c. !imaxillary 4rotrusion
d. 4osterior openbite in case of lateral tongue thrust
e. 4osterior crossbite
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
35/51
$/. :egree of malocclusion
%/. Maturity of the child
Manag!m!nt of tongu! th'ust
Facto's to 2! consi-!'!-"
/. Type of Malocclusion E 1ommon typesa/ 1lass 6 malocclusion with increased overFetb/ Angle
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
36/51
"/. Attitude and the degree of co#operation that canbe
expected from the parents
*/. 4rogressive malocclusion should be considered
forimmediate treatmentK
/. +tructural considerations to be eliminated are
a/ Dasal air blockage
b/ 2xtremely narrow palatal archc/ Maxillary posterior teeth in extremely lingual position
d/ Macroglossia
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
37/51
Th! manag!m!nt of tongu! th'ustin#o$#!s int!'c!%tion of th! ha2it
fo$$o*!- 2 t'!atm!nt of co''!ct th!
ma$occ$usion
.a1Ha2it int!'c!%tion. 6t can be interception by use of habit breaker
5 !oth 8xed and removable cribs or rakes are valuable aidsin breaking the habits
$. 1hild is taught the correct method of swallowing
%. Jarious muscles exercise of tongue
.21T'!atm!nt of ma$occ$usion5. 3nce the habit is intercepted the malocclusion
associated with the tongue thrust is treated using
5 )emovable or
5 ;ixed orthodontic appliances
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
38/51
D!nition " + Mouth breathing de8ned
as habitual respiration through the mouthinstead of the nose
C$assication "
. Anatomic$. 3bstructive
%. 9abitual
f h
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
39/51
Caus!s of Mouth2'!athing
516,a'tia$ o' com%$!t! nasa$o2st'uction ma 2! -u! to
a/ :eviated septum
b/ Darrow nasal passage associated withnarrow maxilla
c/ 6nammatory reaction of nasal mucosawith oedema
d/ Allergic reaction of nasal mucosa
e/ 3bstructive adenoids
716 An Anatomic mouth 2'!ath!'?f/ 4atient having short upper lip
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
40/51
C$inica$ F!atu'!s
The type of malocellusion most often
associated with mouth breathing is called$ong fac! sn-'om! or th! c$assica-!noi- fac!
. 0ong and narrow face
$. Darrow nose and nasal passage
%. +hort and accid upper lip
". 1ontracted upper arch with possibility of posteriorcrossbite
*. An expressionless face or blank face
. 6ncreased over Fet as a result of aring of the incisor7. Anterior marginal gingivitis
'. The dryless of the mouth predisposes to caries
. Anterior open bite
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
41/51
CLINICAL FEATUREJ2+T6!H0A) +1)22D
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
42/51
T'!atm!nt of mouth B'!athing
. 2limination of underlying pathology e.g.. nasal orpharyngeal obstruction
$. Appliance like vestibular screen
%. Application or adhesive tape to the lips
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
43/51
BRUISM"D!nition" !ruxism de8ned asOgnashing and grindingof the teeth fornon#functional purposesP
Etio$og
/ 4sychological B emotional stresses
$/ 3cclusal interference or discrepancy betweencentric relation and centric occlusion
%/ 4ericoronitis B periodontal pain is said to trigger!ruxism.
"/ +urface irregularities of lips, cheek and tongue
*/ 4ain or discomfort of TM- and Faw muscles.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
44/51
C$inica$ f!atu'!sa/ 3cclusal wear facets can be observed on the
teethb/ ;ractures of teeth and restorations
c/ Mobility of teeth
d/ Tenderness and hypertrophy of masticatory
musclese/ Muscles pain when the patient wakes up in the
morning
f/ Temporomandibular Foint pain and discomfort
can occur
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
45/51
T'!atm!nt/ 4sychotherapy
$/ Autosuggestion and 9ypnosis%/ )elaxing exercise and physiotherapy
"/ 2limination of oral pain B discomfort
*/ 3cclusal therapy.
5 e.g. occlusal adFustment of eliminate theprematurities
/ Dight guards or other occlusal splints
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
46/51
Li% 2iting 4 Li%
Suc/ing Ha2it
0ip biting B 0ip +ucking some times appearafter forced discontinuation of thumb or8nger sucking
0ip biting most often involves the lower lipwhich is turned inwards and pressure isexerted of the lingual surface of the maxillaryanterior
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
47/51
C$assication. Getting the lip with tongue.
$. 4ulling the lip into the mouth between the teeth
C$inica$ f!atu'!sa/ 4roclined upper anteriors and retroclined lower
anteriors
b/ 9ypertrophic B redundand lower lipc/ 1racking of lips
T'!atm!nt56 Ha2it can 2! int!'c!%t!- using
0ip bumper or lip plumper 76 Co''!ction of ma$occ$usion
5 e.g. 6f there is a class 66 division 6 malocclusion or
5 excessive over Fet problem
5The abnormal lip activity
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
48/51
Fing!' Nai$ Biting
5
Dail !iting is one of the most common habits inchildren B adults
5 6t is a sign internal tension
Ag! of occu''!nc! " Dail biting absent before % years of age
6ncidence rises sharply from "# years andremains at a fairly constant level between 7 andK year rises again to a peak during
adolescence Etio$og
Any 2motional 4roblem
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
49/51
E3!cts ". :ental e>ects
51rowding, rotation and
5Attrition of incisal edges of the incisors
mandibular/
$. 2>ects on the nails
56nammation of the nail beds B also of thenails
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
50/51
Manag!m!nt E/ Mild cases no treatment is indicated
$/ Avoid punitive methods such as scolding
nagging , threats%/ 2ncourage outdoor activities which may help
in easing tension
"/ Application of nail polish, light cotton mittens
as a reminder.
-
8/9/2019 STOMATOGNATHIC SYSTEM - Copy.pptx
51/51
THAN YOU