Stages of deglutition and tongue thrusting

The presentation features the types and stages of deglutition; types, etiology, classification, diagnosis, clinical findings and management of tongue thrusting.

1. STAGES OF DEGLUTITION AND TONGUE THRUSTING Submitted by:- Musavvar Mansoori Ranjeet Dhonkal B.D.S. final yr Department of Pedodontics Govt . College of Dentistry, indore

2. 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

3. TYPES INFANTILE SWALLOW PATTERN MATURE OR ADULT SWALLOW PATTERN

4. INFANTILE SWALLOWING Infants 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.

5. MECHANISM

6. 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.

7. TONGUE MUSCULATURE EXTRINSIC MUSCLES:- Genioglossus muscle. Styloglossus muscle. palatoglossus muscle. Hyoglossus muscle. INTRINSIC MUSCLES:- Superior longitudinal muscle Inferior longitudinal muscle Transverse muscle Vertical muscle

8. As person swallows the of the tongue contact the:- Tooth surface. Rugae areas. Adjacent to rugae. Vault. Soft palate. And Swallowing of bolus occurs.

9. STAGES Oral stage/ First stage Pharyngeal stage/ Second stage Oesophageal stage/Third stage

10. ORAL STAGE Voluntary stage

11. Pharyngeal stage Involuntary stage

12. ESOPHAGEAL STAGE

13. TONGUE THRUSTING

14. DEFINITION TULLEY (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.

15. 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.

16. CLASIFICATION 1 By 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.

17. TYPE 4:- Deforming anterior and lateral tongue thrust. Anterior and posterior open bite. Proclination of anterior teeth. Posterior cross bite.

18. 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.

19. LATERAL TONGUE THRUST Posterior open bite with tongue thrusting laterally.

20. 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..

21. CLASSIFICATION 3 PHYSIOLOGICAL This comprises the normal tongue thrust swallow of infancy. HABITUAL The tongue thrust swallow is present as a habit even after the correction of the malocclusion. FUNCTIONAL When the tongue thrust mechanism is an adaptive behavior developed to achieve an oral seal.

22. ANATOMIC Person having enlarged tongue can have an anterior tongue posture.

23. 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.

24. UPPER RESPIRATORY TRACT INFECTION Mouth breathing. Chronic tonsillitis. Allergy. NEUROLOGICAL DISTURBANCES Hyposensitive palate. Moderate motor disability. Disruption of sensory control and coordination of swallowing. FUNCTIONAL ADAPTIBLITY TO TRANSIENT CHANGE IN ANATOMY. Missing incisors.

25. FEEDING PRACTICES Bottle feeding. Consistency of infant diet. INDUCED DUE TO OTHER ORAL HABITS Thumb and finger sucking HEREDITARY Inherited hyperactivity of orbicularis oris with specific anatomic configuration and neuromuscular activity. TONGUE SIZE Congenital aglossia . Macroglossia .

26. 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.

27. 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 bite Posterior open bite Posterior cross bite.

28. ANTERIOR OPEN BITE POSTERIOR OPEN BITE

29. POSTERIOR CROSS BITE ANTERIOR CROSS BITE

30. DIAGNOSIS History taking Examination

31. TREATMENT TRAINING OF CORRECT SWALLOW AND POSTURE OF THE TONGUE :- {A} Myofunctional exercises Child is asked to place the tip of tongue in rugae area for 5 min and then swallow. Orthodontic elastics and sugar less fruit drop exercise . 4S exercise :- includes Identifying the spot Salivating Squeezing the spot Swallowing 4 Other exercises :- whistling Reciting the count from 60-69 Gargling yawning

32. {B} Using appliance as a guide Preorthodontic trainer Nance palatal arch

33. 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.

34. MECHANOTHERAPY Fixed and removable appliance- To restrain the anterior tongue movements To force the tongue downward and backward To reeducate the tongue position. Removable appliance therapy- Hawley's appliance

35. Removable appliance therapy- Hawley's appliance

36. Trans palatal arch

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

38. TONGUE CRIB For posterior open bite modified cribs is used

39. CORRECTION OF MALOCLUSION SURGRICAL TREATMENT- orthognathic surgical procedure for correction of skeletal malformation.

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