ABNORMAL FUNCTION OF STOMATOGNATHIC SYSTEM - PowerPoint Presentation

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ABNORMAL FUNCTION OFSTOMATOGNATHIC SYSTEM

Part-3

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ABNORMAL FUNCTION of

stomatognathic

system

Mouth breathing

If the palate is high and narrow, the dorsum of tongue does not fit against the palatal vault every where and a potential away exist between tongue and palate.

If in addition, lips do not meet, the oral airway is complete from open lips to the

oro

-pharynx. So air can be drawn in and expired just as easily through mouth cavity as through nasal cavities.

Mouth breathing is more commonly seen in children and decreases with age. Also more common during sleeping.

 

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Classification

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Etiology

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Effects of mouth breathing

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2) Bruxism

A conscious or

subconcious

act .

overrides the protective neurologic mechanism of

masticatory

system.

Increase in tonic activity in the jaw muscles.

Emotional or nervous tension, pain or discomfort and

occlusal

interferences are the factors that can increase muscle tonus and lead to non-functional clenching. Effects

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Etiology 1)

Psychic tension

Nervous children may develop bruxism

2)

Occlusal

discrepancies

Increased muscle tonus

Also seen in epilepsy, meningitis chorea.

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3) Tongue thrust

Also known as perverted or deviated swallow, retained infantile swallow, tooth apart swallow, tongue thrust syndrome or abnormal swallow.

Masseter

muscle activity is prevented and as a consequence these is no molar contact during deglutition. Active mentalist muscle is noted.

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Classification Anterior tongue- upper and lower incision.

Lateral or posterior – premolar and molar region

Combined

Incidence and duration of tongue thrust

High incidence in school going children and patients with respiratory problem.

 

Fletcher

associates reported following incidence

At age 6 years - 52.3%

8 years - 38.5%

9 years - 49.9%

10 years - 34%

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a) Simple tongue thrust

This is localized posturing forward of the tongue during rest and active function with localized anterior

openbite.

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b) Complex tongue thrust

Forward tongue posture, tongue thrusting during swallowing, contract of

perioral muscles, excessive

buccinator

hyperactivity. When all these symptoms present the pattern is often called as complex tongue thrust.

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Etiology

Bottle feeding

Hereditary or inherited

Oral habits – Thumb sucking, open bite

Ankyloglossia

or

macroglossia

may cause tongue thrust.

CNS disorders – severe enough to prevent normal adult swallow.

Tonsillar

tissue – If enlarged, can create destruction in

oro-pharyngeal area posterior to root of tongue.

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Effects of tongue thrust Anterior

openbite

Lateral or posterior open bite

Proclinated

upper incisors

Hypotonic upper lip and appear retracted or short

Bilateral narrowing of maxillary arch

 

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4) Lisping and stammering

These are commonly occurring speech defects.

Speech defect create difficulty for the child while speaking.  

Lisping

This speech defect involves change of sound of letters and words.

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Etiology

Main cause is continuity of infantile mode of speech.

If the tongue is moved forward without mandible and lies on top of lower incisors lisping may result.

Certain malocclusions like

openbite

, maxillary protrusion,

mandibular

retrusion

and mal-aligned tooth also cause lisping.

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Stammering

In stammering the child fails to produce any sound for sometime. These create emotional tension and difficulty in social adjustment.

Etiology

Hereditary

Due to emotional tension

Lack of balance among two hemispheres of the brain.

Auditory amnesia

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CLINICAL CONSIDERATIONS

Before any treatment is started or during diagnosis all functions of

stomatognathic

system if not proper ,it can be primary etiologic factor in a malocclusion.

Many dysfunctions are acquired in the early stages of development.

Malocclusions that are acquired as a result of dysfunctions can usually be treated simply by elimination of disturbing environmental influences, which will foster normal development

.

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Respiration

Chair side, we should check for breathing weather it is nasal or

oro-nasal.

It is diagnosed by the following test :

Giving a sip of water to patient and ask to keep it in mouth

By placing cotton in between nose and mouth.

Mouth mirror test.

Later ,habit breaking appliances and also different exercises.

- like deep breathing,

- vigorous exercises,

-playing on blowing type of musical instruments

-and lip exercises.

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Mastication

The

masticatory apparatus teeth, muscle of mastication, TMJ movement should be thoroughly checked.

In case of

bruxism

there is presence of

occlusal

fact, or

occlusal

interference, pain in TMJ or tenderness of muscles of mastication.

So the therapy includes elimination of triggering elements, mainly discrepancies between, centric relation and CO by

occlusal adjustment, by giving occlusal bite plate, protective mouth guard or rubber splints.

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Deglutition

Between 2 to 4 years of age mature swallow is seen in normal developmental patterns.

If the infantile swallowing can persists well after 4 years of life and is then considered a dysfunction or abnormal.

A proper diagnosis of tongue thrust should be done on the basis of clinical features or by checking the swallowing patterns.

Circum oral tension is being used as diagnostic criteria by many clinicians.

After diagnosing a tongue thrust habit it should be properly treated.

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If the tongue thrust is present at 3 to 9 years of age no appliance therapy is usually indicated only the dentist instruct the patient how to swallow correctly.

On recall appointments if the

openbite improves or remains same, this approach is continued until 9 years of age.

If open bite continues to increase intraoral therapy is indicated.

If tongue thrusting is associated with lisping, only a speech therapist should be encouraged to correct the speech problem using articulation therapy.

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Speech

During diagnosis attention should be given towards speech also.

The etiology of speech problem should be recognized and proper treatment should be given.

The presence of speech defects in childhood is due to lack of sufficient training and maturity.

As these factors are provided the speech defects disappears. The guardians and teachers should therefore encourage

childrens

to pronounce correctly.

If defect continued till late age when they removed by means of surgery.