Dr. Smriti Narayan Thakur 1st year,P.

G resident(2nd Batch) Department of Prosthodontic and Maxillofacial Prosthetics Peoples Dental College & Hospital,Kathmandu 10/2/2012

Contents
1.Introduction 2.Mastication Neurologic control Chewing stroke Role of teeth Tooth contacts during mastication Muscles involved Role of soft tissue in mastication Role of saliva Forces of mastication 3. Deglutition Physiology Pattern of swallowing Frequency of swallowing 4. Speech Speech Production System Sound categories 5. Clinical significance 6. Conclusion 7. Reference

INTRODUCTION
-Mastication is the act of chewing food. It represents the initial phase of digestion, when food is broken down into small particles for ease of swallowing. -Complex function that utilizes not only muscles and teeth but also the lips ,cheeks, tongue, palate and salivary glands.

Neurological control of mastication

The central nervous system receives input from various sensory receptor through afferent nerve fiber. Motor activity elicited through efferent nerve fiber These motor activities involve the contraction of some muscle groups and the inhibition of others The control of mastication is dependent on sensory feedback, which consists of epithelial mechanoreceptor afferents, periodontal afferents, temporomandibular joint afferents and muscle afferents. Sensory feedback explains the coordination of the tongue, lips, and jaws to move the food around, this is the reason why different food stuffs influence the pattern of masticatory movement

Chewing stroke
Opening and closing of mandible The movement pattern is described as tear shaped. chewing stroke Is divided into i. ii. Opening phase Closing phase Crushing phase Grinding phase

Frontal view of chewing stroke

In frontal plane i. Opening phase

The mandible drops downward from intercuspal position to a point where the incisal edges of teeth are about 16 to 18 mm apart. ii. Closing phase Mandible moves 5 to 6mm laterally from the midline, when closing movement begins

a. Crushing phase This first phase of closure traps food between the teeth. When teeth are 3mm apart Jaw position 3 to 4mm lateral to the starting position of chewing stroke. Buccal cusp of maxillary teeth positioned on buccal cusp of mandibular teeth on the side the mandible has shifted(working side)

b. Grinding phase Mandible continues to close the bolus of food is trapped between the teeth. Mandible is guided by occlusal forces of teeth to intercuspal position, cuspal inclines of teeth pass across each other permitting shearing and grinding of bolus of food.

Chewing stroke in saggital plane

1.Opening phase Mandible moves slightly anterior. Amount of anterior movement depends on the stage of mastication.

2.Closing phase. Follows posterior pathway ending in an anterior movement back to maximum intercuspal position

Incising food mandible moves forwards. Crushing of bolus concentrated on posterior teeth less anterior movement occurs. Movement of molar in chewing stroke on working side Molar moves slightly forward during opening phase. Closes on slight posterior pathway In final closure moves anteriorly as the tooth intercuspates

Movement of mandibular molar on non working side. Left mandibular molar drops vertically with little anterior or posterior movement until complete opening has occurred On closure mandible moves slightly anteriorly and tooth returns to intercuspation

Movement of condyle Condyle on the working side follows this pathway closing in slight posterior position with final anterior movement in intercuspation
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 Condyle on non working side follows same pathway as molar

Variation in chewing stroke

Chewing stroke in children In children jaw opens laterally and closes laterally.

Action of teeth a) Incisors-cutting b) Canines-tearing c) Premolars-grinding d) Molars-grinding

Tooth contacts during mastication

When food is introduced in mouth few tooth contacts occur. Bolus broken down frequency of tooth contact increases. Final stages of contact prior to swallowing, tooth contact occur in every stroke. Gliding contact-occurs as cuspal inclines pass by each other, during opening and grinding phase of mastication. Single contact-maximum intercuspal position Tall cusp with deep fossa-vertical chewing stroke. Flattened or worn tooth-broader chewing stroke. With TMJ disorder-chewing strokes are much shorter,slower and have irregular pathway. Malocclusion-irregular and less repeatable chewing stroke.

Muscle involved
1.Muscle that help regulate mandible i. ii. iii. Masseter Temporalis Medial pterygoid Lateral pterygoid

2)

Muscle that help lip seal Lips

3)

Muscle that help regulating food Muscle of tongue Buccinator

Role of soft tissue in mastication

Lip lip seal lips guide and control intake as well as seal off oral cavity.

Tongue Maneuver food in oral cavity for efficient chewing Food is broken down by pressing against hard palate Food pushed on occlusal surface of teeth and crushed during chewingstroke During opening stroke tongue repositions partially broken food for further breakdown Sweeps teeth to remove any food residue that has been trapped in oral cavity.

Role of tooth form

1.Contour The type of contour determines direction in which food would be pushed cervically during mastication Normal contour-pushes food towards buccal or labial vestibule ,tongue or palate in such a way that passing food stimulates the intervening tissue rather than irritating them Over contoured-inadequate stimulation by passage of food Under contour-trauma to attachment apparatus

2.Occlusal surface Occlusal surface directs masticatory forces along long axis of tooth Occlusal surface provide well formed marginal ridges and occlusal spillways to prevent interproximal food impaction.

3.Embrasure/spillways Serves as spillways for escape of food during mastication Force on tooth reduced Prevents forcing of food into the contact area Attritioned teeth occlusal embrasure is lost so food is easily forced through contact.

Role of saliva
1)Lubrication Digestion Occurs during mastication Action of digestive enzymes-amylase Moistens food Breaks down into smaller particle to initiate digestion Formation of bolus and facilitates deglutition Bolus formation Food is rolled on upper surface of tongue by suitable tongue movements. Then food is mixed with saliva to form bolus.

Forces of mastication
Maximum biting load in females 38.5 to 44.9 kg Maximum biting load in males 53.6 to 64.4 kg Maximum force on first molar 41.3 to 89.8kg Maximum force on central incisor 13.12 to 23.1kg

Maximum biting force increases with age to adolacence. Maximum biting force increases with time practice and exercise. A person whose diet contains tough food will develop stronger biting force. Greatest amount of force in molar region.

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Periodontal response
Teeth and periodontal structures are subjected to intermittent heavy forces When soft substances are chewed force ranging from 1-2kg applied 50kg for hard food When hard force is applied displacement of tooth into periodontal ligament space is prevented by incompressible tissue fluid, force transferred to alveolar bone which bends in response. Bone bending in response to normal function generates piezoelectric current that appear to be an important stimulus to skeletal regeneration and repair.

Time (seconds) Event <1 PDL* fluid incompressible, alveolar bone bends, piezoelectric signal generated 1-2 PDL fluid expressed, tooth moves within PDL space

3-5 PDL fluid squeezed out, tissues compressed; immediate pain if pressure is heavy

Clinical significance
Difficulty in mastication Dry mouth Glossitis Dental cavities TMJ disorders Gingivitis Oral cancer Myasthenia gravis Cleft palate
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DEGLUTITION
Deglutition is also known as Swallowing, it is the process by which the food is passed through the oral cavity into the Gastrointestinal tract.

Swallowing
Transference of material from:

Mouth Throat

Esophagus Stomach

Normal deglutition requires the fine coordination of12 cranial nerve 6 cervical nerve some 60 muscles

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Anatomy of the swallowing mechanism

The anatomic area of swallowing mechanism consists of Oral cavity Pharynx Larynx Esophagus

Physiology of swallowing mechanism Swallowing is composed of four distinct phases: 1- Oral preparatory phase 2 - Oral transit phase 3 - Pharyngeal phase 4 - Esophageal phase.

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Oral preparatory phase The phase begins with introduction of bolus in oral cavity. Voluntary control Anterior sphincter lip Posterior sphincter- base of the tongue & soft palate. Duration & character depends onIntegrity of the masticatory apparatus.

Nature of the bolus At the end the bolus is collected & positioned on the dorsal surface of the tongue.

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Oral transit phase A bolus is formed in the central portion of the tongue and then pushed posteriorly toward the pharynx with an anterior-to-posterior tongue elevation. As the bolus enters the pharynx the actual swallow or pharyngeal reflex is triggered.

Bolus is placed on dorsum of tongue and pressed slightly against the hard palate. Lips sealed tip of tongue rests behind incisors Teeth are in maximum intercuspal position stabilizing the mandible. The mandible is fixed so contraction of suprahyoid and infrahyoid muscles can control proper movement of hyoid bone for swallowing. Presence of bolus initiates reflex wave of contraction in the tongue.
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The tongue presses bolus backward. The bolus is transferred to pharynx. Pharyngeal phase A reflex action. Bolus passes through pharynx quickly and then enters esophagus. This takes place in less than a second. Initiation of this process starts when the bolus passes the anterior faucial arch and reaches the posterior pharyngeal wall. Elevation of soft palate prevents material from entering nasal cavity.

This stage is followed by pharyngeal constrictor muscles pushing bolus further into the pharynx, toward cricopharyngeal sphincter. Larynx prevents material from entering trachea by respectively closing epiglottic folds. Contraction of lower pharyngeal constrictor is followed by relaxation of the cricopharyngeal muscle, allowing the bolus to pass into the esophagus.

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Esophageal stage Upper esophageal sphincter closes Gastroesopaheal sphincter opens Esophagus controls involuntary peristaltic movement Epiglottis reopens Bolus moves from esophagus to stomach.

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This phase begins when the bolus enters the esophagus at UES. Then, peristaltic waves of esophagus push the bolus sequentially downward until it reaches the LES and enters the stomach. This phase lasts from 8 to 20 seconds. In the esophageal phase, the epiglottis returns to its rest position and the airway opens while the esophageal peristalsis movement continues

Pattern of Swallowing
1. Mature swallow 2.Swallowing in infant 3.Infantile swallow 4.Retained infantile swallow

Swallowing in infants
Suckling Small nibbling movements of the lips stimulate the smooth muscle to contract and squit milk into mouth Infant grooves the tongue and allow the milk to flow posteriorly into the pharynx and esophagus.

Infantile swallow
Tongue lies between the gum pads and mandible is stablised by contraction of fascial muscles.

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Buccinator muscle is strong. Seen in infants and disappears after eruption of incisors in primary dentition

Retained infantile swallow

Presence of infantile swallowing even after appearance of permanent teeth Very strong contraction of lip and facial musculature. Thrusts the tongue strongly between teeth in front and on both the sides.

Frequency of swallowing
Swallowing cycle occurs 590 times during 24 hours. 146 cycles during eating 394 cycles between meal while awake 50 cycles during sleep Low level of salivary flow during sleep, less need to swallow.

Clinical consideration

Dysphagia- Difficulty in swallowing

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Speech
Introduction A means of oral communication that employs a linguistic code through which one can express thoughts feelings and understand those of others who employ the same code. Anatomy of the Speech mechanism

Different phases of speech production 1)Respiration 2)Phonation 3)Resonation 4)Articulation

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1)Respiration First step Exhaled air causes vocal cords to vibrate Moves through resonating cavity 2)Phonation Second step Physiologic process where the energy of moving air in the vocal tract is transformed to acoustic energy within the larynx. Breath stream is emitted through lungs and strikes the vocal cord. 3)Resonation Process of modifying the voiced breath system by amplifying or damping certain frequency components. Gives distinguishing quality timber 4)Articulation Adjustments and movement of speech and vocal tract necessary for modifying the breath stream for producing the phonemes and linguistic features of speech.

Speech Production System

I.Respiratory Mechanism II. Laryngeal Mechanism III. Vocal Cavity Mechanism I. Respiratory Mechanism 1.Thoracic Cavity Generate expiratory air pressure and flow required at larynx for phonation.

2.Lungs and Tracheo-broncial tree Generate air pressure required for consonant articulation

3.Neuromuscular System which controls the volume of Thoracic cavity Control of air pressure and flow for regulation of vocal pitch and intensity and to divide speech into syllabus and phrases.
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I. 1.Larynx

Laryngeal Mechanism

Vocal fold vibrations produce sound during voice production

2.Neuromuscular Systems Laryngeal Adjustments coordinate with intratracheal air pressure regulation to control voice pitch and vocal intensity

2.Neuromuscular System controlling movements of the tongue, jaw, lip, soft palate, pharyngeal walls, etc. Articulating consonants by Generation of continuous spectrum noise by constricting air flow at various location in oral tract Generation of transient noises by stopping and sudden release of air flow at various oral cavity locations. II. Vocal Cavity System

1.Pharyngeal, Oral, and nasal cavities (Tongue, teeth, soft palate etc.) Articulation of vowels by Shaping the oral pharyngeal tract to regulate resonance property of tract. Controlling coupling to nasal cavity

2. Neuromuscular systems controlling movements of tongue jaw lips ,soft palate, pharyngeal walls. Articulation of consonants Assists in regulation of air flow through valving action Regulation of voice quality and vocal intensity

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Hearing
Speech depends on auditory input Human beings speak as they hear

Congenitally deaf or those who become deaf before development of speech lack functional receptive and expressive communication

Sound catagories Three sound categories 1. Vowels 2. Diphthongs 3.Consonants 1.Vowels- If the air, once out of the glottis, is allowed to pass freely through the resonators. They are divided into i. ii. iii. iv. Front vowel /i/ as in it,/e/ as in bet,/e/ as in vacation Apex of tongue is below and distal to mandibular incisors Body arched anteriorly Flattens as mandible is depressed Front vowel Central vowel Back vowel Semi vowel

ii. Back vowels /u/boot,/u/foot Tongue body moves to a posterior superior position
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Apex of tongue is pulled distally from the position it assumed for front vowel

iii. Central vowel Tongue obliquely passes from the occlusal surface maxillary molars to gingival portion of first molars iv. semi vowel /w/we,/r/rat These are semi consonants Diphthongs Six diphthongs /ai/gate,/ai/mice,/ i/boy,/ou/go,/au/cow,/iu/music Made by combining two vowel sounds.

3.Consonants-If the air, once out of the glottis, is obstructed, partially or totally, in one
or more places. a. Bilabial b. Labiodental c. Lingua dental d. Lingua alveolar e. Lingua palatal f. Lingua velar a)Bilabial air pressure is build up behind the lip and released with or without a voice sound P,b and m

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2)Labiodental sound Made between the upper incisors and the labiolingual centre to the posterior third of the lower lip V and f

3)lingua dental Th sound ,tip of the tongue extending between upper and lower teeth.

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4)lingua alveolar T,d,s,z T,d,s,z sound formed by contact of tip of tongue with anterior part of palate.

5)Linguo palatal S,z,j,sh,zh Sibilant sound Tongue and alveolus form the controlling valve

6)Lingua velar

K,g,ng

Clinical considerations
Types of speech disorders 1)Articulation disorders i. ii. iii. iv. v. i. Cleft lip and palate Infantile preservation Lalling Lisping Cerebral palsy Cleft palate and lip Defective articulation,resonance Associated with disorder of middle ear can lead to hearing problem Nasal leakage of air makes speaking in phrases or sentences in single breath of air difficult. Infantile preservation Baby talk W substituted for r, y for l, t for k, f for th
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ii.

iii. iv. i. ii. iii. iv.

Lulling Sluggish tongue movement Defective s, z, t, r and l sound Cerebral palsy, mental retardation. Lisping Defective sounds are s,z,sh and zh There are four types of lisp Interdental/ frontal lisp Dentalised lisp Palatal lisp Lateral lisp Interdental lisp

v.

Tongue protrudes between front teeth and airflow directed forwards. /s/ and /z/ sound like th Soup sounds like thoop, missing like mithing, pass like path Cerebral palsy Voice, rhythm, resonation and articulation disorders occur

In malocclusion
Open bite Upper teeth cant touch lower lip-/f/ ,/v/ If upper lips cant contact-p,b,m Increase airspace between tongue tip and hard palate-s,z Deep bite T,d substituted for s,z

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Conclusion Mastication Mastication is the first step in digestion.Food has to be chewed properly for digestion.The tongue,teeth,saliva, have thier indivisual role in mastication.Food has to be properly chewed for swallowing. Deglutition, After food is masticated it is ready for deglutition .The tongue,pharynx and esophagus plays an important role.

Speech Speech is very necessary for communications. There are various types of articulation disorders which should be identified. Hearing is also very essential for reception of speech production.

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References 1.Okeson JP, management of temporomandibular disorders and occlusion, 1992 2.Proffit, Contemporary Orthodontics, 2nd edition, 1992 3.Finn,clinical pedodontics,4th edition 4.Guyton hall,Textbook of medical physiology 5.Nelson, Ash, Wheelers Dental anatomy, physiology and occlusion, 9 th edition, 2007. 6. Bumer ,textbook of maxillofacial prosthodontics

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