Professional Documents
Culture Documents
• INTRODUCTION
When we want to check occlusion of teeth, we have the
patient close his mouth and we open the lips to see how
upper and lower teeth meet, or we carefully articulate the
plaster casts in fullest contact. This static analysis is
important, but equally important is a dynamic appreciation
of how these part functions.
It is becoming increasingly apparent that function can
influence the overall pattern and the very foundation of
stomatognathic system. We must know more about function
than just how mastication works. Equally important is the
full appreciation of, deglutition, respiration, speech and even
the maintenance of head in the constant postural position.
• STRUCTURES OF STOMATOGNATHIC SYSTEM
1) The jaw
2) Teeth
3) Tongue
4) Musculature
1) Jaw
The upper and lower jaws are the major part of
stomatognathic system. It helps in attachment of muscles,
supports the teeth.
2) Teeth
Teeth are arranged in upper and lower jaw and are
supported by alveolar bone and periodontium. Teeth are
helpful for mastication and phonation.
3) Tongue
The tongue is a highly muscular as well as adaptive organ. It
is made up of intrinsic as well as extrinsic muscles.
4) Musculature
Muscles are a potent force, whether they are in active
function or at rest. As we have seen resting muscle still
is performing a function that of maintaining posture
and a relationship of contagious parts.
The teeth and supporting structures are constantly
under the influence of the contagious musculature.
The integrity of dental arches and the relations of the
teeth to each other with opposing members are the
result of morphogenetic patterns, as modified by the
stabilizing and active functional forces of the muscles.
During mastication and deglutition, the tongue may
exert two or three times as much force on the dentition
as the lips and cheeks at any one time.
Buccinator mechanism is a continuous band of muscles
that encircle the dentition & is firmly anchored at the
pharyngeal tubercle of the occipital bone
Starts with decussating fibres of orbicularis oris joining
the right and left fibres of the lip which constitute the
anterior component of the buccinator mechanism
Runs laterally and posteriorly around corner of the
mouth, joining other fibres of the buccinator muscle
which gets inserted into pterygomandibular raphe.
Tongue acts opposite to buccinators mechanism
exerting an outward force
Muscles of mastication
• Temporalis
• Lateral pterygoid
• Medial Pterygoid
• Masseter
Temporalis
• Origin- Bone of temporal fossa and temporal fascia
• Insertion- Coronoid process of mandible and anterior margin
of ramus
• Nerve supply- Deep temporal nerves from anterior trunk of
mandibular nerve
• Function- Elevation and Retraction of mandible
Lateral Pterygoid
•Origin: Upper head – infratemporal surface & crest of greater
wing of sphenoid bone; Lower head – lateral pterygoid plate
• Insertion :Pterygoid fovea on the anterior surface of neck of
mandible and Anterior margin of articular disc & capsule of TMJ
• Nerve Supply: Pterygoid branch of Trigeminal nerve
• Function: Depresses the mandible; Protrudes it forward for
opening of the jaw; Side Movements
Medial Pterygoid
• Origin- Medial surface of lateral plate of pterygoid process
and pyramidal process of palatine bone ; Superficial head-
tuberosity and pyramidal process of maxilla
• Insertion- Medial surface of mandible near angle
• Nerve supply- Nerve to medial pterygoid from the
mandibular nerve
• Function- Elevation and side to side movements of the
mandible
Masseter
• Origin- Zygomatic arch and Maxillary process of zygomatic
bone
• Insertion- Lateral surface of the ramus of the mandible
• Nerve supply-Masseteric nerve from the anterior trunk of the
mandibular nerve
• Function- Elevation of the mandible
Accessory muscles of mastication :-
Suprahyoid muscles Infrahyoid muscles
DiagastricSternohyoid
StylohyoidThyrohyoid
MylohyoidOmohyoid
Geniohyoid
WOLFF’s law of transformation of bone
In the year 1870, Julius Wolff gave the reason for the
arrangement of trabecular pattern
He attributed that the trabecular arrangement is due to the
functional forces.
“A change in the direction and magnitude of force could
produce a marked change in the intermal architecture and
external form of the bone”
Increase in function leads to increase in the density of bone
2) Deglutition (swallowing)
a) Infantile (visceral) swallow
Moyers lists the characteristics of the infantile swallow as
follows:
1) The jaws are apart with the tongue between the gum pads.
1) Preparatory
Starts as soon as liquids are taken in, or after the bolus has
been masticated. The liquid or bolus is then in a swallow –
preparatory position on the dorsum of tongue. The position
on the dorsum of tongue. The oral cavity is sealed by lip and
tongue.
2) Oral phase
During the oral phase the soft palate moves upward and
tongue drops downward and backward. At the same time
the larynx and hyoid bone move upward. The combined
movement create a smooth path for the bolus as it is pulsed
from the oral cavity by the wave-like ripping of the tongue.
3) The pharyngealphase
Begins as the bolus pulses through fauces. The pharyngeal
tube is raised upward and the nasopharynx is sealed off by
closure the soft palate against the posterior pharyngeal wall.
The hyoid bone and the base of the tongue move forward as
both the pharynx and the tongue continue these peristaltic
like movement of the bolus of food.
3) Respiration
Respiration, like mastication and swallowing is an inherent
reflex activity. A wonder to behold is the fantastically
efficient split second opening and closing of the epiglottis,
keeping out the blood but permitting the entry of life giving
air.
4) Speech
Speech like breathing, also makes no gross demands in the
perioral muscles. Although all mammals apparently
masticate, swallow and breathe speech is limited to the
human being.
1) Mouth breathing
Classification
a) Obstructive
Who have increased resistance to or a complete obstruction
of the normal flow of air thorough nasal passages. Because
of difficulty in inspiring and expiring air through nasal
passages the child is forced by sheer necessity to breathe
through his mouth.Seen in adenoid facies.
b) Habitual
A child who continuously breathes through his mouth by
force of habit, although the abnormal obstruction has been
removed.
c) Anatomical
Whose shorter upper lip does not permit closure without
under efforts.
Etiology
1) Naso-pharyngeal obstruction
Obstruction may be due to
2) Mouth habits
Thumb sucking lip biting, finger or nail biting, tongue
thrusting
3) Abnormal development
a) Macroglossia
b) Short upper lip
4) Psychosomatic problems
May also show mouth breathing
Bruxism
Effects
• Tenderness of masticatory muscle
• Incisal wear, occlusal facets
• TMJ pain, headache or tiredness of masticatory muscles.
Etiology
1) Psychic tension
Nervous children may develop bruxism
2) Occlusal discrepancies
Increased muscle tonus
Also seen in epilepsy, meningitis chorea.
3) Tongue Thrust
Classification
Etiology
2) Hereditary
The structure of the components of the face that is inherited,
rather than habit itself.
Lisping
This speech defect involves change of sound of letters and
wards.
Etiology
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
CLINICAL CONSIDERATIONS
Before any treatment is started or during diagnosis, all
functions of stomatognathic system should be checked and 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.
Respiration
When the child is seated on dental chair, we should check for
breathing whether it is nasal or oro-nasal.
It is diagnosed by giving a sip of water to patient and ask to
keep it in mouth and by placing cotton in between nose and
mouth.
The etiologic factors of mouth breath is first recognized and
then they are removed like correction of nasal obstruction.
Later on the restoration of oral health is done by giving
proper habit breaking appliances and also different exercises
like deep breathing, vigorous exercises, playing on blowing
type of musical instruments and lip exercises.
Mastication
The masticatory apparatus contains teeth, muscles of
mastication, TMJ movement. The functioning should be
thoroughly checked.
In case of bruxism there is presence of occlusal facets, 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 correction
by occlusal adjustment, by giving occlusal bite plate,
protective mouth guard or rubber splints.
Deglutition
Between 2 to 4 years of age mature swallow is seen in
normal developmental patterns.
A proper diagnosis of tongue thrust should be done on the
basis of clinical features or by checking the swallowing
patterns. Circumoral tension is being used as diagnostic
criteria by many clinicians.
After diagnosing a tongue thrust habit it should be properly
treated.
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.
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
children to pronounce correctly.
If defect continued till late age then they are removed by the
means of surgery.
REFERENCES
• Grays Anatomy for students 2nd Edition
• Wikipedia
• Friedman MH, Wusberg I. Screening procedures for
temporomandibular joint dysfunction. Am Fam Phys.
1982;25:157–60.