STOMATOGNATHIC

SYSTEM

SURYA KRISHNAN
I MDS

CONTENTS :

Introduction
Definition
Features
Jaw
Muscles
Functional

movement of Mandible

TMJ
Tongue
Functions

of stomatognathic system
Conclusion
Referance

Introduction :

The Description of the parts that make up the

Dentofacial Complex,their intimate relations with each
other and their role in the accomplishment of the overall
pattern are only the part of the story.

The Static Analysis, is impotant, but equally important is

a dynamic appreciation of how these parts function.

An Orthodontist can establish a perfect occlusal relation

ship of the teeth ,but unless he takes into consideration
the effects of the use of these teeth,makes allowances
for the manifold environmental functional influences, the
delicate bony structures along with the teeth positions
are subjected to change.
It is becoming increasingly apparent that function can
influence the overall pattern and the relationships of
these parts, the very foundation of the stomatognathic
system.

DEFINITION:

Contents of the stomatognathic

system
Jaw
Teeth
Tongue
Musculature
Jaw

Upper & Lower Jaw (Bone) are the major part

of the system.
Teeth * Arranged in the upper & Lower jaw.
*Supported by the Alveolar bone &
Periodontium.
*Mastication & Phonation.
Tongue *Highly Muscular & Adaptive Organ.
*Made of Intrinsic & extrinsic muscles.

Jaw BONE COMPONENT.

Bones

form the basic component

structure of the stomatognathic system.
Three main bones make up the skeletal
portion of the stomatognathic system.
MAXILLA
MANDIBLE
PORTION OF THE TEMPORAL BONE OF
THE SKULL.
Maxilla & Mandible are the bones that
hold the teeth.Temporal bone is the site
of the Mandible Articulation with the skull.

wolfFs Law
In

1870 ,Julius Wolff Law of

transformation of Bone.
He attributed the trabecular pattern of
bone ,mainly due to functional forces.
A change in the Direction &
magnitude of Force could Produce a
marked change in the Internal
Architecture and External form of the
bone.
Increase in Function leads to Increase
in the Density of Bone.

Law of orthognality
It

is also expressed by a mechanical

mathematical law Law of Orthognality.
It states that bone elements once formed
rearrange themselves in the direction of the
functional pressure and increase or decrease
their mass to reflect their FUNCTIONAL
STRESS.
It is now established that cartilaginous and
membraneous bones react differently to
forces.
Muscles have a great influence over bones and
may even change the shape.
Thus the timed manipulation of the
musculature maybe beneficial to the
Orthodontist.

Trajectorial theories of bone

formation
Meyer

& Culmann(1867)
Benninghoff (stress
trajectories).
Julius Wolff (1870).
Melvin Moss (Functional
matrix hypothesis).

Benninghoff
The

Trajectorial theory states that the lines of

Orientation of bony Trabaculae follow the
pathways of maximal pressure & tension.these
involve both cancellous as well as Compact
bone.These respond to the demands of
Functional Forces collectively as a unit and not
as a single bone.
They exist not as a manifestations of intrinsic
genetic potential, but direct response to
epigenitic & local functional influences.
Head

is made of two functional unit:

Craniofacial unit
Mandible

Maxillary

Trajectories are:
Vertical Canine, Zygomatic
Buttress, Ptrygomaxillary.
Horizontal Hard Palate, Orbital
floor,Lesser wing of sphenoid bone.

FUNCTIONAL MATRIX
HYPOTHESIS
Proposed

by Melvin Moss
Describes the bone growth within the craniofacial
skeleton as being influenced primarily by Function.
(Moss & Salentijin, 1969)Growth of skull is not
genetically determined.
Moss suggested the Functional cranial component
Head < Functional Matrix & Skeletal Unit.
Functional Matrix All tissues, organs & spaces
that perform a given function.
Skeletal unit Bones, cartilages & tendons that
support this function.Furthur divided into
Microskeletal unit & Macroskeletal unit

Bone formation- Meyer & Culmann

Trajectories were seen crossing at right angles
to each other,enabling bone to resist the
functional stresses it is subjected to.The
alignment of the bony trabaculae followed a
definite engineering principles.

CLINICAL Significance.

Correction

of Maxillo mandibular
deformities

MANDIBLE
The mandible forms the lower part of our
face. It is suspended from the skull by
muscles, ligaments and soft tissues, and
doesnt itself attach bone-to-bone to the
maxilla, but hangs in space.
U-shaped bone, contains mandibular teeth in
alveolar process.
Major structural parts- condyle, coronoid
process, ramus, angle, alveolar process,
mental protuberance

MAXILLA..
Composes most of
upper part of face &
contains maxillary
teeth.
Fused to skull &
hence non-mobile.
Major intra-oral partsalveolar process,
palatal process,
incisive foramen,
mid-palatal suture,
maxillary tuberosity.

MUSCLES
Muscle

fibres grouped into motor

units.
Motor unit = Group of muscle fibres
innervated by one Motor Neuron.
Functional unit of Muscles =
Number of muscle fibres per
neuron, varies according to function
of muscles.
More fibres = Greater force of
movement.

Equilibrium theory
An

object subjected to unequal forces will

be accelerated and thereby will move to
different position in space.it follows that if
any object is subjected to a set of force but
remains in the same position those forces
must be in equilibrium.
The Dentition is in equilibrium since the
teeth are subjected to variety of forces but
dont move to a new location under usual
circumstnces.
The duration of Forces is more important
than its magnitude due to its Biological
effect.

Muscles of Mastication..
Primary

functional muscles.
Performing Majority of Mandibular
movements.
Suprahyoid Group mouth
opening.
Infra hyoid Group - coordinate
Mandibular functions.
Masseter, Temporalis, Medial
Pterygoid, Lateral Pterygoid,
Hyoid, Auxiliary oral muscles.

MASSETER..
Superficial

portion:
Origin Anterior 2\3 rd
of Zygomatic arch.
Insertion Coronoid
Process, Ramus, Angle
of the Mandible.
Function Powerful
Elevator.
DEEP PORTION:
Origin : Medial surface
of Zygomatic arch
Insertion Same.
Function Elevation &
Protrusion.

Medial Pterygoid
Origin

: Medial surface of Lateral

Pterygoid Plate.
Insertion : Medial surface of
Angle of Mandible.
Function : Elevation & Protrusion.

Temporalis
Anterior

Part:
Origin Anterior Temporal
fossa.
Insertion Coronoid Process.
Function - Elevation.
Middle Part :
Origin Middle Temporal Fossa.
Insertion - Coronoid Process.
Function Elevation &
Retraction.
Posterior Part :
Origin Posterior Temporal
fossa.
Insertion Coronoid fossa.
Function Retrusion.

Lateral Pterygoid
INFerior

Head:
Origin : Lateral surface of Lateral Pterygoid Plate.
Insertion :Neck of Condyle. Function : Protrusion.
Superior Head :
Origin Infratemporal surface of Greater sphenoid wing.
Insertion Articular Capsule, Disc , Neck of Condyle.
Function Protraction of disc in conjunction with
elevator muscles.

Auxiliary muscles
Buccinator
Orbicularis

Oris

Tongue
Posterior

neck

Muscles:
Sternocleidomastoid,
Trapezius, Intrinsic
neck muscles.
NERVE SUPPLY
:Mandibular division of
Trigeminal nerve.

Buccinator / whistling Muscle

Origin :
upper
fibres from Maxilla opposite to
molar teeth
Lower Fibres from Mandible opposite to
Molar teeth.
Middle Fibres From pterygomandibular
raphae.
Insertion :
To the Upper & Lower lips.
Action : Flattens cheek against gums &
Teeth.

Buccinator Mechanism
It

is a continous muscle band that encircles the

dentition & is supported at the pharyngeal tubercle.
Components- Orbicularis oris, Buccinator, Superior
constrictor of pharynx. Opposing the buccinator
mechanism is a very powerful muscle Tongue.

The

Force exerted by the Lip musculature

anteriorly & buccinator & muscles of the
cheek posteriorly is counteracted by the
force exerted by the tongue.Thus
balanced force is transmitted to the
Teeth & supporting bone.

CLINICAL SIGNIFICANCE of BUCCINATOR MECHANISM HYPERACTIVE.

Any change in the equilibrium of Buccinator mechanism

Leads to Malocclusion.THE 3 Ms Muscles,
Malformation,Malocclusion-Graber,AJODO 1963 June (418450)Oral habits like thumb sucking, tongue thrusting
Aggravates the imbalance causing changes in dentition
Constricted maxillary arch, increased anterior proclination,

Supra hyoid muscles

GENIOHYOID

Infra hyoid muscle

THYROHYOID

MYLOHYOID
STERNOHYOID
DIAGASTRIC , STYLOHYOID
OMOHYOID
Function :

elevates the hyoid bone &

depresses the Mandible when the mouth is wide open
or against resistance.
Infra hyoid :Lowers hyoid bone allowing
suprahyoids to depress mandible.

Movements of the mandible

Depression

Lateral

Pterygoid.
Diagastric, Geniohyoid
& mylohyoid muscle
helps when mouth is
opened wide or against
resistance,
Elevation Masseter,
Temporalis, Medial
pterygoid.
Protrusion Lateral
Pterygoid .
Retraction Temporalis.
Lateral (side to side )
Medial & lateral
pterygoid.

FUNCTIONAL MOVEMENTS OF
MANDIBLE
It

Can be moved only in certain directions.

The postural stability along with primary
movements.
BASIC POSITIONS:
PHYSIOLOGIC REST
CENTRIC RELATION
INITIAL CONTACT
CENTRIC OCCLUSION
MOST RETRUDED POSITION
MOST PROTRUDED POSITION
HABITUAL RESTING POSITION
HABITUAL OCCLUSION POSITION.

PHYSIOLOGIC REST POSITION

Earliest

Posture Position to be developed.

Mandible is suspended from the cranial base by
cradling musculature.
Jaws are separated by a constant distance.
Factors:
Body & Head Posture
Sleep
Psychic factors influencing muscle tonus
Age
Proprioception from the dentition and muscles
Occlusal changes such as attrition
Pain
Muscle disease and muscle spasm
Temporomandibular Joint disease.

CENTRIC RELATION
IT

is defined as unstrained, neutral

position of the mandible in which
the anteriosuperior surfaces of the
mandibular condyles in contact
with the concavities of the articular
discs as they approximate the
posteroinferior third of their
respective articular eminentia.
Mandibular is deviating neither to
the right or to the left and is
neither protruded nor retruded.

INITIAL CONTACT..
As

the mandible moves to attain

normal occlusion, the point of initial
contact produces no change in the
function of temporomandibular
joint and all the inclined planes are
brought together simultaneously in
the maxillary & mandibular teeth.
Premature contacts are seen
frequently which causes eventually
temporomandibular joint problems.

CENTRIC OCCLUSION
IT

is Harmonious with the Centric

relation. It is a static position
Teeth brought into contact with
unstrained relation of the condyles.
Occlusal vertical dimension is
established.
Maximum intercuspation position
need not be fully attained.

MOST RETRUDED
POSITION
It

is reproducible Terminal Hinge

Position.
Occlusal rehabilitation is the
starting point.

MOST PROTRUDED POSITION

IT

is variable with individuals

&shows a range of movement of
the mandible.
Flacidity of the capsular ligament
allows the condyle to override the
anterior margin of the eminence.

HABITUAL RESTING POSITION

The

physiologic resting position is

not attainable due to
malocclusions.
The physiologic rest positions can
be changed due to mental
disturbances, enlarged
adenoids,temporomandibular
joint pathology, psychic
trauma,mouth breathing etc.

HABITUAL OCCLUSION
POSITION
The

habitual occlusal Position & the

Central Occlusal Position are the same and
that they are in harmony with Centric
relation and the Postural resting Position of
the Mandible. In malocclusion ,there is
asynchronus activity of the closing
muscles in Habitual & working bite
occlusion.
When there is an environmental imbalance
this could be changed so the dentist
should make sure it is the same with
regard to the progress of the treatment.

FUNCTIONAL MOVEMENT OF
MANDIBLE
Opening movement :
Condyle is brought downward &
forward as chin drops downward
& backward.
Primary contraction of lateral
pterygoid muscles.
Stylohyoid changes in length.
stabilizing & adjusting activity
seen in
suprahyoid,infrahyoid,geniohyoid

CLOSING MOVEMENT
More

force is exerted on
closure,with controlled relaxation
of the lateral pterygoid muscles.
Hyoid bone moves upward &
forward.

PROTRUDING & RETRUDING

MOVEMENT
Protrusion

occurs when the medial

& lateral pterygoid muscles contract
together in conjuction with
controlled stabilizing relaxation of
opening muscles.
Retrusion occurs by the contraction
of Posterior fibres of temporalis
muscles along with geniohyoid,
digastric & mylohyoid muscles.
Hyoid bone moves posteriorly.

LATERAL MOVEMENT.
Mandible

is moved to left to masticate a

contraction of the right lateral pterygoid muscle,
controlled relaxation of the right temporalis
muscle, the left side there is contraction of the
left temporalis and controlled relaxation of the
lateral pterygoid muscle on that side. Masseter
contracts on left side, magnitude of contraction is
greater on the working side than on the balancing
side.
Combined Activity Of the Lateral pterygoid
Muscle & the Temporalis Muscle.

WORKING BITE..
Working Bite..
To establish it the mandible should either
move to the right or left. The lateral
movement is brought by the contraction of
lateral ptrygoid muscles on one side &
relaxation on the opposite side.
As the Teeth are brought together on an
end to end relationship the Masseter
contracts on the left side ; as when
together strong activity is elicited in both
the Masseter & Temporalis muscles on both
sides.

BENNET MOVEMENT
During

the lateral shift of the Mandible, the

Articular disc (TMJ) moves towards the side of
the working Bite.This is known as BENNET
MOVEMENT.
On the balancing side, the condyle and disk move
downward and forward on the articular eminence.
Muscle activity on the balancing side consists largely of
primary lateral pterygoid contraction and controlled
relaxation of the masseter, temporalis and suprahyoid
group during the lateral excursive movement.
On the working side, there is primary contraction in the
middle and posterior fibers of the temporalis muscle and
in the posterior fibers of the masseter and some increased
activity in the hyoid group. Activity on the working side
depends on the size and nature of the bolus of food.

Where there is a malocclusion or abnormal

morphologic relationship, certain compensatory or
adaptive muscle functions may arise.
Bennett angle the angle from the sagittal plane to the
end point of the movement of the Condyle Centre.

TEMPOROMANDIBULAR JOINT
Main functional parts are mandibular condyle,
mandibular fossa & articular disc.
Ginglymoarthrodial joint / COMPOUND JOINT.
Components are- Mandibular fossa,Articular
Capsule, Disc, Ligaments.
Articular surfaces covered with dense, fibrous
connective tissue.
It has a Mandibular Fossa also known as the
articular fossa & glenoid fossa. Slope of articular
eminence & medial wall are major determinants
of mandibular movement.

TMJ is divided into 2 distinct joint cavities by articular disc and

ligaments:
Superior joint cavity

Between articular disc & mandibular fossa

Responsible for gliding movements

Inferior joint cavity

Space between articular disc & condyle

Responsible for hinging movements

ARTICULAR DISC:
Composed of dense, smooth, fibrous connective tissue.
Mostly devoid of nerves & blood vessels
Biconcave shape. Condyle articulates in thin intermediate zone.
Condyle, articular disc & mandibular fossa surrounded by soft
tissue attachments.
LIGAMENTS:
Bands of non-elastic collagenous tissue.
Function is to passively limit range of movement & protect joint
structures. 5 ligaments associated with TMJ.
3 functional, 2 accessory
Functional:

Collateral (discal) ligaments

Capsular ligament
Temporomandibular ligament

Accessory:
Sphenomandibular
Stylomandibular

When opening from occlusion to physiologic rest

position, rotary or hinge movements occur in
inferior joint.
When mandible open beyond physiologic rest
position, articular disc glides downward and
forward on articular eminence of temporal bone
and condyle rotates in inferior cavity.
In Bennet movement condyle rotates and moves
slightly laterally on working side

MYOFACIAL PAIN DYSFUNCTION

SYNDROME :
Myofacial pain dysfunction (Laskin & coworkers) is
by far the most prevalent. It is primarily a muscle
disorder resulting from oral parafunctional habits such
as clenching or bruxism.
Precipitating factors: abnormal habits or a
malalignment of the jaw or dentition.TensionalStress.
. Modification of the occlusal surfaces of the teeth
through dentistry or accidental trauma.
. Speech habits resulting in jaw thrusting.
. Excessive gum chewing or nail biting.
. Excessive jaw movements associated with exercise.
. Repetitive unconscious jaw movements associated
with bruxism.
1.

There are four cardinal signs and symptoms of the syndrome:

(1) Pain,
(2) Muscle tenderness;
(3) A clicking or popping noise in the temporomandibular
joint,
(4) Limitation of jaw motion, unilaterally or bilaterally in
approximately an equal ratio, sometimes with deviation on
opening.
Shore- clicking or Popping in the TMJ is due to the jumping
Forward of the Condyle a fraction of a second ahead of the Disk.

DEEP BITE..
It can be Defined as the Overlapping of the Upper
Anterior Teeth over the lowers in the vertical plane.
In deep bite the posterior fibres of temporalis and
deep fibres of masseter exert a posterior thrust on
the condyle and disc.
Lateral Pterygoid muscle is under tension causing
repeated stretch reflex and subsequent muscle
contractions and spasms.
Leth Nielson (ANGLE 91) says that the Vertical
Malocclusions develop as a result of Mandibular
Growth Variations.The upward & forward growth of
the mandibular condyle often have reduced Anterior
Face Height.

CLINICAL SIGNIFICANCE
It is one of the most common Malocclusion & the most
Deleterious one when considering the overall functioning of the
Masticatory Apparatus & the dental unit (STOMATOGNATHIC
SYSTEM)
Effects of deep bite:
Periodontal Defects
Trauma to the Palatal Mucosa
Contributing Factor in the Etiology of TMD
Class II Malocclusion.
Stronger Mandibular Elevator Musculature.
High Mentalis Activity & Deep Mento Labial Fold.
Everted Lower Lip.

Bruxism can be Defined as a Parafunctional

activity of the masticatory system which
includes tightening & Teeth grinding.
Two types Primary & Secondary.
Etiology :
Stress,Anxiety,Malocclusion,Craniomandibular
Disorders, Oral habits.

Clinical significance
Effects of Bruxism:
Tooth wear,Gum
recession,attrition,open bite, cross
bite,Malocclusion.
Relationship between
Bruxism,Occlusal factors & oral habits.
(Dental press journal of orthodontics
vol 15 mar/apr 2010) studies shows
that :
class II malocclusion- 55% , class I
Malocclusion- 45%.

There

is increase in tonic activity of jaw

muscles.
Emotional or nervous tension, pain or
discomfort,occlusal interferences increase the
muscle tone can lead to non-functional
clenching
A high filling,a malposed tooth or deep overbite
is frequently contributory .

Tongue
It

is the single largest muscular organ located inside the

oral cavity.
Opposes the buccinator mechanism.
Begins its activity even before birth,while it functions in
the swallowing of aminiotic fluid.
Relatively one of the best developed structure in the
human body at birth.
Has amazing versatile functional possibilities as it is
anchored at only one end.

Development of Tongue

Orginates

from muscles of occipital myotomes

Mucous membrane of anterior 2/3 rd

- Lingual

swelling and tuberculum impar.

Mucous membrane of posterior 1/3 rd - hypobranchial

eminence.

MUSCLES OF THE TONGUE..

Muscles of tongue

1) Intrinsic muscles

2) Extrinsic muscle

Intrinsic muscles

1) Superior Longitudinal Muscle

2) Inferior Longitudinal Muscle

3) Transverse Muscle

4) Vertical Muscle.

Movements of the Tongue

SUPERIOR

AND

INFERIOR

LONGITUDINAL MUSCLE form the length

of the tongue and moves tip up and down
TRANSVERSE

MUSCLE

go across the

tongue. It narrows and lengthens the tongue.

VERTICAL

MUSCLE go up and down in the

tongue. It flattens and depresses the tongue.

Extrinsic muscles
1) Hyo glossus
2) Stylo glossus
3) Genio glossus
4) Palato glossus

 Genioglossus

:Origin

: Genial tubercle of mandible

Insertion : Body of hyoid and length of tongue

Function : Draws the tongue forward.
Styloglossus

: Origin : Styloid process

Insertion : Lateral surface of tongue

Function : With palatoglossus draw the dorsum up and back during swallowing.

Hyoglossus : Origin

: Greater Horn of hyoid

Insertion : Lateral side of tongue

Function : Draws the tongue backwards and
downwards as in yawning
Palatoglossus

: Origin : Palatine aponeurosis

Insertion : Lateral side & dorsum of tongue

Function : Along with stylo glossus, it draw the
dorsum of tongue up and back during swallowing.

Normal Tongue posture Vs

ABNORMAL POSTURE

CLINICAL SIGNIFICANCE
Abnormal activities of the tongue
causes:
Protrusion & spacing of the maxillary
incisors.
Posterior crossbite.
Open bite.
Speech problems.
Oral habits like mouth breathing
,Tongue thrusting can aggravate the
Malocclussion.

HYPERACTIVE MENTALIS

Compensatory

mentalis muscle
activity may aggravate this process
and exert a strong retracting force
on mandibular incisor.
Due to the strain of the mentalis
muscle.

FUNCTIONS OF TONGUE
TASTE
SPEECH
MASTICATION
DEGLUTITION

FUNCTIONS OF
STOMATOGNATHIC SYSTEM
RESPIRATION
SPEECH
MASTICATION
DEGLUTITION

RESPIRATION

Respiration
Mouth & Nose forms the anatomic beginning of the
Respiratory system.
Respiration unlike mastication & swallowing is an
inherent reflex activity.
Respiration is due to the fantastically efficient split
second opening and closing of the epiglottis, keeping out
the food but permitting the entry of life giving air.

Bosma

and his co-workers have analyzed respiration in

the infants and found that, quiet respiration is typically
carried out through the nose, with the tongue in
proximity to palate, obstructing the oral passageway.

Both

the pharynx and larynx are active during respiration

and it is in this area that the infant differentiates
between respiration and associated activities such as the
cough ,cry or sneeze. Posture also has a significant effect
on respiration.

Positional

stabilization of the dorsal portion

of the mouth is a function shared with the
pharynx and is also apart of the pharyngeal
participation in respiration stated by JAMES
BOSMA 1969.
Respiration starts at 25 wks of intrauterine
life.

JAMES BOSMA 1963 - Mandibles moves

downward and tongue also moves
downward and forward from posterior
pharyngeal wall, thus child permits air
through nose and pharynx and then into
lungs
Neonates are obligate nasal breathers
So if nasal airway is blocked survival is
difficult
Patency of airway in the nose and the
cavity is maintained by the bony skeleton
& adaptive posture of the tongue. In the
pharynx ,the patency is again dependent
upon the tone of the muscles of the
tongue,soft palate &the Pharyngeal walls.

MECHANISM OF RESPIRATION

Nasal airway function has been

implicated as an etiological factor
in Dentofacial development.

Clinical Significance
MOUTH BREATHING
Those who breathe orally even in
relaxed & restful position.
Due to learned Habit or the Airway
position.
This has been attributed as one of the
Possible factors for Maloclussion.
Quality of air is inferior & abnormally
affects the entire system.
It produces altered mandibular position
& extended tongue posture long face
or Adenoid facies.

Classification:

Finn 1987 has classified mouthbreathing into 3

types :
Obstructive
Habitual
Anatomic
Obstructive Complete or Partial obstruction
to the normal flow of air through the nasal
passages.
Causes : Deviated nasal septum,Allergic
rhinitis,Chronic inflammation of the nasal
mucosa, localized benign tumors, obstruction
in the bronchi or Larynx, Enlarged adenoids or
Tonsils.

Anatomic

: A person has short upper lip.

Complete closure of the mouth without
undue effect is not possible.
Habitual : The person continuously breathes
through his mouth by force of habit, although
the abnormal obstruction has been removed.
Other causes of mouth breathing :
Obstructive Sleep Apnoea , Thumb Sucking.

Theories of Mouth Breathing

According

to Compression theory given by

Norland (1918) constriction of the Maxillary
arch is related to lowered position of Tongue
which happens due to nasal obstruction in
order to facilitate breathing.
Tomes (1872) coined the term Adenoid Facies
to describe the dentofacial changes associated
with chronic nasal airway obstruction.
Linder Aronsen (1970- 80) supported the
relationship between nasal obstruction &
craniofacial & Dental Patterns.
Solow & Kreiborg (1977) obstruction to the
airway is a major factor in determining the
Facial Morphology.

EFFECT
S:Mout
h
breathi
ng

Extension Or
Tipping back
of Head.
Lowering of
the Mandible.
Positioning of
Tongue
inferiorly &
Anteriorly.

Increase in the Facial Height.

Clockwise Rotation of the
Mandible.Dryness of mouth
Gingivitis and increased dental
caries.
High Palatal vault , Gummy
Smile.

Supra eruption of
Posterior teeth.
Stretched cheek
Anterior open bite,
Increased overjet,
Narrow maxillary Dental
arch, Posterior
crossbite.

ADENOID FACIES

Short ,Thick ,Incompetent , Flaccid upper lip &

curled over lower lip.
Increased lower anterior Facial Height.
Long & Narrow face.

mastication

IT

is the process by which food is crushed

and ground byteeth
IT is Defined as the reduction of food in size ,
change in consistency , mixing it with saliva
and forming into a bolus suitable for
swallowing.
Action of breaking down of food , preparatory
to deglutition.
The entire Stomatognathic system plays a
vital role.
Mastication of Food
Transported by
deglutition
Digestive Canal.

NEUROMUSCULAR ACTION
Highly

organized complex of
neuromuscular & digestive activities.
Chewing is a Complex reflex activity ,
yet can be brought to conscious control
at any time. (Okeson)
Two simple Brain Stem Activities:
1. Jaw Opening Reflex- Tooth Pressure or
Tactile stimulation of wide areas of
mouth & lips.
2. Jaw Closing Reflex- Follows the
stretching of the elevator muscles
during opening (Sherrington & King et

IT

is a self Perpetuating cycle (Dellow &

Lund)
Within the brain stem there is a pool of
neurons responsible for precise timing of
activities = CENTRAL PATTERN
GENERATOR.
Thus chewing is considered as a complex
reflex activity
FORCE OF MASTICATION:
female - 35.8-44.9 kg
male
- 53.6-64.4 kg

CHEWING PATTERN
ADULT vs CHILD

Child :
Mastication development requires development of
new sensory motor pattern.
Jaw muscles begin to learn mastication process when
maxillary and mandibular teeth touch each other
( Moyers in 1964)
Gets Stabilized when the complete primary dentition
is erupted . The transition to Adult chewing pattern
occurs at 12 yrs. of age (Canine eruption).
Moves the jaw first laterally on opening & then the
masticatory cycle is performed.
ADULT:
Jaw is opened straight down , moves the jaw laterally
& then brings about the teeth into contact.
Chewing must be learned ,occurs only after teeth
eruption.
The Masticatory envelop is usually described as a
Tear Drop shape

Fletcher summarizes, recent work on masticatory

stroke in the adult, using the six phases outlined by
Murphy.
MURPHYS SIX STROKES OF MASTICATION
The preparatory phase
In which food ingested and positioned by the
tongue with in the oral cavity and the mandible is
moved towards chewing side.
Murphy Identified a slight deviation to the opposite
side just before the beginning of Mastication, which
he called the Precise beginning of the Preparatory
phase.
Food contact
It is characterized by a momentary hesitation in
movement. This is interpreted to be a Phase

The crushing phase

It starts with high velocity then slows as the food is crushed and
packed. Equal contact on both sides.
Tooth contact
Accompanied by a slight change in direction According to Murphy all
reflex adjustments of the musculature for tooth contact are completed
in the crushing phase before actual contact is made.Reduced
Muscular activity is noted.
The grinding phase
The Teeth slide in the correct direction Towards the intercuspal
position.Helps to grind the food into a paste.
Centric occlusion
This phase is a connecting link between Mastication &
swallowing referance position to CNS.
When movement of the teeth comes to a definite and distinct stop at
a single terminal point ,from which the preparatory phase of next
stroke begins.

DEGLUTITION
Deglutition

is the act or Process

of swallowing.
Both Suckling & swallowing
movements start developing
from 32nd wk of intrauterine life.
Series of co-ordinated muscle
contraction that moves the
bolus of food from oralcavity
through esophagus to stomach
Depends on fineness of food
and degree of lubrication of
bolus

MECHANISM OF SWALLOWING..

INFANTILE SWALLOW
Suckling

is associated with the

type of Infantile swallowing
Mechanism . It is also called as
Visceral Swallow.
Fletcher stated that : The
infantile swallow is because of
the difference in size or
morphology of the oral cavity and
the increased tongue size

Moyer

listed the features of

Infantile Swallow:
Jaws are apart with the tongue
interposed between the gumpads.
Mandible is stabilised by the
contraction of muscles of facial
expression and by the interposed
tongue.
Swallowing is guided and
controlled by sensory interchange
between lips and tongue

SUCKLE SWALLOW
Suckling

consists of small nibbling

movements of lips around mothers breast
to stimulate smooth muscle contraction
which causes squirting of milk into mouth
Once milk is squirted into mouth, the
neonate positions the tongue anteriorly so
that the tongue is in contact with lower lip.
This facilitates deposition of milk on
tongue
Once deposited the infant moves the
tongue so that the milk flows posteriorly
into pharynx and esophagus

According

to BOSMA : Head is extended,tongue

elongated and low in floor of
mouth,jaws apart and lips pursed
around nipple.
Mandible is protruded
Rhythmic contraction of tongue and facial
muscles stabilise the mandible.

MATURE SWALLOW

With

the change in semisolid and solid food and the

eruption of the teeth there is also a modification of
swallowing act.

The

tongue no longer is forced into the space between

gum pads or incisal surfaces of teeth, which actually
contact momentarily during the swallowing act.

Mandibular

thrust diminishes during transitional period

of 6-12 months. The mandible closing muscles take
over more of the role of stabilizing the mandible as the
cheek and lip muscles reduce the strength of their
contraction.

The

tip of the tongue is no longer moving in and out

between anterior gum pads but assumes a position
near the incisive foramen at the moment of deglutition

After

eruption of teeth and shift to semi

solid and solid food, infantile swallow
disappears at the end of first year of life.
Proprioceptive impulse come into play
The change to the adult swallowing pattern
occurs gradually in , it has been called the
transitional period. Incisors come together
Tip of the tongue lies behind incisors during
swallowing act
At 18 months of age mature swallowing
pattern develops completely in a child
Neuromuscular

maturation, change in head

posture ,gravitational effect on mandible
are conditioning factors.

Usually

by 18 months of
age, the mature swallow
occurs. Features listed
by Moyers are
1) The teeth are together
2) The mandible is
stabilized by contraction
of the mandibular
elevators.Anterior
Mandibular thrust
disappears.
3) The tongue tip is held
against the palate,
above and behind the
incisors.
4) There is minimal
contraction of lips during
the mature swallow.

The

Three Important Pre-requisites

for the Mature Swallow are :
(1)Establishment of pressure
gradient.
(2)prevention of reflux.
(3)protection of airway.

STAGES IN DEGLUTITION..

Phases of deglutition :
Fletcher divides the deglutition cycle in 4
phases, highly integrated and
synergistically coordinated.
1)
2)
3)
4)

Preparatory Phase
Oral phase
Pharyngeal phase
Esophageal phase.

First two stages are voluntary

Second two stages are involuntary

1) Preparatory Phase :
Starts

as soon as Solids are taken in, or after the

bolus has been masticated mechanically which
is mixed with saliva making it suitable for
swallowing .The liquid or bolus is then in a
swallow preparatory position on the dorsum of
tongue. Tongue plays a vital role food is made
into a cohesive ball.
NEUROMUSCULAR ACTION

- Lip closure - hold the food in the mouth

- Tension in labial and buccal musculature

to close the anterior and lateral sulci.

- Lateral rolling motion of tongue to

position food on the teeth.

- Bulging forward of the soft palate to seal

oral cavity and widen the airway
The oral cavity is sealed by lip and tongue.

2) Oral phase : Food moves from oral cavity to

anterior faucial arches and reflexive swallow is
initiated
Neuromuscular action

- Tongue makes vertical contact anteriorly

with alveolar ridge

- Vertical tongue to palate contact progress

posteriorly propelling the bolus to pharynx

- Tongue elevate and move in anterior to

posterior direction
This stage lasts for less than 1 second
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.
The oral cavity, stabilized by the muscles of
masticating maintains an anterior and lateral seal

3) The pharyngeal phase :

Begins as the bolus pulses through Pharynx.
The pharyngeal tube is raised upward and
the nasopharynx is sealed off by closure of
the soft palate against the posterior
pharyngeal wall.
Transport food from Pharyngeal arches to
Esophagus.Protect airway by preventing
aspiration
Neuromuscular action
(1)Velo pharyngeal closure to prevent
entry of food or liquid into the nasal cavity
(2)Pharyngeal peristalsis to propel bolus
through pharynx and clear food residue
from the pharyngeal recess such as
vallecular and pyriform sinuses


(4)Opening

of crico-pharyngeal region allows bolus passage

into esophagus

4) The esophageal phase :

commences as food passes the cricopharyngeal sphincter. While
peristaltic movement carries food through the esophagus, the
hyoid bone palate and tongue return to their original positions.

Transports the food bolus from upper esophagal sphincter to

the stomach
Neuromuscular action
- extends from level of cricoid cartilage to the cardia of stomach
with average length of 25cm in male and 23cm in female
- during esophageal stage there is generation of primary wave
with force of 100cm water pressure which moves the bolus along
length of esophagusSecondary wave can be generated when
there is increased pressure in mid-esophagus

Secondary wave is initiated as

residual food is left after the
completion of the primary wave.
Tertiary wave occurs in the elderly
and in pathologic states. It occurs in
distal esophagus and makes a nonprogressive, corkscrew like motion
Esophageal stage lasts 8-20
seconds.
An apneal pause between 1 and 3.5
seconds in duration occurs during
oral and pharyngeal stages
(Logemann 1989)

Clinical significance
Abnormal

swallowing pattern is caused by

TONGUE THRUST or as TONGUE THRUST
SYNDROME.(when the Visceral swallowing
persist after 4 yrs of age orofacial
dysfunction )
Features:
Protrusion of the tip of the tongue.
No tooth contact of the molars.
Contraction of the perioral muscles during the
deglutional cycle.

ETIOLOGY..
Oral habits (thumb sucking)
Ankyloglossia or macroglossia
Tonsillar tissue enlarged
CNS disorders (to produce oral
seal shows auxiliary function)
Upper respiratory tract
infections
Hyposensitive palate
Bottle feeding
Hereditary

ETIOLOGY

TONGU
E
THRUST

PRIMARY
SECONDARY
ANTERIOR
LATERAL
COMPLEX

HABITUAL
ADAPTIVE
ENDOGENOUS

 classification
Type

1 Non deforming tongue

thrust
Type 2 Deforming anterior
tongue thrust
subgroup 1 Anterior open
bite
subgroup 2 Associated
procumbency of anterior teeth
subgroup 3 Associated
posterior cross bite

Type

3 Deforming lateral tongue

thrust
subgroup 1 Posterior open bite
subgroup 2 Posterior cross bite
subgroup 3 Deep over bite
Type 4 Deforming anterior and
lateral tongue thrust
subgroup 1 Anterior and
posterior open bite
subgroup 2 Associated
procumbency of
anterior
teeth
subgroup 3 Associated
posterior crossbite.

EFFECTS..
Anterior

open bite
Lateral or posterior open bite
Proclined upper incisor
Hypotonic upper lip which appear retracted
or short
Bilateral narrowing of maxillary arch.
The influence of Tongue on Dentofacial
Growth-John Meaw,Angle 2015 states that
Malocclusion is frequently associated wit
unusual form or function of the soft tissues
which may range from a simple sucking
habit to a full fan tongue thrust with only
posterior molars in contact.

SPEECH
A LEARNED
ACTIVITY
Unlike mastication,
deglutition and respiration, which are
reflexive in nature, speech is largely a
learned activity dependent on the
maturation of the Being.
The low placement of larynx which
enables human vocal tract to

The

well developed velopharyngeal

mechanism aids in speech.
Unique feature of Human Beings.
NeuroPhysiology:
Speech production begins in motor area
and motor co ordination of articulation
from bilateral precentral gyri.
Nerve impulses are fed to midbrain
through pyramidal tract. Here speech
is fine tuned.
Cranial nerves involved are trigeminal,
facial, vagal and hypoglossal.

The Language area First discovered is

present in frontal lobe in left hemisphere
called BROCAs AREA (Paul Broca) also it
deals with grammar.
Second discovered language area
WERNICKEs AREA (Carl Wernicke,
German Neurologist) present in upper
portion of temporal lobe.
Brocas area and Wernicke's area
connected by a tract of nerves called
Arcuate fascilicus.
Angular gyres halfway between
Wernicke's area and visual cortex of
occipital bone

Inability

to speak - aphasia
Inability to read
- alexia
Learning disability - dyslexia
Inability to write
- agraphia
Inability to produce speech Brocas
Aphasia

Development of speech follows the principle of front to back maturation.

First sounds produced are bilabial sounds.
Consonants - produced with complete or partial closure of upper vocal
tract(above the larynx)
Vowels pronounced with open vocal tract

MECHANISM OF SPEECH

Air Fills the Lungs

Rib Cage Contracts & forces air
from Lungs to Trachea.
Trachea( amplitude of sound)
Transports Air to Vocal tract.
Vocal Tract (shapes the sound)
passes on to the Pharynx , Mouth ,
Nose.
Articulation of the sound
depends on the position of the
tongue , teeth, lips .

CLINICAL SIGNIFICANCE..
Lip

Dysfunctions are observed while

the patient is speaking &
swallowing .
LISPING & STAMMERING
These are commonly occurring
speech defects.
Speech defect create difficulty for the
child while speaking. The child may
develop inferiority complex. He
develops a sense of insecurity.

LISPING
This speech defect involves change of sound of
letters and words. The Tongue lies on the top of the
lower incisors.
Etiology:
Retained & continued Infantile mode of Speech.
Open Bite
Maxillary Protrusion
Mandibular Retrusion.

STAMMERING

In

stammering the child fails to produce any

sound for sometime. These create emotional
tension and difficulty in social adjustment.
ETIOLOGY:
Hereditary
Emotional tension
Lack of balance among two hemispheres
of brain.

Tooth

Position & Speech by Nicola

.C.L.Johnson ,Angle Aug 1999 states that
Dental Irregularities shows a relationship with
Speech disorders. There is no definitive proof
that Alteration of tooth position can improve
Articulation Disorders.

EFFECTS OF SPEECH ON MALOCCLUSION

Class ll, div 1 malocclusion .
Anterior Open Bite
Class 1 with missing anterior teeth
Excessive overbite & overjet.
Class lll malocclusions with total absence
of incisal contact.
Lip incompetanc with abnormally
positioned tongue.
These malocclusions effects the production
of vowels & consonants leading to speech
defects.
JENSON studied the anterior teeth
relationship & speech in normal & Class ll
div l malocclusions showing that speech

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.
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.

CONCLUSION
It is vital that ,thorough
appreciation of the dynamics
of the Stomatognathic system
is essential for the
Orthodontist ,as the
knowledge of normal
morphology & activity is very
important so as to recognise
& differentiate the

REFERANCE
Orthodontic

Diagnosis Thomas
Rakosi,Thomas .M.Graber ,Irmtrud Jonas.
Orthodotics Om Prakash Kharbanda.
Orthodotics Priciples & practice Graber (3 rd
Edition )
Textbook of Craniofacial growth Premkumar
sridhar.
Contemporary orthodontics William K Proffit.
Grays anatomy, Clinical anatomy Richard S
Snell
Textbook of Anatomy Indirbir singh
Angle Orthodontics.