THE STOMATOGNATHIC

SYSTEM

By-VAISHALI KUSHAWAHA
JR-1
 CONTENTS

 Introduction
 Functional osteology
 Myology
 Reflexes
 Muscles of mastication
 Buccinator mechanism
 Tongue
 TMJ
 Positions of mandible
 Functions of stomatognathic system
 Conclusion
 Refrences
 INTRODUCTION

According to Dorland’s medical dictionary-

Stomatognathic - stomato (mouth) + gnathic (jaws) which means mouth & the
jaws collectively forms stomatognathic system.
FUNCTIONAL OSTEOLOGY

 Bones form the basic underlying structure

of the stomatognathic system.
 Three main bones make up the skeletal
portion of the stomatognathic system.
 The maxilla and mandible are the
bones that hold the teeth, while the
temporal bone is the site of the mandible’s
articulation with the skull.
 Form and function are closely related.
 Functional matrix theory also tell that any particular function on
bone affects its form (morphology).
 Historically, the apparent effect of function on bone was first seen
in femur.
 This was further confirmed by:
 Trajectorial theory of bone formation by Meyer & Culmann in 1867.
 Beninghoff’s trajectories of force
 Wolff’s law in 1870
TRAJECTORIAL THEORY OF BONE
FORMATION- MEYER & CULMANN
•The alignment of the bony trabeculae followed
definite engineering principles.

•When lines were drawn in columns of bony

elements, these lines showed a structure similar
to the trajectories seen in a crane.

•Trajectories were seen to be crossing at right

angles to each other, which enables the bones to
resist its functional stresses.

•e.g Head of femur and condyle

BENINGHOFF’S TRAJECTORIES OF FORCE

 He said that the trajectories of force or lines of stress involve both compact
and spongy bone.
 They exist in direct response to epigenetic and local
functional influences, and not as manifestations of intrinsic
genetic potential.
 These are the pathways of maximal pressure and tension.
 Bone trabeculae are thicker in these regions where
stresses are greater.
Maxillary trajectories are:
 Vertical:
a) canine pillar
b) Zygomatic pillar
c) Pterygoid pillar
 Horizontal:
Hard palate, orbital floors
 Fronto nasal buttress

 This trajectory originates from the

incisors, canines & the 1st Max
premolar and runs cranially along the
sides of the piriform aperture, the
crest of the nasal bone and
terminates in the frontal bone.
Malar zygomatic buttress
 This trajectory transmits stress from the buccal group of teeth in
three pathways:
i. Through the Zygomatic arch to the base of the skull.
ii. Upward to the frontal bone through the lateral walls of the orbit.
iii. Along the lower orbital margin to join the upper part of the Fronto
nasal buttress.

Pterygoid buttress
 This trajectory transmits the
stress from the second and third
molars to the base of the skull.
Trajectories For Mandible
 The trabecular columns radiate from beneath the alveolar
process and join together in a common stress pillar that
terminates in the mandibular condyle.
 The mandibular canal and nerve are protected by thick
concentration of trabeculae, the UNLOADED NERVE
CONCEPT.
 The thick cortical layer of compact bone at the lower
border of mandible offers maximum resistance to the
bending forces.
 Other trajectories are seen at the symphysis, at the gonial angle, and leading
downwards from the coronoid process into the ramus and the body of
mandible.
 These accessory trajectories are primarily due to the direct effect of
attachement of muscles of mastication.
WOLLF’S LAW
 In 1870, JULIUS WOLLF claimed that the trabecular arrangement of bone was
primarily due to functional forces.
 A change in the intensity and direction of these forces would produce a
demonstrable change in the internal architecture and external form of the
bone.
 This concept was referred to as LAW OF ORTHOGONALITY.
POSTURAL ABNORMALITIES AND BONY
CHANGES
Kyphosis – forward curvature of spine may be a
result of uneven stresses on vertebrae.

Osteoporosis- lack of function leads to reduced

density of bone tissue

Osteosclerosis- increased function produces a

greater density of bone in a particular area.
 MYOLOGY
 To propel skeleton, billions of muscle fibers work at
one time or another.

• Muscle has two physical properties for kinetic activity:-

1. Elasticity
2. Contractility.
ELASTICITY
• Normal relaxed muscle can withstand only a certain amount of
elongation (about 6/10 its natural length before rupturing).

Depends upon
• Type of Muscle involved
• Type of stress
• Individual resistance
• Age
• Pathological condition which have produced fibrotic changes
 CONTRACTILITY
• Ability of a muscle to shorten its length under innervational impulse.

• Electric action potential acts on muscle leads to contraction.

• Energy is provided by breakdown of high-energy bonds in ATP.

• Fatigue in a muscle is produced when lactic acid is accumulated , lowering the pH ,occurs
due to lack of oxygen.
• The strength of the contraction depends on the fibers engaged in this activity at a
particular time.

• Even during rest a certain number of peripheral fibers are engaged by the nerve system
for maintenance of posture.
Contraction of muscle depends on

• Striated or smooth muscle

• No. of fibers
• Cross section of muscles
• Frequency of discharge
• Muscle fiber length

 Some muscles may contract as much as 50-75% of their natural length.

The temporalis muscle because of its longer fibers has a great contraction length than
masseter muscle.
 Types of contraction of muscles

3 types of muscle action:

 Isotonic- overall muscle length shortens during contraction. In this movement occurs.
 Isometric- overall muscle length does not shorten during contraction- develops force, but
no movement- stabilization & fixation occurs.
 Controlled relaxation- slow, smooth, relaxation and lengthening of previously contracted
muscle- coordination of movements.
PRINCIPLES OF MUSCLE PHYSIOLOGY

 ALL OR NONE LAW-

The intensity of the contraction of any fiber is independent of the strength of the
exiciting stimulus, provided that the stimulus is adequate.
Stimuli below the threshold strength , elicit NO response.
The strength of the muscle contraction depends on two factors:
1. The frequency of stimuli
2. The number of fibers involved.
This law is applicable only when the muscle is in physiologic reacting state.
 MUSCLE TONUS-
It is a state of slight constant tension which is characteristic of all healthy
muscle and which serves to obviate the muscle taking up slack when it enters
upon contraction.
RESTING LENGTH-
It is rather constant and predeterminable relationship, permitting the
maintenance of postural relations and dynamic equilibrium by contraction of
minimal number of fibers.
MUSCLE REFLEXES

 REFLEX is defined as an automatic and often inborn response to a stimulus

that involves a nerve impulse passing inward from a receptor to a nerve
centre and thence outward to an effector without reaching the level of
consciousness.
RECEPTORS are:
1. Muscle spindles
2. Golgi-tendon organ
3. Temporomandibular joint afferents
4. Skin and mucosal receptors
5. Periodontal mechanoreceptors
TYPES OF REFLEXES

 INCLUDE :

MYOTACTIC CLASP KNIFE JAW CLOSING JAW OPENING

REFLEX REFLEX REFLEX REFLEX
MYOTACTIC REFLEX

 It is the tonic contraction of muscle in response to a stretching force, due to

stimulation of muscle proprioreceptors.
 It is also called as Liddell-Sherrington reflex, muscular reflex and stretch
reflex.
 It requires sensory neurons Muscle spindles

 Motor neurons extrafusal fibres .

 It can be elicited by suddenly lengthening of a muscle, as when the tendon is
tapped.
 It is a type of MONOSYNAPTIC ARC.
 MECHANISM OF MYOTACTIC REFLEX
Stimulus- stretch of muscle

Stretch receptors- muscle spindle Located within the muscle and is composed of 2-15 intrafusal fibers.

Activated muscle spindles

Impulse is generated, conducted by GROUP IA sensory nerve fibers

Sensory nerve fibres synapse with alpha efferents ( motor neurons)

They supply to extrafusal fibers

Causes Contraction of muscle

 REGULATION OF MYOTACTIC REFLEX

Higher centres of brain control the myotactic reflex through the reticular formation.

Gamma efferents supply the intrafusal fibers of muscle spindle

Activation of these will cause polar contraction of the intrafusal fibers It serves as a mechanism for upright
posture or standing.
In the mandible, it acts to maintain
It puts the noncontractile nuclear bag under tension the postural rest position of the
mandible in relation to the maxilla.
Causes mechanical distortion which is similar to passive stretch of muscle

Thus, gamma efferents will initiate spindle discharge and increase the sensitivity
Of the spindle and act like a blasting mechanism regulating the sensitivity of muscle spindles.
CLASP KNIFE REFLEX

 It is produced by stretching an extensor muscle against a background of

increased extensor muscle tone.
 The result is a relaxation of the muscle being stretched i.e. the muscle now
lengthens easily after initial resistance.
 This resembles that of a spring-loaded folding knife blade and hence, called
as clasp-knife reaction.
 The stimulus necessary to elicit the clasp reflex is excessive stretch and when
elicited, it inhibits muscular contraction, thus causing the muscle to relax.
 Receptors are- Golgi tendon organs
 Impulse conducted by GROUP 1B sensory nerve fibers.
 Acts on motor neuron of alpha efferent
supplying the stretched muscle.
 It is a DI-SYNAPTIC reflex arc because
an interneuron is interposed between the
sensory and motor neuron.
 SIGNIFICANCE- to protect the overload by
preventing damaging contraction against strong
stretching forces.
JAW CLOSING REFLEX

 It is the most basic reflex and sometimes referred as JAW JERK REFLEX.
COMPONENTS OF JAW CLOSING REFLEX
RECEPTOR Muscle spindle in jaw closer muscles, PDL receptors, etc.
PRIMARY AFFERENT Spindle Ia afferent
CELL BODY Mesencephalic nucleus of V nerve
CENTRAL PROCESS Monosynaptic connection with trigeminal motoneurons
MOTORNEURONS Jaw closer motoneurons in motor nucleus of V nerve
APPROPRIATE STIMULUS Opening of jaw, stretching of jaw closer muscles
RESPONSE Contraction of jaw closer muscles; jaw closing

FUNCTION Maintain jaw position against gravity and inertial loading

JAW OPENING REFLEX
 It is the first reflex to appear in the orofacial region at 8.5 weeks of IUL.

COMPONENTS OF JAW OPENING REFLEX

RECEPTOR Mechanoreceptors and pain receptors in oral
cavity.
PRIMARY AFFERENT Trigeminal sensory axons.
CELL BODY Trigeminal ganglion
CENTRAL PROCESS Synapse with interneurons in sensory nucleus
of V, which synapse with motoneurons.
MOTONEURONS In humans, closer motoneurons are inhibited.
APPROPRIATE STIMULUS Short-onset, high-intensity localized
mechanical or noxious stimulus within the oral
cavity.
RESPONSE Inhibition of jaw closers; jaw opening
FUNCTION Protection of hard and soft tissues of oral
cavity
MUSCLES OF MASTICATION

 Masseter
 Temporalis
 Medial pterygoid
 Lateral pterygoid
 Masseter
It is a quadrangular muscle that covers the lateral aspect
of ramus and coronoid process of mandible.
Superficial portion-
 Origin-anterior 2/3rd of zygomatic arch.
 Insertion-coronoid process,ramus and angle of
mandible.
 Function-powerful elevator
Deep portion-
 Origin-medial surface of zygomatic arch
 Insertion-coronoid process,ramus & angle of mandible.
 Function- elevation & retrusion.
Medial pterygoid

Thick, quadrilateral muscle, having two heads of origin.

Located deep to ramus of mandible.
Origin : Deep head- Medial surface of lateral pterygoid
plate. Superficial head- tuberosity of maxilla
Insertion :
 Medial surface of the ramus of the mandible, inferior
to mandibular foramen.
Function :
 Elevation & protrusion, closes the jaw
Temporalis muscle
It is an extensive fan-shaped muscle that covers
the temporal region.

ORIGIN: floor of temporal fossa and deep surface Temporalis

of temporal fascia muscle

INSERTION: tip and medial surface of coronoid

process and anterior bordfer of ramus of
mandible.

ACTION: it elevates the mandible, closes the jaw,

and its posterior fibers retrude the mandible
after protrusion.
 Lateral pterygoid
Short, thick muscle with two heads of origin. It is conical
muscle with apex pointing posteriorly.
Inferior head of lateral pterygoid
 Origin: lateral surface of lateral pterygoid plate.
 Insertion:neck of condyle
Superior head of lateral pterygoid
 Origin : infratemporal surface of greater sphenoid
wing.
 Insertion : articular disc, capsule & neck of condyle.
FUNCTION: Acting together, protrude the mandible and
depress the chin. Acting alone and alternately, produce
side-to-side movements of mandible.
Nerve supply
Mandibular division of trigeminal nerve

BLOOD SUPPLY-
Maxillary artery
THE BUCCINATOR MECHANISM
Starting with the decussating fibers of the orbicularis oris muscle, joining right and left
fibers in the lips, which constitute the anterior component of buccinator mechanism, then
runs laterally and posteriorly around the corner of the mouth, joining other fibers of the
buccinator muscle which insert into the pterygomandibular raphe just behind the dentition.
At his point it intermingles with fibers of the superior constrictor muscle and continues
posteriorly and medially to anchor at the pharyngeal tubercle of the occipital bone.
• All these muscles with elasticity
and contractility acts like a
rubber band tightly encircling
the mandible.

• The tongue acts opposite to the

buccinator mechanism exerting
an outward force.
CLINICAL SIGNIFICANCE:

Any imbalance in buccinator mechanism

will lead to malocclusion due to imbalance
between the tongue and the muscles
encircling the mandible.
TONGUE
TONGUE
The tongue has amazingly versatile functional possibilities by virtue of the
fact that it is anchored at only one end.
This very freedom permits the tongue to deform the dental arches when
function is abnormal.
Muscles of tongue-
1. Intrinsic 2. Extrinsic
Intrinsic: These group of muscles are confined Extrinsic:
to the tongue and not attached to bone. 1.Genioglossus
•Superior Longitudinal muscle 2.Hyoglossus
•Inferior Longitudinal muscle 3.Palatoglossus
•Tranverse 4.Styloglossus
•Vertical
Superior Longitudinal muscle lies beneath the mucous membrane. It shortens the
tongue and makes dorsum convex.

Inferior Longitudinal muscle is a narrow band lying close to the inferior surface of
the tongue between the genioglossus and hyoglossus. It shortens the tongue and
makes dorsum convex.

Transverse muscle extends from the median septum to the margins. It makes the
tongue narrow and elongated.

The vertical muscle is found at the borders of the anterior part of the tongue. It
makes the tongue broad and flattened.
EXTRINSIC MUSCLES
Genioglossus – connects the tongue to the inner
surface of symphysis of mandible at the superior
genial tubercle. This attachment prevents the
tongue to fall backward and obstructing the
airway when one is supine.

Hyoglossus - connects the tongue to the hyoid

bone. Depresses the tongue

Styloglossus – connects the tongue to the styloid

process. Elevates tongue and draws it backward
Palatoglossus – connects the tongue to the palate.
Elevates posterior portion of tongue and draws
soft palate down on tongue
In case of abnormal tongue activity, the balance between
outside and inside forces may be disturbed, accentuating
maxillary incisor protrusion, creating an open bite tendency
and fostering a narrowing of the maxillary arch.

Valiathan A. J Ind Ortho Soc 1998;31:53-57

TEMPOROMANDIBULAR JOINT

 It is formed by two bones:

The upper temporal bone which is the part of the cranium
The lower mandible
 It is a compound joint- articular disc acts as a nonossified bone.
 It is a ginglymoarthroidal joint- allows both hinge and gliding movements.
ANATOMY OF TMJ

Includes:
 Articular surface of mandibular condyles
 Articular surface of temporal bone
 Capsule
 Articular disc
 Ligaments
 Lateral pterygoid muscle
ARTICULAR SURFACES

MANDIBULAR COMPONENT-
 Consists of an ovoid condylar process.
 It is 15-20 mm side to side and 8-10 mm front to back with long axis at right
angles to ramus.
 The articular surface lies on its anterosuperior aspect, thus facing the
posterior slope of articular eminence of temporal bone.
CRANIAL COMPONENT-

 Situated on the inferior aspect of temporal squama, anterior to tympanic

plate.
 ARTICULAR EMINENCE: it is the entire transverse bony bar that forms the
anterior root of zygoma. It is most heavily travelled by condyle and disc as
they ride forwards and backwards during jaw movements.
 ARTICULAR TUBERCLE: it is a small bony knob raised on the outer end of
articular eminence. Projects below the level of articular surface and serves as
an attachment to lateral collateral ligament of joint.
CAPSULE

 It is a fibrous membrane that surrounds the joint and incorporates the

articular eminence.
 It is attached to the articular eminence, the articular disc and neck of
condyle.
ARTICULAR DISC

 It is a fibrous extension of the capsule, shaped

to accommodate the condyle and concavity of
mandibular fossa.
 It divides the joint into upper and lower compartments.
 Its upper surface is concavo-convex and lower is concave
 It is thicker medially than laterally.
 In saggital plane, it can be divided into three regions
acc. to thickness-
1.Anterior portion 2. intermediate 3. posterior
 It is thinnest at central intermediate zone and becomes thicker anteriorly and
posteriorly.
 It is attached posteriorly to a region of loose
connective tissue which is highly vascularized
and innervated called as retrodiskal tissue.
 The pain felt during anterior disk displacement
is due to pressing of this area.
LIGAMENTS

 They are made of collagenous connective tissue and do not stretch under
normal conditions.
 They act as passive restraining devices MAJOR MINOR
to limit and restrict the border movements.
 Classified as : Stylomandibular
Capsular ligament
ligament

Temporomandibular Sphenomandibular
joint ligament ligament

Collateral ligament
CAPSULAR LIGAMENT

 The fibers of this ligament encompass the entire articular surface of the
joint.
 It is superiorly attached to temporal bone along the borders of articular
surface; anteriorly to articular eminence; and inferiorly to neck of condyle.
FUNCTIONS-
 Resists any medial, lateral or inferior forces that tend
to dislocate the articular surface.
 Encompasses the joint, thus retaining the synovial fluid.
 It is well innervated and provides proprioceptive feedback
Regarding the position and movement of joint.
TEMPOROMANDIBULAR LIGAMENT

 It is the thickened lateral portion of capsular ligament.

 Has two parts: the outer oblique portion(OOP) and inner horizontal portion(IHP)
Outer oblique portion extends from outer
surface of articular tubercle and zygomatic
process posteroinferiorly to the outer surface of condyle.
 Function- to limit rotational opening movement
Inner horizontal portion extends from outer surface
of articular tubercle and zygomatic process posteriorly
and horizontally.
 Function- resist posterior movement of condyle and disk,
thus protecting the retrodiskal tissues from trauma due to posterior displacement.
COLLATERAL LIGAMENT

 Consists of medial diskal ligament and lateral diskal ligament.

 Medial diskal is attached to medial pole of condyle and
lateral diskal to lateral pole.
 They divide the joint mediolaterally into superior and inferior joint cavities.
 Function- restricts the movement of the disk away from the condyle and allows disk to
move passively with the condyles.
 Thus, they are responsible for the hinge movement of the TMJ.
MINOR LIGAMENTS

 These are accessory ligaments and are not directly attached to any part of the joint.
STYLOMANDIBULAR LIGAMENT-
Seperates the infratemporal region from the
parotid region and runs from the styloid
process to angle of mandible.
Function- limits excessive protrusive movements of mandible.
SPHENOMANDIBULAR LIGAMENT-
Runs from the spine of sphenoid bone and the
lingula of the mandible.
Does not have any significant action in limiting mandibular ligament.
 Blood supply-
Branches from superficial temporal and
maxillary arteries.

 Nerve supply-
Auriculotemporal nerve and massetric
nerve.
 POSITIONS OF MANDIBLE
Basic saggital plane positions of the mandible with respect to the
maxilla and cranium:-
• Postural resting position (physiologic rest).
• Centric relation.
• Centric occlusion.
• Most retruded position (terminal hinge position).
• Most protruded position.
• Habitual resting position.
• Habitual occlusal position.
 POSTURAL RESTING POSITION

•The mandible is suspended from the cranial base by the cradling

musculature.

•Some number of fibers of muscles contract to maintain the relaxed

position of the mandible and posture of head.

CENTRIC RELATION

Centric relation is defined as the unstrained, neutral position of the

mandible in which the mandibular condyles are in contact with the
concavity of the articular disc as it approximates the posteroinferior
third of its respective articular eminence.
 CENTRIC OCCLUSION
Centric occlusion is a static position and can be easily
reproduced by having the patient bring the teeth together, if
there is no malocclusion or malfunction present.

Premature contacts, loss of teeth, over-eruption of teeth,

overextension of artificial restorations, malpositions of
individual teeth – all these mitigate against the establishment
of a centric occlusion.
 MOST RETRUDED POSITION
• Since it is possible to reproduce this most retruded position fairly
easily and to train the patient to assume this position with regularity.

•It has become a common starting point in occlusal analysis and

rehabilitation.

•It is possible for any person to move the mandible a millimeter or more
posteriorly from a position of centric relation and centric occlusion.

•Such movement, frequently elicits a stretch of myotactic reflex, clearly

evident in EMG records.
 MOST PROTRUDED POSITION

•The most protruded position in the mandible is more

variable from individual to individual than the retruded
position.

•The inclination of the condylar path is considered more

important than the actual protrusive position.

•Where there is an inherent flaccidity to the capsular

structures, some patients can dislocate their mandibles in
the extreme protrusive position.
 HABITUAL RESTING POSITION
•The habitual resting position may not be the same as the
true physiological postural position.

•For example, in a severe Class, II, Division 2 malocclusaion

with the maxillary incisors markedly inclined to the lingual,
there is a tendency to force the condyles posteriorly and
superiorly in the articular fossae.
FUNCTION OF THE STOMATOGNATHIC
SYSTEM

 MASTICATION
 TASTE
 SPEECH
 DEGLUTITION
 RESPIRATION
MASTICATION

 It is defined as “ the reduction of food in size, changing in consistency, mixing it with

saliva and forming into a bolus suitable for swallowing”.
 CHILD AND ADULT CHEWING PATTERNS:
The most important factor in maturation of mastication
is the sensory aspect of eruption of teeth.
In child, the jaw moves first laterally on opening and then
masticatory cycle is performed.
In adults, first jaw opens straight down, moves laterally and
then brings about teeth contact.
This transition to adult chewing pattern occurs during
eruption of permanent canine( about 12 yrs of age).
MURPHY’S SIX STROKES OF MASTICATION
Preparatory phase

Contact phase

Crushing phase

Tooth contact phase

Grinding phase

Centric occlusion
 PREPARATORY PHASE
 The ingested food is positioned by tongue in oral cavity.
 Mandible moves towards the chewing side.
 Murphy identified a slight deviation on opposite side, he defined it as precise
beginning of preparatory phase.

CONTACT PHASE
 There is a temporary hesitation in movement as the sensory receptors need
time to judge the consistency of food and decide the amount of force
required to crush the food.
 CRUSHING PHASE
 First 3-4 strokes in mastication emphasize the crushing phase.
 It begins with heavy force and subsequently gets lowered as the food gets
crushed and packed.
 During this phase, there is equal contact on both sides.

TOOTH CONTACT PHASE

 Once the food gets crushed, there is tooth contact which is accompanied by
slight change in direction of chewing.
 Reduced muscular activity in masticatory muscles.
 GRINDING PHASE
 In this stage, the output from the pdl receptors reflexly control the jaw
closing muscles to ensure that the teeth slide in correct direction towards the
intercuspal position.
 This helps to grind the food into paste.

CENTRIC OCCLUSION
 It is a connecting link between mastication and swallowing.
 It is also the beginning of the preparatory phase of next masticatory stroke.
 During this stage, movement of teeth comes to a definite halt.
TASTE

 Different type of taste buds are perceived by different papillae which contain
taste buds
 Circumvallate papilla –bitter
 Foliate papilla – sour
 Fungiform papilla - at the tip of the tongue - sweet, and at periphery - salty
 Tastes are transmitted to the CNS by different nerve roots.
DEGLUTITION

Deglutition is a series of coordinated muscular contractions that moves a bolus of food from
the oral cavity through the esophagus to the stomach. It consists of voluntary,
involuntary, and reflex muscular activity.
INFANTILE SWALLOW

 Suckling is associated with the type of infantile swallow.

 Also called as visceral swallow.
 Suckling consists of small nibbling movements of lips around the mothers’s breast to
stimulate the smooth muscle contraction which causes the squirting of milk into the
mouth.
 The neonate then positions the tongue anteriorly in such a way that the tongue is in
contact with the lower lip.
 This facilitates the deposition of milk on the tongue.
 Once deposited, the infant grooves the tongue so that the milk flows posteriorly into
the pharynx and esophagus.
Moyers characteristics of INFANTILE
swallowing
•Jaws are apart with tongue
interposed between the gum
pads.

•Mandible is stabilized by the

contraction of muscles of facial
expression( supplied by VII CN)
and interposed tongue.

•The swallow is controlled by

sensory interchange between the
lips and the tongue.
MATURE SWALLOW

 Subsequent to eruption of teeth and shift from semisolid to solid food, infantile swallow
disappears at the end of 1st year.
 As the incisors erupt, due to proprioceptive impulses the peripheral portion of tongue
spread laterally.
 This change in tongue function is gradual and is called as TRANSITIONAL STAGE.
 As the incisors erupt completely, the tongue continues to occupy the space between
remaining edentulous areas of upper and lower gum pads, and more mature swallow is
established.
 By 18 months, mature swallowing pattern is established.
Mature swallow

 Teeth are together

 Mandible is stabilized by the
contraction of the mandibular elevator
muscles which are supplied by 5th
cranial nerve
 The tongue tip is held against the
palate above and behind the incisors
 Minimal contractions of the lips during
the mature swallow
STAGES OF SWALLOWING

Oral preparation • Voluntary

stage control

• Voluntary
Oral stage control

Pharyngeal •Involuntary
stage control
Involuntary
Esophagea control

l stage
ORAL PREPARATION STAGE

 PURPOSE:
1.Solid food reduced mechanically by mastication is mixed with saliva to
produce appropriate consistency for swallowing.
2.Produce the pleasurable sensation of eating.
 ACTION:
1.Lip closure to hold food in mouth anteriorly.
2.Tension in labial and buccal musculature to close the anterior and lateral sulci.
3.Rotary motion of jaw for chewing
4.Lateral rolling motion of tongue to position food on teeth during mastication
5.Bulging forward of soft palate to seal oral cavity posteriorly and widen nasal airway.
ORAL STAGE

 PURPOSE:
Move food from the front of the oral cavity to the anterior faucial
arches, where reflexive swallow is initiated.
 ACTIONS:
Tongue makes vertical contact anteriorly with alveolar ridge.
Vertical tongue-to-palate contact progresses posteriorly,
Propelling the bolus ahead of it towards the pharynx.
PHARYNGEAL STAGE

 PURPOSE:
1.Transport food from faucial arches to esophagus.
2.Protect the airway by preventing aspiration.
 ACTIONS:
1.Velopharyngeal closure to prevent entry of food or liquid into
nasal cavity.
2.Pharyngeal peristalsis to propel bolus through pharynx.
3.Preventing aspiration by elevation and closure of larynx.
4.Opening of cricopharyngeal region to allow passage of bolus to
esophagus.
ESOPHAGEAL STAGE

 PURPOSE:
To transport the bolus from UES to stomach.
 ACTIONS:
1.Generation of PRIMARY WAVE of force 100 cm water pressure which
moves bolus along esophageal length.
2.SECONDARY WAVE is generated when residual food is left in
esophagus after completion of primary wave.
3.TERTIARY WAVE may occur in elderly and in certain pathologies.
Occurs in distal esophagus.
TONGUE POSITIONS DURING
DEGLUTITION
Speech

1.Labiodental - “f” and“v”

2.Bi-labial - “p, b--w, m”
3.Linguo-dental - “th”
4.Linguo-alveolar - “t”, “d”, “s”, “z” and
“n”
5.Linguo-palatal - “Ch”, “j” , “sh”.
6.Linguo-velar - …ng”
7.Linguo-velar-pharyngeal - “k” “g”
8.Glottis- “h”
According to Proffit, the speech problems
related to malocclusions are
Speech sounds problem Related
malocclusion
S,Z (sibilants) lisp Anterior open bite

T,D (linguo- Difficulty in Lingual position of

alveolar) production max. incisors
F,V (labio-dental) distortion Skeletal class III
Th, sh, ch (linguo- distortion Anterior open bite
dental)
RESPIRATION

 Starts at about 25 weeks of IUL.

 Breathing is evoked spontaneously at birth.
 Development of respiratory spaces and maintenance of airway are significant
factors in oro-facial growth.
 In infants, the laryngeal skeleton is high in the neck, and there is a close
relationship between the dorsum of the tongue, the soft palate and the epiglottis.
 As the child grows the laryngeal skeleton descends in the neck and the glottis
opening is no longer in close proximity to the uvula.
 Bosma and his co-workers found that in infants, quite respiration is carried out
thorough nose.
 Although mouth breathing can develop in later years because of obstruction of
nasal passages. Normal nasal breather quickly changes to mouth breathing during
exercise.
CONCLUSION

 Knowedge of stomatognathic sysytem helps an

orthodontic treatment in such a manner that the
finished result reflects a balance between the
structural changes obtained and functional forces
acting on the teeth and investing tissue at that
time.
REFERENCES

1. Atlas of anatomy- Grant`s 11th edition Lippincot

Williams & Wilkins - 2005.
2. Atlas of human anatomy- Neter`s 3rd edition Elsevier -
2006..
4. Human anatomy volume -3 B.D.Chaurasia 4th edition
C B S Publication-2005.
5. Human embryology – Inderbersingh 5th editionMac
Millan India -1993.
6. T.M.Graber - Orthodontics Principles and Practice -
4th Edition Elsevier - 2005.
7. Craniofacial growth , sridhar premkumar first
edition
THANK YOU