Tongue and its importance in orthodontic treatment /certified fixed orthodontic courses by Indian dental academy

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Tongue and its importance in orthodontic treatment /certified fixed orthodontic courses by Indian dental academy

  1. 1. TONGUE INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. CONTENTS : Introduction Anatomy Development Functions of normal tongue Tongue in orthodontics Swallowing Examination of the tongue • Morphological examination • Functional examination www.indiandentalacademy.com • D/D of abnormal tongue posture       
  3. 3.  Role of tongue in malocclusion  Tongue thrust  Conclusion  References www.indiandentalacademy.com
  4. 4. Introduction :  Muscular organ (mass of striated muscle covered with MM) in FOM  Functions :  Taste  Speech  Mastication  Deglutition www.indiandentalacademy.com
  5. 5. Anatomy  A root – attached to mandible - above Hyoid bone - below  A tip – free ant. at rest lies behind upper incisors  A body / dorsumconvex,2parts www.indiandentalacademy.com
  6. 6.  ORAL PART (ant 2/3) PAPILLARY-in FOM - Margins are free contact gums & teeth - Sup surface-median furrow & papillae,rough - Inf surface-smooth MM & median fold frenulum lingue  PHARYNGEAL PART (Post 1/3)LYMPHOID-in pharynx - Post surface,MM,no papillae-lymphoids& mucous glands  Seperated by V-shaped sulcus-sulcus terminalis www.indiandentalacademy.com
  7. 7.  Papillae:projections of MM,ant2/3,rough - Vallate ,fungiform,filiform,foliate  Muscles: - Extrinsic- genioglossus,hyoglossus styloglossus, palato glossus ,  Intrinsic- sup longitudinal,Inf longitudinal,T/s & vertical muscle  Genioglossus-protrusion  Hyoglossus-retraction www.indiandentalacademy.com
  8. 8. Blood supply: - Lingual art (br ECA) & Lingual vein Nerve supply:  Motor- all muscles-hypogossal n. Palatgossus-cr accessory n.  Sensory- ant 2/3-lingual (gen sensation) - Chorda tympani (taste) - Post 1/3-glossopharyngeal n - Post most –vagus thro int laryngeal n www.indiandentalacademy.com
  9. 9. Development  Begins at 4th wk, 1st 3rd & 4th br arches  Pharyngeal arches meet in midline below the stomodeum  Local proliferation of the mesenchyme- 1st arch  Tuberculum impar-in midline  Lingual swellings-laterally  Lingual swelling enlarge merge with tuberculum impar- ant2/3 tongue www.indiandentalacademy.com
  10. 10. www.indiandentalacademy.com
  11. 11.  Hypobranchial eminence-large midline swelling-from mesenchyme of 3rd br archgrows rapidly than 2nd arch  It gives-post 1/3 tongue/root  Post most part-4th arch  Tongue seperates from the FOM by downgrowth of the ectoderm around its periphery-degenerates to form lingual sulcus-mobility of tongue  Muscles-occipital myotomes www.indiandentalacademy.com
  12. 12. Functions of normal tongue - Has several imp function of intrest to the orthodontist - Mastication,deglutition,speech,breathing - EQUILIBRIUM & DEVELOPMENT OF THE DENTAL OCCLUSION  Mastication : - placing food in position (ant & lateral portions of body) - Pushing food buccaly during Mastication www.indiandentalacademy.com
  13. 13. Deglutition: - Forming & propelling bolus in to pharynx(1st stg of swallowing) - After swallowing tongue contact hard palate while soft palate is pulled away downward against the post portion of the tongue  Speech: - Formation of sounds - s,z,t,d,sh,e,g,is - Elevation of tongue tip behind maxi incisors as in ‘s’ www.indiandentalacademy.com
  14. 14.  Breathing :  Nasal breathing-tongue in rest position  In forced mouth breathing-habit,exertion - Mandible is depressed,lips are opened - Tongue contacts laterally with lingual surfaces of mandi teeth dropping away from maxilla - The ant portion is lowered lies on lingual surfaces of mandi ant teeth www.indiandentalacademy.com
  15. 15. EQUILIBRIUM & DEVELOPMENT OF THE DENTAL OCCLUSION EQUILIBRIUM THEORY:  As applied in engg “An object subjected to unequal forces will be accelerated & there by will move to a different position in space” It follows that if any object is subjected to a set of forces but remains in the same position, those forces must be in balance or equilibrium www.indiandentalacademy.com
  16. 16.  From this perspective,dentition is in equilibrium as they do not move to a new location under usual circumstances (mastication,swallowin g,speaking)  ‘Tooth movement occurs only when the equilibrium against dentition is unbalanced’ www.indiandentalacademy.com
  17. 17. Contributors to the dental equilibrium: Various factors-effect of pressures,magnitude & its duration  Masticatory forces  Soft tissue pressures from the lips,cheeks & TONGUE  External pressures- habits & orthodontic forces  Intrinsic pressures-gingival & PDL fibers www.indiandentalacademy.com
  18. 18. Soft tissue pressures from the lips,cheeks & TONGUE:  Rest,swallowing,speaking  Though pressure are much lighter than masticatory but longer duration  Studies-very light forcs are succesful in moving teeth if the force is longer duration  So light sustained pressures from the lips,cheeks & TONGUE at rest are imp determinants of tooth position www.indiandentalacademy.com
  19. 19.  Injury to soft tissue of lipsscarring &contracture  Incisors moved lingualy as lips tightens against them- altered equilibrium www.indiandentalacademy.com
  20. 20.  No lip/cheeks (tropical infection)  Teeth move labially/buccaly in rsponse to unoposed pressure from the tongue www.indiandentalacademy.com
  21. 21.  Pressure from the tonguemacroglossia/patho /abnormal posture  labial displacement of teeth though lips & cheeks are intact-altered equilibrium www.indiandentalacademy.com
  22. 22.  From this equilibrium theory;light sustained pressure by the tongue against teeth has significant role in development of OB (proffit)  If a pt has a forward resting posture of the tongue the duration of the pressure even light could affect tooth position(vertical & H/Z) www.indiandentalacademy.com
  23. 23. SWALLOWING Acc T.M Graber 1200-2000/day,4pb of pr/swallow(cl-II div1,openbite-more)  Normal swallowing  Abnormal swallowing  Infantile (visceral) swallowing  Mature (somatic) swallowing  Simple -tongue thrust swallowing  Copmlex-tongue thrust swallowing  RETAINED INFANTILE SWALLOW www.indiandentalacademy.com
  24. 24. Normal swallowing  Teeth are in contact,lips-closed  Dorsum of tongue closely touch the palate  Tip of the tongueinterdental papillae of maxi incisors  No tongue thrust www.indiandentalacademy.com
  25. 25. Infantile(visceral) swallowing Acc Moyers  The jaws are apart with tongue b/w gum pads  Mandible stabilizedcontraction of facial muscles (buccinator) & interposed tongue  Swallow guide sensory interchange b/w lips & tongue www.indiandentalacademy.com
  26. 26.  Change to semi solid & solid food & the eruption of teeth-mature swallow (1yr/18mos)  The normal appearance of feature of both the infantile & mature swallowTRANSITIONAL SWALLOW - Diminishing of buccinator activity - Appearance of contraction of mandi elevators-stabilise occlusion www.indiandentalacademy.com
  27. 27. Mature (somatic) swallowing  Teeth together swallow  Mandible stabilizedcontraction of elevators  Tongue tip touch palate lightly above & behind incisors  Minimal contraction of the lips www.indiandentalacademy.com
  28. 28. RETAINED INFANTILE SWALLOW Def: ‘As predominant persistance of the infantile swallowing reflex after the arrival of perm teeth’ - Rare,may be assoc with craniofacial developmental syndromes/neural defects C/F:  Tongue thrust- ant & lateral  Contraction of buccinator muscle  Expression less face(facial muscles –used for stabilising mandi) www.indiandentalacademy.com
  29. 29.  Difficulty in mastication(as occlusion only on last molar of quadrant)  Mastication-b/w tongue tip & palate(poor occlusion)  Gag threshold is low  AFH - severe AOB www.indiandentalacademy.com
  30. 30. Adaptive features to OB:  Tooth apart swallow with T.T  Infra eruption of incisors & alveolar development  Hyperactive mentalis & lips  Mandible stabilized by facial muscles Treatm :differentiate this with skeltal OB - If require-orthodontic & surgery - Poor prognosis www.indiandentalacademy.com
  31. 31. TONGUE IN ORTHODONTICS “ By examining the tongue of the patient,physicians find out the diseases of the body & philosophers the diseases of the mind “ – St Justin  Examination of the tongue  Role of tongue in malocclusion  Tongue thrust www.indiandentalacademy.com
  32. 32. Examination of the tongue - From an orthodontic point of view other than color,texture  Morphologic examination (size & shape)  Functional examination (tongue posture)-imp  D/D of abnormal tongue posture www.indiandentalacademy.com
  33. 33. Morphologic examination  size & shape – subjective observation,related to patient ,Position imp than size  Length-long tongue can touch tip of nose(not confirmed method) - Microglossia-rare - Macroglossia –scalloping on lateral borders  Asymmetry-placing tongue out - Functional asymmetry-change from one position to other - Morphological asymmetry-persists in drapped position www.indiandentalacademy.com
  34. 34. Clinical implications of asymmetry: Tongue asymmetry is imp in  dental arch symmetry  dental midlines  Maintenance of treated incisal relationships  Open bite etc  Not easily corrected, as treatm involve some compromise www.indiandentalacademy.com
  35. 35. Functional examination - imp than clinical,position imp than size - Tongue & lips often integrated - Examine normal tongue function w/o displacing it or the lips  Posture of the tongue while mandi in its postural position - Clinically- upright position - Cephalometry-METRIC EVALUATION - normal -Dorsum of the tongue touches the palate lightly,tip rest in the lingual fossae/crevices of mandi incisors www.indiandentalacademy.com
  36. 36. Proffit –”Tongue posture is far more adapt to cause of an openbite than tongue thrust,becoz the tongue is always there exerting a mild continous force”  Tongue during mastication: - Difficult test - Assoc with neurological problems www.indiandentalacademy.com
  37. 37.  Tongue during swallow : Normal -Tip touches interdental papillae just behind the maxi incisors     The The The The unconscious swallow – most imp command swallow of saliva command swallow of water unconscious swallow during mastication www.indiandentalacademy.com
  38. 38.  During speech : -Is abnormal tongue activity adaptive/etiologic/unrelated to malocclusion - Usually- adaptive - Ask pt to count 1-10,check for tongue adaptivity,consonants sound - ‘s’-sound (lisping) most affected www.indiandentalacademy.com
  39. 39. Functional analysis:  Metric evaluation- lateral ceph  Palatography  Cineflourography www.indiandentalacademy.com
  40. 40. Metric evaluation of tongue posture: www.indiandentalacademy.com
  41. 41.  Tranparent plastic template in mm  Mark-contours of bony palate & dorsum of tongue www.indiandentalacademy.com
  42. 42.  Measuring the distance b/w sup surfce of tongue & roof mouth-size- but it must be supported by clinical examination  Retracted & elevated tongue  Downward & forward tongue posture www.indiandentalacademy.com
  43. 43. Palatography  Recording the contact areas of the tongue with the palate & teeth during speech/certain tongue functions  A thin layer of contrasting imp material is applied on tongue  Tongue movements-speech/swallowing  Palatogram records photographically eg:lisping-defect S sound,T.T  Evaluation of the influence of functional orthodontic appliance therapy www.indiandentalacademy.com
  44. 44. www.indiandentalacademy.com
  45. 45. www.indiandentalacademy.com
  46. 46.  Speech assessment is also desirable from an orthodontic point of view  In malocclusions with malposed teeth, there can also be a malposition of the tongue, which can impair normal speech  An important diagnostic tool as the clinician establishes a treatment plan and a probable prognosis for functional appliance therapy. www.indiandentalacademy.com
  47. 47.  Cineflourography-tongue movements using camera & film is made during swallowing Tracing-T.T is measured by drawing str line thro labial surfaces of U/L incisors www.indiandentalacademy.com
  48. 48. D/D of abnormal tongue posture  Abnormal tongue posture is more frequent problem than abnormal size  Tongue posture is Related to skeletal morphology  In class-II  Mandi short  Tongue positioned forward www.indiandentalacademy.com
  49. 49.  In class-III  Tongue lie below the plane of occlusion www.indiandentalacademy.com
  50. 50. 2 significant variations:  The retracted tongue posture  The protracted tongue posture The retracted tongue posture/COCKED TONGUE:  Tongue tip is withdrawn from all ant teeth www.indiandentalacademy.com
  51. 51. Variations in tongue posture www.indiandentalacademy.com
  52. 52. significant variations: The retracted tongue posture The protracted tongue posture- retained infantile The retracted tongue posture/COCKED TONGUE: Tongue tip is withdrawn from all ant teeth 2 www.indiandentalacademy.com
  53. 53.  Retracted posture seen-10% children  Assoc with lateral OB  Edentulous adults/pt with bilateral loss of several post teeth  Due to positional sense it retract itself to establish tactile contact laterally with alveo mucosa for better seal during swallowing  Complic:unsettling of mandi denture www.indiandentalacademy.com
  54. 54. The protracted tongue posture:  Tongue b/w incisors  Serious ,results in AOB  Endogenous & acquired adaptive www.indiandentalacademy.com
  55. 55. Endogenous protracted tongue posture:  Retention of the infantile postural pattern  Not unesthetic,stable incisor relationship  Mild AOB  Protracted tongue is adaptation to AFH  Is Endogenous protracted tongue posture caused OB? Or AFH/skeletal dysplasias predispose to tongue protraction?  Treatm:surgery relapse - poor prognosis www.indiandentalacademy.com
  56. 56. Acquired adaptive protracted tongue posture:  Transient-adaptation to tonsilitis/pharyngitis  Treatm:removal of cause(tonsillectomy)  Correctable – good prognosis www.indiandentalacademy.com
  57. 57. Role of tongue in malocclusion  SIZE Microglossia: small tongue  Congenital,piere-robin syndrome  C/F: tongue tip lower level  FOM is elevated& visible  Dental arch-collapsed & reduced  Extreme crowding in premolar area  Severe class-II relation www.indiandentalacademy.com
  58. 58. Macroglossia : Congenital, GH,amyloidosis,tumo rs,edentulous pt  Difficult diagnosisceph,cineradiography  Scalloping of lateral borders  Mandi prognathism?? keeping mandi forwards always www.indiandentalacademy.com
  59. 59.         Wide,broad & flat tongue OB Mandi prognathism / Class III Chronic positioning tongue b/w teeth at rest Buccal tipping of post teeth Incre T/S width of dental arch Inability in ortho treatment Difficult diagnosis-tongue some times adapt to contracted narrower space after ortho treatment www.indiandentalacademy.com
  60. 60. POSTURE  In neonate more forward  Abnomal postureGeneralised spacing,proclination  Prognosis-depends on cause-good in respiratory problems www.indiandentalacademy.com
  61. 61.  TONGUE REFLEXES  Most significant is posture –imp for the maintenance of the phayrngeal airway  Base of the tongue forms ant wall of the pharynx  Maintenance of phayrngeal airway cause base of the tongue to not to intrude into airway  Genioglossus muscle performs this reflex function www.indiandentalacademy.com
  62. 62. Genioglossus reflex (initiated by large tongue/tonsils/mouthbreathing) Sustained jaw opening Sustained tongue posture (T.T) MALOCCLUSION (proclination /OB/ prevent tooth eruption-post open bite/deep overbite) www.indiandentalacademy.com
  63. 63. Consequences of tongue posture & functional abnormalities on skeletal pattern:  In HGP: - Forward position/T.T-Bimax dental protrusion(as tongue pressing on lingual surfaces of both U/L incisors) - Spacing(incisors), AOB  In VGP: - T.T- tip the upper incisors to labialy & Lower incisors-lingually tipped www.indiandentalacademy.com
  64. 64. Movements of the tongue  Protrusion- Genioglossus (both side)  Retraction- Styloglossus & Hyoglossus (both side)  Depression- Genioglossus & Hyoglossus (both side)  Retraction & elevation- Styloglossus & palatoglossus (both side)  Intrinsic muscles - Alters shape tongue www.indiandentalacademy.com
  65. 65.  In the mid line,a fold of MM-frenulum of the tongue connects the ventral surface of the tongue to FOM ANKYLOGLOSSIA:  Complete ankyloglossia: fusion of tongue & FOM  Partial ankyloglossia / tongue tie: Short lingual frenum /attachment of lingual frenum too near the tip of tongue www.indiandentalacademy.com
  66. 66. Tongue tie : is most common  Restricted tongue movements  Speech difficulties (consonants)  Some cases are self corrective  Majority : surgical (frenectomy) www.indiandentalacademy.com
  67. 67. Mesurement of tongue volume  True FISP-true fast imaging with steady precession  MRI  CT scan www.indiandentalacademy.com
  68. 68.      Measuring tongue vol :using true FISP 2D-study,in healthy & acromegaly pts In healthy pts-M-140ml F-90ml Acromegaly pts-M-180ml, F-145ml After treatmnt of acromegaly –M154ml,F-125 ml www.indiandentalacademy.com
  69. 69. MRI:  In 19 adults-coronal & sagittal sections  Series of images & multiplying the thickness of each slice & the gap b/w each slice in th series  Avg vol 72.1cc (coronal) 79.3cc (sagittal)  Results-reproducible -Well definable anatomy of tongue www.indiandentalacademy.com
  70. 70.  MRI experiment on rabbits:  MRI measured vol & actual vol after removing tongue compared-closer to actual vol but slightly underestimated CT scan: reliable measuring vol  Used in measuring vol of tumours in Ca of tongue www.indiandentalacademy.com
  71. 71. Tongue presssure         EMG cineradiography Palatograpic EMG- activity of extrinsic & intrinsic muscles of the tongue Measured –potraction,retraction Genioglossus –most imp Protrusion & maintaining shape maintaining pharyngeal airway www.indiandentalacademy.com
  72. 72. TASTE : Basic tastes:  Salt  Sour (acidic)  Sweet (sugar)  Bitter (vallate papillae)  Umami- new taste to a.a like gluatamate,aspatate www.indiandentalacademy.com
  73. 73.  Taste sensation –taste buds (4600),in papillae  Taste buds-sensory,neuro epi cells  Seen in tongue,soft palate & pharynx  Circum vallate-large, numerous taste buds- sour/bitter  Foliate -numerous taste buds – sour  Fungiform-ant part  Filiform- mechanical, NO TASTE BUDS www.indiandentalacademy.com
  74. 74. TONGUE THRUSTING Defin: Proffit- “placement of the tongue tip forward b/w the incisors during swallowing” (1950&60s) OR It is the habit of thrusting tongue forward against teeth/in b/w swallowing  Misnomer-implies tongue is forcibly thr ust forward www.indiandentalacademy.com
  75. 75.  T.T-an adaptive mechanism to maintain OB caused by something elsethumbsucking  T.T term-1958 force teeth out of alignment  School age children-67-95%(5-8yrs)  Assoc with/contributing to an orthodontic/speech problem  In US 20-80% ortho pts have some form of T.T www.indiandentalacademy.com
  76. 76. Etiology - No one specific cause - Acc to Fletcher 1.Genetic factors -anatomic/neruomuscular eg:hypertonic orbicularis oris activity 2.Learned behavior (habit)-acquired as habit - prolonged thumb sucking,tonsillitis & URTI,improper bottle feeding 3.Maturational –infantile swallow persists in adulthood www.indiandentalacademy.com
  77. 77. 4.Mechanical restrictionmacroglossia,constricted dental arches,enlarged adenoids 5.Neurological disturbances -hypersensitive palate,motor disability of tongue 6.Psyhcogenic factors – forced discontinuation of thumbsucking 7.Younger children with reasonably normal occlusion-trasitional stage in physiologic maturation www.indiandentalacademy.com
  78. 78. Classification  According to Moyers (1970) a. simple tongue thrust swallow b. complex tongue thrust swallow  Backlund (1963) a. Ant tongue thrust b.Post tongue thrust  Pickett’s (1966) a.Adaptive-missing teeth/thumb sucking b.Trasitory c.Habitual-postural problem,habit/OB www.indiandentalacademy.com
  79. 79. James S.Braner and Holt  Type I: Non-deforming tongue thrust  Type II: Deforming ant tongue thrust sub group 1- assoc with AOB sub group 2- ant proclination sub group 3- post cross bite  Type III: Deforming lateral tongue thrust sub group 1- posterior open bite sub group 2- posterior cross bite sub group 3- deep overbite www.indiandentalacademy.com
  80. 80.  Type IV- Deforming ant & lateral tongue thrust sub group 1- ant & posterior open bite sub group 2- ant proclination sub group 3- post cross bite Non-deforming: occlusion & profile within normal range & acceptable Deforming: dentoalveolar defect www.indiandentalacademy.com
  81. 81. C/F - Seen from birth - School age children-67-95%(5-8yrs) - If retained after 4yr-concerned&need correction  Proclination of ant teeth  AOB  Bimax dental protrusion  Post cross bite  Post open bite in lateral T.T www.indiandentalacademy.com
  82. 82. Simple T.T Complex T.T www.indiandentalacademy.com
  83. 83. Simple T.T Complex T.T  Teeth apart  Teeth together swallow –T.T swallow –T.T to seal OB  Well circumscribed  Diffuse OB/no OB OB  Precise occlusion  Poor occlusion-reinforced by teeth no reinforcing together swallow  Contraction of  Contraction of lips,mentalis & lips,mentalis & facial muscles.NO www.indiandentalacademy.com mandi elevators mandi elevators
  84. 84.  H/O thumb sucking -T.T as adaaptive mechanism to OB  No respi problems  Diminishes with age  Prognosis - good  H/O breathing/chronic URTI & allergies  Respi problems  Does not Diminishes with age  Prognosis - poor www.indiandentalacademy.com
  85. 85. Diagnosis  Extra oral-facial profile ,OB,AFH  Examination of- tongue posture - tongue function  Careful differentiation should be made of  Simple tongue thrust  Complex tongue thrust  Retention of infantile swallowing pattern  Faulty tongue posture www.indiandentalacademy.com
  86. 86. Tests for diagnosis 1. swallowing: jaw drops- lips,mentalis muscle contracts strongly-tongue thrust 2.Seperate the lips while swallowing to watch tongue thrust,and in doing so,strong muscle contractions can be felt Methods of examination tongue dysfunction:  Position & size- LATERAL CEPH  Tongue pressure- EMG,cineradiography palatograpic,neurolophysiologic examin www.indiandentalacademy.com
  87. 87. Treatment Simple tongue thrust: 3 phases 1.Conscious learning of the new reflex 2.Transferal of control of the new swalow pattern to the subconscious level 3.Reinforcement of the new reflex - If proclination is severe- correct the habit after retraction - Simple T.T-correct by itself during ortho treatment www.indiandentalacademy.com
  88. 88. Conscious learning of the new reflex:  Teaching correct tongue position by tactile signals (index finger)  Tip of tongue & palate  Put tongue tip-close teeth & lips-swallow  40times/day  With little water/food www.indiandentalacademy.com
  89. 89.  Small ortho intraoral elastics-held by tip of tongue aginst palate during swallowing  If correct swallow- elastic will be retained Incorrect swallow- elastic will be swallowed  2-3times /day www.indiandentalacademy.com
  90. 90. Reinforcing the new swallow subconsciously:  To avoid abnormal unconscious swallow-2nd visit  Flat sugarless fruit drops-citric flavoured(lemon)  Fruit drop on Tip of tongue-hold against palate until dissolves www.indiandentalacademy.com
  91. 91.  Record timing  Initialy-less time,later more time  Distraction & self competition  Ones/day  Timing distraction-Best technique www.indiandentalacademy.com
  92. 92. Reinforcing the new reflex:  Appliance therpyTongue crib  Should not as the 1st step of treatment  As it traumatic to pt/ do not wear properly www.indiandentalacademy.com
  93. 93. Tongue crib:  Ni-cr/S.S, 3-4 projections (spurs)  Follow the palatal contour  Forms barrier/picket fence just behind cingulum of mandi incisors  Duration:depends on severity of OB(4-9mos) www.indiandentalacademy.com
  94. 94. MOA:  Eliminate the strong T.T & plunger like action during swallowing  Reeducate the tongue posture -Dorsum-to touch palate vault Tip - palatal rugae  Effects: as tongue confines with in dentition-rests on occlusal surfaces of post teeth-maintains IOD-supra eruption & narrowing of max post teeth preventedwww.indiandentalacademy.com NO OB
  95. 95.  After habit interception  Treat malocclusion assoc with T.Twith removable / fixed ortho appliances  By these above 3 sequential therapy simple T.T is correctable  Prognosis - good www.indiandentalacademy.com
  96. 96. Complex tongue thrust :  Occlusion treatm – 1st  Muscle exercises smilar to simple T.T with minor modification - Swallowing with teeth together - Prolonged appliance therapy  Prognosis – Poor  More relapses www.indiandentalacademy.com
  97. 97. Management of tongue thrust Factors to be considered:  Diagnosis – GDP,orthodontist,pedodontist/pediatri cians  Majority –by Orthodontist - when child displays dental/speech problem 1.Type of malocclusion: The common types of malocclusion associated with tongue thrust habits are www.indiandentalacademy.com
  98. 98. a.Class I malocclusion with incr over jet. b.Angle’s Class II division I malocclusion with increased over jet. c. Deep bite d. Marked open bite. 2. Degree of malocclusion 3. Scope of the problem: habitual,severe tongue thrusting-needs immediate attention. www.indiandentalacademy.com
  99. 99. 4. Maturity of the child. 5. Attitude and the degree of cooperation-from the parents. 6. Progressive malocclusions should be considered for immediate treatment. 7. Structural considerations to be eliminated are a. Nasal air blockage. b. Extremely narrow palatal arch. c. Maxillary posterior teeth in extremely, lingual position d. Macroglossia. www.indiandentalacademy.com
  100. 100. Probability of correction:  Sincere commitment & cooperation of pt & parents  No neuromuscular problems- successful  70%- successful  25%- unsuccessful (poor cooperation of pt & parents/both)  5%- unsuccessful (factore that make treatm impossible www.indiandentalacademy.com
  101. 101. Case reports Tongue muscle activity after ortho treatm of AOB-AJODO1999;115:660-66  Class I with AOB & bimax dental protrusion-T.T,lisping  Prior to treat- EMG activity of GG & OI (protrusion)  After treat – activity www.indiandentalacademy.com
  102. 102. Severe dental OB with tongue reduction after ortho treat AO2001;71:228-36  21yr,Class III with OB,macroglossia  Edgewise with crib & begg retainer  Relapse –mandi arch-spacing,flaring of ant teeth,incre mobility  Partial glossectomy-1/3 middle dorsum  Improvement itself w/o further appliance after surgery in 4months  Shows - EQUILIBRIUM www.indiandentalacademy.com
  103. 103. A cineradiographic study of deglutive tongue movement & nasopharyngeal closure in pt with AOB AO 2000;70:284-89  Results-tongue tip protrusion  Slow movement of ppost part of dorsum  Suggest – compensatory coordination of tongue www.indiandentalacademy.com
  104. 104. Conclusion  Hence position of tongue & its function plays an important role or a contributing factor in dental malocclusion (T.T,macroglossia)  Tongue thrust troubled orthodontic treatment, discouraged orthodontists as there is more relapses due to continuous force by tongue (protrusion) www.indiandentalacademy.com
  105. 105.  Accomplishment of successful orthodontic treatment is pssible through proper diagnosis & treatment plan taking into consideration of all the surrounding oral structres www.indiandentalacademy.com
  106. 106. References  Hand book of orthodontics,4th edition,Robert E.Moyers  Contemporary orthodontics,3rd edition,William R.Proffit  Color atlas of dental medicine-ortho diagnosis,Thomas Rakosi  Human anatomy vol3 head & neck,3rdedition, B.D Chaurasias  Tencate’s Oral histology,6th edition www.indiandentalacademy.com
  107. 107. www.indiandentalacademy.com

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