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Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy
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Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  • 1. TONGUETONGUE www.indiandentalacademy.comwww.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  • 2. CONTENTSCONTENTS  INTRODUCTIONINTRODUCTION  ANATOMY OF TONGUEANATOMY OF TONGUE  EMBRYOLOGY Of TONGUEEMBRYOLOGY Of TONGUE  DEVELOPMENT OF THE TONGUEDEVELOPMENT OF THE TONGUE  FUNCTIONS OF NORMAL TONGUEFUNCTIONS OF NORMAL TONGUE  ANOMALIES OF THE TONGUEANOMALIES OF THE TONGUE  RELATION OF NORMAL TONGUE AND DENTAL FUNCTIONRELATION OF NORMAL TONGUE AND DENTAL FUNCTION  SWALLOWINGSWALLOWING  CLASSIFICATION OF SWALLOWINGCLASSIFICATION OF SWALLOWING  EXAMINATION OF THE TONGUEEXAMINATION OF THE TONGUE  CEPHALOMETRIC EVALUATION OF THE TONGUECEPHALOMETRIC EVALUATION OF THE TONGUE POSTUREPOSTURE  ROLE OF TONGUE IN MALOCCLUSIONROLE OF TONGUE IN MALOCCLUSION  TONGUE THRUSTTONGUE THRUST  TREATMENT OF TONGUE THRUSTING HABITSTREATMENT OF TONGUE THRUSTING HABITS  CONCLUSIONCONCLUSION  REFERENCESREFERENCES www.indiandentalacademy.comwww.indiandentalacademy.com
  • 3. ANATOMY OF THE TONGUEANATOMY OF THE TONGUE The tongue is a highly muscular organ ofThe tongue is a highly muscular organ of deglutition taste and speech; it is partly oraldeglutition taste and speech; it is partly oral and partly pharyngeal in position. Theand partly pharyngeal in position. The tongue is located in the floor of the mouth. Ittongue is located in the floor of the mouth. It is a muscular organ with a mucousis a muscular organ with a mucous membrane covering. It has amembrane covering. It has a  rootroot  an apexan apex  a curved dorsum anda curved dorsum and  an inferior surface.an inferior surface. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 4.  It is divided by V - shaped sulcus terminalis intoIt is divided by V - shaped sulcus terminalis into an anterior , oral or presulcular part facingan anterior , oral or presulcular part facing upwardsupwards Muscles of the tongueMuscles of the tongue  Its mucosa is normally pink and moist. The root ofIts mucosa is normally pink and moist. The root of the tongue is attached to the hyoid bone andthe tongue is attached to the hyoid bone and mandible. The dorsum is generally convex in allmandible. The dorsum is generally convex in all directions.directions. There are two groups of muscles associated withThere are two groups of muscles associated with the tongue; the extrinsic and the intrinsic.the tongue; the extrinsic and the intrinsic. Extrinsic-genioglossus, HyoglossusExtrinsic-genioglossus, Hyoglossus Chondroglossus, palatoglossus.Chondroglossus, palatoglossus. Intrinsic muscles- sup. Longitudinal,infIntrinsic muscles- sup. Longitudinal,inf longitudinal, transverse and vertical muscle.longitudinal, transverse and vertical muscle. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 5. Blood SupplyBlood Supply The blood is supplied to the tongue by right andThe blood is supplied to the tongue by right and left lingual arteries which are branches of theleft lingual arteries which are branches of the external carotid arteries; lingual veins carry theexternal carotid arteries; lingual veins carry the blood to the internal jugular vein.blood to the internal jugular vein. Nerve SupplyNerve Supply The motor nerve supply is the hypoglossalThe motor nerve supply is the hypoglossal nerve, which supplies both the intrinsic musclesnerve, which supplies both the intrinsic muscles and all but of the extrinsic muscles. That one isand all but of the extrinsic muscles. That one is the palatoglossus muscle, which is innervatedthe palatoglossus muscle, which is innervated from the vagus through the pharyngel plexus.from the vagus through the pharyngel plexus. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 6. DEVELOPMENT OF TONGUEDEVELOPMENT OF TONGUE The tongue is seen at the end of the firstThe tongue is seen at the end of the first month of intrauterine life. As the tonguemonth of intrauterine life. As the tongue develops, it has two parts ; the body and thedevelops, it has two parts ; the body and the root. A fibrous connective tissue layerroot. A fibrous connective tissue layer divides the tongue into two halves. Itdivides the tongue into two halves. It begins development from a pair of lateralbegins development from a pair of lateral lingual swellings in the floor of the mouth atlingual swellings in the floor of the mouth at the level of the first branchial arch. Theythe level of the first branchial arch. They fuse medially, forming the body.fuse medially, forming the body. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 7. The root develops from the second, third,The root develops from the second, third, and fourth branchial arches. The musclesand fourth branchial arches. The muscles seem to develop from thickened mesodermseem to develop from thickened mesoderm in the floor of the mouth. The tongue is firstin the floor of the mouth. The tongue is first seen at 1 month and is found to beseen at 1 month and is found to be completed state at 8 weeks. It is found atcompleted state at 8 weeks. It is found at birth that the tongue protrudes beyond thebirth that the tongue protrudes beyond the alveolar ridges, which facilitates thealveolar ridges, which facilitates the necessary sucking process, but as thenecessary sucking process, but as the maxillae develop, the tongue becomesmaxillae develop, the tongue becomes enclosed within the alveolar processes.enclosed within the alveolar processes. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 8. TONGUE EMBRYOLOGY The tongue arises in theTONGUE EMBRYOLOGY The tongue arises in the ventral wall of the primitive oropharynx from theventral wall of the primitive oropharynx from the inner lining of the first four branchial arches.inner lining of the first four branchial arches. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 9. During the 4th week i.u., paired lateral thickeningDuring the 4th week i.u., paired lateral thickening of mesenchyme appear on the internal aspect ofof mesenchyme appear on the internal aspect of the first branchial arches to form the lingualthe first branchial arches to form the lingual swellings.swellings. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 10. Between and behind these swellings a medianBetween and behind these swellings a median eminence appears, the tuberculum impareminence appears, the tuberculum impar (unpaired tubercle), whose caudal border is(unpaired tubercle), whose caudal border is marked by a blind pit.marked by a blind pit. This pit, the foramen caecum marks the site ofThis pit, the foramen caecum marks the site of origin of the thyroid diverticulum, anorigin of the thyroid diverticulum, an endodermal duct that appears during theendodermal duct that appears during the somite period. the diverticulum migratessomite period. the diverticulum migrates caudally ventral to the pharynx as thecaudally ventral to the pharynx as the thyroglossal duct, which bifurcates andthyroglossal duct, which bifurcates and subdivides to form the thyroid gland.subdivides to form the thyroid gland. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 11. The lingual swelling grow and fuse with eachThe lingual swelling grow and fuse with each other, encompassing the tuberculum impar, toother, encompassing the tuberculum impar, to provide the ectodermal derived mucosa of theprovide the ectodermal derived mucosa of the body (anterior two thirds) of the tongue.body (anterior two thirds) of the tongue. The ventral bases of the second, third andThe ventral bases of the second, third and fourth branchial arches elevate into a united,fourth branchial arches elevate into a united, single midventral prominence knows as thesingle midventral prominence knows as the copula (a yoke). A posterior subdivision of thiscopula (a yoke). A posterior subdivision of this prominence is identified as the hypobranchialprominence is identified as the hypobranchial eminence. The endodermally derived mucosaeminence. The endodermally derived mucosa of the second to fourth branchial arches andof the second to fourth branchial arches and the copula provide the covering for the rootthe copula provide the covering for the root (posterior one-third) of the tongue.(posterior one-third) of the tongue. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 12. Also, the large tongue in a small mouth partlyAlso, the large tongue in a small mouth partly accounts for the peculiar tongue thrustingaccounts for the peculiar tongue thrusting character of the infant’s early swallowingcharacter of the infant’s early swallowing pattern, in which the tongue fills the spacepattern, in which the tongue fills the space between the separated jaws during swallowing.between the separated jaws during swallowing. The later enlargement of the mouth facilitatesThe later enlargement of the mouth facilitates the conversion to the adult pattern ofthe conversion to the adult pattern of swallowing, in which the tongue tip lies againstswallowing, in which the tongue tip lies against the palate behind the maxillary incisor teeth.the palate behind the maxillary incisor teeth. The hypobranchial eminence, derived from theThe hypobranchial eminence, derived from the bases of the third and fourth branchial arches,bases of the third and fourth branchial arches, forms the epiglottis, which guards the entranceforms the epiglottis, which guards the entrance to the larynx during swallowing.to the larynx during swallowing. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 13. FUNCTIONS OF THE NORMAL TONGUEFUNCTIONS OF THE NORMAL TONGUE Equilibrium theory and Developmental ofEquilibrium theory and Developmental of the Dental Occlusionthe Dental Occlusion Equilibrium theory, as applied inEquilibrium theory, as applied in engineering, states that an object subjected toengineering, states that an object subjected to unequal forces will be accelerated and therebyunequal forces will be accelerated and thereby will move to a different position in space. Itwill move to a different position in space. It follows therefore that if any object is subjectedfollows therefore that if any object is subjected to a set of forces but remains in the sameto a set of forces but remains in the same position, those forces must be in balanceposition, those forces must be in balance equilibrium. From this perspective, theequilibrium. From this perspective, the dentition is obviously in equilibrium, since thedentition is obviously in equilibrium, since the teeth are subjected to a variety of forces, butteeth are subjected to a variety of forces, but do not move to a new location under usualdo not move to a new location under usual circumstances.circumstances. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 14. The effectiveness of orthodontic treatment isThe effectiveness of orthodontic treatment is itself a demonstration that forces on theitself a demonstration that forces on the dentition is normally in equilibrium. Althoughdentition is normally in equilibrium. Although the dentition is subjected to very heavy forcesthe dentition is subjected to very heavy forces during function, small additional forces, if theyduring function, small additional forces, if they are maintained for a long enough time, canare maintained for a long enough time, can upset the equilibrium and lead to toothupset the equilibrium and lead to tooth movementmovement www.indiandentalacademy.comwww.indiandentalacademy.com
  • 15. The normal tongue has several very importantThe normal tongue has several very important normal functions of interest to the orthodontist.normal functions of interest to the orthodontist. In mastication,In mastication,. it does so by placing the food. it does so by placing the food in position, chiefly by the anterior and lateralin position, chiefly by the anterior and lateral portions of the body of the tongue pushing theportions of the body of the tongue pushing the food buccally when mastication begins.food buccally when mastication begins. In deglutitionIn deglutition the tongue is essential, first ofthe tongue is essential, first of all, in forming the bolus, and then in propellingall, in forming the bolus, and then in propelling the bolus into the pharynx in the first stage ofthe bolus into the pharynx in the first stage of swallowing. Immediately after swallowing, theswallowing. Immediately after swallowing, the position of the tongue is found to be contactingposition of the tongue is found to be contacting the hard palate while the soft palate is pulledthe hard palate while the soft palate is pulled away downward against the posterior portion ofaway downward against the posterior portion of the tonguethe tongue www.indiandentalacademy.comwww.indiandentalacademy.com
  • 16. The formations of sounds in speechThe formations of sounds in speech areare another function of the tongue. The tongue isanother function of the tongue. The tongue is in perpetual motion during speech and takes ain perpetual motion during speech and takes a very necessary part in forming the sounds forvery necessary part in forming the sounds for “s”, “z”. “t”, “d”, “sh”, “e”, “g”, “l”, and “r”. Some“s”, “z”. “t”, “d”, “sh”, “e”, “g”, “l”, and “r”. Some of the necessary movements are protrusionof the necessary movements are protrusion between the anterior teeth, as in “b”, andbetween the anterior teeth, as in “b”, and elevation of the tip alone directly behind theelevation of the tip alone directly behind the maxillary incisor teeth, as in the sound “s”.maxillary incisor teeth, as in the sound “s”. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 17. In normal breathingIn normal breathing using the nasal airusing the nasal air passages, the tongue is found to be in a restpassages, the tongue is found to be in a rest position, a description of which follows later. Inposition, a description of which follows later. In normal forced breathing through the mouth,normal forced breathing through the mouth, such as an athlete may do upon exertion, thesuch as an athlete may do upon exertion, the mandible is depressed, the lips are opened,mandible is depressed, the lips are opened, and the tongue laterally remains in contact withand the tongue laterally remains in contact with the lingual surfaces of the mandibular teeththe lingual surfaces of the mandibular teeth dropping away from the maxilla; the anteriordropping away from the maxilla; the anterior part of the tongue, including the tip, is loweredpart of the tongue, including the tip, is lowered to contact the lingual surfaces of theto contact the lingual surfaces of the mandibular anterior teeth.mandibular anterior teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 18. ABNORMAL FUNCTIONSABNORMAL FUNCTIONS Ankyloglossia –this refers to fixation of tongueAnkyloglossia –this refers to fixation of tongue to the floor of the mouth.it may be eitherto the floor of the mouth.it may be either complete or partial.complete or partial. Fissured tongueFissured tongue Median rhomboid glossitisMedian rhomboid glossitis Geographic tongueGeographic tongue Hairy tongueHairy tongue www.indiandentalacademy.comwww.indiandentalacademy.com
  • 19. RELATION OF NORMAL TONGUE ANDRELATION OF NORMAL TONGUE AND DENTAL FUNCTIONDENTAL FUNCTION The normal growth, development, andThe normal growth, development, and function of the tongue integrated with thefunction of the tongue integrated with the normal growth, development, and function of allnormal growth, development, and function of all other related oral and dental structures willother related oral and dental structures will inevitably lead to what is considered to beinevitably lead to what is considered to be normal jaw relationships and normal dentalnormal jaw relationships and normal dental function.function. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 20. SWALLOWINGSWALLOWING Normal mature swallowing takes place withoutNormal mature swallowing takes place without contracting the muscles of facial expression. Thecontracting the muscles of facial expression. The teeth are momentarily in contact and the tongueteeth are momentarily in contact and the tongue remains inside the mouth.remains inside the mouth. Abnormal swallowing is caused by tongue-Abnormal swallowing is caused by tongue- thrust, either as a simple thrusting action or asthrust, either as a simple thrusting action or as “tongue-thrust syndrome”. The following“tongue-thrust syndrome”. The following symptoms distinguish this syndrome.symptoms distinguish this syndrome. Protrusion of the tip of the tongue.Protrusion of the tip of the tongue. No tooth contact of the molars.No tooth contact of the molars. Contraction of peri-oral muscles during theContraction of peri-oral muscles during the deglutition cycle. During their first few years,deglutition cycle. During their first few years, infants swallow viscerally, i.e. with the tongueinfants swallow viscerally, i.e. with the tongue between the teeth. As the deciduous dentition isbetween the teeth. As the deciduous dentition is completed, the visceral swallowing is graduallycompleted, the visceral swallowing is gradually replaced by somatic swallowing.replaced by somatic swallowing. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 21. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 22. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 23. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 24. CLASSIFICATION OF SWALLOWINGCLASSIFICATION OF SWALLOWING Visceral (infantile) swallowVisceral (infantile) swallow – During the– During the normal infantile swallow, the tongue liesnormal infantile swallow, the tongue lies between the gum pads and the mandible isbetween the gum pads and the mandible is stabilized by obvious contractions of the facialstabilized by obvious contractions of the facial muscles. The buccinator muscle is particularlymuscles. The buccinator muscle is particularly strong in the infantile swallow as it is duringstrong in the infantile swallow as it is during infantile nursing.infantile nursing. The cessation of the infantile swallow and theThe cessation of the infantile swallow and the appearance of the mature swallow are not aappearance of the mature swallow are not a simple on-and-off phenomenon. Rather,simple on-and-off phenomenon. Rather, elements of both intermix during the primaryelements of both intermix during the primary dentition and sometimes even in to the earlydentition and sometimes even in to the early mixed dentition.mixed dentition. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 25. This normal appearance of feature of bothThis normal appearance of feature of both the infantile and mature swallow is termedthe infantile and mature swallow is termed the “Transitional swallow”. Diminishing ofthe “Transitional swallow”. Diminishing of buccinator activity is part of the transitionalbuccinator activity is part of the transitional period, but the most characteristic feature ofperiod, but the most characteristic feature of the start of cessation of the infantile swallowthe start of cessation of the infantile swallow is the appearance of contractions of theis the appearance of contractions of the mandibular elevators during the swallow asmandibular elevators during the swallow as they stabilize the teeth in occlusion.they stabilize the teeth in occlusion. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 26. Normal Mature Swallow -Normal Mature Swallow - The normal matureThe normal mature swallow is characterized by very little lip andswallow is characterized by very little lip and cheek activity, and the contraction of thecheek activity, and the contraction of the mandibular elevators bringing the teeth intomandibular elevators bringing the teeth into occlusion.occlusion. During the mixed dentition, when some teethDuring the mixed dentition, when some teeth are missing and there is normal interdentalare missing and there is normal interdental spacing, the lips may contract a bit to securespacing, the lips may contract a bit to secure the seal. All of these features are not seen all ofthe seal. All of these features are not seen all of the time in all kinds of swallows in youngthe time in all kinds of swallows in young children during the transitional period.children during the transitional period. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 27. Simple Tongue – Thrust Swallow -Simple Tongue – Thrust Swallow - TheThe simple tongue – thrust swallow typicallysimple tongue – thrust swallow typically displays contractions of the lips, mentalisdisplays contractions of the lips, mentalis muscle, and mandibular elevators and the teethmuscle, and mandibular elevators and the teeth are in occlusion as the tongue protrudes into anare in occlusion as the tongue protrudes into an open bite. There is a normal teeth togetheropen bite. There is a normal teeth together swallow, but a “Tongue-thrust” is present toswallow, but a “Tongue-thrust” is present to seal the open bite.seal the open bite. A simpleA simple tongue – thrust swallow may also betongue – thrust swallow may also be found with hypertrophied tonsils which are notfound with hypertrophied tonsils which are not enlarged and / or inflamed sufficiently toenlarged and / or inflamed sufficiently to prompt a tooth apart swallow.prompt a tooth apart swallow. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 28. Malocclusion associated with simple tongue thrust swallow www.indiandentalacademy.comwww.indiandentalacademy.com
  • 29. Complex Tongue – thrust SwallowComplex Tongue – thrust Swallow - The- The complex tongue – thrust swallow is defined ascomplex tongue – thrust swallow is defined as tongue-thrust with a teeth-apart swallow.tongue-thrust with a teeth-apart swallow. Patients with a complex tongue-thrust combinePatients with a complex tongue-thrust combine contractions of the lip, facial, and mentaliscontractions of the lip, facial, and mentalis muscles, lack of contractions of the mandibularmuscles, lack of contractions of the mandibular elevators, a tongue-thrust between the teeth,elevators, a tongue-thrust between the teeth, and a teeth apart swallow.and a teeth apart swallow. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 30. Malocclusion associated with complex tongue thrust swallowwww.indiandentalacademy.comwww.indiandentalacademy.com
  • 31. Retained infantile swallowRetained infantile swallow It is defined as predominant persistence of theIt is defined as predominant persistence of the infantile swallowing reflex after the arrival ofinfantile swallowing reflex after the arrival of permanent teethpermanent teeth The tongue thrusts strongly between the teethThe tongue thrusts strongly between the teeth in front and on both sides.in front and on both sides. Patient with a retained infantile swallow havePatient with a retained infantile swallow have serious difficulties in mastication,for theyserious difficulties in mastication,for they ordinarily occlude on only one molar in eachordinarily occlude on only one molar in each quadrant.quadrant. The gag threshold is typically lowThe gag threshold is typically low Food is often placed on the dorsum of theFood is often placed on the dorsum of the tongue and mastication occurs between tonguetongue and mastication occurs between tongue tip and palate because of thetip and palate because of thewww.indiandentalacademy.comwww.indiandentalacademy.com
  • 32. Inadequacy of occlusal contacts.The prognosisInadequacy of occlusal contacts.The prognosis for conditioning of such a primitive reflex is veryfor conditioning of such a primitive reflex is very poor.poor. The retained infantile swallowing may beThe retained infantile swallowing may be associated with skeletal cranio-facialassociated with skeletal cranio-facial development syndromes and neural deficits.development syndromes and neural deficits. Excessive anterior face height often producesExcessive anterior face height often produces severe frontal open bites and extremes ofsevere frontal open bites and extremes of adaptive swallowing behaviour as theadaptive swallowing behaviour as the neuromusculature attempts to cope withneuromusculature attempts to cope with skeletal imbalance.such strained adaptiveskeletal imbalance.such strained adaptive swallowing behaviour must be carefullyswallowing behaviour must be carefully discriminated from the complex and retaineddiscriminated from the complex and retained infantile swallow.infantile swallow. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 33. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 34. CEPHALOMETRIC EVALUATION OFCEPHALOMETRIC EVALUATION OF TONGUE POSTURETONGUE POSTURE The assessment is made on lateralThe assessment is made on lateral cephalograms taken in postural rest andcephalograms taken in postural rest and habitual occlusion. Exposure is adjusted tohabitual occlusion. Exposure is adjusted to visualize the soft tissue. The size of the tonguevisualize the soft tissue. The size of the tongue can be measured on the occlusion film. Acan be measured on the occlusion film. A successful analysis depends on the propersuccessful analysis depends on the proper utilization of correct measurable data. Autilization of correct measurable data. A baseline or reference line for measurementbaseline or reference line for measurement should satisfy the following criteria.should satisfy the following criteria. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 35. Assessment of tongue position on lateral cephalogramwww.indiandentalacademy.comwww.indiandentalacademy.com
  • 36. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 37. The greatest possible area of the tongue shouldThe greatest possible area of the tongue should like above the reference line, since the twolike above the reference line, since the two dimensional radiographs do not show thedimensional radiographs do not show the anatomical borders of the tongue and theanatomical borders of the tongue and the transverse dimensions.transverse dimensions. The baseline should be independent of variationsThe baseline should be independent of variations in skeletal structures.in skeletal structures. Its relation to the tongue should not change withIts relation to the tongue should not change with changes in position of the mandible.changes in position of the mandible. It should remain constant in relation to changes inIt should remain constant in relation to changes in tongue position.tongue position. It should relate to the anatomical and functionalIt should relate to the anatomical and functional properties of the tongue.properties of the tongue. The measurement should be an easy one to makeThe measurement should be an easy one to make and to replicate.and to replicate. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 38. I = the mesial margin of the lower incisors, V =I = the mesial margin of the lower incisors, V = the most caudal point on the shadow of the softthe most caudal point on the shadow of the soft palate or its projection on to the reference line,palate or its projection on to the reference line, M= the tip of the distobuccal cusp of the lowerM= the tip of the distobuccal cusp of the lower first molar. I and M are connected by a straightfirst molar. I and M are connected by a straight line, which is extended to V to form theline, which is extended to V to form the reference line. It has the following advantages.reference line. It has the following advantages. A relatively large part of the tongue as seen onA relatively large part of the tongue as seen on the cephalogram normally lies superior to thethe cephalogram normally lies superior to the line.line. The line does not depend on skeletalThe line does not depend on skeletal relationships.relationships. Changes in tongue position do not affect theChanges in tongue position do not affect the reference line.reference line. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 39. After constructing the line, it is bisected between IAfter constructing the line, it is bisected between I and V. This point is called O, and a perpendicularand V. This point is called O, and a perpendicular is constructed from it to the palatal contour. Ais constructed from it to the palatal contour. A transparent template has been developed to maketransparent template has been developed to make the necessary measurements. The baseline of thethe necessary measurements. The baseline of the template coincides with the constructed referencetemplate coincides with the constructed reference line, whereas the vertical line intersects theline, whereas the vertical line intersects the reference line at O. from O, at which point threereference line at O. from O, at which point three lines now meet, four more lines are constructed aslines now meet, four more lines are constructed as shown by the illustration of the template. Theseshown by the illustration of the template. These seven lines from six angles of 30 degrees each.seven lines from six angles of 30 degrees each. The lines can be marked in millimeters. Placing theThe lines can be marked in millimeters. Placing the template over the constructed lines permitstemplate over the constructed lines permits reading the exact measurements.reading the exact measurements. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 40. Assessment of tongue size from the occlusionAssessment of tongue size from the occlusion cephalogram requires measuring the distancecephalogram requires measuring the distance between the superior tongue surface and thebetween the superior tongue surface and the roof of the mouth. This is done along the sevenroof of the mouth. This is done along the seven constructed lines.constructed lines. The measurements give the relative size ofThe measurements give the relative size of the tongue, that is, the size in relationship tothe tongue, that is, the size in relationship to the oral cavity. only when the entire oral cavitythe oral cavity. only when the entire oral cavity is filled can a diagnosis of macroglossia beis filled can a diagnosis of macroglossia be made. This, of course, must be supported bymade. This, of course, must be supported by clinical evidence.clinical evidence. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 41. Examination of tongueExamination of tongue From an orthodontic point of viewFrom an orthodontic point of view considerations other than its color textureconsiderations other than its color texture are important for example its relative size itsare important for example its relative size its postural position and its role and positionspostural position and its role and positions in several reflex functions.in several reflex functions. An assessment of lingual motor skills mustAn assessment of lingual motor skills must also be part of any examinations.also be part of any examinations. study the posture of the tongue while thestudy the posture of the tongue while the mandible is its postural position .this can bemandible is its postural position .this can be done if the lips are rest apart , or tonguedone if the lips are rest apart , or tongue posture can be noted in the lateralposture can be noted in the lateral cephalogram of mandibular posture.cephalogram of mandibular posture.www.indiandentalacademy.comwww.indiandentalacademy.com
  • 42. Observe the tongue during variousObserve the tongue during various swallowing proceduresswallowing procedures – the unconscious swallow.the unconscious swallow. – The command swallow of salivaThe command swallow of saliva – The command swallow of waterThe command swallow of water – And the unconscious swallow duringAnd the unconscious swallow during chewingchewing observe the role of the tongue duringobserve the role of the tongue during masticationmastication observe the role of the tongue duringobserve the role of the tongue during speech morphologic examinationspeech morphologic examination www.indiandentalacademy.comwww.indiandentalacademy.com
  • 43. The tongue should be examined for size andThe tongue should be examined for size and shape, though both are subjective observations.shape, though both are subjective observations. The best clinical sign of a tongue is too large forThe best clinical sign of a tongue is too large for its dental arch is the presence of scalloping on theits dental arch is the presence of scalloping on the lateral borderslateral borders Asymmetry of the tongue is more adapt to be aAsymmetry of the tongue is more adapt to be a functional than a morphological matter. Ask thefunctional than a morphological matter. Ask the patient to protrude the tongue and note thepatient to protrude the tongue and note the symmetry of its position.Then ask the patient tosymmetry of its position.Then ask the patient to relax the tongue allowing it to drape over the lowerrelax the tongue allowing it to drape over the lower lip.Functional asymmetry of the tongue changeslip.Functional asymmetry of the tongue changes from one position to other. Morphologicalfrom one position to other. Morphological asymmetries will persist in the drappedasymmetries will persist in the drapped position.Any asymmetry of the tongue haveposition.Any asymmetry of the tongue have important clinical implications to dental archimportant clinical implications to dental arch symmetry, dental midlines maintenance of treatedsymmetry, dental midlines maintenance of treated incisal relationships,openbites.incisal relationships,openbites.www.indiandentalacademy.comwww.indiandentalacademy.com
  • 44. ..Functional examinationFunctional examination 1.Observe the posture of the tongue while the1.Observe the posture of the tongue while the mandible is in its postural position.this may bemandible is in its postural position.this may be done in a cephalogram taken at the mandibulardone in a cephalogram taken at the mandibular postural position or it may be done by gently andpostural position or it may be done by gently and casually examining the tongue lip relationshipcasually examining the tongue lip relationship while the patient is seated in an uprightwhile the patient is seated in an upright position.during mandibular posture the dorsumposition.during mandibular posture the dorsum touches the palate lightly and the tongue tiptouches the palate lightly and the tongue tip normally is at rest in the lingual fossa at thenormally is at rest in the lingual fossa at the crevices of the mandibular incisors.crevices of the mandibular incisors. 2.observe the tongue during the various swallow2.observe the tongue during the various swallow a.The unconscious swallowa.The unconscious swallow b.the command swallow of salivab.the command swallow of saliva c.The command swallow of waterc.The command swallow of water d.And the unconscious swallow duringd.And the unconscious swallow during masticationmastication www.indiandentalacademy.comwww.indiandentalacademy.com
  • 45. Variations in normal tongue posture www.indiandentalacademy.comwww.indiandentalacademy.com
  • 46. The tongue tip during the normal mature swallowThe tongue tip during the normal mature swallow touches the curvature of the palate just behindtouches the curvature of the palate just behind maxillary incisorsmaxillary incisors 3.Observe the role of the tongue during mastication.3.Observe the role of the tongue during mastication. 4.Observe the role of tongue during speech4.Observe the role of tongue during speech Differential diagnosis of abnormal tongue postureDifferential diagnosis of abnormal tongue posture Two significant variations from normal tongueTwo significant variations from normal tongue posture can be seen;posture can be seen; 1.The retracted tongue ,in which the tongue tip is1.The retracted tongue ,in which the tongue tip is withdrawn from all the anterior teethwithdrawn from all the anterior teeth 2.and the protracted tongue posture, in which the2.and the protracted tongue posture, in which the resting tongue is in between the theincisorsresting tongue is in between the theincisors The retracted tongue posture is more frequent inThe retracted tongue posture is more frequent in edentulous adults or those who have bilateral lossedentulous adults or those who have bilateral loss of several posterior teeth.It is often assosciatedof several posterior teeth.It is often assosciated with a posterior open bite since the tongue maywith a posterior open bite since the tongue may spread laterallyspread laterally www.indiandentalacademy.comwww.indiandentalacademy.com
  • 47. Retracted tongue posture www.indiandentalacademy.comwww.indiandentalacademy.com
  • 48. The protracted tongue posture may be a seriousThe protracted tongue posture may be a serious problem since it usually results in open bite.problem since it usually results in open bite. There are two forms of the protracted tongueThere are two forms of the protracted tongue posture:posture: 1.the endogenous.1.the endogenous. 2.And the acquired adaptive2.And the acquired adaptive The endogenous protracted tongue posture mayThe endogenous protracted tongue posture may be a retention of the infantile postural pattern.be a retention of the infantile postural pattern. Profitt has drawn attention to the fact that tongueProfitt has drawn attention to the fact that tongue posture is far more adopt to cause of open biteposture is far more adopt to cause of open bite than tongue –thrusting simply because the tonguethan tongue –thrusting simply because the tongue is always there exerting a mild continuous force.is always there exerting a mild continuous force. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 49. The acquired protracted tongue posture is usuallyThe acquired protracted tongue posture is usually a transitory adaptation to enlargeda transitory adaptation to enlarged tonsils,pharyngitis or tonsillitis.when the acutelytonsils,pharyngitis or tonsillitis.when the acutely inflamed throat is thus anesthetized the adaptiveinflamed throat is thus anesthetized the adaptive protracted tongue posture may spontaneouslyprotracted tongue posture may spontaneously correct to a more normal position.correct to a more normal position. To summarize,there are two clinically significantTo summarize,there are two clinically significant problems in abnormal tongue posture.problems in abnormal tongue posture. 1.endogenous protracted tongue posture for1.endogenous protracted tongue posture for which the prognosis is poor and around whichwhich the prognosis is poor and around which unfortunately the occlusion must be builtunfortunately the occlusion must be built 2.and the acquired protracted tongue2.and the acquired protracted tongue posture,which usually can be correctedposture,which usually can be corrected www.indiandentalacademy.comwww.indiandentalacademy.com
  • 50. Tongue Size:Numerous clinical methods areTongue Size:Numerous clinical methods are done to assess tongue size.The most commondone to assess tongue size.The most common is to check whether the patient can touch hisis to check whether the patient can touch his chin with his tongue tip.In case of macroglossiachin with his tongue tip.In case of macroglossia this test gives good result.this test gives good result. In case of Microglossia the protrudedIn case of Microglossia the protruded tongue tip reaches the Lower incisors at besttongue tip reaches the Lower incisors at best and the floor of the mouth is elevated andand the floor of the mouth is elevated and visible on each side of diminutive tongue.Thevisible on each side of diminutive tongue.The dental arch reflects the small tongue size and isdental arch reflects the small tongue size and is collapsed and reduced with extreme crowdingcollapsed and reduced with extreme crowding in the premolar area.There is usually a severein the premolar area.There is usually a severe class two relationship.The centrifugal force ofclass two relationship.The centrifugal force of the tongue is minimized or absent.the tongue is minimized or absent. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 51. Macroglossia(large tongue)Macroglossia(large tongue) The lateral edges of the tongue when it is tooThe lateral edges of the tongue when it is too large for the alveolar arch,usually displaylarge for the alveolar arch,usually display scalloping where the tongue rests against thescalloping where the tongue rests against the lingual surface of the mandibularlingual surface of the mandibular teeth.treatment is contraindicated unless grossteeth.treatment is contraindicated unless gross malocclusion is present.malocclusion is present. Abnormal tongue postureAbnormal tongue posture This can also cause generalized spacing.TheThis can also cause generalized spacing.The prognosis is dependent on the reason for theprognosis is dependent on the reason for the atypical postural position,often are correctableatypical postural position,often are correctable when normal respiratory function returns.when normal respiratory function returns. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 52. Posture in New bornPosture in New born Tongue posture in the neonate isTongue posture in the neonate is more forward .Later when the incisors erupt themore forward .Later when the incisors erupt the tongue posture changes to a maturetongue posture changes to a mature position.Mandibular growth,downward andposition.Mandibular growth,downward and forward increases the intraoral volume,andforward increases the intraoral volume,and alveolar process grow vertically during eruptionalveolar process grow vertically during eruption aids in normal change in the tongue postureaids in normal change in the tongue posture during the first year of life.during the first year of life. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 53. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 54. Tongue reflexesTongue reflexes The genioglossus reflex may be initiated by aThe genioglossus reflex may be initiated by a large tongue or large tonsils or by jawlarge tongue or large tonsils or by jaw opening.sustained Tongue protraction such asopening.sustained Tongue protraction such as forward posturing of the tongue may forceforward posturing of the tongue may force incisor teeth basically or prevent eruption of theincisor teeth basically or prevent eruption of the mandibular incisors if the tongue rests over themandibular incisors if the tongue rests over the incisal edges.large tongue may spill over theincisal edges.large tongue may spill over the buccal teeth preventing their eruption andbuccal teeth preventing their eruption and produce an posterior open bite or deep overbiteproduce an posterior open bite or deep overbite www.indiandentalacademy.comwww.indiandentalacademy.com
  • 55. TONGUE DYSFUNCTIONTONGUE DYSFUNCTION The most common tongue dysfunctions are thoseThe most common tongue dysfunctions are those involved selective outer pressure and tongueinvolved selective outer pressure and tongue biting. Tongue thrusting can be anterior, posteriorbiting. Tongue thrusting can be anterior, posterior or combined. The consequences of theor combined. The consequences of the localization of aberrant pressure seen arelocalization of aberrant pressure seen are dependent on the area of applied pressure.dependent on the area of applied pressure.  An anterior open bite is caused by anterior tongueAn anterior open bite is caused by anterior tongue thrust (and posture).thrust (and posture).  A lateral open bite or deep overbite is the result ofA lateral open bite or deep overbite is the result of lateral tongue thrust or postural spread, whichlateral tongue thrust or postural spread, which causes infra-occlusion of the posterior teeth.causes infra-occlusion of the posterior teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 56. An edge to edge incisal relationship andAn edge to edge incisal relationship and cuspal relationship of the teeth in thecuspal relationship of the teeth in the buccal segments may mean a combinedbuccal segments may mean a combined thrust. Anterior and posterior open bite canthrust. Anterior and posterior open bite can occur from what a complex tongue thrust.occur from what a complex tongue thrust. The dentoalveolar anterior and posteriorThe dentoalveolar anterior and posterior open bite problems are usually attributableopen bite problems are usually attributable to abnormal tongue posture and functionto abnormal tongue posture and function and usually respond successfully toand usually respond successfully to functional appliance intervention in mixedfunctional appliance intervention in mixed dentition. This is also true for cases of deepdentition. This is also true for cases of deep overbite, in which lateral tongue spreadoverbite, in which lateral tongue spread during function and posture has resulted induring function and posture has resulted in infra occlusion of the posterior teeth.infra occlusion of the posterior teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 57. The space is maintained by invagination of theThe space is maintained by invagination of the peripheral portions of the tongue into theperipheral portions of the tongue into the interocclusal space during postural rest of theinterocclusal space during postural rest of the mandible. In such cases, there is a large freewaymandible. In such cases, there is a large freeway space and the deep overbite is functional inspace and the deep overbite is functional in nature.nature.  A second type of overbite is caused by supra-A second type of overbite is caused by supra- occlusion of the incisors. In the instance, there isocclusion of the incisors. In the instance, there is a small freeway space. This type of problem isa small freeway space. This type of problem is called a functional pseudo overbite. Functionalcalled a functional pseudo overbite. Functional appliance intervention in these cases, particularlyappliance intervention in these cases, particularly when there a developmental disturbances, is notwhen there a developmental disturbances, is not indicated. Fixed appliances and orthopedicindicated. Fixed appliances and orthopedic guidance are more likely to correct the problem.guidance are more likely to correct the problem. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 58. In skeletal open bite problems, there is aIn skeletal open bite problems, there is a genetically determined vertical growthgenetically determined vertical growth pattern, which is often associated withpattern, which is often associated with marked antegonial notching. This type ofmarked antegonial notching. This type of case does not offer a favorable prognosiscase does not offer a favorable prognosis for orthodontic therapy. The inclination offor orthodontic therapy. The inclination of the maxillary base should also bethe maxillary base should also be considered in the evaluation of open biteconsidered in the evaluation of open bite relationship, where a maxillary base that isrelationship, where a maxillary base that is tipped down anteriorly compensates for it.tipped down anteriorly compensates for it. The inclination of the maxillary base can beThe inclination of the maxillary base can be influenced by both functional factors, bothinfluenced by both functional factors, both good and bad habits.good and bad habits. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 59. The consequence of tongue posture andThe consequence of tongue posture and function abnormalities in the dentoalveolarfunction abnormalities in the dentoalveolar region also depends on the skeletal pattern.region also depends on the skeletal pattern. In a horizontal growth pattern, the forwardIn a horizontal growth pattern, the forward tongue thrust or posture can result in atongue thrust or posture can result in a bimaxillary protrusion. With the tonguebimaxillary protrusion. With the tongue pressing against the lingual surfaces ofpressing against the lingual surfaces of both upper and lower incisorsboth upper and lower incisors simultaneously, there is often spacing in thesimultaneously, there is often spacing in the incisor segments.incisor segments. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 60. In a vertical growth pattern, the tongueIn a vertical growth pattern, the tongue thrust can open the bite, and the lowerthrust can open the bite, and the lower incisors may be tipped lingually.incisors may be tipped lingually. During the abnormal functional andDuring the abnormal functional and postural forward positioning, the tip ofpostural forward positioning, the tip of the tongue lies between the dentalthe tongue lies between the dental arches and is in contact with the lowerarches and is in contact with the lower lip, which the patient constantly sucks.lip, which the patient constantly sucks. Thus, the incisors are tipped lingually.Thus, the incisors are tipped lingually. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 61. Tongue thrustTongue thrust ETIOLOGYETIOLOGY 1.genetic factors1.genetic factors 2. learned behavior (habit)2. learned behavior (habit) 3.maturation3.maturation 4.mechanical restriction4.mechanical restriction 5.neurological disturbances5.neurological disturbances 6.psyhcogenic factors6.psyhcogenic factors 7.craniofacial growth and maturation7.craniofacial growth and maturation 8 .open spaces during mixed dentition8 .open spaces during mixed dentition 9.other factors9.other factors www.indiandentalacademy.comwww.indiandentalacademy.com
  • 62. Classification of tongue thrustClassification of tongue thrust According to MoyersAccording to Moyers a. normal infantile swallowa. normal infantile swallow b. normal mature swallowb. normal mature swallow c. simple tongue thrust swallowc. simple tongue thrust swallow d. complex tongue thrust swallowd. complex tongue thrust swallow e. retained infantile swallowe. retained infantile swallow www.indiandentalacademy.comwww.indiandentalacademy.com
  • 63. BRANER AND HOLTBRANER AND HOLT classified tongue thrust asclassified tongue thrust as type 1 non deformity tongue thrusttype 1 non deformity tongue thrust typ2 deformity tongue thrusttyp2 deformity tongue thrust sub group 1-anterior open bitesub group 1-anterior open bite sub group 2-associated with pro-cumbency ofsub group 2-associated with pro-cumbency of incisorsincisors sub group 3-associated with posterior crossbitesub group 3-associated with posterior crossbite type 3-deformity lateral tongue thrusttype 3-deformity lateral tongue thrust sub group 1-posterior open bitesub group 1-posterior open bite sub group2- posterior cross bitesub group2- posterior cross bite subgroup 3 –deep overbitesubgroup 3 –deep overbite type 4- deformity anterior and lateral tongue thrusttype 4- deformity anterior and lateral tongue thrust sub group 1- anterior and posterior open bitesub group 1- anterior and posterior open bite sub group 2 associated pro-cumbency of anteriorsub group 2 associated pro-cumbency of anterior teethteeth sub group 3- associated posterior cross bitesub group 3- associated posterior cross bitewww.indiandentalacademy.comwww.indiandentalacademy.com
  • 64. DiagnosisDiagnosis careful differentiation should be made ofcareful differentiation should be made of – simple tongue thrustsimple tongue thrust – complex tongue thrustcomplex tongue thrust – retention of infantile swallowing patternretention of infantile swallowing pattern – faulty tongue posturefaulty tongue posture Tests for diagnosisTests for diagnosis 1.when the jaw drops and mentalis muscle1.when the jaw drops and mentalis muscle contracts strongly while swallowing,there iscontracts strongly while swallowing,there is probably a tongue thrustprobably a tongue thrust 2.you may part the lips while swallowing to2.you may part the lips while swallowing to watch tongue thrust,and in doing so,strongwatch tongue thrust,and in doing so,strong muscle contractions can be feltmuscle contractions can be felt Cineflourography-Cineflourography-www.indiandentalacademy.comwww.indiandentalacademy.com
  • 65. Here the patient is asked to swallow and theHere the patient is asked to swallow and the camera is started.A cineflurographic film iscamera is started.A cineflurographic film is made of the movements of the tongue frommade of the movements of the tongue from the beginning of the swallowing patternthe beginning of the swallowing pattern ,regarding backward and downward,regarding backward and downward movements of the tip of tongue until themovements of the tip of tongue until the tongue moves back to its original positiontongue moves back to its original position at the end of swallowing which will be in aat the end of swallowing which will be in a matter of few seconds.matter of few seconds. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 66. After the cineflourographic film had beenAfter the cineflourographic film had been developed,the tracing technique consisteddeveloped,the tracing technique consisted of drawing a straight line from the labialof drawing a straight line from the labial surface of the upper central incisor downsurface of the upper central incisor down ward until extends past the lower incisor.ward until extends past the lower incisor. Then ,measurement can be made to knowThen ,measurement can be made to know how far tongue has extended past this line.how far tongue has extended past this line. 4.payne technique4.payne technique www.indiandentalacademy.comwww.indiandentalacademy.com
  • 67. Simple tongue thrustSimple tongue thrust 1.it is defined as the tongue thrust with1.it is defined as the tongue thrust with teeth together swallowteeth together swallow 2.malocclusion which is associated with it2.malocclusion which is associated with it is usually well circumscribed type of openis usually well circumscribed type of open bite in anterior region.bite in anterior region. 3.cuspal interference are not present and3.cuspal interference are not present and there is perfect fit of posterior teeth inthere is perfect fit of posterior teeth in occlusion.occlusion. 4. intercuspation is firm but the4. intercuspation is firm but the anteroposterior relationship is notanteroposterior relationship is not necessarily correct.necessarily correct. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 68. 5.it is associated with abnormal function of5.it is associated with abnormal function of lips mentalis and other circum orallips mentalis and other circum oral muscles.as the patient swallows anterior lipmuscles.as the patient swallows anterior lip seal is made partly with the teeth and partlyseal is made partly with the teeth and partly with the lips.with the lips. 6.teeth are held together prior to and6.teeth are held together prior to and through out swallowingthrough out swallowing 7.open bite has a definite beginning and an7.open bite has a definite beginning and an endingending 8.prognosis is excellent8.prognosis is excellent www.indiandentalacademy.comwww.indiandentalacademy.com
  • 69. TreatmentTreatment Steps in correctionSteps in correction 1.1. Learning of a new reflex at the conscious level,Learning of a new reflex at the conscious level, i.e., teach the exact position of tongue byi.e., teach the exact position of tongue by pointing with patient’s own index finger; ask thepointing with patient’s own index finger; ask the patient to swallow by holding the tongue in thatpatient to swallow by holding the tongue in that position.position. 2.2. Transferral to the subconscious level: By thisTransferral to the subconscious level: By this position, it is to reinforce the reflex atposition, it is to reinforce the reflex at subconscious level done by placing flatsubconscious level done by placing flat sugarless fruit drops at the position occupied bysugarless fruit drops at the position occupied by tip of tongue.tip of tongue. 3.3. Appliances : If proclination is severe treat theAppliances : If proclination is severe treat the procumbency of teeth first and then correct theprocumbency of teeth first and then correct the habit. If procumbency is not so much correct thehabit. If procumbency is not so much correct the habit then correct the malocclusion.habit then correct the malocclusion.www.indiandentalacademy.comwww.indiandentalacademy.com
  • 70. Complex tongue thrustComplex tongue thrust This is defined as tongue thrust with teeth apartThis is defined as tongue thrust with teeth apart swallow. The malocclusion associated with it hasswallow. The malocclusion associated with it has two distinct characteristics.two distinct characteristics. 1.1. Poor occlusal fit resulting in a slide intoPoor occlusal fit resulting in a slide into occlusion.occlusion. 2.2. There is generalized anterior open bite.There is generalized anterior open bite. 3.3. Absence of temporal muscle contraction duringAbsence of temporal muscle contraction during swallowing.swallowing. 4.4. There is dropping of mandible and strongThere is dropping of mandible and strong contraction of circum oral muscles.contraction of circum oral muscles. 5.5. Prognosis for correction of a complex tonguePrognosis for correction of a complex tongue thrust is fair at best, as there are twothrust is fair at best, as there are two neuromuscular problems.neuromuscular problems.  An abnormal occlusal reflexAn abnormal occlusal reflex  An abnormal swallow reflex.An abnormal swallow reflex. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 71. TreatmentTreatment Similar to the management of simple tongueSimilar to the management of simple tongue thrust. However, the occlusal correction shouldthrust. However, the occlusal correction should be carried out only after the correction of thebe carried out only after the correction of the habit. Inspite of clinicians best efforts, there willhabit. Inspite of clinicians best efforts, there will be partial relapse in some cases.be partial relapse in some cases. Retained infantile swallowRetained infantile swallow 1.1. This is the persistence of the infantileThis is the persistence of the infantile swallowing reflex even after the arrival of theswallowing reflex even after the arrival of the permanent teeth. Very few people have this typepermanent teeth. Very few people have this type of swallow.of swallow. 2.2. Teeth occlude on only one molar in eachTeeth occlude on only one molar in each quadrant.quadrant. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 72. 3.3. They demonstrate violent contractions ofThey demonstrate violent contractions of seventh cranial nerve musculature duringseventh cranial nerve musculature during swallowing and tongue is markedlyswallowing and tongue is markedly protruded between all the teeth duringprotruded between all the teeth during initial stages of swallow.initial stages of swallow. 4.4. The patients will have an expression lessThe patients will have an expression less face since facial muscles are used forface since facial muscles are used for stabilizing the mandible.stabilizing the mandible. 5.5. Following the loss of teeth, satisfactoryFollowing the loss of teeth, satisfactory denture prosthesis is almost impossible.denture prosthesis is almost impossible. 6.6. Prognosis for correction is poor.Prognosis for correction is poor. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 73. Management of tongue thrustManagement of tongue thrust Factors to be considered.Factors to be considered. 1.1. Type of malocclusion: The common types ofType of malocclusion: The common types of malocclusion associated with tongue thrustmalocclusion associated with tongue thrust habits are :habits are : a. Class I malocclusion with increased over jet.a. Class I malocclusion with increased over jet. b. Angle’s Class II division I malocclusion withb. Angle’s Class II division I malocclusion with increased over jet.increased over jet. c. Deep bitec. Deep bite d. Marked open bite.d. Marked open bite. 2.2. Degree of malocclusionDegree of malocclusion 3.3. Scope of the problem : A child who habitually,Scope of the problem : A child who habitually, keeps mouth open and does all functions withkeeps mouth open and does all functions with the thrusting tongue needs immediate attention.the thrusting tongue needs immediate attention. In cases of occasional tongue thrusters, theIn cases of occasional tongue thrusters, the treatment can be postponed for sometimes.treatment can be postponed for sometimes. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 74. 4.4. Maturity of the child.Maturity of the child. 5.5. Attitude and the degree of cooperation thatAttitude and the degree of cooperation that can be expected from the parents.can be expected from the parents. 6.6. Progressive malocclusions should beProgressive malocclusions should be considered for immediate treatment.considered for immediate treatment. 7.7. Structural considerations to be eliminatedStructural considerations to be eliminated areare a. Nasal air blockage.a. Nasal air blockage. b. Extremely narrow palatal arch.b. Extremely narrow palatal arch. c. Maxillary posterior teeth in extremely,c. Maxillary posterior teeth in extremely, lingual positionlingual position d. Macroglossia.d. Macroglossia.www.indiandentalacademy.comwww.indiandentalacademy.com
  • 75. PALATOGRAPHIC EXAMINATION OF THE TONGUEPALATOGRAPHIC EXAMINATION OF THE TONGUE AA Complementary evaluation of tongue function isComplementary evaluation of tongue function is possible using a palatographic examination. Thispossible using a palatographic examination. This method enables the observation of tonguemethod enables the observation of tongue function during swallowing and speaking and alsofunction during swallowing and speaking and also allows the evaluation of the influence of variousallows the evaluation of the influence of various functional orthodontic appliances on the tongue.functional orthodontic appliances on the tongue. There is a direct and indirect method.There is a direct and indirect method. In the current direct method, the superior surface ofIn the current direct method, the superior surface of the tongue is covered with a precise impressionthe tongue is covered with a precise impression material. For example, Imprex. A thin, even layermaterial. For example, Imprex. A thin, even layer is applied on the tongue with a spatula. Afteris applied on the tongue with a spatula. After functional exercises, a Polaroid print is made offunctional exercises, a Polaroid print is made of the palatal region, with the help of a surfacethe palatal region, with the help of a surface mirror. The evaluation of the palatogram ismirror. The evaluation of the palatogram is possible by direct measurements on the picture.possible by direct measurements on the picture. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 76. Speech assessment is also desirable from anSpeech assessment is also desirable from an orthodontic point of view. The tongue plays aorthodontic point of view. The tongue plays a central role in phonation, together with thecentral role in phonation, together with the pharynx, velum, palate, and teeth. The movementspharynx, velum, palate, and teeth. The movements of the tongue during speech are sophisticated andof the tongue during speech are sophisticated and dependent on local conditions. In malocclusionsdependent on local conditions. In malocclusions with malposed teeth, there can also be awith malposed teeth, there can also be a malposition of the tongue, which can impairmalposition of the tongue, which can impair normal speech. Usually, the tongue with itsnormal speech. Usually, the tongue with its inherent flexibility can compensate for atypicalinherent flexibility can compensate for atypical morphological relationships. However, the abilitymorphological relationships. However, the ability to compensate or adapt can be assessed by theto compensate or adapt can be assessed by the palatographic record.palatographic record. This compensatory potential is an importantThis compensatory potential is an important diagnostic clue as the clinician establishes adiagnostic clue as the clinician establishes a treatment plan and a probable prognosis fortreatment plan and a probable prognosis for functional appliance therapy.functional appliance therapy.www.indiandentalacademy.comwww.indiandentalacademy.com
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  • 82. Comparison of tongue functions between MatureComparison of tongue functions between Mature and Tongue thrust swallowing –an Ultrasoundand Tongue thrust swallowing –an Ultrasound investigationinvestigation A Study done by Paul-Georg Jost-Brinkmann et.al.A Study done by Paul-Georg Jost-Brinkmann et.al. (Am J Orthod Dentofacial orthop 2004;125:562-70)(Am J Orthod Dentofacial orthop 2004;125:562-70) Ultrasonography has been used in many studiesUltrasonography has been used in many studies for static imaging of the oral cavity.(eg,forfor static imaging of the oral cavity.(eg,for studying tongue morphology and cysts andstudying tongue morphology and cysts and tumours).Dynamic ultrasound investigation oftumours).Dynamic ultrasound investigation of tongue movement through submental scanningtongue movement through submental scanning has been described by many researchers.A majorhas been described by many researchers.A major obstacle of these ultrasound investigations is thatobstacle of these ultrasound investigations is that it causes various artifacts resulting in inaccurateit causes various artifacts resulting in inaccurate measurements of tongue movements.measurements of tongue movements. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 83. Cushion scanning method provides aCushion scanning method provides a solution to these problems.with a cushionsolution to these problems.with a cushion scanning system that consists of a cushionscanning system that consists of a cushion device,a head support.a probe holder,and adevice,a head support.a probe holder,and a head position recording device,tonguehead position recording device,tongue dynamic can be correctly recorded anddynamic can be correctly recorded and measured.measured. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 84. CONCLUSIONSCONCLUSIONS The tongue movements of mature swallowing andThe tongue movements of mature swallowing and tongue thrust swallowing can be differentiatedtongue thrust swallowing can be differentiated with an ULTRA SOUNDwith an ULTRA SOUND Tongue thrust swallowing has a prolongedTongue thrust swallowing has a prolonged duration in the late transport phase compared withduration in the late transport phase compared with mature swallowing.mature swallowing. The center of the tongue might serve as an idealThe center of the tongue might serve as an ideal representative of the whole tongue and can giverepresentative of the whole tongue and can give the observer a brief view of whole tonguethe observer a brief view of whole tongue movement during swallowing.movement during swallowing. The cushion scanning technique ultrasoundThe cushion scanning technique ultrasound visualization of tongue thrust,compared with othervisualization of tongue thrust,compared with other methods that require opening of the lips,foreignmethods that require opening of the lips,foreign bodiesin the mouth ,or x-ray radiation,offers abodiesin the mouth ,or x-ray radiation,offers a safer and more attractive way to evaluate tonguesafer and more attractive way to evaluate tongue movement.movement. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 85. CONCLUSIONCONCLUSION Hence position of tongue and its function playsHence position of tongue and its function plays an important role or a contributing factor inan important role or a contributing factor in dental malocclusion.dental malocclusion. Accomplishment of successful orthodonticAccomplishment of successful orthodontic treatment is possible through proper diagnosistreatment is possible through proper diagnosis and treatment plan taking into consideration alland treatment plan taking into consideration all the surrounding oral structures.the surrounding oral structures. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 86. REFERENCESREFERENCES GROWTH AN DEVELOPMENT OF TONGUE –GROWTH AN DEVELOPMENT OF TONGUE – GREYS ANATOMYGREYS ANATOMY EMBRYOLOGY – INDERBIR SINGHEMBRYOLOGY – INDERBIR SINGH ORAL PATHOLOGY-SHAFERORAL PATHOLOGY-SHAFER HAND BOOK OF ORTHODONTICS- ROBERTHAND BOOK OF ORTHODONTICS- ROBERT E MOYERSE MOYERS TEXT BOOK OF ORTHODONTICS -WILLIAMTEXT BOOK OF ORTHODONTICS -WILLIAM R PROFITTR PROFITT www.indiandentalacademy.comwww.indiandentalacademy.com
  • 87. For more details please visitFor more details please visit www.indiandentalacademy.comwww.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com

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