ROLE OF TONGUE IN DEVELOPMENT OF MALOCCLUSION

ROLE OF TONGUE IN DEVELOPMENT OF MALOCCLUSION.
PRESENTED BY -
DR. DEEKSHA BHANOTIA
MDS FIRST YEAR
DEPARTMENT OF
ORTHODONTICS AND
DENTOFACIAL
ORTHOPEDICS
NIMS DENTAL COLLEGE AND
HOSPITAL
GUIDED BY -
DR. MRIDULA TREHAN
PROFESSOR AND HEAD OF
DEPARTMENT OF
ORTHODONTICS AND
DENTOFACIAL ORTHOPEDICS
1

CONTENT
• Introduction .
• General features.
• Part and surfaces of tongue .
• Development of tongue .
• Muscles of tongue.
• Blood supply of Tongue.
• Taste pathway.
• Papillae.
• Taste Bud.
• Examination of tongue.
• Measurement of tongue pressure.
• Tongue In Orthodontics.
• Tongue Thrust and Malocclusion.
• Abnormal tongue posture.
• Tongue Anomalies.
• D/D of abnormal tongue posture.
• Conclusion.
• References.
2

INTRODUCTION
• Tongue is a muscular organ situated in
the floor of mouth.
• It is the strongest muscle.
• Length -3 inches.
• Shape – triangular.
• Attachment – with mandible and
hyoid bone.
• Has an apex, body and root.
B.D.Chaurasia:Human Anatomy For Dental Students:First edition;270-274.
3

GENERAL FEATURE
• Surfaces – Two surfaces
1) Superior surface a) anterior two third –Oral part
b) Posterior one third – Pharyngeal part
c) Base of tongue
2) Inferior surface
4

DEVELOPMENT OF TONGUE
Anterior two third
From two lingual swellings
and one tuberculum impar,
which arise from first
branchial arch.
The tuberculum impar soon
disappears.
Therefore , it is supplied by
lingual nerve and chorda
tympani.
6
Human Embryology:Inderbir Singh, G.P.Pal: 7th Edition;159-162

Posterior one third
• From cranial part of the
hypobranchial eminence
i.e from the third arch.
• Therefore, it is supplied by
glossopharyngeal nerve.
7

Posterior most part from the
fourth arch
Vagus nerve.
8

2) Muscles – they develop from the
occipital myotomes which are supplied by the
hypoglossal nerve.
3) Connective Tissue – they develop
from local mesenchyme.
9

MUSCLES OF TONGUE
Intrinsic muscles
1. Superior longitudinal
2. Inferior longitudinal
3. Transverse
4. Vertical
10

Extrinsic muscles
1. Genioglossus
2. Hyoglossus
3. Styloglossus
4. Palatoglossus
11

Blood Supply Of Tongue
Arterial Supply Venous Drainage
Lingual artery, Tonsillar and Lingual vein
Ascending pharyngeal artery.
12

TASTE PATHWAY
Anterior two third
Chorda tympani
Posterior one third
Glossopharyngeal nerve
Posterior most part
Vagus nerve
13

PAPILLAE OF TONGUE - These are projections of mucous
membrane which give anterior two third of the tongue its characteristics
roughness.
• These are of following four types –
1. Circumvallate papilla
2. Fungiform papilla
3. Filiform papilla
4. Foliate papilla
14

1. CIRCUMVALLATE PAPILLA
1. Largest among papillae.
2. Size – 1-2 mm diameter
3. Number – 10-12
4. Shape - blunt end cylindrical
5. Arrangement – occur in V
shape line.
B.D.Chaurasia:Human Anatomy ForDental Students:First edition;270-274.
15

2. FUNGIFORM PAPILLA
1. Shape – slightly mushroom shaped.
2. Taste buds on their surface located
mainly on lingual margin
3. Location – apex of the tongue as
well as on the margins.
4. Differ from filiform because they are larger,
rounded and deep red in colour.
16

3. FILIFORM PAPILLA
1. Shape – Thin long papillae having
pointed ends.
2. Number – numerous.
3. Location – present at pre sulcul
area of tongue.
4. Increases the friction between
tongue and food.
B.D.Chaurasia:Human Anatomy For Dental Students:First edition;270-274. 17

4.FOLIATE PAPILLA
1. Shape – Short vertical folds.
2. Red leaf – like mucosal ridges.
3. Location - Bilaterally at the
sides of the tongue near sulcus
terminalis.
4. Bear numerous taste buds.
18

TASTE BUDS
• Sensory receptor for taste.
• The sensation of taste is called
GUSTATION.
• Taste buds are located on the
surface of papillae except filiform
papillae.

TASTE BUDS
• Four taste sensations, are perceived in tongue:
1) Sour
2) Sweet
3) Salty
4) Bitter

ELECTRONIC MICROSCOPIC STRUCTURE OF
TASTE BUDS -
21

• TONGUE IN ORTHODONTICS
Whatever the cause for the tongue habit may be (size, posture or function ), it
serves as an effective cause of malocclusion.
• For an instance, as the tongue thrusts forward constantly, increasing the
overjet and overbite, the peripheral portion no longer lie over the lingual cusps
of the buccal segments.
• Posterior teeth erupt and gradually eliminate the interocclusal clearance.
• The postural resting vertical dimension and occlusal vertical dimension
become one and same,with posterior teeth in contact at all times.
• One side effect may be bruxism; other may be the bilateral narrowing of the
maxillary arch as the tongue drops lower in the mouth, providing less support
for the maxillary arch.
T.M. Graber Vansardall:Orthodontic Current Principles and Technique:Vol 2:322-327 22

•
Clinically this may be observed as a unilateral cross bite , with a
convenience swing to one side or the other as the mandible is moved
laterally under the influence of tooth guidance.
T.M. Graber Vansardall:Orthodontic Current Principles and Technique:Vol 2:322-327 23

• The contribution of the forces of the lips, cheeks, and tongue are of
particular interest to orthodontist, in correct treatment planning.
• The technical skills and protocol that the orthodontist uses to assess these
forces may determine the ultimate success of orthodontic treatment.
24
Helen Lambrechts, Evelvne de Baets,Steffen Fieuws, Guy Willems.Lip and Tongue pressure in orthodontic
;patients:European Journal of Orthodontics:2010;32:466-471

• Bone is one of the hardest tissues of the body, although is very responsive
to changes in environmental balance.
• The musculature plays a major role in this field. It is generally assumed
that alveolar bone responds to external influences.
Helen Lambrechts, Evelvne de Baets,Steffen Fieuws, Guy Willems.Lip and Tongue pressure in orthodontic
patients:European Journal of Orthodontics:2010;32:466-471
25

• Most dental professionals accept the theory of Tomes (1873), who
asserted that “opposing forces or pressure from the lips and cheeks on
one side and the tongue on the other, determine the position of the
teeth.”
• Helen Lambrechts, Evelvne de Baets,Steffen Fieuws, Guy Willems: Lip and Tongue pressure in orthodontic
patients:European Journal of Orthodontics:2010;32:466-471
26

Examination of Tongue
Morphologic Examination:
The Tongue should be examined for size and shape .
The best clinical sign of a tongue too large for its dental arch is the presence of
scalloping on the lateral borders.
Symmetry of the tongue position is checked by asking the patient to protude the
tongue followed by asking the patient to relax the tongue and allowing to drape over the
lower lip.
Morphologic asymmetries will persist in the draped position.
Any asymmetry of tongue has clinical implications to dental arch symmetry,
dental midlines, maintenance of treated incisal relationships, openbites, etc.
Robert E. Moyers: Handbook Of Orthodontics: 4th Edition; 203 27

Examination of Tongue
Functional Examination:
1) Study the posture of the tongue while in the postural position.
Sometimes it can be done if lips rest apart, or tongue posture can be
noted in the lateral cephalogram of mandibular posture.
2) Observe the tongue during various swallowing procedures. Do not
separate the lips to see what is happening, rather observe the contraction
of orbicularis oris and mentalis muscles and deduce from their activity
the tongue’s position during swallowing.
3) Observe the tongue during mastication.
4) Observe the tongue during speech.
Robert E. Moyers: Handbook Of Orthodontics: 4th Edition; 203 28

Abnormal Tongue Posture and Associated
Malocclusion
Abnormal Tongue Posture can be associated with the following features:
a. Proclination of anterior teeth.
b. Anterior Open bite.
c. Bimaxillary protusion.
d. Posterior open bite in case of lateral tongue thrust.
e. Posterior crossbite.
S.I.Bhalajhi:OrthodonticsThe Art and Science:5th Edition;134.
29

Tongue Thrust and Malocclusion
Tulley 1969 - states Tongue thrust as the forward movement of the tongue
tip between the teeth to meet the lower lip during deglutition and in
sounds of speech, so that the tongue becomes interdental.
Moyer’s classification:
Suchita Madhukar Tarvade, Sheetal Ramkrishna.Tongue thrusting habit: A review :International Journal of
Contemporary Dental and Medical Reviews 2015 :151214;1-2
Simple tongue thrust Complex tongue thrust Retained infantile swallow
Defined as tongue thrusting with
teeth together swallow.
Defined as tongue thrust with a teeth
apart swallow
Is persistence of the infantile
swallow.
Teeth occlude on only one molar
each quadrant.
30

Types of tongue thrust:
1. Physiologic:
This comprises of the normal tongue thrust swallow of infancy.
2. Habitual:
The tongue thrust swallow is present as a habit even after the
correction of the malocclusion
3. Functional:
When the tongue thrust mechanism is an adaptive behavior
developed to achieve an oral seal, it can be grouped as functional.
4. Anatomic tongue thrust:
Persons having enlarged tongue can have an anterior tongue
posture.
Suchita Madhukar Tarvade, Sheetal Ramkrishna:Tongue thrusting habit. A review :International Journal of
Contemporary Dental and Medical Reviews :2015 ;151214: 1-2 31

Simple Tongue Thrust Swallow (Anterior tongue
thrusting)
 Defined as tongue thrust with teeth together
swallow .
 Extra oral features seen in patients are:
1. Usually dolichocephalic face.
2. Increased lower anterior facial height
3. Incompetent lips
4. Expresion less face as the mandible is stabilized
by facial muscles instead of masticatory muscles
during deglutition.
.
Gowri sankar singaraju ,Chetan kumar:TONGUE THRUST HABIT-review:2009:2 ;18-20
32

Simple Tongue Thrust Swallow
(Anterior tongue thrusting).
Intra oral features
1. Proclined, spaced and some times flared upper
anteriors resulting in increased overjet.
2. Presence of an anterior open bite.
3. Presence of posterior crossbites.
4. The simple tongue thrust is characterized by a
normal tooth contact during the swallowing act. They exhibit
good intercuspation of posterior teeth in contrast to complex
tongue thrust.
5. The tongue is thrust forward during swallowing
to help establish an anterior lip seal. At rest the tongue tip
lies at a lower level.
Gowri sankar singaraju ,Chetan kumar:TONGUETHRUSTHABIT-A review:2009:2 ;18-
20 33

2. COMPLEX TONGUE THRUST: ( ANTERIOR
AND POSTERIOR TONGUE THRUST)
• It is defined as tongue thrust with a teeth apart swallow.
• Etiology
• Pain and decrease of space in the throat precipitates a new forward
tongue posture and swallowing reflex. Because maintenance of airway
patency is a more primitive and demanding reflex than the mature
swallow, the later is conditioned to the necessity for mouth breathing.
The jaws are thus held apart during swallow in order that the tongue can
remain in a protruded position.
• Gowri sankar singaraju ,Chetan kumar:TONGUETHRUSTHABIT-A review:2009: 2 ;18-20
34

2. COMPLEX TONGUE THRUST: ( ANTERIOR
AND POSTERIOR TONGUE THRUST).
• Features
The following features are seen :
1. Proclination of anterior teeth .
2. Bimaxillary protrusion
3. This kind of tongue thrust is characterized by a teeth
apart swallow.
4. The anterior open bite can be diffuse or absent.
5. Absence of temporal muscle constriction during
swallowing.
6. The occlusion of teeth may be poor. Poor occlusal fit,
no firm intercuspation.
7. Posterior open bite in case of lateral tongue thrust
8. Posterior crossbite
35
Gowri sankar singaraju ,Chetan kumar:TONGUETHRUSTHABIT-A review:2009: 2 ;18-20

Retained Infantile Swallow/Tongue Sucking
Undue persistence of the infantile
swallow even after the normal time of its
departure.
Teeth occlude only on one molar in each
quadrant.
Strong contraction of facial muscle during
swallowing.
Difficulties in mastication and low gag
threshold.
36
Gowri sankar singaraju ,Chetan kumar:TONGUETHRUSTHABIT-A review:2009: 2 ;18-20

Diagnosis of Tongue Thrust.
The subject is seated upright on the
dental chair. The fingers of both the hands
of the examiner is used to palpate the
masseter muscle, while both the thumbs
are used simultaneously to retract the
lower lip lightly so that the tongue thrust if
present could be seen .
37
R.G.Chour,Suryakanth M Pai,G VChour,Sangeetha M Kenchappannavar, Poornima Parameshwarappa .
Assessment of various deleterious oral habits and its effects on primary dentition among 3-5 years old children
in Davangere city: 2014 :2; 37-43

Diagnosis of Tongue Thrust.
With the hands in this position, the subject is asked to swallow
the saliva; subjects in whom there was absence of palpable
contraction of masseter muscle as well as forward thrust of tongue
causing it to protrude between the incisors were ranked as tongue
thrust swallowers. Subjects who didn't demonstrate the above-
mentioned habit were classified as normal swallowers.
38
R.G.Chour,Suryakanth M Pai,G V Chour,Sangeetha M Kenchappannavar, Poornima Parameshwarappa .
Assessment of various deleterious oral habits and its effects on primary dentition among 3-5 years old children in
Davangere city: 2014:2; 37-43

Management
Diﬀerent methods have been attempted to correct the
tongue thrust habit with variable success.
The American Academy of Pediatric Dentistry states
that the management of the tonguethrust may include “myofunctional
therapy, simple habit control, habit-breaking appliances, orthodontics and
possible surgery” (American Academy of Pediatric Dentistry Council on
Clinical Aﬀ airs, 2005).
1. Training of correct swallow and posture of the
tongue. These exercises help in toning up respective muscles thereby
eliminating tongue thrust.
Gowri sankar singaraju ,Chetan kumar:TONGUETHRUSTHABIT-A review; 2009: 2 ;18-20
39

Management
• Myofunctional exercises: The patient can be guided
regarding the correct posture of the tongue during swallowing by
various exercises. The child is asked to place the tip of the tongue in
the rugae areas for 5 min and is asked to swallow.
• Orthodontic elastics and sugarless fruit drop
exercises
• 2S exercise: It includes identifying - spot and
squeeze
• Other exercise: Whistling, reciting the count from
60 to 69, gargling, yawning
• Orthodontic trainers: Tooth channels, labial
bows, tongue guard, tongue tag, lip bumpers.
Gowri sankar singaraju ,Chetan kumar:TONGUETHRUSTHABIT-A review; 2009: Issue 2 ;18-20 40

Abnormal Tongue Posture
The continous effects of abnormal tongue posture may produce more open
bites than the more obvious tongue thrusts.
Two forms of protracted tongue posture is present
a) the endogenous .
b) the acquired.
•
• Robert E. Moyers: Handbook Of Orthodontics: 4th Edition; 550-551
41

During the arrival of teeth, the tongue normally changes its posture and
comes to rest inside the encircling dentition.
• However some children have inherently abnormal tongue position and
the tip of the tongue persists in lying between the incisors.
• Fortunately great majority of the endogenous protracted posture
problems are not unesthetic and there is stability of the incisor
relationship even though mild open bite is seen.
• On serious occasion serious open bites have been present from the first
stage of eruption.
Robert E. Moyers: Handbook Of Orthodontics: 4th Edition;550-551 42

The acquired protracted tongue position usually results from chronic
pharyngitis, tonsillitis or any nasorespiratory disorders.
Patient with such conditions should be referred to an otolaryngologist
before starting the orthodontic therapy, for as long as the precipitating
cause is present the tongue will posture itself forward and any
positioning of incisors may be unstable.
However in condition where nasopharyngeal condition no longer exists but
the tongue remains in forward position, the posture of the tongue can be
induced to change by the simple expedient of attaching sharp spurs to a
bonded anterior sectional lingual wire or directly to the teeth.
Robert E. Moyers: Handbook Of Orthodontics: 4th Edition; 550-551
43

• An adaptive tongue posture is sometimes seen when the
maxilla is narrower than the mandible.
• Since the tongue must aid in the encircling seal to complete the
swallow, it may adapt a posture atop the lower teeth.
• Posterior open bites are more often postural problems than
“ lateral tongue-thrusts”.
Robert E. Moyers: Handbook Of Orthodontics: 4th Edition;550-551
44

Tongue Anomalies
1) Microglossia –
C/F : severe crowding and
collapsed dental arch .
O P kharbanda
45

2) Macroglossia –
C/F: scalloping on lateral border.
46

Measurement of Tongue Pressure
Maximum lip and tongue pressure was measured with a Myometer .
(1) bar graph showing the
current and peak values
(2) scale (0–3 pounds or 0–6 pounds)
(3) probe, and
(4) tongue plate.
47
Helen Lambrechts, Evelvne de Baets,Steffen Fieuws, Guy Willems. Lip and Tongue pressure in orthodontic
patients:European Journal of Orthodontics:2010:32;466-471

• This type of myometer, manufactured specifically for measurement of
pressure or tension of the intra- and perioral muscles in the field of
orthodontics, used in the study of Horn et al. (1995). The Myometer
160 contains a probe, which consists of two plates that are screwed
together on one side. On the other side (probe tip), the two plates can
be pushed towards each other. The applied force is measured by an
electronic device installed between the plates.
• Helen Lambrechts, Evelvne de Baets,Steffen Fieuws, Guy Willems.Lip and Tongue pressure in
orthodontic patients:European Journal of Orthodontics:2010:32;466-471
48

• Dentofacial morphology is influenced by the tongue and that tongue
thrusting or forward tongue posture can affect the stomatognathic
function and can cause open bite malocclusion.
• Tongue pressure ranges from 41 to 709g/cm2 according to Winders
and that constant tongue thrust or forward tongue posture can cause
proclination of maxillary and mandibular anterior teeth and cause
anterior open bite.
• A Arif Yezdani*1 and Jabeen Fathima2. Tongue - Cause and Correction of Anterior Open Bite Malocclusion:
13;2-4
49

• Posterior open bite too can be a sequelae of lateral tongue thrust.
• The role of the tongue and the transpalatal arch has been well documented
in the literature.
• A Arif Yezdani*1 and Jabeen Fathima2.Tongue - Cause and Correction of Anterior Open Bite Malocclusion:13;2-4
50

• It has been reported that the tongue during deglutition and mastication
greatly encourages molar intrusion, molar expansion and molar
distalization.
51
A Arif Yezdani*1 and Jabeen Fathima2. Tongue - Cause and Correction of Anterior Open Bite Malocclusion: 13;2-4

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 facial Skeleton:
Tongue is positioned forward .
Mandible is short with steep mandibular plane.
In severe class III Skeletons:
Tongue tends to lie below the plane of occlusion.
Robert E. Moyers: Handbook Of Orthodontics: 4th Edition;204
52

CONLUSION
Position of tongue and its function plays an important role or a contributing
factor in dental malocclusion.
Retaining the achieved results is a major challenge faced by every
orthodontist. Not only esthetically pleasing arch form and occlusion but
positioning the teeth where muscular forces ( intra and extra oral) are balanced
should be aimed at right from the day one of the treatment.
Accomplishment of successful orthodontic treatment is possible through
proper diagnosis and treatment plan taking into consideration of all the
surrounding oral structures.
53

References
1. B.D.Chaurasia.Human Anatomy For Dental Students:First edition;270-274.
2. Human Embryology:Inderbir Singh, G.P.Pal: 7th Edition;159-162
3. Robert E. Moyers: Handbook Of Orthodontics: 4th Edition; 173-174
4. Helen Lambrechts, Evelvne de Baets,Steffen Fieuws, Guy Willems.Lip and Tongue
pressure in orthodontic patients:European Journal of Orthodontics:2010:32;466-471
5. T.M. Graber Vansardall:Orthodontic Current Principles and Technique:Vol 2:322-327
54

References
6. Suchita Madhukar Tarvade, Sheetal Ramkrishna.Tongue thrusting habit: A review :International Journal of
Contemporary Dental and Medical Reviews 2015: 151214; 1-2
7. Gowri Sankar singaraju ,Chetan kumar:TONGUE THRUSTHABIT-A review; 2009;2 ;18-20
8. A Arif Yezdani1 and Jabeen Fathima2.Tongue - Cause and Correction of Anterior Open Bite
Malocclusion:13;2-4
9. T. M. GRABER, D.D.S., M.S.D., Ph.D. Kenilworth, Ill: The “three M’s”: Muscles, malformation, and
malocclusion: vol 49
10. R.G.Chour,Suryakanth M Pai,G V Chour,Sangeetha M Kenchappannavar, Poornima Parameshwarappa .
Assessment of various deleterious oral habits and its effects on primary dentition among 3-5 years old
children in Davangere city: 2015: 2; 37-43
11. S.I.Bhalajhi:OrthodonticsThe Art and Science:5th Edition;134.
55

ROLE OF TONGUE IN DEVELOPMENT OF MALOCCLUSION

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to ROLE OF TONGUE IN DEVELOPMENT OF MALOCCLUSION

Similar to ROLE OF TONGUE IN DEVELOPMENT OF MALOCCLUSION (20)

More from Deeksha Bhanotia

More from Deeksha Bhanotia (20)

Recently uploaded

Recently uploaded (20)

ROLE OF TONGUE IN DEVELOPMENT OF MALOCCLUSION