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Temporomandibular Joint and
     related structures




       • Claver O. Acero Jr. DMD, PhD
(Functional Occlusion system)

          N ervous system



          N eurom uscular



   TM J                     D entition
The Temporomandibular Joint
PHYSIOLOGIC CHARACTERISTICS OF
             THE TEETH
1. Growth
   a. Initiation (6th wk. of intrauterine life)
   b. proliferation
   c. histodifferentiation & morphodifferentiation
   d. apposition or critical calcification
2. Calcification
   Nollas stages of calcification
Nolla’s Stages of tooth
calcification
3.Eruption
     Active eruption
     Passive eruption- attrition, lost of opposing
  Parameters of eruption Assignment
-time of eruption
-sequence of eruption
4. Resorption & exfoliation of primary teeth
   primary teeth only,
5. Attrition
Favorable sequence of eruption for permanent dentition
Dentitional Period & Occlusal
                Development
I.Primary dentitional period (fr. 6 mos. to 5 years)
      start from 6 mos. Completed at 24 to 30 months

General Characteristics
1. Crown proportion
2. Molar relationship. Flush terminal plane
3. Anterior interdental spaces & primate spaces
4. Overbite & overjet
Sequence of eruption of Primary teeth




    A     B       D    C         E
A             B   D    C    E
Dentitional Period & Occlusal
                Development
I.Primary dentitional period (fr. 6 mos. to 5 years)
      start from 6 mos. Completed at 24 to 30 months

General Characteristics
1. Crown proportion
2. Molar relationship. Flush terminal plane
3. Anterior interdental spaces & primate spaces
4. Overbite & overjet
Dentitional Period & Occlusal
                 Development
I.Primary dentitional period (fr. 6 mos. to 5 years)
      start from 6 mos. Completed at 24 to 30 months

General Characteristics
1. Crown proportion
2. Molar relationship. Flush terminal plane
3. Anterior interdental spaces & primate spaces
4. Overbite & overjet
Significance of primary dentition
II. Mixed Dentitional Period (transitional period)
-from 6 years to 13 years
Characteristics: a.Early Mixed
• Distal flaring of upper anteriors
• End to end molar relationship
• Transient anterior crowding of lower anterior teeth

b. Late mixed dentition
*space closed because of erupting canine
*crossbite/negative overbite
*zero overbite
*posterior overbite
II. Mixed Dentitional Period (transitional period)
-from 6 years to 13 years
Characteristics: a.Early Mixed
• Distal flaring of upper anteriors
• End to end molar relationship
• Transient anterior crowding of lower anterior teeth

b. Late mixed dentition
*space closed because of erupting canine
*crossbite/negative overbite
*zero overbite
*posterior overbite
II. Mixed Dentitional Period (transitional period)
-from 6 years to 13 years
Characteristics: a.Early Mixed
• Distal flaring of upper anteriors
• End to end molar relationship
• Transient anterior crowding of lower anterior teeth

 Late mixed dentition
*space closed because of erupting canine
*crossbite/negative overbite
*zero overbite
*posterior overbite
II. Mixed Dentitional Period (transitional period)
-from 6 years to 13 years
Characteristics: a.Early Mixed
• Distal flaring of upper anteriors
• End to end molar relationship
• Transient anterior crowding of lower anterior teeth

 Late mixed dentition
*space closed because of erupting canine
*crossbite/negative overbite
*zero overbite
*posterior overbite
Incisor liability ( 8 -9 year old)




    1.6 mm in the mandible
How we overcome incisor liability

1. Slight increase in arch width
2. Labial positioning of permanent incisor relative
    to primary incisor
3. Repositioning of canines in the mandibular arch
4. Continued development of the arches improves
    spacing.
Nance leeway space
Favorable sequence of eruption for permanent dentition
III. Permanent Dentitional Period
General characteristics
3. Normal surface contact
4. Normal cuspid to fossa relationship
5. Normal triangular ridge to embrassure or groove
   contact

TOOTH CONTACTS
-stamp cuspids
-shear cuspids
Six Keys to occlusion
  by Lawrence Andrew
Key I. Molar Relationship
Key II. Crown Angulation ( Tip )
Key III. Crown Inclination
( labiolingual or buccolingual inclination, torque)
Key IV. Rotations
Key V. Tight contacts.
Key VI. Occlusal plane.
Significance of ABC contacts
•  Concept of Tripodization
Function of tooth contacts
c. Prevent horizontal or lateral drift of the teeth
   buccolingually
d. Prevent mesial & distal drifting
下顎窩,下顎頭および関節円板の
    相対的位置関係
開口初期に関節円板に生じる
   くさび効果
開口時の下顎頭と関節円板の挙動
Concepts of occlusion
•   Balanced occlusion
•   Mutual protection
•   Canine protected occlusion
•   Multiple group function occlusal contacts
Chewing pattern
• Chopping type chewing
• Crushing type chewing
Normal buccolingual arch relationship
両側性平衡咬合
片側性平衡咬合
臼歯離開咬合
Basic mandibular positions
•   Centric relation
•   Maximum Intercuspation
•   Centric occlusion
•   Centric relation of occlusion
•   Physiologic rest position
    PRP- VDO =FWS
Directional movement of the Mandible


• Bilateral movement – condyle move at same
  direction and dimension
• Unilateral movements- working and nonworking
      side
Bilateral Directional movement of the
                mandible

              Rotation       Translation
Elevation     upward        backward & upward
Depression    downward      forward & downward
Protrusion    downward      forward
Retrusion
Salivary glands
•   Parotid gland – Stensens duct
•   Submandibular gland – Wartons duct
•   Sublingual gland – Bartolins duct
•   Minor:
    – Mucous glands: glossopalatine glands, palatin glands, anterior
               2/3 of tongue, posterior 1/3 of tongue
    – Mixed: retromolar, labial, buccal mucosa.
    – Serous: salivary protein and amylase
    – Von Ebner gland: beside circumvalate papilla to clean the papilla.
Salivary glands
•   Parotid gland – Stensens duct
•   Submandibular gland – Wartons duct
•   Sublingual gland – Bartolins duct
•   Minor:
    – Buccal and Labial glands
    – Palatoglossal glands – pharyngeal isthmus
    – Palatal glands- soft and hard palate
    – Anterior lingual glands- embedded w/in muscle in ventral surface of
       tongue
    – Posterior gland - root of the tongue
    – Von Ebner gland: empty- trench of circumvalate papilla to clean the
       papilla. serous
Properties
•   99 percent water 1 percent inorganic and organic
•   5.6 to 7.6 pH
•   1.002 to 1.008 specific. Gravity
•   Frothy, colorless or slightly opalescent, odorless
•   1 t 1.5 liters a day

                      Types of Saliva
    – Pure or active – stimulated saliva, clear and colorless
    – Resting or mixed saliva- frothy

    Serous cells – has zymogen granules
    Mucous cells – mucous cells
Functions of saliva
              Effect                      Component
Protection    Lubrication                  Glycoprotein, mucin
              Water proofing
              Lavage
              Pellicle formation



Buffering    Maintains pH unsuitable       Phosphate, bicarbonate
             for microbial colonization    Sialin
             Neutralizes acid

Digestion    Bolus formation              water
             Neutralizes esophageal       Phosphate, carbonate
             contents                     protease, lipase, ribonuclease
             Digest starch                Amylase
Functions of saliva

                   Effect                     Component
Taste             Solution of molecules       Water
                  Taste bud growth and        Gustin
                  maturation



Antimicrobial     Barrier                     Glycoprotein
                  Antibodies                  Immunoglubulin A
                  Hostile environment         Lysozyme, Lactoferrin

Tooth integrity   Enamel maturation           Calcium, Phosphate
• Masticatory salivary reflex
• Gustatory salivary reflex

• Symphathetic – Noradrinalin – constric salivary gland duct – decrease secretion
• Parasymphathetic – acetylcholine – dilates salivary duct – increase secretion



• Calcium binding proteins
   – Statherin – prevents formation of calcified masses
   – Proline rich proteins – acidic, inhibit Ca PO4 nucleation – prevents calcular deposits
• Salivary proteins with antimicrobial action
  –   Immunoglobulin - aggregation
  –   Mucin – agglutination
  –   Lysosyme – autolysis
  –   Lactoferrin
  –   Peroxidase – block essential metabolic process

  Growth factors in saliva
  – Epidermal growth factors – wound healing
  – NGF – stimulates ganglionic factor
  – Transforming GF – differentiation and growth
  – Fibroblast growth factor – woung healing
•    Diagnostic tests
    – Calorimeter test – caries susceptivility test
        a. Hyd ion test - indicate pH – pink, brown, blue
        b. Methyl red test – acts as disclosinh solution
        c. Snyder test - chew food- inoculate test 24, 48, 72 hrs.
                     if turns yellow – acidic
    2. Microbial test
        a. Bacteriologic test
    3. Chemical test - flouride
Growth Factors in SALIVA
• a. Epidermal Growth Factor- wound healing
                 effect; mucosal defense barrier
• b. Nerve Growth Factor- stimulating effect on
                 ganglionic factor.
• c. Transforming Growth Factor- causes cell
                 differentiation & growth
• d. Fibroblast Growth Factor- regulator of wound
                 healing
Mouth and Clinical Examination
• 1. soft tissue
      •   Posterior
      •   Superior
      •   Lateral
      •   Anterior
• 2. individual tooth examination (DMFT)
Mastication
Control of mastication
• Voluntary Movements- result of deliberate
           effort and will.
• Reflex Movements- programmed in CPG
                 -fine-ture voluntary movements
Reflex Movements
•   Stretch reflex from muscle spindles- maintain
      the posture of the jaw in its rest position
•   Periodontal Reflex- give sensation about
    pressure on the teeth (pacinian corpuscles)
      - guide teeth into occlusion during the
    grinding phase as teeth slide across each other
      towards occlusal position
3. Tendon organ reflexes- monitor the force exerted
     by a number of different motor units during
  weak contractions.

4. Joint Reflexes- signal extremes of movement (e.g
      opening, protrusion, or lateral excursion) that
      oppose movement beyond safe limit.
Cyclical Movements
    -rhythmic and well-controlled functional
    mandibular movements due to
 proprioceptors and nociceptors that receive
    stimuli.
Chewing stroke
     -basic unit of mastication
     -represents each cycle of opening and closing
     movements of the mandible.
 1. opening phase- downward with slight lateral
     movement of the mandible.
 2. closing phase
           a. crushing phase- initial upward
                 movement of mandible
           b. grinding phase
           c. chopping type
Tooth Contacts during mastication
Single tooth contact
     -tooth contact B
     -occurs in the maximum intercuspal position
Gliding tooth contact
     -occurs as the cuspal inclines of the stamp
  cusp pass by each other during the opening
  (56%) and grinding phase ( 60%) of mastication
Stages of Mastication
•   Incision stage- performed by incisors to cut food into
    smaller pieces
•   Direct crushing stage- buccal inclines of maxillary
    stamp cusps pass over lingual inclines of mandibular
    stamp cusps to tear food into morsels.
•   Trituration stage- performed by molars to grind food
    ready for swallowing
Factors that affect Forces of Mastication
1. Gender
            female- 35.8 - 44.4 kg
            male- 53.6 - 64.4 kg
2. Tooth
            incisor- 13.2 - 23.1 kg
            molar- 41.3 – 89.8 kg
4. Type of food
5.Age and Diet
6. Dentition (dentulous, edentulous, partial edentulous)
7. Craniofacial morphology - brachycephalic, dolichocephalic
8. Masticatory muscle size - masseter
Factors that affect Chewing stroke
1. quality & quantity of tooth contacts
             -more tooth contacts , smaller chewing strokes
2. occlusal condition of teeth
             -flat occlusal table- broader chewing stroke
             -tall cusps with deep fossa- predominantly
             vertical chewing stroke.
3. TMJ
             -normal TMJ- well rounded strokes with definite
             borders and less repeated
             -painful TMJ- repeated pattern & shorter strokes,
             slower & irregular pattern
Swallowing
Types

1. Infantile or Visceral swallowing
      a. mandible is stabilized by placing the tongue
      forward & between the gumpads
      b.
      c. occurs until posterior primary teeth errupt to
      assume somatic or mature swallow
    -approximately before 2 years old
2. Mature or Somatic swallowing

     -requires maximum intercuspation
     a. mandible is stabilized by maximum
 intercuspation of teeth.
     most important tooth contact: single tooth contact
           (tooth contact B)
     b. normal oral seal
Types of Swallowing
1. Bucco-pharyngeal phase
     -voluntary movement from oral cavity to pharynx
   (oropharynx)

   Space of Donder- where the bolus is placed
          - space between tongue & palate (when
          tongue is elevated)
    -ends when tongue goes down.
2. Pharyngo-esophageal phase
     -involuntary movement from pharynx to
  esophagus
     epiglottis- most important structure to prevent
                 choking
               - closes the oropharynx
               - closes the airway during
                 swallowing

  “during choking, food enters the larynx therefore bolus blocks
  larynx.”
3. Esophagus to Stomach
      -peristaltic movement of esophagus
      -involuntary
    regurgitation-movement of bolus from esophagus
            to oral cavity
    vomiting-movement of chyme from stomach to
      esophagus to oral cavity
              -pressure is in stomach
  GERD (Gastro-esophageal Reflux Disease)
      oral significance: increase susceptibility to
  caries (acid reflux)
Frequency of Swallowing
-  approximately 590 times a day
     a. 146- while eating
     b. 394- between meals while awake
     c. 50-while sleeping
Unique Features:
6.   Occurs as early as intrauterine life.
7.   Occurs at the end of respiratory phase.
8.   Occurs even in the absence of food.
9.   Most frequently repeated activity of the masticatory system.
Speech
Processes involved
• respiration- major physiology for speech
• resonance- paranasal sinuses
• articulation
     a. lips- come together and touch to produce
   M,             B, P sounds
     b. teeth- incisal edges of anterior teeth
          approximate each other to produce “Sh”
          sound
     c. tongue & palate- tip of tongue touches
          palate behind incisors to produce D sound
d. tongue and teeth- tongue touches upper
             incisors to produce Th and S sound.
      e. lip & teeth- lower lip touches incisal edges
             of upper incisors to make F & V
             sound.
      f. tongue & soft palate- posterior portion of
             tongue touches soft palate to make K &
             G sound.
4. verbalization

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Occlusion

  • 1. Temporomandibular Joint and related structures • Claver O. Acero Jr. DMD, PhD
  • 2. (Functional Occlusion system) N ervous system N eurom uscular TM J D entition
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  • 13. PHYSIOLOGIC CHARACTERISTICS OF THE TEETH 1. Growth a. Initiation (6th wk. of intrauterine life) b. proliferation c. histodifferentiation & morphodifferentiation d. apposition or critical calcification 2. Calcification Nollas stages of calcification
  • 14. Nolla’s Stages of tooth calcification
  • 15.
  • 16. 3.Eruption Active eruption Passive eruption- attrition, lost of opposing Parameters of eruption Assignment -time of eruption -sequence of eruption 4. Resorption & exfoliation of primary teeth primary teeth only, 5. Attrition
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  • 20. Favorable sequence of eruption for permanent dentition
  • 21.
  • 22. Dentitional Period & Occlusal Development I.Primary dentitional period (fr. 6 mos. to 5 years) start from 6 mos. Completed at 24 to 30 months General Characteristics 1. Crown proportion 2. Molar relationship. Flush terminal plane 3. Anterior interdental spaces & primate spaces 4. Overbite & overjet
  • 23. Sequence of eruption of Primary teeth A B D C E A B D C E
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  • 30.
  • 31. Dentitional Period & Occlusal Development I.Primary dentitional period (fr. 6 mos. to 5 years) start from 6 mos. Completed at 24 to 30 months General Characteristics 1. Crown proportion 2. Molar relationship. Flush terminal plane 3. Anterior interdental spaces & primate spaces 4. Overbite & overjet
  • 32.
  • 33.
  • 34. Dentitional Period & Occlusal Development I.Primary dentitional period (fr. 6 mos. to 5 years) start from 6 mos. Completed at 24 to 30 months General Characteristics 1. Crown proportion 2. Molar relationship. Flush terminal plane 3. Anterior interdental spaces & primate spaces 4. Overbite & overjet
  • 35.
  • 37. II. Mixed Dentitional Period (transitional period) -from 6 years to 13 years Characteristics: a.Early Mixed • Distal flaring of upper anteriors • End to end molar relationship • Transient anterior crowding of lower anterior teeth b. Late mixed dentition *space closed because of erupting canine *crossbite/negative overbite *zero overbite *posterior overbite
  • 38.
  • 39.
  • 40. II. Mixed Dentitional Period (transitional period) -from 6 years to 13 years Characteristics: a.Early Mixed • Distal flaring of upper anteriors • End to end molar relationship • Transient anterior crowding of lower anterior teeth b. Late mixed dentition *space closed because of erupting canine *crossbite/negative overbite *zero overbite *posterior overbite
  • 41.
  • 42.
  • 43.
  • 44. II. Mixed Dentitional Period (transitional period) -from 6 years to 13 years Characteristics: a.Early Mixed • Distal flaring of upper anteriors • End to end molar relationship • Transient anterior crowding of lower anterior teeth Late mixed dentition *space closed because of erupting canine *crossbite/negative overbite *zero overbite *posterior overbite
  • 45.
  • 46. II. Mixed Dentitional Period (transitional period) -from 6 years to 13 years Characteristics: a.Early Mixed • Distal flaring of upper anteriors • End to end molar relationship • Transient anterior crowding of lower anterior teeth Late mixed dentition *space closed because of erupting canine *crossbite/negative overbite *zero overbite *posterior overbite
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  • 51.
  • 52. Incisor liability ( 8 -9 year old) 1.6 mm in the mandible
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  • 62. How we overcome incisor liability 1. Slight increase in arch width 2. Labial positioning of permanent incisor relative to primary incisor 3. Repositioning of canines in the mandibular arch 4. Continued development of the arches improves spacing.
  • 64. Favorable sequence of eruption for permanent dentition
  • 65. III. Permanent Dentitional Period General characteristics 3. Normal surface contact 4. Normal cuspid to fossa relationship 5. Normal triangular ridge to embrassure or groove contact TOOTH CONTACTS -stamp cuspids -shear cuspids
  • 66. Six Keys to occlusion by Lawrence Andrew
  • 67. Key I. Molar Relationship
  • 68. Key II. Crown Angulation ( Tip )
  • 69. Key III. Crown Inclination ( labiolingual or buccolingual inclination, torque)
  • 71. Key V. Tight contacts.
  • 73.
  • 74. Significance of ABC contacts • Concept of Tripodization Function of tooth contacts c. Prevent horizontal or lateral drift of the teeth buccolingually d. Prevent mesial & distal drifting
  • 78. Concepts of occlusion • Balanced occlusion • Mutual protection • Canine protected occlusion • Multiple group function occlusal contacts
  • 79. Chewing pattern • Chopping type chewing • Crushing type chewing
  • 80. Normal buccolingual arch relationship
  • 84. Basic mandibular positions • Centric relation • Maximum Intercuspation • Centric occlusion • Centric relation of occlusion • Physiologic rest position PRP- VDO =FWS
  • 85. Directional movement of the Mandible • Bilateral movement – condyle move at same direction and dimension • Unilateral movements- working and nonworking side
  • 86. Bilateral Directional movement of the mandible Rotation Translation Elevation upward backward & upward Depression downward forward & downward Protrusion downward forward Retrusion
  • 87. Salivary glands • Parotid gland – Stensens duct • Submandibular gland – Wartons duct • Sublingual gland – Bartolins duct • Minor: – Mucous glands: glossopalatine glands, palatin glands, anterior 2/3 of tongue, posterior 1/3 of tongue – Mixed: retromolar, labial, buccal mucosa. – Serous: salivary protein and amylase – Von Ebner gland: beside circumvalate papilla to clean the papilla.
  • 88.
  • 89. Salivary glands • Parotid gland – Stensens duct • Submandibular gland – Wartons duct • Sublingual gland – Bartolins duct • Minor: – Buccal and Labial glands – Palatoglossal glands – pharyngeal isthmus – Palatal glands- soft and hard palate – Anterior lingual glands- embedded w/in muscle in ventral surface of tongue – Posterior gland - root of the tongue – Von Ebner gland: empty- trench of circumvalate papilla to clean the papilla. serous
  • 90. Properties • 99 percent water 1 percent inorganic and organic • 5.6 to 7.6 pH • 1.002 to 1.008 specific. Gravity • Frothy, colorless or slightly opalescent, odorless • 1 t 1.5 liters a day Types of Saliva – Pure or active – stimulated saliva, clear and colorless – Resting or mixed saliva- frothy Serous cells – has zymogen granules Mucous cells – mucous cells
  • 91. Functions of saliva Effect Component Protection Lubrication Glycoprotein, mucin Water proofing Lavage Pellicle formation Buffering Maintains pH unsuitable Phosphate, bicarbonate for microbial colonization Sialin Neutralizes acid Digestion Bolus formation water Neutralizes esophageal Phosphate, carbonate contents protease, lipase, ribonuclease Digest starch Amylase
  • 92. Functions of saliva Effect Component Taste Solution of molecules Water Taste bud growth and Gustin maturation Antimicrobial Barrier Glycoprotein Antibodies Immunoglubulin A Hostile environment Lysozyme, Lactoferrin Tooth integrity Enamel maturation Calcium, Phosphate
  • 93. • Masticatory salivary reflex • Gustatory salivary reflex • Symphathetic – Noradrinalin – constric salivary gland duct – decrease secretion • Parasymphathetic – acetylcholine – dilates salivary duct – increase secretion • Calcium binding proteins – Statherin – prevents formation of calcified masses – Proline rich proteins – acidic, inhibit Ca PO4 nucleation – prevents calcular deposits
  • 94. • Salivary proteins with antimicrobial action – Immunoglobulin - aggregation – Mucin – agglutination – Lysosyme – autolysis – Lactoferrin – Peroxidase – block essential metabolic process Growth factors in saliva – Epidermal growth factors – wound healing – NGF – stimulates ganglionic factor – Transforming GF – differentiation and growth – Fibroblast growth factor – woung healing
  • 95. Diagnostic tests – Calorimeter test – caries susceptivility test a. Hyd ion test - indicate pH – pink, brown, blue b. Methyl red test – acts as disclosinh solution c. Snyder test - chew food- inoculate test 24, 48, 72 hrs. if turns yellow – acidic 2. Microbial test a. Bacteriologic test 3. Chemical test - flouride
  • 96. Growth Factors in SALIVA • a. Epidermal Growth Factor- wound healing effect; mucosal defense barrier • b. Nerve Growth Factor- stimulating effect on ganglionic factor. • c. Transforming Growth Factor- causes cell differentiation & growth • d. Fibroblast Growth Factor- regulator of wound healing
  • 97. Mouth and Clinical Examination • 1. soft tissue • Posterior • Superior • Lateral • Anterior • 2. individual tooth examination (DMFT)
  • 98. Mastication Control of mastication • Voluntary Movements- result of deliberate effort and will. • Reflex Movements- programmed in CPG -fine-ture voluntary movements
  • 99. Reflex Movements • Stretch reflex from muscle spindles- maintain the posture of the jaw in its rest position • Periodontal Reflex- give sensation about pressure on the teeth (pacinian corpuscles) - guide teeth into occlusion during the grinding phase as teeth slide across each other towards occlusal position
  • 100. 3. Tendon organ reflexes- monitor the force exerted by a number of different motor units during weak contractions. 4. Joint Reflexes- signal extremes of movement (e.g opening, protrusion, or lateral excursion) that oppose movement beyond safe limit.
  • 101. Cyclical Movements -rhythmic and well-controlled functional mandibular movements due to proprioceptors and nociceptors that receive stimuli.
  • 102. Chewing stroke -basic unit of mastication -represents each cycle of opening and closing movements of the mandible. 1. opening phase- downward with slight lateral movement of the mandible. 2. closing phase a. crushing phase- initial upward movement of mandible b. grinding phase c. chopping type
  • 103. Tooth Contacts during mastication Single tooth contact -tooth contact B -occurs in the maximum intercuspal position Gliding tooth contact -occurs as the cuspal inclines of the stamp cusp pass by each other during the opening (56%) and grinding phase ( 60%) of mastication
  • 104. Stages of Mastication • Incision stage- performed by incisors to cut food into smaller pieces • Direct crushing stage- buccal inclines of maxillary stamp cusps pass over lingual inclines of mandibular stamp cusps to tear food into morsels. • Trituration stage- performed by molars to grind food ready for swallowing
  • 105. Factors that affect Forces of Mastication 1. Gender female- 35.8 - 44.4 kg male- 53.6 - 64.4 kg 2. Tooth incisor- 13.2 - 23.1 kg molar- 41.3 – 89.8 kg 4. Type of food 5.Age and Diet 6. Dentition (dentulous, edentulous, partial edentulous) 7. Craniofacial morphology - brachycephalic, dolichocephalic 8. Masticatory muscle size - masseter
  • 106. Factors that affect Chewing stroke 1. quality & quantity of tooth contacts -more tooth contacts , smaller chewing strokes 2. occlusal condition of teeth -flat occlusal table- broader chewing stroke -tall cusps with deep fossa- predominantly vertical chewing stroke. 3. TMJ -normal TMJ- well rounded strokes with definite borders and less repeated -painful TMJ- repeated pattern & shorter strokes, slower & irregular pattern
  • 107. Swallowing Types 1. Infantile or Visceral swallowing a. mandible is stabilized by placing the tongue forward & between the gumpads b. c. occurs until posterior primary teeth errupt to assume somatic or mature swallow -approximately before 2 years old
  • 108. 2. Mature or Somatic swallowing -requires maximum intercuspation a. mandible is stabilized by maximum intercuspation of teeth. most important tooth contact: single tooth contact (tooth contact B) b. normal oral seal
  • 109. Types of Swallowing 1. Bucco-pharyngeal phase -voluntary movement from oral cavity to pharynx (oropharynx) Space of Donder- where the bolus is placed - space between tongue & palate (when tongue is elevated) -ends when tongue goes down.
  • 110. 2. Pharyngo-esophageal phase -involuntary movement from pharynx to esophagus epiglottis- most important structure to prevent choking - closes the oropharynx - closes the airway during swallowing “during choking, food enters the larynx therefore bolus blocks larynx.”
  • 111. 3. Esophagus to Stomach -peristaltic movement of esophagus -involuntary regurgitation-movement of bolus from esophagus to oral cavity vomiting-movement of chyme from stomach to esophagus to oral cavity -pressure is in stomach GERD (Gastro-esophageal Reflux Disease) oral significance: increase susceptibility to caries (acid reflux)
  • 112. Frequency of Swallowing - approximately 590 times a day a. 146- while eating b. 394- between meals while awake c. 50-while sleeping Unique Features: 6. Occurs as early as intrauterine life. 7. Occurs at the end of respiratory phase. 8. Occurs even in the absence of food. 9. Most frequently repeated activity of the masticatory system.
  • 113. Speech Processes involved • respiration- major physiology for speech • resonance- paranasal sinuses • articulation a. lips- come together and touch to produce M, B, P sounds b. teeth- incisal edges of anterior teeth approximate each other to produce “Sh” sound c. tongue & palate- tip of tongue touches palate behind incisors to produce D sound
  • 114. d. tongue and teeth- tongue touches upper incisors to produce Th and S sound. e. lip & teeth- lower lip touches incisal edges of upper incisors to make F & V sound. f. tongue & soft palate- posterior portion of tongue touches soft palate to make K & G sound. 4. verbalization