The presentation features the types and stages of deglutition; types, etiology, classification, diagnosis, clinical findings and management of tongue thrusting.

1. STAGES OF DEGLUTITION
AND
TONGUE THRUSTING
Submitted by:-
Musavvar Mansoor
Ranjeet Dhonkal
B.D.S. final yr
Department of Pedodontics
Govt. College of Dentistry, indore

2. DEFINITION---THE SERIES OF CO-
ORDINATED MUSCLE CONTRACTION
THAT MOVES A BOLUS OF FOOD FROM
THE ORAL CAVITY THROUGH THE
ESOPHAGUS TO THE STOMACH.
IT IS AN IMPORTANT FUNCTION
CARRIED OUT BY STOMATOGNATHIC
SYSTEM.
DEGLUTIOTION

3. TYPES
 INFANTILE SWALLOW PATTERN
 MATURE OR ADULT SWALLOW
PATTERN

4. INFANTILE SWALLOWING
Infants swallow food by suckling. This
is an autonomic reflex in human
beings.
Development of swallowing begins
around 12.5 wks of intrauterine life.
Full swallowing and sucking is
established by 32-36 wks of IU life.
Sucking and swallowing reflexes are
present in a full term baby and their
absence would suggest a
developmental defect.

5. MECHANISM
Breastfeeding
Infant lips closed around the areola of the breast.
Tongue protrudes to the lower lip and forms a spoon like
closure around nipple.
Relaxation of the elevator muscles of the mandible
Mouth is open wide
Milk is directed to the pharynx by the peristaltic movement of
the tongue.

6. MATURE SWALLOWING PATTERN
Mature swallow develops around 4-5 yrs.
Maturation of swallow pattern occurs with
the addition of semi-solid and solid food
to the diet.
It is characterized by the relaxation of the
lips, placement of the tongue behind the
maxillary incisors and elevation of the
mandible until posterior teeth are in
contact.

7. TONGUE MUSCULATURE
EXTRINSIC MUSCLES:- Genioglossus
muscle.
Styloglossus
muscle.
palatoglossus
muscle.
Hyoglossus muscle.
INTRINSIC MUSCLES:-
Superior longitudinal muscle
Inferior longitudinal muscle

9. As person swallows the of the tongue
contact the:-
Tooth surface.
Rugae areas.
Adjacent to rugae.
Vault.
Soft palate.
And Swallowing of bolus occurs.

10. STAGES
Oral stage/ First stage
Pharyngeal stage/ Second stage
Oesophageal stage/Third stage

11. ORAL STAGE
Voluntary stage
Food move into pharynx from mouth.
Positive pressure created at posterior part
Posterior part is elevated and retracted against hard palate.
Anterior part of tongue is retracted and depressed.
Bolus is placed on posterodorsal surface of tongue.

12. Pharyngeal stage
Involuntary stage
Bolus moves into esophagus
Peristalsis contraction of pharynx
Upper3-4 cm of esophagus relaxes
Stretching of esophagus due to upward movement of larynx

13. ESOPHAGEAL STAGE
Bolus entered to stomach.
Relaxation of lower esophageal sphincter
Bolus enters the lower part of esophagus
Bolus is propel down
Initiation of peristalsis in esophagus.

15. TONGUE THRUSTING

16. DEFINITION
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.

17.  BARBER (1975):- Tongue thrust is
an oral habit pattern related to the
persistence of infantile swallow
pattern during childhood and
adolescence and thereby produces
an open bite and protrusion of the
anterior tooth segment.

18. CLASIFICATION 1
By JAMES and HOLT
TYPE 1:- Non deforming tongue thrust.
TYPE 2:- Deforming anterior tongue
thrust.
Anterior open bite.
Anterior proclination.
Posterior cross bite .
TYPE 3:- Deforming lateral tongue
thrust.
Posterior open bite.

19. TYPE 4:- Deforming anterior and
lateral tongue thrust.
Anterior and posterior open bite.
Proclination of anterior teeth.
Posterior cross bite.

20. SIMPLE TONGUE THRUST
The simple tongue thrust is
characterized by normal
tooth contact during
swallowing.
Presence of an anterior
open bite.
They exhibit good
intercuspation of teeth.
The tongue is thrust
forward during swallowing
to help establish an anterior
lip seal.

21. LATERAL TONGUE THRUST
Posterior
open bite
with tongue
thrusting
laterally.

22. COMPLEX TONGUE
THRUST
It is characterized by
teeth apart during
swallowing.
Anterior open bite can
be diffuse or absent.
Absence of temporal
muscle contraction
during swallowing.
Contraction of
circumoral muscle
during swallowing.
The occlusion of the
teeth may be poor..

23. CLASSIFICATION 3
PHYSIOLOGICAL
This comprises the normal tongue thrust
swallow of infancy.
HABITUAL
The tongue thrust swallow is present as a
habit even after the correction of the
malocclusion.
FUNCTIONAL
When the tongue thrust mechanism is an
adaptive behavior developed to achieve
an oral seal.

24. ANATOMIC
Person having enlarged tongue can
have an anterior tongue posture.

25. ETIOLOGY
Retained infantile swallow
During infantile swallow the tongue is
placed between the gum pads. After 6
months of age several maturational
movements occur that alters the
functioning of orofacial musculature.
With the arrival of the incisors the tongue
assumes a retracted position. If the
transition of the infantile swallow to the
mature swallow do not take place with
the eruption of incisors then tongue
thrusting develops.

26. UPPER RESPIRATORY TRACT
INFECTION
Mouth breathing.
Chronic tonsillitis.
Allergy.
NEUROLOGICAL DISTURBANCES
Hyposensitive palate.
Moderate motor disability.
Disruption of sensory control and
coordination of swallowing.
 FUNCTIONAL ADAPTIBLITY TO
TRANSIENT CHANGE IN ANATOMY.

27. FEEDING PRACTICES
Bottle feeding.
Consistency of infant diet.
INDUCED DUE TO OTHER ORAL
HABITS
Thumb and finger sucking
HEREDITARY
Inherited hyperactivity of orbicularis oris
with specific anatomic configuration and
neuromuscular activity.
TONGUE SIZE
Congenital aglossia.

28. EXTRAORAL
FINDINGSLIP POSTURE
Greater lip separation.
MANDIBULAR MOVEMENTS
 More erratic movements and no in coordination
between tongue tip and mandible itself.
 The average path of mandibular movement is
upward and backward with the tongue moving
forward.
SPEECH
 Sibilant distortions
 Lisping
 Problems in articulation of S, N, T, D, I, Th, Z, V,
Ph, Sh sounds.
 FACIAL FORM

29. INTRAORAL FINDINGS
TONGUE MOVEMENTS:- jerky and
irregular
TONGUE POSTURE:- lowered tongue tip.
MALOCCLUSION:-
 Proclination of maxillary anteriors.
Generalized spacing between teeth.
Maxillary constriction.
Retroclination or proclination of mandibular
teeth.
Anterior open bite
Posterior open bite
Posterior cross bite.

30. ANTERIOR
OPEN BITE
POSTERIOR
OPEN BITE

31. POSTERIOR
CROSS BITE
ANTERIOR
CROSS BITE

32. DIAGNOSIS
 History taking
 Examination

33. TREATMENT
TRAINING OF CORRECT SWALLOW AND
POSTURE OF THE TONGUE:-
{A} Myofunctional exercises
1. Child is asked to place the tip of tongue in rugae area
for 5 min and then swallow.
2. Orthodontic elastics and sugar less fruit drop
exercise.
3. 4S exercise:- includes
 Identifying the spot
 Salivating
 Squeezing the spot
 Swallowing
4 Other exercises:-
 whistling
 Reciting the count from 60-69
 Gargling

34. {B} Using appliance as a guide
Preorthodontic trainer Nance palatal arch

35. SPEECH THERAPY:-
It is not indicated before the age of 8 yrs.
To pronounce words beginning with s and
repeat s.
Multiplication table of 6.

36. MECHANOTHERAPY
Fixed and removable appliance-
 To restrain the anterior tongue
movements
 To force the tongue downward and
backward
 To reeducate the tongue position.
Removable appliance therapy- Hawley's
appliance

37. Removable appliance therapy-
Hawley's appliance

38. Trans palatal arch

39. Oral screen- modified acrylic
plate used to control muscles
forces both inside and outside
the dental arches

40. TONGUE CRIB
For posterior open bite modified
cribs is used

41. CORRECTION OF MALOCLUSION
SURGRICAL TREATMENT-
orthognathic surgical procedure for
correction of skeletal malformation.

42. THANK YOU