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BDS2 - BAMS > oral functions 4 - aerodigestive tract reflexes and speech > Flashcards

oral functions 4 - aerodigestive tract reflexes and speech Flashcards

1
Q

what are the 3 stages in swallowing

A
  • buccal phase = voluntary
  • pharyngeal phase = involuntary
  • oesophageal = involuntary
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2
Q

what is swallowing

A
  • process by which the accumulated food bolus is transported through the lower pharynx and oesophagus to the stomach (feeding function)
  • prevents ingested material from entering the lower airway (protective function)
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3
Q

how is bolus formed

A
  • the water in saliva allows the bolus to stick together to be swallowed
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4
Q

why is swallowing potentially dangerous

A
  • because the ‘food-way’ crosses the airway
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5
Q

how are liquids swallowed

A
  • liquids are gathered on the tongue, anterior to the pillars of the fauces
  • the mouth is separated from the pharynx by a posterior oral seal = this doesn’t happen with solid bolus
  • the liquid bolus is then propelled through the oropharynx and hypo pharynx and then into the oesophagus
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6
Q

how is solid bolus swallowed

A
  • chewed food material accumulates on the pharyngeal part of the tongue and vallecula (oropharynx)
  • there is no true posterior oral seal
  • the bolus is then propelled from the tongue through the hypo pharynx and then into the oesophagus
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7
Q

what are some key points of swallowing

A
  • liquids are swallowed from the mouth = oral seal
  • solids are swallowed from the oropharynx = no oral seal
  • both are mixed rapidly through the hypo pharynx past the laryngeal inlet
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8
Q

what do tongue movements do in swallowing

A
  • the forward movement of the tongue during the occlusal and initial opening phases creates a contact between the tongue and hard palate
  • the contact zone moves progressively backwards, squeezing the processed food through the fauces
  • tongue breaks up the bolus to be swallowed in smaller amounts
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9
Q

what are the swallowing events

A
  • propulsion of food
  • prevention of reflux
  • protecting the airway
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10
Q

what is the duration of the masticatory sequence

A
  • the duration varies with the different extents of food consistency
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11
Q

how strong are swallowing forces

A
  • these are strong enough to move bolus up hill or down hill
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12
Q

how is reflux prevented

A
  • elevation of the soft palate
  • tongue (sides) contacts pillars of fauces
  • tongue (dorsal) contacts posterior pharyngeal wall
  • upper oesophageal sphincter stops reflux from oesophagus into pharynx
  • lower oesophageal sphincter stops reflux from stomach into oesophagus
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13
Q

how can erosion occur

A
  • stomach acid can erode teeth by reflux, vomitting, regurgitation and rumination
  • when palatal surface erosion is present, 2/3 of the time stomach acid is responsible = causes cupping on the palatal surface - is intrinsic erosion
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14
Q

how can you prevent fizzy drinks causing erosion

A
  • patients will not stop drinking these even if asked

- instead need to suggest that they drink them with a straw or only at mealtimes to lessen damage

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15
Q

what are other types of tooth surface loss than erosion

A
  • attrition
  • abrasion
  • abfractions
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16
Q

what is attrition

A
  • is tooth wear occlusally caused by contact between occluding teeth
  • the teeth inter-digitate indication that attrition is occurring
  • there are equal amounts between upper and lower
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17
Q

what is abrasion

A
  • occurring on its own is unusual = might be caused by biting or chewing objects between the teeth
  • the most common presentation of tooth wear it the result of a combined lesion involving erosion and abrasion
  • acids weaken the outer 3-5 microns of mineralised tissue and increase the susceptibility of the enamel and dentine to abrasion from tooth brushing with or without toothpaste
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18
Q

what is abfraction

A
  • stress lesion s
  • wedge-shaped notch caused by the flexure and ultimate material fatigue of susceptible teeth at locations away from the point of loading
  • the breakdown is dependant on the magnitude, duration, frequency and location of occlusal forces
  • premolars are specifically at risk due to high occlusal load here
19
Q

how is the airway protected during swallowing

A
  • upward and forward movement of larynx
  • closure of laryngeal inlet = aryepiglottic muscles, epiglottis
  • adduction of vocal folds = movement of them towards midline of body, or towards other part
  • stop breathing = apnoea
20
Q

what is dysphasia

A
  • sometime called aphasia
  • a specific language disorder
  • involving damage to particular parts of the brain = Broca’s area and Wernick’s area
21
Q

what is dysphagia

A
  • difficulty/inability to swallow
22
Q

what is odynophobia

A
  • pain on swallowing
  • a pathological condition in which the affected person experiences extreme pain when swallowing be it foods, liquids, drugs
23
Q

what is dysarthria

A
  • difficulty speaking that is caused by problems with the muscle used in speech
  • due to neuro-muscular defects = important to notice these in a patient as can affect treatment - e.g. dentures
24
Q

what are some oral causes of language and speech defects

A
  • malocclusions
  • loss of teeth and denture
  • cleft lip/palate
  • tongue related issues
  • dry mouth
25
Q

what is malocclusions

A
  • e.g. anterior open bite
  • caused by digit sucking as a baby
  • tongue thrust
  • skeletal origin
26
Q

what can cleft lip/palate do to speech

A
  • oral and nasal cavities are not separated
  • speech as a ‘nasal’ quality
  • palatal defect has to be repaired or filled with an obturator
27
Q

what are some tongue related issues with speech

A
  • tongue tie = easy fix
  • partial atrophy = tongue not completed
  • tongue stud
28
Q

what does dry mouth do

A
  • xerostomia
  • one of the serious repercussions of dry mouth if impeded speech
  • wit inadequate saliva production, pronouncing words becomes difficult
  • people who have dry mouth and difficulty speaking cannot simply swallow and start talking normally
29
Q

what is torus mandibularis/tori

A
  • does not affect speech of languor but can affect RPD’s
  • have to change design to accommodate if patient doesn’t want them removed
  • they are just lumps in the mouth - benign
  • also get it on the palate (torus platinus) = need to deist a horseshoe denture to accommodate it
30
Q

what are some denture related issues for speech

A
  • problems mainly arise from restricted tongue space
  • denture base can be too thick
  • artificial teeth may not be set properly
31
Q

how does the tongue need to be situated to make ‘s’ sounds

A
  • the polished surface is correctly shaped so the tongue can form narrow channel in the midline for producing the ‘s’ sound
32
Q

how is the sound ‘sh’ made

A
  • excessive thickening of the palate laterally prevents close adaptation of the tongue to the palate so that the ‘s’ becomes a ‘sh’
33
Q

what can happen to prevent sounds ‘f’, ‘v’ and ‘ph’ being made properly

A
  • wrong occlusal planes may mean pronouncing these sounds wrong = labio-dental sounds
  • dentures must be fabricated to a morphology that does not cause interference with tongue/lip/cheek movement
34
Q

what can happen if loss of teeth

A
  • loss of anterior teeth may present the clear reproduction of certain sounds particularly ‘f’ and ‘v’ which are made by the lower lip contacting the edges of the maxillary incisors
  • the replacement of missing upper teeth make a significant contribution to quality of speech
35
Q

how are ‘f’ ‘v’ and ‘ph’ sounds made

A
  • the lips of the maxillary incisor teeth should touch the vermilion border of the lip during fricative sounds
36
Q

how is speech assessed after replacing missing teeth

A
  • the tone of the lips and cheeks may be assessed by asking fundamental questions such as address, family etc
  • this will indicate the functional relationship of the lips and tongue to dentures in speech
37
Q

why must musical instruments be considered when replacing missing teeth

A
  • the aerodigestbive tract and facial tissues produce vocal sounds and also contribute to the playing of wind instruments
  • dentists should be aware of the implications of oral an dental disease, and treatments, in patients who are musicians
38
Q

what factors influence the final choice of treatment fro missing teeth for musicians

A
  • cost
  • effects on adjacent teeth
  • aesthetics
  • function = embouchure is important as a musician
39
Q

what is embouchure

A
  • the position and use of lips, tongue and teeth in playing a wind instrument
  • vary between player and instrument
40
Q

what instruments have an intra-oral mouthpiece

A
  • single-reed = clarinet, saxophone

- double reed = oboe, bassoon

41
Q

what instruments have extra oral mouthpieces

A
  • piccola, flute

- trumpet, horn, trombone, tuba

42
Q

what changes in the mouth when playing ‘high’ and ‘low’ sounds

A
  • position of mouthpiece relative to teeth
  • mouth opening
  • relation of jaws
  • position of hyoid bone
  • position of dorsum of tongue
43
Q

why must you consider denture design when treating musicians

A
  • for example trumpet mouthpiece is usually entered on the lips
  • it tends to move all from teeth backwards
  • wind instrument players may have special needs in respect to the retention of the appliance and placement of teeth
44
Q

what are issues for musician and dentists for treatment

A
  • teeth = restorations, loss and replacement, aesthetic dentistry
  • tongue
  • facial muscles = lip, cheeks

BDS2 - BAMS (18 decks)

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