Oral functions - speech Flashcards
What are the 3 stages of swallowing called?
- buccal phase (voluntary)
- pharyngeal stage (involuntary)
- esophageal stage (involuntary)
What are the two purposes of swallowing
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)
Why is swallowing potentially dangerous
the ‘foodway’ crosses the ‘airway’
How are liquids swallowed
- 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
- The liquid ‘bolus’ is then propelled through the oro- and hypo-pharynx, and then into the oesophagus
How are ‘solid’ bolus’s swallowed
- Chewed food material accumulates on the pharyngeal part of tongue and vallecula (oro-pharynx).
THERE IS NO TRUE POSTERIOR ORAL SEAL
- The ‘bolus’ is then propelled from the tongue through the hypo-pharynx, and then into the oesophagus
Where are liquids swallowed from
the mouth proper
Where are solids swallowed from
the oro-pharynx
When swallowing liquids do you have an oral seal
yes
When swallowing solids do you have an oral seal
no
What is similar between liquids and solids with how they are swallowed
both are moved rapidly through the hypophyarynx past the laryngeal inlet
The forward movement of the tongue during the occlusal and initial opening phases creates
a contact between the tongue and the hard palate.
The contact zone moves
progressively backwards, squeezing the processed food through the fauces.
What is this mechanism called?
the squeeze-back mechanism
Describe the squeeze back mechanism
The forward movement of the tongue during the occlusal and initial opening phases creates
a contact between the tongue and the hard palate.
The contact zone moves
progressively backwards, squeezing the processed food through the fauces.
What events happen during swallowing
- propulsion of food
- prevention of ‘reflux’
- protecting the airway
What causes the duration of masticatory sequence to vary
food consistency
How strong are swallowing forces
very strong - strong enough to move a bolus ‘uphill’ as well as ‘downhill’
What actions during swallowing act to prevent reflux
- elevation of soft palate
- tongue (sides) contacts pillars of fauces
- tongue (dorsum) contacts posterior pharyngeal wall
- Upper oesophageal sphincter (reflux from oesophagus into pharynx)
- Lower oesophageal sphincter (reflux from stomach into oesophagus)
How can stomach acid erode teeth?
By:
- reflux
- vomiting
- regurgitation
- rumination
How often is stomach acid responsible for palatal surface erosion
in 2/3 of cases
What is a common characteristic of palatal erosion
cupping
Name types of tooth surface loss
- erosion
- attrition
- abrasion
- abfraction
define attrition
tooth wear occlusally caused by contact between occluding teeth (bruxism/parafunction)
what indicates attrition is occuring
the teeth inter-digitate (equal amounts between upper and lower ?)
how does abrasion occur
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.
what is the most common presentation of tooth wear?
a combined lesion involving erosion and abrasion
does abrasion occur on its own
unusual - it might be caused by biting or chewing objects between the teeth for example tobacco pipes, nails or pens.
what are abfractions
Wedge-shaped notch caused by flexure and ultimate material fatigue of susceptible teeth at locations away from the point of loading (cervical regions).
what causes abfractions
The break down is dependent on the magnitude, duration, frequency and location of the occlusal forces.
how is the airway protected during swallowing
- Upward and forward movement of larynx
- Closure of laryngeal inlet (aryepiglottic muscles,
epiglottis) - Adduction of vocal folds
- Stop breathing (apnoea)
what teeth do abfractions occur on
premolars
what does dysphasia mean
inability to generate speech
what does dysphagia mean
inability to swallow
what word describes pain on swallowing
odynophagia
what areas of the brain are affected with dysphasia
- Broca’s area
- Wernicke’s area
what word describes difficulty speaking that is caused by problems with the muscles used in speech
dysarthria
what is the difference between dysphasia and dysarthria
dysphasia - caused by the brain (broca’s and wernicke’s area)
dysarthria - caused by muscles used in speech
what causes dysarthria
caused by problems with the muscles used in speech.
- due to neuro-muscular defects
- lesions in descending neural pathways, cranial nerves, vocal muscles, neuromuscular junctions
What are some oral causes of language and speech defects
- Malocclusions
- Loss of teeth and denture related
- Cleft lip/palate
- Tongue - related
- Dry mouth
what are causes of anterior open bite
- digit-sucking
- tongue thrust
- skeletal origin
what is a cleft palate
oral and nasal cavities are not separated (speech has a ‘nasal’ quality)
How are cleft palates treated
repaired surgically or filled with an obturator
What are conditions which affect the tongue
- tongue tie
- partial atrophy
- tongue stud
How does xerostomia cause impeded speech
With inadequate saliva production, pronouncing words becomes difficult.
People who have dry mouth and difficulty speaking cannot simply ‘swallow’ and start talking normally
What is/ are torus mandibularis/ tori mandibular and torus palatinus/ tori palatinus
benign overgrowth of bone
How can dentures cause speech impedment
- restricted tongue space
- denture base plate too thick
- artificial teeth not set properly e.g. wrong occlusal planes
The wrong shape of palate of a denture gives problems producing which sounds
s becomes sh
The wrong shape of occlusal planes of a denture gives problems producing which sounds
f,v and ph (labio-dental sounds/ fricative sounds)
The loss of which teeth may prevent the clear reproduction of certain sounds particularly F and V
maxillary anterior teeth (they are made by the lower lip contacting the edges of maxillary incisors)
during fricative sounds, where should the lips of the maxillary incisor teeth touch
the vermilion border of the lip
How can you assess speech when replacing missing teeth
by asking fundamental questions e.g. address, family details
Apart from producing vocal sounds, what else do aerodigestive tract contribute to
the playing of wind and brass instruments
What factors might influence the final choice of treatment of a musician with a missing tooth
- cost
- effects on adjacent teeth; OH; preparation as abutments
- aesthetics
- Function. The patient is a musician, so her embrouchure is v important. She may experience pain with pressure from the trumpet mouthpiece on the healing socket
- Life span of prosthesis and eventual replacement
what does embouchure mean
the position and use of lips, tongue and teeth in playing a wind instrument
How do embouchures very
- between individuals
- particular wind instrument (intra oral = clarinet, oboe, saxophone etc), (extra oral = trumpet, flute, tuba etc)
What might string players struggle with
TMJ
