Speech - oral function Flashcards
what breaks down starch
salivary amylase
what combines with the food to form the bolus
water
what are the 2 functions of swallowing
protective and feeding
describe the protective and feeding function 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)
- choke
how is swallowing potentially dangerous
the foodway crosses the airway
swallowing solid foods
Chewed food material accumulates on the pharyngeal part of tongue and vallecula (oro-pharynx).
There is no true posterior oral seal.
swallowing liquids
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
- True oral phase (unlike solid food – no seal)
The liquid ‘bolus’ is then propelled through the oro- and hypo-pharynx, and then into the oesophagus
key difference in swallowing liquids and solids
Liquids are swallowed from the mouth proper;
- Oral Seal
Solids are swallowed from the oro-pharynx
- No oral seal
Both are moved rapidly through the hypopharynx past the laryngeal inlet
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.
the 3 events/phases in swallowing
Propulsion of food
Prevention of ‘reflux’
Protecting the airway
why does the duration of masticatory phases vary
durations of masticatory sequence components vary to different extents with food consistency
- not with age
how strong does the swallowing forces need to be
swallowing forces need to be strong enough to move the bolus uphill as well as downhill
Masseter muscle problem effect the process of swallowing
- Need to stabilise masticatory system to swallow
5 methods of preventing 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
dorsum of tongue
top side
ventral of tongue
underside
erosion
Stomach acid can erode teeth by reflux, vomiting, regurgitation and rumination
When palatal surface erosion is present, stomach acid is responsible in two thirds of cases.
- Query Bulimia
Cupping on palatal aspect of teeth (concave area)
cupping of palatal surface of teeth characteristic of
eroision
what can lead to erosion on the labial surface of teeth
high consumption of fizzy drinks
what can be used to gage whether teeth have been lost
if still have occlusal vertical dimension
attrition
tooth wear occlusally caused by contact between occluding teeth
- The teeth inter-digitate indicating that attrition is occurring.
bruxism – grinding/ clenching at night
- Parafunction
Equal amounts between upper and lower
Central nervous system controlled – stress
- Have to manage consequence, cannot truly treat only reduce effect
- Night guards
what controls attrition?
Central nervous system controlled – stress
- Have to manage consequence, cannot truly treat only reduce effect
- Night guards
abrasion
caused by biting or chewing objects between the teeth for example tobacco pipes, nails, pens, toothbrushes
- notch like lesion in cervical area
what is the most common presentation of tooth wear
combination of 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.
abfractions
stress lesions
Wedge-shaped notch caused by flexure and ultimate material fatigue of susceptible teeth at locations away from the point of loading (cervical regions).
- Common cervical region of premolars
The break down is dependent on the magnitude, duration, frequency and location of the occlusal forces.
- Stress accumulates on area due to high tooth load
4 methods of airway protection
Upward and forward movement of larynx
Closure of laryngeal inlet
- aryepiglottic muscles
- epiglottis
Adduction of vocal folds
Stop breathing (apnoea)
dysphasia
a.k.a aphasia
a specific language disorder
involving damage to particular parts of the brain
- broca’s area
- wernicke’s area
dysphagia
difficulty/inability swallowing
G=GAG
odynophagia
pathological condition in which the affected person experience extreme pain when swallwoing be it food, liquids and medication
pain on swallowing
dysarthria
difficulty speaking that is 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
- spot neuro-muscular disease before enters room
- will affect their treatment e.g. complete dentures will never be stable
5 oral causes of language and speech defects
Malocclusions
Loss of teeth and denture related
Cleft lip/palate
Tongue - related
Dry mouth
Not mandible tori
an example of problem with occlusion which can affect speech and language
anterior open bite
due to
- digit sucking
- tongue thrust
- skeletal origin
cleft palate impact on speech and language
Oral and nasal cavities are not separated
Speech has ‘nasal’ quality
Palatal defect has to be repaired or filled with an obturator
- Hard to intervene in some cases
- But important to solve as can help with speech at later age
3 conditions that can effect the tongue ability for speech and language
Tongue tie
- can be corrected by dentist or someone who specialises in oral surgery
- Release frenulum
Partial atrophy
- Not fully formed
Tongue stud
- Can adapt to cope with
how does xerostomia affect speech and language
With inadequate saliva production, pronouncing words becomes difficult.
- People who have dry mouth and difficulty speaking cannot simply ‘swallow’ and start talking normally.
- Difficult to get masticatory muscle to swallow
Can be due to medication or radiotherapy
torus mandibularis/ tori mandibular
mandibular toru/tori
Torus Palatinus (pl. tori palatinus)/ palatinus torus (pl. palatal tori)
2 bumps at the side of mandible
Benign overgrowth/tumour of the bone
- Can vary in size
No problems with speech
- Issue with need RPD
- Interfere with major connector
- Can remove by surgery (some refuse)
- can design major connector around it but compromise function
denture related issues that can effect speech and function
Problems arise mainly from restricted tongue space
- denture base plate is too thick
- –effect tongue
- artificial teeth not set properly
- —effect stability and tongue
- ——–wobbly in mouth
not type of material used to make the denture
how does the thickness of denture base effect function
The position of tongue for producing the sounds:
/th/ /s/ and /sh/
The polished surface is correctly shaped so the tongue can form narrow channel in the middline for producing the /s/ sound
Excessive thickening of the palate laterally prevents close adaptation of the tongue to the palate so that the /s/ becomes /sh/
- S sounds created by anterior teeth and tongue
- –Space created between tongue and palate
- —–Too thick from side - tunnel too big, letter won’t be made
what sound can the loss of maxillary anterior teeth prevent
certain sounds like F and V
- lower lip contracting the edges of the maxillary incisors
what are labio-dental sounds
f, v, ph
fricative sounds
what should be checked to ensure in replacing teeth so fricative sounds can be made
The lips of the maxillary incisor teeth should touch the vermilion border of the lip during Fricative sounds.
- touching vermillion zone of lip
Dentures must be fabricated to a morphology that does not cause interference with tongue/lip/cheek movement
what should be done when delivering a denture before the pt leaves the surgery
speech assessment
indicate the functional relationship of the lips and tongue to dentures in speech.
what factors may influence the final choice of treatment for a denture pt
Cost
Effects on adjacent teeth
- Oral hygiene
- Preparation of abutments
Aesthetics
Function
- Musician – embouchure is very important
- May experience pain with pressure from the trumpet mouthpiece on the healing socket
Life span of the prosthesis and eventual replacement
- Temporary adhesive bridge restoration may be appropriate with follow up to review to determine the best-long term option
embouchure
position and use of lips, tongue and teeth in playing a wind instrument”
vary, both between individuals and with the particular wind instrument in use
inra-oral mouthpieces wind instruments
Single reed:
- clarinet, saxophone
Double reed:
- oboe, bassoon
extra-oral mouthpieces wind instruments
Piccolo, flute
Trumpet, horn, trombone, tuba
special needs to consider if wind instrument musician in designing replacement teeth
in respect to the retention of an appliance and placement of teeth.
what are some of the head and neck anatomical features contribute to instrument playing
Position of mouthpiece relative to teeth
Mouth opening (gape)
Relation of jaws
Position of hyoid bone
Position of dorsum of tongue
what are issues that a dentist treating a musician needs to consider
Teeth
- restorations
- loss and replacement
- aesthetic dentistry
Tongue
Facial muscles
- lips
- cheeks
