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oral functions Flashcards

1
Q

masseter origin

A

zygomatic arch

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2
Q

masseter insertion

A

lateral surface and angle of mandible

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3
Q

which muscles are tender in pts with Bruxism?

A

masseter

temporalis

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4
Q

fct of masseter

A

elevates mandible

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5
Q

testing masseter

A

one finger IO, other on cheek

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6
Q

temporalis origin

A

floor of temporal fossa

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7
Q

temporalis insertion

A

coronoid process and anterior border of mandible

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8
Q

temporalis fct

A

elevates and retracts mandible

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9
Q

palpating temporalis

A

digital palpation between superior and inferior temporal lines, just above ear, extending forwards towards the supraorbital region

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10
Q

LP origin

A

lat surface lat pterygoid plate

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11
Q

LP insertion

A

inferior - anterior border of condyle

superior - intra-articular disc

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12
Q

LP fct

A

protrudes mandible and lateral deviation

inferior head functions with the mandibular depressors during openings

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13
Q

testing LP

A

not accessible to manual palpation - resistance test

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14
Q

MP origin

A

deep head - medial surface of LP plate

superficial head - tuberosity of maxilla

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15
Q

MP insertion

A

medial surface of angle of mandible

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16
Q

fct of MP

A

elevates and protrudes

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17
Q

MP testing

A

can’t palpate or resistive movement tests - no reliable way of examining

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18
Q

which muscle hit with needle during IDB can cause temp trismus?

A

MP

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19
Q

how to avoid causing trismus IDB?

A

contact bone to ensure correct position

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20
Q

movements of TMJ

A

rotation - initial opening - hinge

translation - wider opening - sliding
- protrusive/retrusive

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21
Q

what happens to the condyles in protrusive movements?

A

both condyles leave fossa and move forward along the articular eminences

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22
Q

what happens to the condyles in retrusive movements?

A

both condyles leave the eminences and move back into their respective fossa

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23
Q

Ulf Posselt

A

graphical recordings in occlusal and sagittal plane and profile radiography

all produced similar shape

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24
Q

max clenching/biting forces

A

varies between teeth

max between molars (200-700N)

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25
Q

factors affecting max bite force

A 
psychological - fear of tooth fracture
muscle mass
 - bigger muscles = larger forces
 - Bruxists often hypertrophic muscles
 - look for facial asymmetry
muscle fibre type
tooth type and position
root area (PD support)
nutcracker analogy
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26
Q

what does your predominant muscle fibre type vary depending on?

A

jaw morphology and diet

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27
Q

max bite force - tooth type and position

A

greatest bite force generated between 1st molars

position relative to TMJ and muscles (molars are nearer the force generating muscles and the fulcrum - TMJ)

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28
Q

type 1 muscle fibres

A

slow low forces

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29
Q

type 2 muscle fibres

A

fast stronger forces

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30
Q

subtypes of muscle fibres

A

IIA
IIX
IIB

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31
Q

evidence for people with ‘squarer’ jaws

A

have more type 2 fibres and can generate stronger bite forces

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32
Q

suprahyoid muscles

A

mylohyoid
digastric
geniohyoid
stylohyoid

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33
Q

infrahyoid muscles

A

thyrohyoid
omohyoid
sternohyoid
sternothyroid

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34
Q

when the hyoid bone is fixed by contraction of the infra hyoids, which muscles act as jaw depressors?

A

mylohyoid
geniohyoid
digastric

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35
Q

fct of intrinsic tongue muscles?

A

alter shape

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36
Q

intrinsic tongue muscles

A

longitudinal (superior and inferior)
vertical
transverse

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37
Q

fct of extrinsic tongue muscles?

A

alter shape and position

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38
Q

extrinsic tongue muscles

A

genioglossus
hyoglossus
styloglossus
palatoglossus

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39
Q

orbicularis oris and buccinator role

A

help to control food bolus and prevent spillage

dysfunction can be the 1st signs of a stroke

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40
Q

mandibular division of trigeminal nerve

A 
mental 
auriculotemporal
buccal
lingual
IAN
n to mylohyoid
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41
Q

how to avoid ulceration after IDB?

A

warn pt not to bite lip as will be numb

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42
Q

paraesthesia

A

abnormal sensation typically tingling or pricking (pins and needles)
favourable prognosis - no complete sectioning of nerve

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43
Q

dysaesthesia

A

abnormal unpleasant sensation felt when touched, caused by damage to the peripheral nerves

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44
Q

function of gagging reflex

A

mechanical mechanism - acts to prevent material entering pharynx

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45
Q

what is the gagging reflex?

A

mechanical stimulation of fauces, palate, posterior tongue, pharynx
contract
similar to vomiting but no ejection of material

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46
Q

what is an oversensitive gag reflex?

A

a clinical problem

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47
Q

gag reflex neural pathway

A

stimulus
receptor - glossopharyngeal
sensory neuron - afferent sensorial response from CN9
association neuron
motor neuron - efferent motor response from CN5,9,10,11,12
effector - posterior part of tongue/SP contracts
response

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48
Q

what are also stimulated in the gag reflex?

A

motor (secretory) visceral nerves of the salivary glands and lacrimal gland

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49
Q

nerves involved in gagging reflex

A 
trigeminal 5
glossopharyngeal 9
vagus 10
accessory 11
hypoglossal 12
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50
Q

afferent sensory neurons

A

carry a message into CNS

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51
Q

efferent motor neurons

A

carry message away from CNS

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52
Q

interneuron

A

connect one neuron with another

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53
Q

RPDs and gag reflex

A

retaining mesh in posterior part - facilitate attachment of acrylic extension
- indicated when post-dam can’t be tolerated by pt (gag reflex) - allows it to be adjusted more easily
reduces weight of large metal connector

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54
Q

alginates and gag reflex

A

take U behind pt - push up at back first so excess doesn’t run down throat
distract pt
reduce temp of water - use fast setting alginate
nose breathing
don’t want alginate behind post-dam of pt
U imp sitting up

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55
Q

Bell’s palsy

A

unilateral
motory disorder
any type of facial paralysis that does not have any other associated causes e.g. tumours, trauma, salivary gland inflammation

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56
Q

signs of Bell’s palsy

A

inability to wrinkle brow
drooping eyelid - can’t close eye/blink
can’t puff cheeks
drooping mouth - food stuck in cheek

57
Q

causes of Bell’s palsy

A

infections (HSV/cold sores)
otitis media (inflammation middle ear)
diabetes
trauma
toxins
temp by infiltration of LA to facial nerve branches
- LA given too far distally and parotid gland penetrated
- avoid - position above contralateral premolars

58
Q

facial nerve branches

A 
temporal
zygomatic 
buccal
mandibular
cervical
59
Q

trismus after IDB

A

hit MP

60
Q

facial nerve palsy after IDB management

A

pts may feel something is wrong but be unable to identify exactly what problem is, usually operator who notices specific changes
inform and reassure pt - transitory and reversible
protect eye with loose pad - cornea protected until protective blink reflex returns
recovery often in v short time (within 1hr)

61
Q

how to prepare mouth for over dentures?

A

good if few remaining teeth
decoronation - keep roots and PDL
can use precision attachments
- either do RCT and use space for attachment
- if elderly pt decoronation may not reach pulp - GI lining as cap
- help with support

62
Q

advantages of overdentures

A

PD mechanoreceptors allow finer discrimination of
- food texture
- tooth contacts
more precise control of mandibular movements and levels of fct loading - less likely to break dentures with accidental occ overload
psychological benefit - prevent feeling of total loss of natural teeth - more acceptable to pt
makes eventual transition to complete dentures more acceptable
good as resorbed alveolar ridge if no teeth - so keep teeth to prevent resorption. Potential of implants in future

63
Q

loss of PD mechanoreceptors influences:

A

control of jaw fct
precision of magnitude
direction
rate of occ load application

64
Q

loss of PD mechanoreceptors in complete dentures

A

conventional complete dentures don’t carry enough sensory info to restore necessary natural feedback pathways for motor fct
inherently unstable during normal jaw movements

65
Q

joint receptors

A 
joint position (mouth open/closed)
joint movement (opening/closing)
 - info useful in controlling jaw movements e.g. chewing
66
Q

dysphagia

A

difficulty swallowing - food stuck in oesophagus

67
Q

causes of dysphagia

A 
stroke - may be one of first symptoms
brain injury
MS
GORD
tumours
68
Q

detecting a stroke

A

compare sensorial and motor responses from both sides of face and oropharynx - stroke unilateral

69
Q

nociceptors

A

free nerve endings
high thresholds
respond to intense (noxious) stimuli - usually associated with pain
- myelinated (Ad fibres):noxious mechanical and heat stimuli
- unmyelinated (C-fibres)
nociceptors carry several types of receptor proteins, responsive to diff noxious stimuli
dental pulp, muscles, joints, mucosa, PDL

70
Q

“sensitivity”

A

orofacial tissues v sensitive
receptors have low thresholds for activation
but not all regions equally sensitive

71
Q

general senses

A

touch
proprioception
temp
pain
facial skin and mucosa (mouth, pharynx) - mechanoreceptors, thermoreceptors, nociceptors
sensory abilities in these regions similar

72
Q

special senses

A

taste - oral chemoreceptors

smell - nasal chemoreceptors

73
Q

mechanoreceptors

A 
low thresholds (0.5mN) - senses of touch, pressure
adaptation to constant stimulus
slowly and rapidly adapting types
a sensory receptor that responds to mechanical pressure or distortion
74
Q

role of PD mechanoreceptors

A 
v sensitive - enable us to assess direction of forces applied to teeth
contribute to oral functions
 - mastication (food consistency)
 - salivation
 - interdental discrimination
75
Q

proprioception

A

self-sense
awareness of position and orientation of body parts
served by various proprioceptors
- joint
- muscle - muscle spindles, Golgi tendon organs
- PD receptors

found in diff points in mouth

76
Q

interdental discrimination

A 
ability to gauge extent of mouth opening
co-ordination of masticatory movements
monitoring size of food particles
detection of 'high' spots
TMJ, muscle and PDL receptors

PDL can detect materials between teeth down to 1/2 the thickness of a human hair - remember when placing/adjusting Rxs

77
Q

Shimstock

A

metal foil for occlusion testing

8 microns thick

78
Q

2 point discrimination example - polo mint

A

have taste buds and olfaction of mint
have experience of tasting polo - facilitates the correlation
acquire format of mint - compress it against the hard palate with tongue
- mechanoreceptors can identify format (hole)
- 2 point discrimination of both tissues
nociceptors - primitive response of mint

79
Q

smell

A

olfactory epithelium
- millions of olfactory sensory cells
- cilia project down into mucus layer produced by Bowman’s glands
odor molecules dissolved in mucus - stimulates receptor sites on the cilia
nerve signals - olfactory bulb - brain

80
Q

where are taste buds located?

A

around base and sides of papillae

- few taste buds in centre of tongue

81
Q

senses involved in taste

A 
gustatory receptors - nerves
olfactory receptors
salivary glands stimulated - increase taste
past experiences
mechanoreceptors - texture
thermoreceptors - temp
82
Q

thickening response

A

sucrose and fructose thickeners in drink
provide quenching taste
why many pts prefer soft drinks

83
Q

smell and taste

A

smell stimulates salivary glands - so smelling disorders often affect taste
infection of nasopharnyx - loss of olfactory sense (anosmia) may be associated
pts have difficulty discerning between taste and olfaction - interchange terms

84
Q

motor innervation of tongue

A

palatoglossus - CN10

all other intrinsic and extrinsic tongue muscles - CN12

85
Q

anterior 2/3 tongue sensory innervation

A

general - lingual nerve CN5

special - chords tympani CN7

86
Q

posterior 1/3 tongue sensory innervation

A

general and special - CN9

area innervated by internal laryngeal nerve CN10

87
Q

special sensory nerves

A

taste

88
Q

general sensory nerves

A 
touch
pressure
heat 
cold
etc
89
Q

the feeding sequence

A

ingestion
stage 1 transport
mechanical processing
stage 2 transport

90
Q

ingestion

A

external env into mouth
biting (anteriors) / tools (cutlery)
lips provide anterior oral ‘seal’ - orbicularis oris

91
Q

stage 1 transport

A

move material from front of mouth to level of posterior teeth
food gathered on tongue tip
tongue retracts, pulling material to posterior teeth (about 1sec)
associated with retraction of hyoid bone and narrowing of oropharynx

92
Q

mechanical processing

A 
break down, mix with saliva
moist solid foods e.g. fruit need fluid removed before transport and swallowing
mastication by premolars and molars
some foods (soft) are 'squashed' by tongue against HP
coordinated actions of many muscles
 - mandibular muscles
 - suprahyoids
 - tongue muscles
 - lips and cheeks
93
Q

stage 2 transport

A

moving food into oropharynx
tongue gathers bolus for transport
forward movement of tongue during occlusal and initial opening phases creates a contact between the tongue and HP
contact zone moves progressively backwards, squeezing the processed food through the fauces ‘squeeze back mechanism’
material accumulates on pharyngeal surface of tongue, stays there until swallowing occurs

94
Q

processing of solid foods

A

mouth continuous with oropharynx

95
Q

when is a posterior oral seal produced?

A

ingestion of liquids

they are swallowed from the mouth i.e. without stage 2 transport

96
Q

tongue actions in chewing

A

controls and transports bolus within mouth
gathers food and rotates to reposition bolus on occlusal table
along with cheeks keeps bolus on chewing surfaces
- tongue and cheeks act in a reciprocal manner “tongue pushing and cheek pushing” cycles
tongue moves bolus from side to side of the mouth and gathers it for transport

97
Q

chewing cycle phases

A

occlusal phase - ICP
opening phase - jaw depressor muscles are active
closing phase - jaw elevator muscles are active

98
Q

how can you avoid hyper/hypotrophic muscles?

A

advise pt to chew bilaterally

99
Q

variations in chewing cycles?

A

tough food e.g. meat has wider cycle than brittle foods e.g. carrot
occlusal conditions also has an effect on the chewing stroke
gum very broad stroke

100
Q

consider chewing style when designing prostheses

A

balanced articulation
ruminator mandibular movements - use teeth with cusps to achieve a balanced occlusion (esp where pts have a favourable ridge form)
if dentures have evenly worn/flat occlusal surfaces - suggests vertical (chopping) mandibular movements - esp in flat atrophic mandibular ridges could use cuspless teeth

101
Q

consider tongue movements when designing prostheses

A

inaccurate placement of L posterior teeth - could interfere with tongue’s movements - will compromise retention and stability of denture

  • if teeth inclined lingually will bite tongue while chewing
  • if teeth inclined buccally will bite cheek while chewing
102
Q

chewing performance

A

is it necessary to chew food?
- mechanical breakdown of food in mouth
= facilitates swallowing
= might improve digestive efficiency in GIT
“min chewing with ‘good’ dentition sufficient to ensure adequate digestion of most foods” - don’t need max

deteriorated MP can lead to dietary restrictions - avoiding foods that are ‘difficult’ e.g. green veg, some meats
but no clear evidence that poor mastication causes malnutrition in people with GIT disorders esp with modern foods and methods of preparation

103
Q

what does masticatory performance correlate with?

A

occlusal contact area

104
Q

occlusal contact area vs occlusal surface area

A

occlusal contact area usually smaller than the total occlusal area unless a lot of toothwear

105
Q

min teeth

A

20 teeth considered the min for acceptable:
- masticatory fct
- aesthetics
- maintenance of OH
but other tx options may be appropriate here

106
Q

SDA

A

“a dentition where most posterior teeth are missing”
can be good as compliance with L dentures v poor esp with FES
only replace molars if absence causing problems
provides sufficient occ stability, satisfactory comfort and appearance
chewing and comfort were not greatly increased by RPD

no of people who might have a fct SDA falls with age

107
Q

biting forces and complete dentures

A

biting forces reduced in complete denture wearers
biting load carried by mucosa of residual ridge
- not designed to bear masticatory loads
- why bone gets resorbed below it - better to utilise teeth
support area reduced (mucosa vs PDL)
bite forces can be increased by supporting dentures on teeth or implants

108
Q

when are cantilever bridges not recommended?

A

when occ forces on the pontic will be heavy

109
Q

“food keeps getting stuck in cheek and ear infection”

A

otitis media has temporarily damaged facial nerve so buccinator and orbicularis oris not fct properly

110
Q

swallowing phases

A 
buccal phase (voluntary)
pharyngeal phase (involuntary)
oesophageal phase (involuntary)
111
Q

swallowing fcts

A

feeding fct - process by which accumulated food bolus is transported through the lower pharynx and oesophagus to the stomach
protective fct - prevents ingested material from entering the L airway

112
Q

why is swallowing potentially dangerous?

A

‘foodway’ crosses the ‘airway’

113
Q

swallowing liquids

A

no stage 2 transport
liquids gathered on tongue, anterior to pillars of fauces
mouth separated from pharynx by posterior oral seal
liquid ‘bolus’ propelled through oro and hypopharynx, then into oesophagus

swallowed from mouth proper - oral seal

114
Q

swallowing solid bolus

A

chewed food accumulates on the pharyngeal part of the tongue and vallecula (oropharynx)`
no true posterior oral seal
bolus then propelled from tongue through the hypopharynx and then into the oesophagus

swallowed from oropharynx - no oral seal

115
Q

similarity when swallowing solids and liquids

A

both are moved rapidly through the hypopharynx past the laryngeal inlet

116
Q

tongue movements in swallowing

A

forward movement of tongue during occlusal and initial opening phases creates a contact between the tongue and hard palate
contact zone moves progressively backwards, squeezing the processed food through the fauces

117
Q

swallowing events

A

propulsion of food
prevention of reflux
protecting the airway

118
Q

phases - durations of swallowing

A

durations of masticatory sequence components vary to different extents with food consistency

119
Q

swallowing forces

A

strong enough to move a bolus ‘uphill’ as well as ‘downhill’

120
Q

preventing reflux

A

elevation of SP
tongue (sides) contacts pillar of fauces
tongue (dorsum) contacts posterior pharyngeal wall
UOS - reflux from oesophagus into pharynx
LOS - reflux from stomach into oesophagus

121
Q

airway protection

A 
upward and forward movement of larynx
closure of laryngeal inlet
 - aryepiglottic muscles
 - epiglottis
adduction of vocal folds
stop breathing 'apnoea'
122
Q

conditions affecting the tongue

A

tongue tie
partial atrophy
tongue stud

123
Q

xerostomia and speech

A

impedes speech

difficulty in pronouncing words

124
Q

dysphasia (aphasia)

A

specific language disorder
damage to particular parts of brain
- Broca’s area, Wernicke’s area

125
Q

dysarthria

A

difficulty speaking - caused due to NM defects of the muscles used in speech
lesions in descending neural pathways, CNs, vocal muscles, NM jcts

126
Q

odynophagia

A

pain on swallowing

127
Q

oral causes of language and speech defects

A 
malocclusions
loss of teeth and denture related
CL/P
tongue-related
dry mouth
128
Q

denture-related language and speech defects

A

problems mostly from restricted tongue space
denture base plate too thick
artificial teeth not set properly
material used in denture doesn’t affect speech

129
Q

denture-related language and speech defects - pronouncing th/s/sh

A

position of the tongue for pronouncing sounds th/s/sh
if polished surface of denture correctly shaped so tongue can form narrow channel in the middle for pronouncing (s) sound
but if excessive thickening of the plate laterally - prevents close adaptation of the tongue to the palate so s becomes sh

130
Q

denture-related language and speech defects - wrong occlusal planes

A

problem pronouncing f, v, ph - labio-dental (fricative) sounds
dentures can’t interfere with tongue/lip/cheek movement
lips of U incisors should touch vermillion border of lip during fricative sounds

131
Q

speech assessment when replacing missing teeth

A

assess tone of lips and cheek by asking fundamental Qs

- indicates fct relationship of lips and tongue to dentures in speech

132
Q

music

A

aerodigestive tract and facial tissues produce vocal sounds and also contribute to playing wind instruments

133
Q

embouchure

A

the position and use of lips, tongue and teeth in playing a wind instrument
vary - instruments and individuals

134
Q

IO mouthpieces wind instruments

A

single reed - clarinet, sax

double reed - oboe, bassoon

135
Q

EO mouthpieces wind instruments

A

piccolo, flute

trumpet, horn, trombone, tuba

136
Q

SH instruments

A

ask about instruments

wind - may have special needs in respect to the retention of an appliance and placement of teeth

137
Q

factors that vary between high and low notes

A 
position of mouthpiece relative to teeth
mouth opening (gape)
relation of jaws
position of hyoid bone
position of dorsum of tongue
138
Q

trumpet mouthpiece

A

usually centred on lips

tends to move all front teeth backwards

bds2 bams (6 decks)

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