Mastication, Deglution and Dysphagia

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Questions and Answers

What are the three phases of the masticatory cycle?

  • Initial Phase, Secondary Phase, Terminal Phase
  • Preparation Phase, Mixing Phase, Digestion Phase
  • Opening Phase, Occlusal Phase, Closing Phase (correct)
  • Opening Phase, Chewing Phase, Swallowing Phase

Which structure is NOT directly involved in the process of mastication?

  • Esophagus (correct)
  • Muscles of mastication
  • Teeth
  • Saliva

What is the primary function of saliva in the digestive process?

  • To aid in the formation of the bolus
  • To initiate the breakdown of carbohydrates (correct)
  • To provide nutrients
  • To neutralize stomach acid

What is dysphagia?

<p>A difficulty in swallowing (D)</p> Signup and view all the answers

Which of the following is a consideration in the dental management of patients with dysphagia?

<p>Assessing their ability to manage oral hygiene (A)</p> Signup and view all the answers

What is the primary function of the swallow centre located in the medulla?

<p>To coordinate the motor functions of swallowing (B)</p> Signup and view all the answers

Which nerves are involved in transmitting afferent impulses to the swallow centre?

<p>Trigeminal and glossopharyngeal nerves (D)</p> Signup and view all the answers

How long does it approximately take for the bolus to travel from the oral cavity to the stomach?

<p>7 seconds (B)</p> Signup and view all the answers

What triggers the reflex action of swallowing?

<p>Stimulation of tactile receptors in the oropharynx (B)</p> Signup and view all the answers

What type of swallow is considered to be voluntarily initiated?

<p>Voluntarily initiated swallow (B)</p> Signup and view all the answers

What role do the lips play during swallowing?

<p>They create intra-oral pressure. (D)</p> Signup and view all the answers

Which structure is primarily responsible for supporting the tongue?

<p>Hyoid bone (D)</p> Signup and view all the answers

What is the primary function of the epiglottis during the swallowing process?

<p>To protect the airway. (B)</p> Signup and view all the answers

During the swallowing process, which structure relaxes to allow food to enter the oesophagus?

<p>Cricoid cartilage (A)</p> Signup and view all the answers

What initiates the swallowing process?

<p>Voluntary action (C)</p> Signup and view all the answers

Which phase of swallowing involves the formation of a bolus of food?

<p>Oral phase (D)</p> Signup and view all the answers

What anatomical feature prevents food from entering the nasopharynx during swallowing?

<p>Soft palate (C)</p> Signup and view all the answers

Which function is associated with the vocal cords during swallowing?

<p>They close to protect the airway. (C)</p> Signup and view all the answers

Which of the following is a consequence of dysphagia that relates to oral health?

<p>Increased dry mouth risk (B)</p> Signup and view all the answers

What positioning is recommended for a patient with dysphagia to ensure comfort during treatment?

<p>Semi-supine position (B)</p> Signup and view all the answers

Which of the following considerations is essential when provision of treatment for a dysphagia patient?

<p>Careful use of water during procedures (C)</p> Signup and view all the answers

In assessing a patient with dysphagia, what is an important aspect to consider?

<p>The extent of their dysphagia (C)</p> Signup and view all the answers

Which of the following increases the risk of dental caries for patients with dysphagia?

<p>Reduced oral clearance (B)</p> Signup and view all the answers

Which of the following is recommended to help prevent lengthy dental procedures for patients with swallowing difficulties?

<p>Ensuring good suction with saliva ejectors (A)</p> Signup and view all the answers

What type of toothbrush is suggested for patients with swallowing problems?

<p>Aspirating toothbrush (B)</p> Signup and view all the answers

Which of the following is NOT a consideration for dietary adjustments in patients with dysphagia?

<p>Limit water consumption (A)</p> Signup and view all the answers

In managing dental procedures for patients with swallowing difficulties, which material is advisable to avoid?

<p>Fast setting materials (D)</p> Signup and view all the answers

What is an important precaution to take when performing dental impressions for patients at risk of swallowing problems?

<p>Inform the patient about each step (A)</p> Signup and view all the answers

What should be considered when giving preventative advice to patients with dysphagia?

<p>Frequent breaks during eating or drinking (A)</p> Signup and view all the answers

Which of the following is a better alternative if patients require antibiotics?

<p>Liquid preparations (A)</p> Signup and view all the answers

For patients with swallowing challenges, what type of dietary analysis is important?

<p>Analysis of viscosity for foods and drinks (C)</p> Signup and view all the answers

What initiates the swallow reflex?

<p>Receptors in the pillars of fauces (B)</p> Signup and view all the answers

What occurs during the pharyngeal phase of swallowing?

<p>Bolus tilts the epiglottis backwards (B)</p> Signup and view all the answers

What closes to prevent food from entering the nasopharynx during swallowing?

<p>Soft palate (C)</p> Signup and view all the answers

Which nerve is responsible for taste sensation from the posterior one-third of the tongue?

<p>Glossopharyngeal Nerve IX (D)</p> Signup and view all the answers

What action is performed by the larynx during the swallowing process?

<p>Larynx is elevated by the hyoid bone (A)</p> Signup and view all the answers

What is the term for swallowing difficulties?

<p>Dysphagia (B)</p> Signup and view all the answers

How is the bolus transported down the esophagus?

<p>By peristaltic waves of smooth muscle (A)</p> Signup and view all the answers

What triggers the opening of the hypopharyngeal sphincter?

<p>Contraction of skeletal muscles (C)</p> Signup and view all the answers

Which nerve provides motor function to the pharyngeal constrictors?

<p>Glossopharyngeal Nerve IX (C)</p> Signup and view all the answers

What is the primary role of the epiglottis during swallowing?

<p>To protect the trachea (B)</p> Signup and view all the answers

Flashcards

Mastication

The process of chewing food, breaking it down into smaller pieces to aid in digestion.

Muscles of mastication

The muscles responsible for chewing: masseter, temporalis, medial pterygoid, and lateral pterygoid. They work together to move the jaw up, down, and side to side.

Salivary amylase

The primary enzyme in saliva that begins the digestion of carbohydrates. It breaks down starch into simpler sugars.

Deglutition

The act of swallowing, moving food from the mouth through the esophagus to the stomach.

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Dysphagia

Difficulty in swallowing, which can be caused by various factors including neurological disorders, muscle weakness, or anatomical abnormalities.

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Automatic Swallow

A type of swallow that is triggered automatically, like when your mouth is dry.

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Voluntarily Initiated Swallow

A type of swallow that is initiated voluntarily, when you consciously decide to eat or drink.

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Swallow Center

The part of the brain that controls the complex process of swallowing.

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Tactile Receptors

The sensory receptors in the back of the throat that trigger the swallowing reflex.

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Lip role in swallowing

The lips close to create pressure inside the mouth, helping push food towards the back of the throat.

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Tongue role in swallowing

The tongue forms a ball of food (bolus) and moves it back towards the throat.

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Soft palate role in swallowing

The soft palate moves up to block the nasal passageway, preventing food from going up your nose.

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Hyoid Bone

A horseshoe-shaped bone that supports the tongue and helps lift the larynx during swallowing.

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Epiglottis

A leaf-shaped flap that protects the airway during swallowing by closing over it.

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Vocal cord role in swallowing

The vocal cords close to prevent any food from entering the airway.

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Cricopharyngeal Sphincter

A ring-shaped cartilage that relaxes to allow food to pass from the throat into the esophagus.

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Swallowing Phases

The three stages of swallowing: oral, pharyngeal, and esophageal.

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Pharyngeal Phase

The stage of swallowing where the food bolus moves from the back of the mouth into the pharynx.

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Oesophageal Phase

The stage of swallowing where the food bolus travels down the esophagus to the stomach.

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Swallowing Reflex

The reflex that initiates the swallowing process, triggered by receptors in the back of the mouth.

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Glottis

The opening between the vocal cords that is closed during swallowing to prevent food from entering the trachea.

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Hypopharyngeal Sphincter

A ring of muscle at the top of the esophagus that opens during swallowing to allow the food bolus to pass.

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Peristaltic Waves

A muscular wave of contraction that moves the food bolus down the esophagus.

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Facial Nerve (VII)

The nerve responsible for taste sensations from the anterior two-thirds of the tongue and motor control of facial muscles.

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Glossopharyngeal Nerve (IX)

The nerve that provides motor control to the muscles involved in swallowing, including the pharyngeal constrictors and stylopharyngeus muscle.

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Vagus Nerve (X)

The nerve that provides motor control to the muscles of the palate, pharynx, and larynx, and autonomic control to the esophagus.

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Power-driven Scaling

A dental procedure used to remove plaque and calculus from teeth, utilizing powered instruments. Careful use is crucial for patients with dysphagia to prevent aspiration.

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3-in-1

A dental tool that combines a scaler, explorer, and probe, used for plaque and calculus removal, and is commonly utilized in patients with dysphagia for its versatility.

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Semi-supine Position

The position where the patient lies on their back with their head elevated at a 30-45 degree angle. This is often used for patients with dysphagia to make swallowing easier and reduce aspiration risk.

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Preventative Oral Care Advice for Dysphagia Patients

Important oral care advice for patients with dysphagia, including techniques and frequency of brushing, flossing, and oral rinses, to facilitate effective oral hygiene and prevent complications.

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Aspirating Toothbrush

A type of toothbrush designed to minimize aspiration risk by reducing the splashing of toothpaste and water. It incorporates a unique design that promotes a smooth, gentle brushing experience while minimizing the potential for fluid to enter the airway.

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Rubber Dam

Using a rubber sheet to isolate a specific tooth or area of the mouth during a dental procedure. This barrier helps protect the patient's airway from saliva, water, debris, and materials used.

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Good Suction (Saliva Ejector and HVS)

Utilizing a high-speed suction system to remove saliva, debris, and water during a dental procedure. This enhances visibility, improves the working environment, and reduces the risk of aspiration.

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Aspirating

The act of withdrawing fluid or air from the mouth using a suction device, often during dental procedures. It ensures a clear field of vision, assists in maintaining a dry and sterile environment, and prevents the accumulation of saliva or debris.

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Fast Setting Materials

A dental material that cures or hardens quickly, minimizing the time required for the procedure and allowing for faster completion. It is beneficial for patients with swallowing difficulties, reducing the duration of the procedure and minimizing discomfort.

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Altered Diet/OH

A diet modification tailored to an individual's specific needs and preferences. This involves altering the texture, consistency, portion size, and frequency of meals to enhance swallowing safety and ease of consumption.

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Avoid Where Possible

A strategy involving avoiding specific dental procedures that may be lengthy, complex, or pose a significant risk to patients experiencing swallowing difficulties. This approach helps ensure their safety and minimize complications.

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Preventative Advice

A proactive approach that emphasizes measures taken to prevent swallowing difficulties and complications during dental procedures. This includes early intervention, risk assessment, and tailoring procedures to meet individual patient needs.

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Study Notes

Mastication, Deglutition & Dysphagia

  • Mastication is the process of chewing food
  • Deglutition is the process of swallowing
  • Dysphagia is difficulty swallowing
  • GDC Learning Outcomes include describing relevant/appropriate dental, oral, craniofacial, and general anatomy and physiology, and explaining application to patient management
  • Specific topics to relate to/include the muscles of mastication, tongue, saliva & salivation, the palate, xerostomia, and regional anatomy

Intended Learning Outcomes

  • Understand the processes of mastication and deglutition, both in health and disease
  • Identify structures involved in these processes
  • Describe disorders affecting normal swallowing
  • Outline considerations for dental management of patients with dysphagia

Mastication

  • Mastication involves the mouth's structures (teeth, tongue, muscles of mastication, lips).
  • The purpose of mastication is to break down food to make swallowing easier, enabling the digestive process to commence.
  • The masticatory cycle includes opening, closing, and occlusal phases.
  • Saliva is crucial for mixing food into bolus for easier swallowing and initiating digestion. An enzyme in saliva is necessary to begin the digestive process.

Deglutition (The Normal Swallow)

  • Swallowing is a complex process needing coordinated actions from 25 skeletal muscles.
  • It takes about 7 seconds for food to go from the oral cavity to the stomach
  • The openings between the oropharynx, nasopharynx, and laryngopharynx/larynx are closed simultaneously
  • Three phases of swallowing: oral, pharyngeal, and esophageal
  • During swallowing the larynx moves, the epiglottis and soft palate close off the airway and nasopharynx, and the vocal cords close.

Swallowing Structures

  •  Lips, Tongue, Soft Palate, Hyoid Bone, Epiglottis, Vocal Cords, and Cricoid Cartilage are key structures.

Phases of Swallowing

  • Oral phase: Food is prepared, chewed, and shaped into a bolus
  • Pharyngeal phase: Begins with the bolus reaching the back of the tongue, the soft palate/epiglottis/larynx move to close the airway and nasopharynx
  • Oesophageal phase: Bolus is moved to the stomach through peristalsis

Disorders of the Pharyngeal Stage

  • Delay in the swallow reflex can lead to food or liquids entering the airway before the reflex has begun to protect it.
  • Reduced pharyngeal peristalsis can cause residue to remain in the pharynx and potentially enter the airway after the swallow.

Disorders of the Oesophageal Stage

  • Reduced peristalsis in the oesophagus can lead to reflux in the oesophagus and potential aspiration. Poor positioning of the patient after eating can also contribute to this.

Abnormal Swallow (Associated Problems)

  • Infection can affect normal swallowing, particularly by aspiration, and is often associated with a chest infection
  • Dehydration leads to insufficient fluid intake when swallowing difficulty exists. Consequences can encompass infection, confusion, and reduced saliva production.
  • Malnutrition results from inadequate nutritional intake and is a significant consequence of dysphagia because eating and swallowing are impacted.

Gastric Reflux and Heartburn

  • Stomach contents can be forced up into the esophagus, producing heartburn, and inflammation can also occur.
  • The esophageal lining is vulnerable because it does not have the same protection as the stomach.

Dental Management of Dysphagia

  • Dysphagia influences oral health by reducing oral clearance, potentially leading to increased plaque and calculus deposits, dry mouth, and caries risk.
  • Assessment, positioning, preventative advice, and additional considerations for treatment/care are essential for patients with dysphagia.

Nerve Innervation

  • Various cranial nerves are involved in both chewing and swallowing functions, including those for taste, sensory, and motor control.

Dysphagia (Swallowing Difficulties)

  • Dysphagia is a condition of difficulty swallowing and is often due to a throat infection that causes pain
  • Risk factors encompass stroke/cerebral palsy/Parkinson's disease, structural abnormalities (such as cleft palate), cancer/treatments, infections, dementia, and recreational/prescription medications.
  • Possible signs/symptoms of dysphagia include: food or drink going down the wrong way, coughing, feeling that food is stuck in the throat, food or drink left in the mouth after swallowing, dribbling, taking a long time to swallow, needing effort to clear the throat after swallowing, croaky/wet sounding voice, and inability to chew food properly

Additional Resources

  • Leaflets and videos providing information on swallowing difficulties, available online via the Stroke Association website
  • YouTube videos that illustrate anatomical aspects of the pharynx

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