Today we will continue talking about the mastication ,the doctor emphasize that this lecture will be very

important even after graduation And many students ask him to repeat it, so make sure to get it :P *we will cover the slides from (14 to 29) from MASTICATION & DYNAMICS OF OCCLUSION slide, and dont forget that this lecture contains at least 10 Q in the final exam !!! Ok let us start :

* Slide 14 : Electromyography of masticatory muscles

Last time we stopped at electromyography of masticatory muscles we want to study the electrical activity of these muscles of mastication (we put an electrode on these muscles and we study the electrical activity of these muscles in contraction and relaxation).To produce a specific movement in the mandible you need a complex combination of activation. So in the mandible to do one movement: For example elevation the mandible, this movement need a complex or a combination of activation (not only one muscle is included in the elevation of the mandible its actually complex) So more than one muscle participate in movement . Masseter, Temporal and Medial pterygoid these are activated in a sequence during mandibular approximation . When you approximate the mandible (elevate the mandible), you want to close the mouth, the first muscle response is the Masseter, the second one is Temporal and the third is Medial pterygoid.The doctor said that it is important to know this sequence! Masseter Temporal Medial pterygoid All of these muscles actively participate in elevating the mandible or in jaw approximation, but the sequence of activation is difference (one is faster than the another, so M is fastest then T then MP) . Digastrics muscles has bursts of activity during elevation, we notice that while you elevate the mandible the digastrics muscle is activated, But this is not logical! Supposing the digastrics muscle open the mouth why
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it is being activated when you approximate the jaw? Because this muscle makes braking, it brakes the rate of occlusion force (in order not to bite your teeth forcefully) If we use all muscle of mastication to close the jaw, you will bite strongly so to make a braking to this rapid movement, digastrics muscle make a brake in order to prevent the rapid approximation movement, so you will not hurt yourself! Digastrics muscles is one of the muscle that is activated but it brakes the fast approximation of jaws (but doesnt activate in jaw approximation) in this way you dont actually bite your tongue and you dont damage your cheek or teeth when you close your mouth! Activity in masseter muscle begins late during the elevation and ceases (stop) before the stroke is completed. Ya3ne the messter muscle, the activation of it begins late in elevation and it stops, the activity stops before the jaw are about to be closed. Sternocleoidomastoid muscle is active in clenching.. What do we mean by clenching? Clenching: when you close your teeth on each other and bite further ( bet3le8 asnank w betshed 3alehom). If you clench your teeth laterally we call this bruxism.

* Slide 15 + 16 : Occlusion
We put all the points and lines that the doctor talked about in a separate pictures in the next page, so refer to it and you will understand everything inshalla ;p Now we will talk; about occlusion and this is very important slide so take care guys ^^! At least 10 Q in final exam here

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Centric occlusion the lower teeth against the upper Mouth backward position Edge to edge

E
Condyle rotate without translation The rest positio

The maximum protrusion ( forward position )

H
Jaw elevation and condyle translation Mastication area ( chewing )

The maximum jaw opening

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We have what we call the envelop of motion. y3ne we want to attach a pencil on the lower central incisor and brought a paper (in the sagittal plane ) and let the person make different mandibular movement and the pencil started to draw based on moving the mandible in different movement (opening, closer, backward, forward ..) and observing what the pencil will draw ?? If you will do the maximum possible location of the mandible in each of these movement, this will produce this envelop of motion.

When you close your teeth (when you close your jaw on molars teeth) we will be on a point which is called the centric occlusion, (please check it in the picture), when your teeth are exactly in the position (the lower against the upper teeth) the pencil will draw this point .

Now I want to ask the person to make the mandible forward , now your teeth are in occlusion ( the perfect occlusion) what happen ? if you rememberThe upper incisor overlap the lower incisor, when you move your mandible forward the first thing that your incisor will slide ,so we go anteriorlly . But also because we have some slopping they will drop slightly until your teeth will be edge to edge as shown in the picture. If you put your teeth edge to edge .. Can you move your teeth more than forward? Yes. So what happens when you move the mandible to the maximum forward position? We will draw that point, so this point represent the maximum forward position or protrusion or the maximum protrusion.
Again centric occlusion, when I ask you to move your mandible forward then it drops slightly the teeth will bind edge to edge.. So this is edge to edge relation, then you can still move the mandible forward for same distance until the mandible reaches its maximum forward position .

Now from maximum forward position, I want you to open widely you will drop until reaching this point, which represent the maximum jaw opening.
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From the maximum jaw opening I want you now to close your mandible. Remember that the mandible closes into two phases, the first phase is the sliding of the condyle, and the second phase is the rotation of condyle. Now when you close your mandible from the maximum opening (the condyle be forward w be6ale el condyle bedo yerja3) it produce this distance.. Shown in the picture This mean jaw approximation or jaw elevation plus translation of the condyle. The condyle move from very forward to the normal position until the point (H) from this point to this point (E) the condyle now rotating against or rotating around an axis passing through the condyle.

If you remember from TMJ , the first movement when you open your mouth, the first movement the condyle isnt translated but is rotating around an axis through condoyle( bedoro 7awaleen nafshom la3'ait ma y9eer 22 to 23 mm of jaw separation), after this when you open further, the condyle start to move translating forward, thats why mandible closer isnt like mandibular opening . When you open the mandible from the maximum forward position, what happen when you open the mandible for maximum forward position?( btkoon el condyle already 6al3a mn ma7alha)! when you open from maximum forward position of condyle isnt normally in its position.. so there is no rotation its sliding.

When the condyle reaches the maximum forward position, you will open your mouth at this maximum forward position. But when you close, the mandible berja3 lawa7do but it will back in stages! The first stage involve translation of the condyle and the second is rotation of the condyle .. The continuous lines in the picture represent jaw elevation and condyle translation. While interrupted line represent jaw elevation and condyle rotation around its axis without translation.

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Let us discus the point centric occlusion , when you put your teeth in centric occlusion can you move your mandible backward ? Yes we can do that. But we can do that maybe for 2 mm , we can retrude the mandible and the muscle that is involve in retrusion is the horizontal fibers of the temporalis muscle. So dropping from centric occlusion to the most retruded position (the most backward position) involve some drop because when the cusp of lower teeth lies in the fosse of upper teeth, and you want to move your mandible slightly backward the mandible will drop slightly because the cusp isnt in the fossa now .. maybe the cusp on the cusp or the cusp on the marginal ridge, so there is a simple drop.

Now can you move the mandible from the maximum backward position? Yes you can. From the most backward position you can open the mandible but remember that the first opening is rotation against the condyle axis, until the condyle start to translate until the maximum opening .

Ok.. There is a line looks like (the tear) as the doctor said, it represent the movement of the mandible in chewing, when you eat you will not open your mouth to the maximum position no way! so when you eat the mandible open for a short distance, so we call this distance the mastication area of chewing and finally the doctor pointed at the rest position when you are at rest your teeth dont occlude to each other, there is a distance that is called the resting position of the mandible. (mesh lma ykon 3na rest bel awal !!! )

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Slide 17 ..
Occlusion means that teeth in contact position. Centric occlusion (CO) equals intercusped position (intercusped position: where the cusps are exactly in the fosse), but when the cusp and margined ridges of one jaw are exactly in the fossa of the others jaw this called maximum intercusped position ICP.. bema3na a5er al cusp bekon in the maximum contact and this is the best akeed ! But not all people have ICP, fe nas ele6ba8 taba3hom saye2 (when they bite the molars arent in their normal position), so that why centric occlusion is in ICP only in healthy people or only in people with good occlusion . But notice that when you hold your teeth in centric occlusion these are in light contact (ya3ne el asnan bekoon el contact taba3ha 5afeef or light m$ $aded). But when you bring your teeth in occlusion and bite forcefully, this is called the intercusped clenching position (mtel elnas yalle bt$ed 3ala asnanha bt7o6ha bel occlusion w bt$ed) Clenching ---> when you put your teeth in centric occlusion wt$ed Bruxism ----> when you put your teeth 3ala ba3ad then start moving the mandible forward, backward , laterally.. Actually its not a functional habit! Functional habit is clenching because your teeth are functionally (close) in centric position, but what you also do is forcefully bite. When you bite your teeth move forcefully in non-functional position of the mandible this is bruxism and its really bad . In centric occlusion the head of condyle is located in the maximum or highest area in the glenoid fossa. Centric occlusion in complete dentures ( hal2 people who lose their teeth) if you remember we said that we have prop-receptor in the periodontal ligament (PDL), the function of them is to guide the elevation of the mandible. When you open your mouth then close it, the teeth will occlude exactly in its position (hal hia sha6ara menak .?? No !! ) In the PDL in lower
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teeth there are a prop-receptors thats tell the brain about the position of mandible then you close perfectly. People with upper and lower denture will lose the prop-receptors cant bite as people with their natural teeth! So its not that easy to close the upper and lower denture in a position! (in centric occlusion ) So that, we need to make a centric occlusion for these people, and we need to make a centric occlusion isnt exactly as centric occlusion with people they dont have denture. The centric occlusion in dentures wear usually is most retruded position (ab3ad no86a tomathel el centric occlusion) In these people who wear denture! Why??
! !!*_* ..

As that we need to make a position (the most backward position) for denture people the mandible dose not move after this backward (hada 7do ela89a) , then he will know the end of the position and finally he could bite ! The most retruded position is actually the centric occlusion in denture wears and you as a dentist have to create this centric occlusion. Also we have ICP and ICCP, these are static position (no movement) but sometimes we have median occlusion position (light tooth contact) reached in a normal drop then move upward, when it moves upward maybe touch the teeth slightly, this contact position is called the median contact position and this position is dynamic not static, its very close to the centric occlusion.

* Slide 18: Clenching Position:

The Inter Cuspal Clenching Position (ICCP),we also have the Incisal clenching position, now if you put the incisors in edge to edge and bite forcefully we call it "Incisal Clenching Position", lateral clenching position is when you actually move your mandible to one side and clench forcefully.
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* Slide 19: Rest position

When you are at rest position what happen is our teeth are held slightly separate (there is a small space between them) and the mandible is held by the sling of medial pterygoid muscle and masseter muscels. In another words the MP and M are the ones responsible in holding the mandible at rest position . TMJ is not loaded in this position , now is the masseter muscle contracted? Conflicting evidence that means that some people say yes it contracted (masseter muscle) to keep this position ,other people say No it is not contracted, so there is some debate on this specific

subject , but this is not important " it won't come in the exam",
any thing with a question mark is not required for the exam BUT that doesn't mean you shouldn't read it :P Freeway space, is the space between the mandible and the maxilla at rest position , so this space found between upper and lower teeth at rest position is called "freeway position" and it's usually measured from the premolars area "at the middle of arch". It is also called " the interdental space" Or "speech space".. So many letters in English won't be pronounced unless our mandible is at rest position like ( S,T,D,M,B) ,that's why rest position is sometimes called speech space.

*Slide 20: Teeth articulation

The contact between upper and lower jaws via teeth. we all know that for articulation we have one bone and another bone that are connected with each other by one joint and "This is articulation " and also the upper and lower teeth articulate with each other.. periodontal ligament receptors (PDL receptors), we have articular receptors that monitor the load upon the articulating surfaces, so receptors found in PDL and we call it "proprio receptors ", it tells the
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brain about the amount of load that the tooth is facing .. pressure receptors are also found in the apical area of PDL ,these are equivalent to Golgi tendon organs. y3ne they are important in sending information to the brain about the level of the load that the teeth are subjected to..

*Slide 21: Incision

Now we will talk about incising a piece of apple let's think about what happen when we want to incise an apple.. First of all Protrusive movement, the condylar heads sliding forward and downward onto articular eminence, so this is the condylar in it's position then it's translated forward where it's with the articular eminence , now at this condition you bring the mandible forward "protrude" then you open the mandible to the maximum, so depression in the protruded position, and of course Hinge movement to elevate the body edge to edge incisal position. (enta lma 7raket el mandible forward el condyle is out of it's place w lama fata7et your mouth to the maximum , the condyle is also at maximum position bel tali el condyle lama fata7 be hay el 7aleh ma btkon translating btkon Hinge l2nha already 9art forward ,lw kano fe mkanhom backward kan felbedayeh b9er fe Hing then sliding) In another words, if you want to open your mouth from the centric occlusion, the first stage is Hinge access or Hinge rotation then sliding but when you bring your mandible to the max. forward position already the condyle is in the max. forward and now you want to open, Hinge will occur to the condyle because noway sliding occur because it's already in it's max. position anteriorly. Now you want to close from the most forward and also the max. opening position, the mandible Hinge will close because it's still in the max. forward position , so hinge movement to elevate the body to edgeedge incisal relationship , because when you want to put the apple our teeth become edge to edge and not their original relationship the acting muscle are :
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1- Lateral pterygoid muscle for protrusion. 2- medial pterygoid & masseter muscles for final elevation.
The maximum separation is about 3 cm. We always say when you want to make incision the distance between your teeth should be 3 cm." fe nas akthar w fe nas a8l". beyond that it 's considered to be dislocation, because when you try to open your mouth you will notice that we have a range about 35 mm, some people can open their jaws for a larger distance especially males "the doctor treat a patient and he was able to open his jaws up to 60 mm ". But don't try to open it further because the condyle might actually move from it's location and become in front of articular eminence

*Slide 22: Dislocation of condyle

Excessive jaw separation, look what happened to this person here , he opened his mouth to the maximum and the condyle was here exactly at the articular eminence but when he opened it widely the condyle became anterior and locked, so to treat the patient from this condition we have to hold the mandible at the molar region, drop it forcefully, and move it backward "only male dentist can do that I've never heard about female dentist was able to do so, because it needs force and courage ". Usually this condition occurs when you are sleepy and yawning hard and out of a sudden you discover you have a condyle dislocation. In dentistry this usually occur while you are making a cavity for one of the teeth for example making a cavity for 3rd molar the patient should open his mouth to the extreme then he might dislocate his jaw "condyle ", or maybe during taking an x-ray. Anyways condyle moving beyond articular eminence, you can reduce by downward and backward pressure in 3rd region on both sides.

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Slide 23: Incising resistant food..

what happen when you want to incise something resistant ? When you want to incise something solid like almond not something soft like cake, what happen is that the mandible begins to retrude but stops as resistance is felt because you want something else to do, so teeth are pressed into food. And we have side to side oscillating retrusive slide. When you want to bite something solid like a piece of apple our teeth stop, then start oscillating movement laterally and retrusive in the same time. Some lateral movement in protrusion "sawing movement", then food portion separate, mandible drop slightly to release the particle, lips guide it toward cheek teeth.

Slide 24: Incising moderately resistant & soft food

When you bite something soft like piece of cake what happen is the mandible slide back into the Inter Cusped Position (ICP) and food portion separated in scissor blade movement "no oscillation or lateral movement ".When you cut something soft it is sheared by incisors not cut through. " y3ny when you bite a soft cake you don't bite completely through its whole thickness, you only join your teeth to make initial cut then your whole teeth separate that piece, so you don't have to continue in taking the mandible until it come in contact , just make initial cut then food portion will separate away easily.

Slide 25 : Incision & head movement

Have you ever incise something and moved your head? sometimes if you are eating something hard like a piece of meat and you want to separate that piece of meat from the bone you move your head and this btw is done in animal, so incisors grip food, fracture by a downward jerk of the head, so you fracture "cut" that piece of food by moving your head sharp movement, this movement needs the action of the trapezius and sternocleidomastoid muscles.

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Slide 26: Food transport muscles

Tongue , lips and cheek muscles they pass food back and forth between the teeth .

Slide 27 : Extrinsic muscles of the tongue :

We are not going to discuss them .The Doctor only said that all muscles
are supplied by Hypoglossal nerve except Palatoglossus muscle is supplied by Pharyngeal plexus.

Slide 28: Intrinsic tongue muscles

We have : Superior longitudinal muscle: shorten the tongue and elevate its edges. Inferior longitudinal muscle: they shorten the tongue but they depress its edges. Transverse muscle :elongate and narrow the tongue . Vertical muscle: when they contract they broaden and flatten the tongue .
(We have to memorize and recognize the action of these muscles)

Slide 29: Facial muscles involved in food transport

These muscle include: Buccinator and perioral muscles. Buccinator muscle : push food back between occlusal surfaces , they oppose outward pressure of the tongue " The outward pressure of the tongue controlled by equal pressure from the cheek also outward pressure from the tongue anteriorly is opposed by equal pressure from the lips"

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Aids in transverse movement of food during mastication " from right to left ". Storage of food during mastication " less important in human" because we don't store food , but some animals store food until it's ready for ingestion . Perioral muscles: the muscles that surround the oral cavity they have the same function of buccinator during mastication but this function is anteriorly. . And we are DONE, the Doctor announced that next lecture we are going to finish this lecture quickly in addition to the Swallowing" lecture.

Forgive us for any mistake dentists Good luck in your exam

Done by : Ala'a Khalaf Noor Bdeir Ruba Ghanem Sanaa Qassem

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