Tongue seminar presentation (2) /certified fixed orthodontic courses by Indian dental academy

TONGUETONGUE
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INDIAN DENTAL ACADEMY
Leader in continuing dental education
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CONTENTSCONTENTS
 INTRODUCTIONINTRODUCTION
 ANATOMY OF TONGUEANATOMY OF TONGUE
 EMBRYOLOGY Of TONGUEEMBRYOLOGY Of TONGUE
 DEVELOPMENT OF THE TONGUEDEVELOPMENT OF THE TONGUE
 FUNCTIONS OF NORMAL TONGUEFUNCTIONS OF NORMAL TONGUE
 ANOMALIES OF THE TONGUEANOMALIES OF THE TONGUE
 RELATION OF NORMAL TONGUE AND DENTAL FUNCTIONRELATION OF NORMAL TONGUE AND DENTAL FUNCTION
 SWALLOWINGSWALLOWING
 CLASSIFICATION OF SWALLOWINGCLASSIFICATION OF SWALLOWING
 EXAMINATION OF THE TONGUEEXAMINATION OF THE TONGUE
 CEPHALOMETRIC EVALUATION OF THE TONGUECEPHALOMETRIC EVALUATION OF THE TONGUE
POSTUREPOSTURE
 ROLE OF TONGUE IN MALOCCLUSIONROLE OF TONGUE IN MALOCCLUSION
 TONGUE THRUSTTONGUE THRUST
 TREATMENT OF TONGUE THRUSTING HABITSTREATMENT OF TONGUE THRUSTING HABITS
 CONCLUSIONCONCLUSION
 REFERENCESREFERENCES www.indiandentalacademy.comwww.indiandentalacademy.com

ANATOMY OF THE TONGUEANATOMY OF THE TONGUE
The tongue is a highly muscular organ ofThe tongue is a highly muscular organ of
deglutition taste and speech; it is partly oraldeglutition taste and speech; it is partly oral
and partly pharyngeal in position. Theand partly pharyngeal in position. The
tongue is located in the floor of the mouth. Ittongue is located in the floor of the mouth. It
is a muscular organ with a mucousis a muscular organ with a mucous
membrane covering. It has amembrane covering. It has a
 rootroot
 an apexan apex
 a curved dorsum anda curved dorsum and
 an inferior surface.an inferior surface.

 It is divided by V - shaped sulcus terminalis intoIt is divided by V - shaped sulcus terminalis into
an anterior , oral or presulcular part facingan anterior , oral or presulcular part facing
upwardsupwards
Muscles of the tongueMuscles of the tongue
 Its mucosa is normally pink and moist. The root ofIts mucosa is normally pink and moist. The root of
the tongue is attached to the hyoid bone andthe tongue is attached to the hyoid bone and
mandible. The dorsum is generally convex in allmandible. The dorsum is generally convex in all
directions.directions.
There are two groups of muscles associated withThere are two groups of muscles associated with
the tongue; the extrinsic and the intrinsic.the tongue; the extrinsic and the intrinsic.
Extrinsic-genioglossus, HyoglossusExtrinsic-genioglossus, Hyoglossus
Chondroglossus, palatoglossus.Chondroglossus, palatoglossus.
Intrinsic muscles- sup. Longitudinal,infIntrinsic muscles- sup. Longitudinal,inf
longitudinal, transverse and vertical muscle.longitudinal, transverse and vertical muscle.

Blood SupplyBlood Supply
The blood is supplied to the tongue by right andThe blood is supplied to the tongue by right and
left lingual arteries which are branches of theleft lingual arteries which are branches of the
external carotid arteries; lingual veins carry theexternal carotid arteries; lingual veins carry the
blood to the internal jugular vein.blood to the internal jugular vein.
Nerve SupplyNerve Supply
The motor nerve supply is the hypoglossalThe motor nerve supply is the hypoglossal
nerve, which supplies both the intrinsic musclesnerve, which supplies both the intrinsic muscles
and all but of the extrinsic muscles. That one isand all but of the extrinsic muscles. That one is
the palatoglossus muscle, which is innervatedthe palatoglossus muscle, which is innervated
from the vagus through the pharyngel plexus.from the vagus through the pharyngel plexus.

DEVELOPMENT OF TONGUEDEVELOPMENT OF TONGUE
The tongue is seen at the end of the firstThe tongue is seen at the end of the first
month of intrauterine life. As the tonguemonth of intrauterine life. As the tongue
develops, it has two parts ; the body and thedevelops, it has two parts ; the body and the
root. A fibrous connective tissue layerroot. A fibrous connective tissue layer
divides the tongue into two halves. Itdivides the tongue into two halves. It
begins development from a pair of lateralbegins development from a pair of lateral
lingual swellings in the floor of the mouth atlingual swellings in the floor of the mouth at
the level of the first branchial arch. Theythe level of the first branchial arch. They
fuse medially, forming the body.fuse medially, forming the body.

The root develops from the second, third,The root develops from the second, third,
and fourth branchial arches. The musclesand fourth branchial arches. The muscles
seem to develop from thickened mesodermseem to develop from thickened mesoderm
in the floor of the mouth. The tongue is firstin the floor of the mouth. The tongue is first
seen at 1 month and is found to beseen at 1 month and is found to be
completed state at 8 weeks. It is found atcompleted state at 8 weeks. It is found at
birth that the tongue protrudes beyond thebirth that the tongue protrudes beyond the
alveolar ridges, which facilitates thealveolar ridges, which facilitates the
necessary sucking process, but as thenecessary sucking process, but as the
maxillae develop, the tongue becomesmaxillae develop, the tongue becomes
enclosed within the alveolar processes.enclosed within the alveolar processes.

TONGUE EMBRYOLOGY The tongue arises in theTONGUE EMBRYOLOGY The tongue arises in the
ventral wall of the primitive oropharynx from theventral wall of the primitive oropharynx from the
inner lining of the first four branchial arches.inner lining of the first four branchial arches.

During the 4th week i.u., paired lateral thickeningDuring the 4th week i.u., paired lateral thickening
of mesenchyme appear on the internal aspect ofof mesenchyme appear on the internal aspect of
the first branchial arches to form the lingualthe first branchial arches to form the lingual
swellings.swellings.

Between and behind these swellings a medianBetween and behind these swellings a median
eminence appears, the tuberculum impareminence appears, the tuberculum impar
(unpaired tubercle), whose caudal border is(unpaired tubercle), whose caudal border is
marked by a blind pit.marked by a blind pit.
This pit, the foramen caecum marks the site ofThis pit, the foramen caecum marks the site of
origin of the thyroid diverticulum, anorigin of the thyroid diverticulum, an
endodermal duct that appears during theendodermal duct that appears during the
somite period. the diverticulum migratessomite period. the diverticulum migrates
caudally ventral to the pharynx as thecaudally ventral to the pharynx as the
thyroglossal duct, which bifurcates andthyroglossal duct, which bifurcates and
subdivides to form the thyroid gland.subdivides to form the thyroid gland.

The lingual swelling grow and fuse with eachThe lingual swelling grow and fuse with each
other, encompassing the tuberculum impar, toother, encompassing the tuberculum impar, to
provide the ectodermal derived mucosa of theprovide the ectodermal derived mucosa of the
body (anterior two thirds) of the tongue.body (anterior two thirds) of the tongue.
The ventral bases of the second, third andThe ventral bases of the second, third and
fourth branchial arches elevate into a united,fourth branchial arches elevate into a united,
single midventral prominence knows as thesingle midventral prominence knows as the
copula (a yoke). A posterior subdivision of thiscopula (a yoke). A posterior subdivision of this
prominence is identified as the hypobranchialprominence is identified as the hypobranchial
eminence. The endodermally derived mucosaeminence. The endodermally derived mucosa
of the second to fourth branchial arches andof the second to fourth branchial arches and
the copula provide the covering for the rootthe copula provide the covering for the root
(posterior one-third) of the tongue.(posterior one-third) of the tongue.

Also, the large tongue in a small mouth partlyAlso, the large tongue in a small mouth partly
accounts for the peculiar tongue thrustingaccounts for the peculiar tongue thrusting
character of the infant’s early swallowingcharacter of the infant’s early swallowing
pattern, in which the tongue fills the spacepattern, in which the tongue fills the space
between the separated jaws during swallowing.between the separated jaws during swallowing.
The later enlargement of the mouth facilitatesThe later enlargement of the mouth facilitates
the conversion to the adult pattern ofthe conversion to the adult pattern of
swallowing, in which the tongue tip lies againstswallowing, in which the tongue tip lies against
the palate behind the maxillary incisor teeth.the palate behind the maxillary incisor teeth.
The hypobranchial eminence, derived from theThe hypobranchial eminence, derived from the
bases of the third and fourth branchial arches,bases of the third and fourth branchial arches,
forms the epiglottis, which guards the entranceforms the epiglottis, which guards the entrance
to the larynx during swallowing.to the larynx during swallowing.

FUNCTIONS OF THE NORMAL TONGUEFUNCTIONS OF THE NORMAL TONGUE
Equilibrium theory and Developmental ofEquilibrium theory and Developmental of
the Dental Occlusionthe Dental Occlusion
Equilibrium theory, as applied inEquilibrium theory, as applied in
engineering, states that an object subjected toengineering, states that an object subjected to
unequal forces will be accelerated and therebyunequal forces will be accelerated and thereby
will move to a different position in space. Itwill move to a different position in space. It
follows therefore that if any object is subjectedfollows therefore that if any object is subjected
to a set of forces but remains in the sameto a set of forces but remains in the same
position, those forces must be in balanceposition, those forces must be in balance
equilibrium. From this perspective, theequilibrium. From this perspective, the
dentition is obviously in equilibrium, since thedentition is obviously in equilibrium, since the
teeth are subjected to a variety of forces, butteeth are subjected to a variety of forces, but
do not move to a new location under usualdo not move to a new location under usual
circumstances.circumstances. www.indiandentalacademy.comwww.indiandentalacademy.com

The effectiveness of orthodontic treatment isThe effectiveness of orthodontic treatment is
itself a demonstration that forces on theitself a demonstration that forces on the
dentition is normally in equilibrium. Althoughdentition is normally in equilibrium. Although
the dentition is subjected to very heavy forcesthe dentition is subjected to very heavy forces
during function, small additional forces, if theyduring function, small additional forces, if they
are maintained for a long enough time, canare maintained for a long enough time, can
upset the equilibrium and lead to toothupset the equilibrium and lead to tooth
movementmovement

The normal tongue has several very importantThe normal tongue has several very important
normal functions of interest to the orthodontist.normal functions of interest to the orthodontist.
In mastication,In mastication,. it does so by placing the food. it does so by placing the food
in position, chiefly by the anterior and lateralin position, chiefly by the anterior and lateral
portions of the body of the tongue pushing theportions of the body of the tongue pushing the
food buccally when mastication begins.food buccally when mastication begins.
In deglutitionIn deglutition the tongue is essential, first ofthe tongue is essential, first of
all, in forming the bolus, and then in propellingall, in forming the bolus, and then in propelling
the bolus into the pharynx in the first stage ofthe bolus into the pharynx in the first stage of
swallowing. Immediately after swallowing, theswallowing. Immediately after swallowing, the
position of the tongue is found to be contactingposition of the tongue is found to be contacting
the hard palate while the soft palate is pulledthe hard palate while the soft palate is pulled
away downward against the posterior portion ofaway downward against the posterior portion of
the tonguethe tongue

The formations of sounds in speechThe formations of sounds in speech areare
another function of the tongue. The tongue isanother function of the tongue. The tongue is
in perpetual motion during speech and takes ain perpetual motion during speech and takes a
very necessary part in forming the sounds forvery necessary part in forming the sounds for
“s”, “z”. “t”, “d”, “sh”, “e”, “g”, “l”, and “r”. Some“s”, “z”. “t”, “d”, “sh”, “e”, “g”, “l”, and “r”. Some
of the necessary movements are protrusionof the necessary movements are protrusion
between the anterior teeth, as in “b”, andbetween the anterior teeth, as in “b”, and
elevation of the tip alone directly behind theelevation of the tip alone directly behind the
maxillary incisor teeth, as in the sound “s”.maxillary incisor teeth, as in the sound “s”.

In normal breathingIn normal breathing using the nasal airusing the nasal air
passages, the tongue is found to be in a restpassages, the tongue is found to be in a rest
position, a description of which follows later. Inposition, a description of which follows later. In
normal forced breathing through the mouth,normal forced breathing through the mouth,
such as an athlete may do upon exertion, thesuch as an athlete may do upon exertion, the
mandible is depressed, the lips are opened,mandible is depressed, the lips are opened,
and the tongue laterally remains in contact withand the tongue laterally remains in contact with
the lingual surfaces of the mandibular teeththe lingual surfaces of the mandibular teeth
dropping away from the maxilla; the anteriordropping away from the maxilla; the anterior
part of the tongue, including the tip, is loweredpart of the tongue, including the tip, is lowered
to contact the lingual surfaces of theto contact the lingual surfaces of the
mandibular anterior teeth.mandibular anterior teeth.

ABNORMAL FUNCTIONSABNORMAL FUNCTIONS
Ankyloglossia –this refers to fixation of tongueAnkyloglossia –this refers to fixation of tongue
to the floor of the mouth.it may be eitherto the floor of the mouth.it may be either
complete or partial.complete or partial.
Fissured tongueFissured tongue
Median rhomboid glossitisMedian rhomboid glossitis
Geographic tongueGeographic tongue
Hairy tongueHairy tongue

RELATION OF NORMAL TONGUE ANDRELATION OF NORMAL TONGUE AND
DENTAL FUNCTIONDENTAL FUNCTION
The normal growth, development, andThe normal growth, development, and
function of the tongue integrated with thefunction of the tongue integrated with the
normal growth, development, and function of allnormal growth, development, and function of all
other related oral and dental structures willother related oral and dental structures will
inevitably lead to what is considered to beinevitably lead to what is considered to be
normal jaw relationships and normal dentalnormal jaw relationships and normal dental
function.function.

SWALLOWINGSWALLOWING
Normal mature swallowing takes place withoutNormal mature swallowing takes place without
contracting the muscles of facial expression. Thecontracting the muscles of facial expression. The
teeth are momentarily in contact and the tongueteeth are momentarily in contact and the tongue
remains inside the mouth.remains inside the mouth.
Abnormal swallowing is caused by tongue-Abnormal swallowing is caused by tongue-
thrust, either as a simple thrusting action or asthrust, either as a simple thrusting action or as
“tongue-thrust syndrome”. The following“tongue-thrust syndrome”. The following
symptoms distinguish this syndrome.symptoms distinguish this syndrome.
Protrusion of the tip of the tongue.Protrusion of the tip of the tongue.
No tooth contact of the molars.No tooth contact of the molars.
Contraction of peri-oral muscles during theContraction of peri-oral muscles during the
deglutition cycle. During their first few years,deglutition cycle. During their first few years,
infants swallow viscerally, i.e. with the tongueinfants swallow viscerally, i.e. with the tongue
between the teeth. As the deciduous dentition isbetween the teeth. As the deciduous dentition is
completed, the visceral swallowing is graduallycompleted, the visceral swallowing is gradually
replaced by somatic swallowing.replaced by somatic swallowing.

CLASSIFICATION OF SWALLOWINGCLASSIFICATION OF SWALLOWING
Visceral (infantile) swallowVisceral (infantile) swallow – During the– During the
normal infantile swallow, the tongue liesnormal infantile swallow, the tongue lies
between the gum pads and the mandible isbetween the gum pads and the mandible is
stabilized by obvious contractions of the facialstabilized by obvious contractions of the facial
muscles. The buccinator muscle is particularlymuscles. The buccinator muscle is particularly
strong in the infantile swallow as it is duringstrong in the infantile swallow as it is during
infantile nursing.infantile nursing.
The cessation of the infantile swallow and theThe cessation of the infantile swallow and the
appearance of the mature swallow are not aappearance of the mature swallow are not a
simple on-and-off phenomenon. Rather,simple on-and-off phenomenon. Rather,
elements of both intermix during the primaryelements of both intermix during the primary
dentition and sometimes even in to the earlydentition and sometimes even in to the early
mixed dentition.mixed dentition.

This normal appearance of feature of bothThis normal appearance of feature of both
the infantile and mature swallow is termedthe infantile and mature swallow is termed
the “Transitional swallow”. Diminishing ofthe “Transitional swallow”. Diminishing of
buccinator activity is part of the transitionalbuccinator activity is part of the transitional
period, but the most characteristic feature ofperiod, but the most characteristic feature of
the start of cessation of the infantile swallowthe start of cessation of the infantile swallow
is the appearance of contractions of theis the appearance of contractions of the
mandibular elevators during the swallow asmandibular elevators during the swallow as
they stabilize the teeth in occlusion.they stabilize the teeth in occlusion.

Normal Mature Swallow -Normal Mature Swallow - The normal matureThe normal mature
swallow is characterized by very little lip andswallow is characterized by very little lip and
cheek activity, and the contraction of thecheek activity, and the contraction of the
mandibular elevators bringing the teeth intomandibular elevators bringing the teeth into
occlusion.occlusion.
During the mixed dentition, when some teethDuring the mixed dentition, when some teeth
are missing and there is normal interdentalare missing and there is normal interdental
spacing, the lips may contract a bit to securespacing, the lips may contract a bit to secure
the seal. All of these features are not seen all ofthe seal. All of these features are not seen all of
the time in all kinds of swallows in youngthe time in all kinds of swallows in young
children during the transitional period.children during the transitional period.

Simple Tongue – Thrust Swallow -Simple Tongue – Thrust Swallow - TheThe
simple tongue – thrust swallow typicallysimple tongue – thrust swallow typically
displays contractions of the lips, mentalisdisplays contractions of the lips, mentalis
muscle, and mandibular elevators and the teethmuscle, and mandibular elevators and the teeth
are in occlusion as the tongue protrudes into anare in occlusion as the tongue protrudes into an
open bite. There is a normal teeth togetheropen bite. There is a normal teeth together
swallow, but a “Tongue-thrust” is present toswallow, but a “Tongue-thrust” is present to
seal the open bite.seal the open bite.
A simpleA simple tongue – thrust swallow may also betongue – thrust swallow may also be
found with hypertrophied tonsils which are notfound with hypertrophied tonsils which are not
enlarged and / or inflamed sufficiently toenlarged and / or inflamed sufficiently to
prompt a tooth apart swallow.prompt a tooth apart swallow.

Malocclusion associated with simple tongue thrust
swallow

Complex Tongue – thrust SwallowComplex Tongue – thrust Swallow - The- The
complex tongue – thrust swallow is defined ascomplex tongue – thrust swallow is defined as
tongue-thrust with a teeth-apart swallow.tongue-thrust with a teeth-apart swallow.
Patients with a complex tongue-thrust combinePatients with a complex tongue-thrust combine
contractions of the lip, facial, and mentaliscontractions of the lip, facial, and mentalis
muscles, lack of contractions of the mandibularmuscles, lack of contractions of the mandibular
elevators, a tongue-thrust between the teeth,elevators, a tongue-thrust between the teeth,
and a teeth apart swallow.and a teeth apart swallow.

Malocclusion associated with complex tongue thrust
swallowwww.indiandentalacademy.comwww.indiandentalacademy.com

Retained infantile swallowRetained infantile swallow
It is defined as predominant persistence of theIt is defined as predominant persistence of the
infantile swallowing reflex after the arrival ofinfantile swallowing reflex after the arrival of
permanent teethpermanent teeth
The tongue thrusts strongly between the teethThe tongue thrusts strongly between the teeth
in front and on both sides.in front and on both sides.
Patient with a retained infantile swallow havePatient with a retained infantile swallow have
serious difficulties in mastication,for theyserious difficulties in mastication,for they
ordinarily occlude on only one molar in eachordinarily occlude on only one molar in each
quadrant.quadrant.
The gag threshold is typically lowThe gag threshold is typically low
Food is often placed on the dorsum of theFood is often placed on the dorsum of the
tongue and mastication occurs between tonguetongue and mastication occurs between tongue
tip and palate because of thetip and palate because of thewww.indiandentalacademy.comwww.indiandentalacademy.com

Inadequacy of occlusal contacts.The prognosisInadequacy of occlusal contacts.The prognosis
for conditioning of such a primitive reflex is veryfor conditioning of such a primitive reflex is very
poor.poor.
The retained infantile swallowing may beThe retained infantile swallowing may be
associated with skeletal cranio-facialassociated with skeletal cranio-facial
development syndromes and neural deficits.development syndromes and neural deficits.
Excessive anterior face height often producesExcessive anterior face height often produces
severe frontal open bites and extremes ofsevere frontal open bites and extremes of
adaptive swallowing behaviour as theadaptive swallowing behaviour as the
neuromusculature attempts to cope withneuromusculature attempts to cope with
skeletal imbalance.such strained adaptiveskeletal imbalance.such strained adaptive
swallowing behaviour must be carefullyswallowing behaviour must be carefully
discriminated from the complex and retaineddiscriminated from the complex and retained
infantile swallow.infantile swallow.

CEPHALOMETRIC EVALUATION OFCEPHALOMETRIC EVALUATION OF
TONGUE POSTURETONGUE POSTURE
The assessment is made on lateralThe assessment is made on lateral
cephalograms taken in postural rest andcephalograms taken in postural rest and
habitual occlusion. Exposure is adjusted tohabitual occlusion. Exposure is adjusted to
visualize the soft tissue. The size of the tonguevisualize the soft tissue. The size of the tongue
can be measured on the occlusion film. Acan be measured on the occlusion film. A
successful analysis depends on the propersuccessful analysis depends on the proper
utilization of correct measurable data. Autilization of correct measurable data. A
baseline or reference line for measurementbaseline or reference line for measurement
should satisfy the following criteria.should satisfy the following criteria.

Assessment of tongue position on lateral
cephalogramwww.indiandentalacademy.comwww.indiandentalacademy.com

The greatest possible area of the tongue shouldThe greatest possible area of the tongue should
like above the reference line, since the twolike above the reference line, since the two
dimensional radiographs do not show thedimensional radiographs do not show the
anatomical borders of the tongue and theanatomical borders of the tongue and the
transverse dimensions.transverse dimensions.
The baseline should be independent of variationsThe baseline should be independent of variations
in skeletal structures.in skeletal structures.
Its relation to the tongue should not change withIts relation to the tongue should not change with
changes in position of the mandible.changes in position of the mandible.
It should remain constant in relation to changes inIt should remain constant in relation to changes in
tongue position.tongue position.
It should relate to the anatomical and functionalIt should relate to the anatomical and functional
properties of the tongue.properties of the tongue.
The measurement should be an easy one to makeThe measurement should be an easy one to make
and to replicate.and to replicate.

I = the mesial margin of the lower incisors, V =I = the mesial margin of the lower incisors, V =
the most caudal point on the shadow of the softthe most caudal point on the shadow of the soft
palate or its projection on to the reference line,palate or its projection on to the reference line,
M= the tip of the distobuccal cusp of the lowerM= the tip of the distobuccal cusp of the lower
first molar. I and M are connected by a straightfirst molar. I and M are connected by a straight
line, which is extended to V to form theline, which is extended to V to form the
reference line. It has the following advantages.reference line. It has the following advantages.
A relatively large part of the tongue as seen onA relatively large part of the tongue as seen on
the cephalogram normally lies superior to thethe cephalogram normally lies superior to the
line.line.
The line does not depend on skeletalThe line does not depend on skeletal
relationships.relationships.
Changes in tongue position do not affect theChanges in tongue position do not affect the
reference line.reference line.

After constructing the line, it is bisected between IAfter constructing the line, it is bisected between I
and V. This point is called O, and a perpendicularand V. This point is called O, and a perpendicular
is constructed from it to the palatal contour. Ais constructed from it to the palatal contour. A
transparent template has been developed to maketransparent template has been developed to make
the necessary measurements. The baseline of thethe necessary measurements. The baseline of the
template coincides with the constructed referencetemplate coincides with the constructed reference
line, whereas the vertical line intersects theline, whereas the vertical line intersects the
reference line at O. from O, at which point threereference line at O. from O, at which point three
lines now meet, four more lines are constructed aslines now meet, four more lines are constructed as
shown by the illustration of the template. Theseshown by the illustration of the template. These
seven lines from six angles of 30 degrees each.seven lines from six angles of 30 degrees each.
The lines can be marked in millimeters. Placing theThe lines can be marked in millimeters. Placing the
template over the constructed lines permitstemplate over the constructed lines permits
reading the exact measurements.reading the exact measurements.

Assessment of tongue size from the occlusionAssessment of tongue size from the occlusion
cephalogram requires measuring the distancecephalogram requires measuring the distance
between the superior tongue surface and thebetween the superior tongue surface and the
roof of the mouth. This is done along the sevenroof of the mouth. This is done along the seven
constructed lines.constructed lines.
The measurements give the relative size ofThe measurements give the relative size of
the tongue, that is, the size in relationship tothe tongue, that is, the size in relationship to
the oral cavity. only when the entire oral cavitythe oral cavity. only when the entire oral cavity
is filled can a diagnosis of macroglossia beis filled can a diagnosis of macroglossia be
made. This, of course, must be supported bymade. This, of course, must be supported by
clinical evidence.clinical evidence.

Examination of tongueExamination of tongue
From an orthodontic point of viewFrom an orthodontic point of view
considerations other than its color textureconsiderations other than its color texture
are important for example its relative size itsare important for example its relative size its
postural position and its role and positionspostural position and its role and positions
in several reflex functions.in several reflex functions.
An assessment of lingual motor skills mustAn assessment of lingual motor skills must
also be part of any examinations.also be part of any examinations.
study the posture of the tongue while thestudy the posture of the tongue while the
mandible is its postural position .this can bemandible is its postural position .this can be
done if the lips are rest apart , or tonguedone if the lips are rest apart , or tongue
posture can be noted in the lateralposture can be noted in the lateral
cephalogram of mandibular posture.cephalogram of mandibular posture.www.indiandentalacademy.comwww.indiandentalacademy.com

Observe the tongue during variousObserve the tongue during various
swallowing proceduresswallowing procedures
– the unconscious swallow.the unconscious swallow.
– The command swallow of salivaThe command swallow of saliva
– The command swallow of waterThe command swallow of water
– And the unconscious swallow duringAnd the unconscious swallow during
chewingchewing
observe the role of the tongue duringobserve the role of the tongue during
masticationmastication
observe the role of the tongue duringobserve the role of the tongue during
speech morphologic examinationspeech morphologic examination

The tongue should be examined for size andThe tongue should be examined for size and
shape, though both are subjective observations.shape, though both are subjective observations.
The best clinical sign of a tongue is too large forThe best clinical sign of a tongue is too large for
its dental arch is the presence of scalloping on theits dental arch is the presence of scalloping on the
lateral borderslateral borders
Asymmetry of the tongue is more adapt to be aAsymmetry of the tongue is more adapt to be a
functional than a morphological matter. Ask thefunctional than a morphological matter. Ask the
patient to protrude the tongue and note thepatient to protrude the tongue and note the
symmetry of its position.Then ask the patient tosymmetry of its position.Then ask the patient to
relax the tongue allowing it to drape over the lowerrelax the tongue allowing it to drape over the lower
lip.Functional asymmetry of the tongue changeslip.Functional asymmetry of the tongue changes
from one position to other. Morphologicalfrom one position to other. Morphological
asymmetries will persist in the drappedasymmetries will persist in the drapped
position.Any asymmetry of the tongue haveposition.Any asymmetry of the tongue have
important clinical implications to dental archimportant clinical implications to dental arch
symmetry, dental midlines maintenance of treatedsymmetry, dental midlines maintenance of treated
incisal relationships,openbites.incisal relationships,openbites.www.indiandentalacademy.comwww.indiandentalacademy.com

..Functional examinationFunctional examination
1.Observe the posture of the tongue while the1.Observe the posture of the tongue while the
mandible is in its postural position.this may bemandible is in its postural position.this may be
done in a cephalogram taken at the mandibulardone in a cephalogram taken at the mandibular
postural position or it may be done by gently andpostural position or it may be done by gently and
casually examining the tongue lip relationshipcasually examining the tongue lip relationship
while the patient is seated in an uprightwhile the patient is seated in an upright
position.during mandibular posture the dorsumposition.during mandibular posture the dorsum
touches the palate lightly and the tongue tiptouches the palate lightly and the tongue tip
normally is at rest in the lingual fossa at thenormally is at rest in the lingual fossa at the
crevices of the mandibular incisors.crevices of the mandibular incisors.
2.observe the tongue during the various swallow2.observe the tongue during the various swallow
a.The unconscious swallowa.The unconscious swallow
b.the command swallow of salivab.the command swallow of saliva
c.The command swallow of waterc.The command swallow of water
d.And the unconscious swallow duringd.And the unconscious swallow during
masticationmastication

Variations in normal tongue posture

The tongue tip during the normal mature swallowThe tongue tip during the normal mature swallow
touches the curvature of the palate just behindtouches the curvature of the palate just behind
maxillary incisorsmaxillary incisors
3.Observe the role of the tongue during mastication.3.Observe the role of the tongue during mastication.
4.Observe the role of tongue during speech4.Observe the role of tongue during speech
Differential diagnosis of abnormal tongue postureDifferential diagnosis of abnormal tongue posture
Two significant variations from normal tongueTwo significant variations from normal tongue
posture can be seen;posture can be seen;
1.The retracted tongue ,in which the tongue tip is1.The retracted tongue ,in which the tongue tip is
withdrawn from all the anterior teethwithdrawn from all the anterior teeth
2.and the protracted tongue posture, in which the2.and the protracted tongue posture, in which the
resting tongue is in between the theincisorsresting tongue is in between the theincisors
The retracted tongue posture is more frequent inThe retracted tongue posture is more frequent in
edentulous adults or those who have bilateral lossedentulous adults or those who have bilateral loss
of several posterior teeth.It is often assosciatedof several posterior teeth.It is often assosciated
with a posterior open bite since the tongue maywith a posterior open bite since the tongue may
spread laterallyspread laterally

Retracted tongue posture

The protracted tongue posture may be a seriousThe protracted tongue posture may be a serious
problem since it usually results in open bite.problem since it usually results in open bite.
There are two forms of the protracted tongueThere are two forms of the protracted tongue
posture:posture:
1.the endogenous.1.the endogenous.
2.And the acquired adaptive2.And the acquired adaptive
The endogenous protracted tongue posture mayThe endogenous protracted tongue posture may
be a retention of the infantile postural pattern.be a retention of the infantile postural pattern.
Profitt has drawn attention to the fact that tongueProfitt has drawn attention to the fact that tongue
posture is far more adopt to cause of open biteposture is far more adopt to cause of open bite
than tongue –thrusting simply because the tonguethan tongue –thrusting simply because the tongue
is always there exerting a mild continuous force.is always there exerting a mild continuous force.

The acquired protracted tongue posture is usuallyThe acquired protracted tongue posture is usually
a transitory adaptation to enlargeda transitory adaptation to enlarged
tonsils,pharyngitis or tonsillitis.when the acutelytonsils,pharyngitis or tonsillitis.when the acutely
inflamed throat is thus anesthetized the adaptiveinflamed throat is thus anesthetized the adaptive
protracted tongue posture may spontaneouslyprotracted tongue posture may spontaneously
correct to a more normal position.correct to a more normal position.
To summarize,there are two clinically significantTo summarize,there are two clinically significant
problems in abnormal tongue posture.problems in abnormal tongue posture.
1.endogenous protracted tongue posture for1.endogenous protracted tongue posture for
which the prognosis is poor and around whichwhich the prognosis is poor and around which
unfortunately the occlusion must be builtunfortunately the occlusion must be built
2.and the acquired protracted tongue2.and the acquired protracted tongue
posture,which usually can be correctedposture,which usually can be corrected

Tongue Size:Numerous clinical methods areTongue Size:Numerous clinical methods are
done to assess tongue size.The most commondone to assess tongue size.The most common
is to check whether the patient can touch hisis to check whether the patient can touch his
chin with his tongue tip.In case of macroglossiachin with his tongue tip.In case of macroglossia
this test gives good result.this test gives good result.
In case of Microglossia the protrudedIn case of Microglossia the protruded
tongue tip reaches the Lower incisors at besttongue tip reaches the Lower incisors at best
and the floor of the mouth is elevated andand the floor of the mouth is elevated and
visible on each side of diminutive tongue.Thevisible on each side of diminutive tongue.The
dental arch reflects the small tongue size and isdental arch reflects the small tongue size and is
collapsed and reduced with extreme crowdingcollapsed and reduced with extreme crowding
in the premolar area.There is usually a severein the premolar area.There is usually a severe
class two relationship.The centrifugal force ofclass two relationship.The centrifugal force of
the tongue is minimized or absent.the tongue is minimized or absent.

Macroglossia(large tongue)Macroglossia(large tongue)
The lateral edges of the tongue when it is tooThe lateral edges of the tongue when it is too
large for the alveolar arch,usually displaylarge for the alveolar arch,usually display
scalloping where the tongue rests against thescalloping where the tongue rests against the
lingual surface of the mandibularlingual surface of the mandibular
teeth.treatment is contraindicated unless grossteeth.treatment is contraindicated unless gross
malocclusion is present.malocclusion is present.
Abnormal tongue postureAbnormal tongue posture
This can also cause generalized spacing.TheThis can also cause generalized spacing.The
prognosis is dependent on the reason for theprognosis is dependent on the reason for the
atypical postural position,often are correctableatypical postural position,often are correctable
when normal respiratory function returns.when normal respiratory function returns.

Posture in New bornPosture in New born
Tongue posture in the neonate isTongue posture in the neonate is
more forward .Later when the incisors erupt themore forward .Later when the incisors erupt the
tongue posture changes to a maturetongue posture changes to a mature
position.Mandibular growth,downward andposition.Mandibular growth,downward and
forward increases the intraoral volume,andforward increases the intraoral volume,and
alveolar process grow vertically during eruptionalveolar process grow vertically during eruption
aids in normal change in the tongue postureaids in normal change in the tongue posture
during the first year of life.during the first year of life.

Tongue reflexesTongue reflexes
The genioglossus reflex may be initiated by aThe genioglossus reflex may be initiated by a
large tongue or large tonsils or by jawlarge tongue or large tonsils or by jaw
opening.sustained Tongue protraction such asopening.sustained Tongue protraction such as
forward posturing of the tongue may forceforward posturing of the tongue may force
incisor teeth basically or prevent eruption of theincisor teeth basically or prevent eruption of the
mandibular incisors if the tongue rests over themandibular incisors if the tongue rests over the
incisal edges.large tongue may spill over theincisal edges.large tongue may spill over the
buccal teeth preventing their eruption andbuccal teeth preventing their eruption and
produce an posterior open bite or deep overbiteproduce an posterior open bite or deep overbite

TONGUE DYSFUNCTIONTONGUE DYSFUNCTION
The most common tongue dysfunctions are thoseThe most common tongue dysfunctions are those
involved selective outer pressure and tongueinvolved selective outer pressure and tongue
biting. Tongue thrusting can be anterior, posteriorbiting. Tongue thrusting can be anterior, posterior
or combined. The consequences of theor combined. The consequences of the
localization of aberrant pressure seen arelocalization of aberrant pressure seen are
dependent on the area of applied pressure.dependent on the area of applied pressure.
 An anterior open bite is caused by anterior tongueAn anterior open bite is caused by anterior tongue
thrust (and posture).thrust (and posture).
 A lateral open bite or deep overbite is the result ofA lateral open bite or deep overbite is the result of
lateral tongue thrust or postural spread, whichlateral tongue thrust or postural spread, which
causes infra-occlusion of the posterior teeth.causes infra-occlusion of the posterior teeth.

An edge to edge incisal relationship andAn edge to edge incisal relationship and
cuspal relationship of the teeth in thecuspal relationship of the teeth in the
buccal segments may mean a combinedbuccal segments may mean a combined
thrust. Anterior and posterior open bite canthrust. Anterior and posterior open bite can
occur from what a complex tongue thrust.occur from what a complex tongue thrust.
The dentoalveolar anterior and posteriorThe dentoalveolar anterior and posterior
open bite problems are usually attributableopen bite problems are usually attributable
to abnormal tongue posture and functionto abnormal tongue posture and function
and usually respond successfully toand usually respond successfully to
functional appliance intervention in mixedfunctional appliance intervention in mixed
dentition. This is also true for cases of deepdentition. This is also true for cases of deep
overbite, in which lateral tongue spreadoverbite, in which lateral tongue spread
during function and posture has resulted induring function and posture has resulted in
infra occlusion of the posterior teeth.infra occlusion of the posterior teeth.

The space is maintained by invagination of theThe space is maintained by invagination of the
peripheral portions of the tongue into theperipheral portions of the tongue into the
interocclusal space during postural rest of theinterocclusal space during postural rest of the
mandible. In such cases, there is a large freewaymandible. In such cases, there is a large freeway
space and the deep overbite is functional inspace and the deep overbite is functional in
nature.nature.
 A second type of overbite is caused by supra-A second type of overbite is caused by supra-
occlusion of the incisors. In the instance, there isocclusion of the incisors. In the instance, there is
a small freeway space. This type of problem isa small freeway space. This type of problem is
called a functional pseudo overbite. Functionalcalled a functional pseudo overbite. Functional
appliance intervention in these cases, particularlyappliance intervention in these cases, particularly
when there a developmental disturbances, is notwhen there a developmental disturbances, is not
indicated. Fixed appliances and orthopedicindicated. Fixed appliances and orthopedic
guidance are more likely to correct the problem.guidance are more likely to correct the problem.

In skeletal open bite problems, there is aIn skeletal open bite problems, there is a
genetically determined vertical growthgenetically determined vertical growth
pattern, which is often associated withpattern, which is often associated with
marked antegonial notching. This type ofmarked antegonial notching. This type of
case does not offer a favorable prognosiscase does not offer a favorable prognosis
for orthodontic therapy. The inclination offor orthodontic therapy. The inclination of
the maxillary base should also bethe maxillary base should also be
considered in the evaluation of open biteconsidered in the evaluation of open bite
relationship, where a maxillary base that isrelationship, where a maxillary base that is
tipped down anteriorly compensates for it.tipped down anteriorly compensates for it.
The inclination of the maxillary base can beThe inclination of the maxillary base can be
influenced by both functional factors, bothinfluenced by both functional factors, both
good and bad habits.good and bad habits.

The consequence of tongue posture andThe consequence of tongue posture and
function abnormalities in the dentoalveolarfunction abnormalities in the dentoalveolar
region also depends on the skeletal pattern.region also depends on the skeletal pattern.
In a horizontal growth pattern, the forwardIn a horizontal growth pattern, the forward
tongue thrust or posture can result in atongue thrust or posture can result in a
bimaxillary protrusion. With the tonguebimaxillary protrusion. With the tongue
pressing against the lingual surfaces ofpressing against the lingual surfaces of
both upper and lower incisorsboth upper and lower incisors
simultaneously, there is often spacing in thesimultaneously, there is often spacing in the
incisor segments.incisor segments.

In a vertical growth pattern, the tongueIn a vertical growth pattern, the tongue
thrust can open the bite, and the lowerthrust can open the bite, and the lower
incisors may be tipped lingually.incisors may be tipped lingually.
During the abnormal functional andDuring the abnormal functional and
postural forward positioning, the tip ofpostural forward positioning, the tip of
the tongue lies between the dentalthe tongue lies between the dental
arches and is in contact with the lowerarches and is in contact with the lower
lip, which the patient constantly sucks.lip, which the patient constantly sucks.
Thus, the incisors are tipped lingually.Thus, the incisors are tipped lingually.

Tongue thrustTongue thrust
ETIOLOGYETIOLOGY
1.genetic factors1.genetic factors
2. learned behavior (habit)2. learned behavior (habit)
3.maturation3.maturation
4.mechanical restriction4.mechanical restriction
5.neurological disturbances5.neurological disturbances
6.psyhcogenic factors6.psyhcogenic factors
7.craniofacial growth and maturation7.craniofacial growth and maturation
8 .open spaces during mixed dentition8 .open spaces during mixed dentition
9.other factors9.other factors

Classification of tongue thrustClassification of tongue thrust
According to MoyersAccording to Moyers
a. normal infantile swallowa. normal infantile swallow
b. normal mature swallowb. normal mature swallow
c. simple tongue thrust swallowc. simple tongue thrust swallow
d. complex tongue thrust swallowd. complex tongue thrust swallow
e. retained infantile swallowe. retained infantile swallow

BRANER AND HOLTBRANER AND HOLT classified tongue thrust asclassified tongue thrust as
type 1 non deformity tongue thrusttype 1 non deformity tongue thrust
typ2 deformity tongue thrusttyp2 deformity tongue thrust
sub group 1-anterior open bitesub group 1-anterior open bite
sub group 2-associated with pro-cumbency ofsub group 2-associated with pro-cumbency of
incisorsincisors
sub group 3-associated with posterior crossbitesub group 3-associated with posterior crossbite
type 3-deformity lateral tongue thrusttype 3-deformity lateral tongue thrust
sub group 1-posterior open bitesub group 1-posterior open bite
sub group2- posterior cross bitesub group2- posterior cross bite
subgroup 3 –deep overbitesubgroup 3 –deep overbite
type 4- deformity anterior and lateral tongue thrusttype 4- deformity anterior and lateral tongue thrust
sub group 1- anterior and posterior open bitesub group 1- anterior and posterior open bite
sub group 2 associated pro-cumbency of anteriorsub group 2 associated pro-cumbency of anterior
teethteeth
sub group 3- associated posterior cross bitesub group 3- associated posterior cross bitewww.indiandentalacademy.comwww.indiandentalacademy.com

DiagnosisDiagnosis
careful differentiation should be made ofcareful differentiation should be made of
– simple tongue thrustsimple tongue thrust
– complex tongue thrustcomplex tongue thrust
– retention of infantile swallowing patternretention of infantile swallowing pattern
– faulty tongue posturefaulty tongue posture
Tests for diagnosisTests for diagnosis
1.when the jaw drops and mentalis muscle1.when the jaw drops and mentalis muscle
contracts strongly while swallowing,there iscontracts strongly while swallowing,there is
probably a tongue thrustprobably a tongue thrust
2.you may part the lips while swallowing to2.you may part the lips while swallowing to
watch tongue thrust,and in doing so,strongwatch tongue thrust,and in doing so,strong
muscle contractions can be feltmuscle contractions can be felt
Cineflourography-Cineflourography-www.indiandentalacademy.comwww.indiandentalacademy.com

Here the patient is asked to swallow and theHere the patient is asked to swallow and the
camera is started.A cineflurographic film iscamera is started.A cineflurographic film is
made of the movements of the tongue frommade of the movements of the tongue from
the beginning of the swallowing patternthe beginning of the swallowing pattern
,regarding backward and downward,regarding backward and downward
movements of the tip of tongue until themovements of the tip of tongue until the
tongue moves back to its original positiontongue moves back to its original position
at the end of swallowing which will be in aat the end of swallowing which will be in a
matter of few seconds.matter of few seconds.

After the cineflourographic film had beenAfter the cineflourographic film had been
developed,the tracing technique consisteddeveloped,the tracing technique consisted
of drawing a straight line from the labialof drawing a straight line from the labial
surface of the upper central incisor downsurface of the upper central incisor down
ward until extends past the lower incisor.ward until extends past the lower incisor.
Then ,measurement can be made to knowThen ,measurement can be made to know
how far tongue has extended past this line.how far tongue has extended past this line.
4.payne technique4.payne technique

Simple tongue thrustSimple tongue thrust
1.it is defined as the tongue thrust with1.it is defined as the tongue thrust with
teeth together swallowteeth together swallow
2.malocclusion which is associated with it2.malocclusion which is associated with it
is usually well circumscribed type of openis usually well circumscribed type of open
bite in anterior region.bite in anterior region.
3.cuspal interference are not present and3.cuspal interference are not present and
there is perfect fit of posterior teeth inthere is perfect fit of posterior teeth in
4. intercuspation is firm but the4. intercuspation is firm but the
anteroposterior relationship is notanteroposterior relationship is not
necessarily correct.necessarily correct.

5.it is associated with abnormal function of5.it is associated with abnormal function of
lips mentalis and other circum orallips mentalis and other circum oral
muscles.as the patient swallows anterior lipmuscles.as the patient swallows anterior lip
seal is made partly with the teeth and partlyseal is made partly with the teeth and partly
with the lips.with the lips.
6.teeth are held together prior to and6.teeth are held together prior to and
through out swallowingthrough out swallowing
7.open bite has a definite beginning and an7.open bite has a definite beginning and an
endingending
8.prognosis is excellent8.prognosis is excellent

TreatmentTreatment
Steps in correctionSteps in correction
1.1. Learning of a new reflex at the conscious level,Learning of a new reflex at the conscious level,
i.e., teach the exact position of tongue byi.e., teach the exact position of tongue by
pointing with patient’s own index finger; ask thepointing with patient’s own index finger; ask the
patient to swallow by holding the tongue in thatpatient to swallow by holding the tongue in that
position.position.
2.2. Transferral to the subconscious level: By thisTransferral to the subconscious level: By this
position, it is to reinforce the reflex atposition, it is to reinforce the reflex at
subconscious level done by placing flatsubconscious level done by placing flat
sugarless fruit drops at the position occupied bysugarless fruit drops at the position occupied by
tip of tongue.tip of tongue.
3.3. Appliances : If proclination is severe treat theAppliances : If proclination is severe treat the
procumbency of teeth first and then correct theprocumbency of teeth first and then correct the
habit. If procumbency is not so much correct thehabit. If procumbency is not so much correct the
habit then correct the malocclusion.habit then correct the malocclusion.www.indiandentalacademy.comwww.indiandentalacademy.com

Complex tongue thrustComplex tongue thrust
This is defined as tongue thrust with teeth apartThis is defined as tongue thrust with teeth apart
swallow. The malocclusion associated with it hasswallow. The malocclusion associated with it has
two distinct characteristics.two distinct characteristics.
1.1. Poor occlusal fit resulting in a slide intoPoor occlusal fit resulting in a slide into
2.2. There is generalized anterior open bite.There is generalized anterior open bite.
3.3. Absence of temporal muscle contraction duringAbsence of temporal muscle contraction during
swallowing.swallowing.
4.4. There is dropping of mandible and strongThere is dropping of mandible and strong
contraction of circum oral muscles.contraction of circum oral muscles.
5.5. Prognosis for correction of a complex tonguePrognosis for correction of a complex tongue
thrust is fair at best, as there are twothrust is fair at best, as there are two
neuromuscular problems.neuromuscular problems.
 An abnormal occlusal reflexAn abnormal occlusal reflex
 An abnormal swallow reflex.An abnormal swallow reflex.

TreatmentTreatment
Similar to the management of simple tongueSimilar to the management of simple tongue
thrust. However, the occlusal correction shouldthrust. However, the occlusal correction should
be carried out only after the correction of thebe carried out only after the correction of the
habit. Inspite of clinicians best efforts, there willhabit. Inspite of clinicians best efforts, there will
be partial relapse in some cases.be partial relapse in some cases.
Retained infantile swallowRetained infantile swallow
1.1. This is the persistence of the infantileThis is the persistence of the infantile
swallowing reflex even after the arrival of theswallowing reflex even after the arrival of the
permanent teeth. Very few people have this typepermanent teeth. Very few people have this type
of swallow.of swallow.
2.2. Teeth occlude on only one molar in eachTeeth occlude on only one molar in each
quadrant.quadrant.

3.3. They demonstrate violent contractions ofThey demonstrate violent contractions of
seventh cranial nerve musculature duringseventh cranial nerve musculature during
swallowing and tongue is markedlyswallowing and tongue is markedly
protruded between all the teeth duringprotruded between all the teeth during
initial stages of swallow.initial stages of swallow.
4.4. The patients will have an expression lessThe patients will have an expression less
face since facial muscles are used forface since facial muscles are used for
stabilizing the mandible.stabilizing the mandible.
5.5. Following the loss of teeth, satisfactoryFollowing the loss of teeth, satisfactory
denture prosthesis is almost impossible.denture prosthesis is almost impossible.
6.6. Prognosis for correction is poor.Prognosis for correction is poor.

Management of tongue thrustManagement of tongue thrust
Factors to be considered.Factors to be considered.
1.1. Type of malocclusion: The common types ofType of malocclusion: The common types of
malocclusion associated with tongue thrustmalocclusion associated with tongue thrust
habits are :habits are :
a. Class I malocclusion with increased over jet.a. Class I malocclusion with increased over jet.
b. Angle’s Class II division I malocclusion withb. Angle’s Class II division I malocclusion with
increased over jet.increased over jet.
c. Deep bitec. Deep bite
d. Marked open bite.d. Marked open bite.
2.2. Degree of malocclusionDegree of malocclusion
3.3. Scope of the problem : A child who habitually,Scope of the problem : A child who habitually,
keeps mouth open and does all functions withkeeps mouth open and does all functions with
the thrusting tongue needs immediate attention.the thrusting tongue needs immediate attention.
In cases of occasional tongue thrusters, theIn cases of occasional tongue thrusters, the
treatment can be postponed for sometimes.treatment can be postponed for sometimes.

4.4. Maturity of the child.Maturity of the child.
5.5. Attitude and the degree of cooperation thatAttitude and the degree of cooperation that
can be expected from the parents.can be expected from the parents.
6.6. Progressive malocclusions should beProgressive malocclusions should be
considered for immediate treatment.considered for immediate treatment.
7.7. Structural considerations to be eliminatedStructural considerations to be eliminated
areare
a. Nasal air blockage.a. Nasal air blockage.
b. Extremely narrow palatal arch.b. Extremely narrow palatal arch.
c. Maxillary posterior teeth in extremely,c. Maxillary posterior teeth in extremely,
lingual positionlingual position
d. Macroglossia.d. Macroglossia.www.indiandentalacademy.comwww.indiandentalacademy.com

PALATOGRAPHIC EXAMINATION OF THE TONGUEPALATOGRAPHIC EXAMINATION OF THE TONGUE
AA Complementary evaluation of tongue function isComplementary evaluation of tongue function is
possible using a palatographic examination. Thispossible using a palatographic examination. This
method enables the observation of tonguemethod enables the observation of tongue
function during swallowing and speaking and alsofunction during swallowing and speaking and also
allows the evaluation of the influence of variousallows the evaluation of the influence of various
functional orthodontic appliances on the tongue.functional orthodontic appliances on the tongue.
There is a direct and indirect method.There is a direct and indirect method.
In the current direct method, the superior surface ofIn the current direct method, the superior surface of
the tongue is covered with a precise impressionthe tongue is covered with a precise impression
material. For example, Imprex. A thin, even layermaterial. For example, Imprex. A thin, even layer
is applied on the tongue with a spatula. Afteris applied on the tongue with a spatula. After
functional exercises, a Polaroid print is made offunctional exercises, a Polaroid print is made of
the palatal region, with the help of a surfacethe palatal region, with the help of a surface
mirror. The evaluation of the palatogram ismirror. The evaluation of the palatogram is
possible by direct measurements on the picture.possible by direct measurements on the picture.

Speech assessment is also desirable from anSpeech assessment is also desirable from an
orthodontic point of view. The tongue plays aorthodontic point of view. The tongue plays a
central role in phonation, together with thecentral role in phonation, together with the
pharynx, velum, palate, and teeth. The movementspharynx, velum, palate, and teeth. The movements
of the tongue during speech are sophisticated andof the tongue during speech are sophisticated and
dependent on local conditions. In malocclusionsdependent on local conditions. In malocclusions
with malposed teeth, there can also be awith malposed teeth, there can also be a
malposition of the tongue, which can impairmalposition of the tongue, which can impair
normal speech. Usually, the tongue with itsnormal speech. Usually, the tongue with its
inherent flexibility can compensate for atypicalinherent flexibility can compensate for atypical
morphological relationships. However, the abilitymorphological relationships. However, the ability
to compensate or adapt can be assessed by theto compensate or adapt can be assessed by the
palatographic record.palatographic record.
This compensatory potential is an importantThis compensatory potential is an important
diagnostic clue as the clinician establishes adiagnostic clue as the clinician establishes a
treatment plan and a probable prognosis fortreatment plan and a probable prognosis for
functional appliance therapy.functional appliance therapy.www.indiandentalacademy.comwww.indiandentalacademy.com

Comparison of tongue functions between MatureComparison of tongue functions between Mature
and Tongue thrust swallowing –an Ultrasoundand Tongue thrust swallowing –an Ultrasound
investigationinvestigation
A Study done by Paul-Georg Jost-Brinkmann et.al.A Study done by Paul-Georg Jost-Brinkmann et.al.
(Am J Orthod Dentofacial orthop 2004;125:562-70)(Am J Orthod Dentofacial orthop 2004;125:562-70)
Ultrasonography has been used in many studiesUltrasonography has been used in many studies
for static imaging of the oral cavity.(eg,forfor static imaging of the oral cavity.(eg,for
studying tongue morphology and cysts andstudying tongue morphology and cysts and
tumours).Dynamic ultrasound investigation oftumours).Dynamic ultrasound investigation of
tongue movement through submental scanningtongue movement through submental scanning
has been described by many researchers.A majorhas been described by many researchers.A major
obstacle of these ultrasound investigations is thatobstacle of these ultrasound investigations is that
it causes various artifacts resulting in inaccurateit causes various artifacts resulting in inaccurate
measurements of tongue movements.measurements of tongue movements.

Cushion scanning method provides aCushion scanning method provides a
solution to these problems.with a cushionsolution to these problems.with a cushion
scanning system that consists of a cushionscanning system that consists of a cushion
device,a head support.a probe holder,and adevice,a head support.a probe holder,and a
head position recording device,tonguehead position recording device,tongue
dynamic can be correctly recorded anddynamic can be correctly recorded and
measured.measured.

CONCLUSIONSCONCLUSIONS
The tongue movements of mature swallowing andThe tongue movements of mature swallowing and
tongue thrust swallowing can be differentiatedtongue thrust swallowing can be differentiated
with an ULTRA SOUNDwith an ULTRA SOUND
Tongue thrust swallowing has a prolongedTongue thrust swallowing has a prolonged
duration in the late transport phase compared withduration in the late transport phase compared with
mature swallowing.mature swallowing.
The center of the tongue might serve as an idealThe center of the tongue might serve as an ideal
representative of the whole tongue and can giverepresentative of the whole tongue and can give
the observer a brief view of whole tonguethe observer a brief view of whole tongue
movement during swallowing.movement during swallowing.
The cushion scanning technique ultrasoundThe cushion scanning technique ultrasound
visualization of tongue thrust,compared with othervisualization of tongue thrust,compared with other
methods that require opening of the lips,foreignmethods that require opening of the lips,foreign
bodiesin the mouth ,or x-ray radiation,offers abodiesin the mouth ,or x-ray radiation,offers a
safer and more attractive way to evaluate tonguesafer and more attractive way to evaluate tongue
movement.movement.

CONCLUSIONCONCLUSION
Hence position of tongue and its function playsHence position of tongue and its function plays
an important role or a contributing factor inan important role or a contributing factor in
dental malocclusion.dental malocclusion.
Accomplishment of successful orthodonticAccomplishment of successful orthodontic
treatment is possible through proper diagnosistreatment is possible through proper diagnosis
and treatment plan taking into consideration alland treatment plan taking into consideration all
the surrounding oral structures.the surrounding oral structures.

REFERENCESREFERENCES
GROWTH AN DEVELOPMENT OF TONGUE –GROWTH AN DEVELOPMENT OF TONGUE –
GREYS ANATOMYGREYS ANATOMY
EMBRYOLOGY – INDERBIR SINGHEMBRYOLOGY – INDERBIR SINGH
ORAL PATHOLOGY-SHAFERORAL PATHOLOGY-SHAFER
HAND BOOK OF ORTHODONTICS- ROBERTHAND BOOK OF ORTHODONTICS- ROBERT
E MOYERSE MOYERS
TEXT BOOK OF ORTHODONTICS -WILLIAMTEXT BOOK OF ORTHODONTICS -WILLIAM
R PROFITTR PROFITT

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