• Users Online: 573
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 1  |  Page : 16-20

Devices used for measuring tongue force: A review


Department of Orthodontics and Dentofacial Orthopaedics, Saraswati Dental College, Lucknow, Uttar Pradesh, India

Date of Submission28-Nov-2019
Date of Acceptance21-Feb-2020
Date of Web Publication10-Apr-2020

Correspondence Address:
Dr. Parijat Chakraborty
Saraswati Dental College, Tiwaryganj, Lucknow - 227 105, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijor.ijor_44_19

Rights and Permissions
  Abstract 

Over many decades, medical representatives, researchers, etc., are making an attempt to quantify the force/pressure put by the tongue within the oral cavity. Evaluation of the abovementioned may be done by qualitative or quantitative methods. The aim of this study was to assemble a review of literature regarding the devices to measure tongue strength used by different researchers over a period of time from everywhere the globe. A critical analysis regarding the devices custom-made or used to quantify tongue force was meted out in different words such as “tongue pressure,” “role of tongue,” and “malocclusion” in varied search engines using the Internet. The articles considered were over a period of 60 years approximately, i.e., 1956 dated up to March 2018. In addition, searches were also made within the references of the chosen articles. Every custom-made device has drawbacks in its own. In an overall view, most of the devices measure pressure in just one direction. However, tongue activity throughout the features entails a combination of dynamic and static forces because the tongue is oriented in a diffusion of various positions. The employment of quantitative ways to measure tongue force helps the skilled in the evaluation of orofacial physiology, making the diagnosis of tongue force more reliable, particularly in those subjects with a small strength deficit which are difficult to be noted by clinical evaluation.

Keywords: Devices, malocclusion, tongue force


How to cite this article:
Chakraborty P, Chandra P, Tandon R, Singh K, Chauhan A. Devices used for measuring tongue force: A review. Int J Orthod Rehabil 2020;11:16-20

How to cite this URL:
Chakraborty P, Chandra P, Tandon R, Singh K, Chauhan A. Devices used for measuring tongue force: A review. Int J Orthod Rehabil [serial online] 2020 [cited 2020 May 29];11:16-20. Available from: http://www.orthodrehab.org/text.asp?2020/11/1/16/282185


  Introduction Top


Over a couple of decades, medical representatives, researchers, etc., are making an attempt to quantify the force/pressure put by the tongue within the mouth. Tongue, as we all know, plays a really vital role in performing functions such as chewing, swallowing, suction, respiration, and speech articulation and conjointly keeps correct tooth position. Besides, it balances the force exerted by the lips and cheeks on the teeth.

Evaluation of the abovementioned may be done by qualitative or quantitative ways. Qualitative analysis is a kind used in speech-language clinical practice on a daily basis that depends a lot on the expertise of the skilled and is not free from controversies. Procedure includes protrusion of the tongue against the finger of the skilled or the depressor that exerts resistance. The opposite and therefore the more accepted technique of quantitative analysis are performed using instruments that help in the quantitative assessment of the force exerted by the individual's tongue. This technique ensures more accuracy.

The purpose of this study was to assemble a review of literature regarding the devices to measure tongue strength utilized by different researchers over a period of time from all over the globe.


  Materials and Methods Top


Inclusion criteria: a critical analysis regarding the devices customized or accustomed to quantify tongue force was carried out in different words such as “tongue pressure,” “role of tongue,” and “malocclusion” in various search engines using web. The articles considered were over a period of 60 years close to, i.e., 1956 dated up to March 2018. In addition, searches were additionally made within the references of the chosen articles. Exclusion criteria: all the results were totally scrutinized in three stages: foremost, those that were not almost like the target were excluded, second, the recurrent ones were removed, and in conclusion, the authors who used a similar variety of strategies were omitted from the ultimate list of references. The author name, year, and device used are listed in [Table 1].
Table 1: List of authors along with the year and the devices used by them

Click here to view



  Results Top


A total of 150 reference articles resembling the objectives were settled. After scrutinization, inclusion, and exclusion, 44 articles were left to contend with. The devices were divided into eight categories according to their technology: mouthpiece with gauge (n = 9), load cells (n = 1), or force-sensing resistors (n = 5); sensing elements connected on teeth or on palatal plates (n = 11); dynamometers (n = 4); Iowa Oral Performance Instrument and bulbs stuffed with some fluid and connected to a pressure sensor (n = 15); and different technologies (n = 10).


  Discussion Top


Mouthpiece with gauge

A plate base fabricated from methyl methacrylate was created by Kydd et al. (1963);[1] the vertical dimensions were maintained between the bases by four vertical rods embedded within the lower plate base. Electric resistance strain gauges were connected to those blocks. Pressure exerted by tongue on the block produced a deformation on the gauge, modifying its resistance. Proffit et al.[2] conjointly used the abovementioned, and three rather than two intraoral transducers were placed on the upper central tooth and first upper molar by a resin.

Sanders[3] described a device that consisted of a force-displacement electrical device connected to one-channel direct-writing portable audio system, a specially designed tongue pressure disk, and a head stabilizer. The electrical device consisted of 4 strain gauges that measured strain.

Durkee and Manning (1987)[6] custom built a tool to measure tongue force in three directions on the axes X, Y, and Z. Scardella et al.[31] quantified tongue force employing a force electrical device that interpreted direct compression forces generated by the tongue to an active arm outside of the mouth connected to a gauge with linear response for forces between 50 and 100 gf, which was incorporated into a two-arm active electric circuit.

Mouthpiece containing load cells

Mortimore et al.[10] customized a transducer consisting of a machined nylon hand grip and a mouthpiece along with a 0 ± 6 kgf button load cell behind it. The electrical device was connected to a linear visual scale displaying force in Newton or as a percentage of the subject's maximum force.

Mouthpiece containing force-sensing resistors

An instrument consisting of two mouthpieces, one superior and one inferior, with three force-sensing resistors in every, were planned by Sangave et al.[15] The sensors were piezoresistive FlexiForce with measuring range from 0 to 110 N. Every sensing element was mounted to a stainless-steel plate connected to the mouthpiece.

Xu et al.[25] changed the transpalatal arch used for vertical management of the molars, based on individual muscle strength and morphology features of the tongue during swallowing. Tongue pressure exerted on the surface and the acrylic pads at three distances to the palatal mucosa during swallowing was measured by pressure sensors.

Pressure sensors connected on teeth or on palatal plates

Staehlin et al.[9] created a palatal plate equipped with more than one pressure sensors to measure tongue force during function. Hori et al. (2009)[13] measured tongue pressure during manduction and swallowing using seven pressure sensors (capacity of 200 kPa) installed in a palatal plate and recorded on a computer. Hewitt et al.[16] introduced the Madison Oral Strengthening Therapeutic consisting of an adult sized polymer mouthguard with a palatal plate was connected with a semiconductive elastomeric force sensing element. The palatal plate developed by Kieser et al.[32] supplied simultaneous measuring of pressure at totally different locations within the mouth and was made from a chrome-cobalt alloy. Two pairs of gauges measured pressure contributions of the lateral tongue margin and cheeks on the canine and first molar teeth.

Sardini et al.[19] projected a tool with the aim to supply the continual force measuring on the surface wirelessly on show. The device consisted of tactile sensors fictional over a plastic sheet. Furlan et al. (2013)[23] quantified the tongue protrusion force employing a Forling instrument developed within the Biomechanical Engineering Group from Brazil.

Dynamometers

Posen[4] measured maximum tongue force in subjects with the instrument that was fabricated from a gauge and a spring. Trawitzki et al. (2011)[18] investigated the tongue strength in young adults and determined the variations during this strength between tongue regions.

Bulbs filled with some fluid and connected to a pressure-sensing element and intraoral performance instrument

Robin and Lushei[8] customized a portable pressure detecting device using a water-filled bulb of an acceptable size to fit inside the mouth. The Iowa Oral Performance Instrument (IOPI) was a second version of the instrument utilized by Robin et al. The difference was that the IOPI's bulb is full of air. IOPI was commercially available, and it was utilized by many authors in tongue pressure investigations (Laura L et al., 2014; Jong ha Lee et al., 2015; Imrak Partal; Dong Min et al.;[33] and Leen Van Steen et al., 2017).[27]

Hayashi et al.[11] used an air crammed bulb made up of rubber connected by a tube to a pressure electrical device, an amplifier, and a record system. Ball et al.[14] used another tongue pressure measuring device using bulbs, the Kay Swallowing Workstation. Utanohara et al.[34] created a tongue pressure measuring device consisting of a disposable oral probe, an infusion tube as a connector, and a recording device. Asami et al.[35] measured tongue pressure using JMS measuring device (balloon based).

Other technologies

Wallen[5] planned an electrical device system capable of measuring pressure in numerous planes. The transducers were mounted in acrylic base connected to the surface of incisor teeth. Secure Wires connected the transducers to the input of a dynograph. Fröhlich et al. (1991)[7] used an open cannula (internal diameter: 0.7 mm) embedded in a small customized acrylic shield that was secure to the teeth. The tubing was connected to a pressure instrument by a tube passing between lips.

Other analysis group measured tongue protrusion force employing a force electrical device (Grass FT10 force-displacement transducer) trapped in a surface. This piece had a cushion for teeth positioning that the subjects had to bite and press the tongue against a spherical button of 20 mm diameter connected to the force electrical device by a cylindrical steel beam of 5 mm diameter and 50 mm length.[36]

The Myometer 160 contained a probe that consisted of 2 plates that were screwed one along each side. On the other side (probe tip), the two plates can be pushed toward one another.[17]


  Conclusion Top


Each custom-built device has drawbacks in its own. The primary disadvantage of utilizing dynamometers is that they are not sensitive to very little changes operative, and at times, the measures do not seem to be reliable, as a measure of force can be made by the patient's or the specialist's hand pushing the electrical device toward the patient's mouth. The problem of the bulb is that the issue of positioning and reproducibility within the oral cavity. Air-filled bulb positions are laborious to change because it slides too effortlessly on the tongue surface, and the connected tube is not scaled to demonstrate things of the bulb when lips closure. Palatal plates ought to be changed as each individual has his/her surface size and that they assess tongue force solely in a cranial direction, which is incompatible to the emotional assessment made by speech pathologists, not allowing examinations among quantitative and qualitative assessments. Anyway, they are produced to quantify tongue force amid the capabilities, as they enable the patient to shut his mouth and perform the capacities (speech, mastication, and swallowing) generally.

Another elective technique is to attach the sensors straightforwardly on the surface of the teeth. This strategy has two inconveniences. First, the difficulty to oblige the sensors at the setup focuses to form relative appraisal conceivable. The second weakness is that the sensors are laborious to clean and sterilize, so they cannot be utilized in numerous patients. This technique is better to measure tongue force during functions than the relatively bulkier palatal plates. The instruments that used strain gauges typically have a cumbersome mechanical structure needed for his or her performance, and therefore, the hard inflexible structure of the gauges will cause intraoral lacerations or discomfort to the patient. The device created by the Biomechanical Engineering Group from Universidade Federal de Minas Gerais (Federal University of Minas Gerais - UFMG) is the first device to degree tongue strength advanced in Brazil. The main diagnosed drawback within the device was the problem to seal the tubes that precipitated some leak that encouraged the measurements and created air bubbles within the system.

In an overall view, most of the devices measure pressure in only one direction. However, tongue activity throughout the features entails a combination of dynamic and static forces because the tongue is oriented in the diffusion of varied positions. The employment of quantitative strategies to measure tongue force facilitates the skilled in the analysis of orofacial physiology, creating the diagnosing of tongue force additional reliable, particularly in those subjects with a small strength deficit that is difficult to be noted by clinical evaluation. However, it is far more crucial to remember that the quantitative assessment needs to not be used to substitute the qualitative, rather complement it, because skilled expertise is vital to understand the pathology of the affected person.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kydd WL, Akamine JS, Mendel RA, Kraus BS. Tongue and lip forces exerted during deglutition in subjects with and without an anterior open bite. J Dent Res 1963;42:858-66.  Back to cited text no. 1
    
2.
Proffit WR, Kydd WL, Wilskie GH, Taylor DT. Intraoral pressures in a young adult group. J Dent Res 1964;43:555-62.  Back to cited text no. 2
    
3.
Sanders LJ. Instrumentation for measurement of lingual strength. J Speech Hear Res 1968;11:189-93.  Back to cited text no. 3
    
4.
Posen AL. The influence of maximum perioral and tongue force on the incisor teeth. Angle Orthod 1972;42:285-309.  Back to cited text no. 4
    
5.
Wallen TR. Vertically directed forces and malocclusion: A new approach. J Dent Res 1974;53:1015-22.  Back to cited text no. 5
    
6.
Durkee DL, Manning FE. Tongue force measuring device. US Pat. 4.697.601; 1987. p. 7.  Back to cited text no. 6
    
7.
Fröhlich K, Thüer U, Ingervall B. Pressure from the tongue on the teeth in young adults. Angle Orthod 1991;61:17-24.  Back to cited text no. 7
    
8.
Robin DA, Lushei ES. System and method for detecting pressure of selected body parts. US Pat 5.119.831; 1992. p. 13.  Back to cited text no. 8
    
9.
Staehlin. Method and Apparatus for Oral Motor Therapy using a Visual Display. U.S. Patent; 1999.  Back to cited text no. 9
    
10.
Mortimore IL, Fiddes P, Stephens S, Douglas NJ. Tongue protrusion force and fatigability in male and female subjects. Eur Respirat J 1999;14:191-5.  Back to cited text no. 10
    
11.
Hayashi R, Tsuga K, Hosokawa R, Yoshida M, Sato Y, Akagawa Y. A novel handy probe for tongue pressure measurement. Int J Prosthodont 2002;15:385-8.  Back to cited text no. 11
    
12.
Wakumoto M, Masaki S, Ooue T. System for Measure Tongue Pressure. US Pat 6.511.441 B1; 2003. p. 16.  Back to cited text no. 12
    
13.
Hori K, Ono T, Tamine K, Kondo J, Hamanaka S, Maeda Y, et al. Newly developed sensor sheet for measuring tongue pressure during swallowing. J Prosthodont Res 2009;53:28-32.  Back to cited text no. 13
    
14.
Ball S, Idel O, Cotton SM, Perry A. Comparison of two methods for measuring tongue pressure during swallowing in people with head and neck cancer. Dysphagia 2006;21:28-37.  Back to cited text no. 14
    
15.
Sangave A, Manuccia T, Kay M, Zderic V. Lingual force detection system. Conf Proc IEEE Eng Med Biol Soc 2008;2008:4844-7.  Back to cited text no. 15
    
16.
Hewitt A, Hind J, Kays S, Nicosia M, Doyle J, Tompkins W, et al. Standardized instrument for lingual pressure measurement. Dysphagia 2008;23:16-25.  Back to cited text no. 16
    
17.
Lambrechts H, De Baets E, Fieuws S, Willems G. Lip and tongue pressure in orthodontic patients. Eur J Orthod 2010;32:466-71.  Back to cited text no. 17
    
18.
Trawitzki LV, Borges CG, Giglio LD, Silva JB. Tongue strength of healthy young adults. J Oral Rehabil 2011;38:482-6.  Back to cited text no. 18
    
19.
Sardini E, Serpelloni M, Fiorentini R. Wireless intraoral sensor for the physiological monitoring of tongue pressure. Transducers. Spain: Barcelona; 2013. p. 16-20.  Back to cited text no. 19
    
20.
Ueki K, Marukawa K, Moroi A, Sotobori M, Ishihara Y, Iguchi R, et al. The time-course change in the lip closing force in Class III malocclusion after orthognathic surgery. J Craniomaxillofac Surg 2014;42:896-900.  Back to cited text no. 20
    
21.
Van Lierde KM, Bettens K, Luyten A, Plettinck J, Bonte K, Vermeersch H, et al. Oral strength in subjects with a unilateral cleft lip and palate. Int J Pediatr Otorhinolaryngol 2014;78:1306-10.  Back to cited text no. 21
    
22.
Shiono Y, Morikawa K, Maki K. Comparative clinical study evaluating lip-closure forces in association with tongue pressure in children. Pediatr Dent J 2015;25:19-25.  Back to cited text no. 22
    
23.
Furlan RM, Motta AR, Valentim AF, Barroso MF, Costa CG, Las Casas EB. Protrusive tongue strength in people with severely weak tongues. Int J Speech Lang Pathol 2013;15:503-10.  Back to cited text no. 23
    
24.
Lee JH, Kim HS, Yun DH, Chon J, Han YJ, Yoo SD, et al. The relationship between tongue pressure and oral dysphagia in stroke patients. Ann Rehabil Med 2016;40:620-8.  Back to cited text no. 24
    
25.
Xu K, Zeng J, Xu T. Effect of an intraoral appliance on tongue pressure measured by force exerted during swallowing. Am J Orthod Dentofacial Orthop 2016;149:55-61.  Back to cited text no. 25
    
26.
Hiraki K, Yamada Y, Kurose M, Ofusa W, Sugiyama T, Ishida R. Application of a barometer for assessment of oral functions: Donders space. J Oral Rehabil 2017;44:65-72.  Back to cited text no. 26
    
27.
Partal I, Aksu M. Changes in lips, cheeks and tongue pressures after upper incisor protrusion in Class II division 2 malocclusion: A prospective study. Prog Orthod 2017;18:29.  Back to cited text no. 27
    
28.
Hiraoka A, Yoshikawa M, Nakamori M, Hosomi N, Nagasaki T, Mori T, et al. Maximum tongue pressure is associated with swallowing dysfunction in ALS patients. Dysphagia 2017;32:542-7.  Back to cited text no. 28
    
29.
Fujita Y, Ichikawa M, Hamaguchi A, Maki K. Comparison of masticatory performance and tongue pressure between children and young adults. Clin Exp Dent Res 2018;4:52-8.  Back to cited text no. 29
    
30.
Sakai K, Nakayama E, Tohara H, Takahashi O, Ohnishi S, Tsuzuki H, et al. Diagnostic accuracy of lip force and tongue strength for sarcopenic dysphagia in older inpatients: A cross-sectional observational study. Clin Nutr 2019;38:303-9.8.  Back to cited text no. 30
    
31.
Scardella AT, Krawciw N, Petrozzino JJ, Co MA, Santiago TV, Edelman NH. Strength and endurance characteristics of the normal human genioglossus. Am Rev Respir Dis 1993;148:179-84.  Back to cited text no. 31
    
32.
Kieser J, Singh B, Swain M, Ichim I, Waddell JN, Kennedy D, et al. Measuring intraoral pressure: Adaptation of a dental appliance allows measurement during function. Dysphagia 2008;23:237-43.  Back to cited text no. 32
    
33.
Jeong DM, Shin YJ, Lee NR, Lim HK, Choung HW, Pang KM, et al. Maximal strength and endurance scores of the tongue, lip, and cheek in healthy, normal Koreans. J Korean Assoc Oral Maxillofac Surg 2017;43:221-8.  Back to cited text no. 33
    
34.
Utanohara Y, Hayashi R, Yoshikawa M, Yoshida M, Tsuga K, Akagawa Y. Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device. Dysphagia 2008;23:286-90.  Back to cited text no. 34
    
35.
Asami T, Ishizaki A, Ogawa A, Kwon H, Kasama K, Tanaka al AE. Analysis of factors related to tongue pressure during childhood. Dent Oral Craniofac Res 2017;3:1-7.  Back to cited text no. 35
    
36.
O'Connor CM, Lowery MM, Doherty LS, McHugh M, O'Muircheartaigh C, Cullen J, et al. Improved surface EMG electrode for measuring genioglossus muscle activity. Respir Physiol Neurobiol 2007;159:55-67.  Back to cited text no. 36
    



 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed280    
    Printed33    
    Emailed0    
    PDF Downloaded68    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]