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A. The Iowa Oral Performance Instrument (IOPI) is used to measure the pressure of the anatomical structures in the oral cavity. B. The position of the tongue bulb placed on the maxillary anterior hard palate area when measuring the maximal tongue strength and endurance score. C. The tongue bulb is placed in between two tongue depressors, the lips must be pursed forward with maximum force when measuring the maximal lip strength and endurance score.
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Objectives:
The purpose of this study was to establish normative data for healthy Korean adults by measuring the maximal strength and endurance scores of the tongue, lip, and cheek, and to examine correlations between these measurements.
Materials and methods:
This study included 120 subjects that were divided into three groups according to age:...
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Citations
... This method allows for the detection of the timing and presence of ingested substances at the level of the true vocal cords during swallowing [49,50], aiding in identifying the physiological causes of swallowing disorders. Furthermore, VFSS enables clinicians to assess the impact of various bolus volumes, textures, and compensatory strategies on swallowing physiology [51]. ...
Dysphagia is a pervasive health issue that impacts diverse demographic groups worldwide, particularly the elderly, stroke survivors, and those suffering from neurological disorders. This condition poses substantial health risks, including malnutrition, respiratory complications, and increased mortality. Additionally, it exacerbates economic burdens by extending hospital stays and escalating healthcare costs. Given that this disorder is frequently underestimated in vulnerable populations, there is an urgent need for enhanced diagnostic and therapeutic strategies. Traditional diagnostic tools such as the videofluoroscopic swallowing study (VFSS) and flexible endoscopic evaluation of swallowing (FEES) require interpretation by clinical experts and may lead to complications. In contrast, non-invasive sensors offer a more comfortable and convenient approach for assessing swallowing function. This review systematically examines recent advancements in non-invasive swallowing function detection devices, focusing on the validation of the device designs and their implementation in clinical practice. Moreover, this review discusses the swallowing process and the associated biomechanics, providing a theoretical foundation for the technologies discussed. It is hoped that this comprehensive overview will facilitate a paradigm shift in swallowing assessments, steering the development of technologies towards more accessible and accurate diagnostic tools, thereby improving patient care and treatment outcomes.
... In the present study, we evaluated the influence of sex and age on MTS and MLS in healthy adults whose native language is Spanish to provide reference values for the Spanish population because, as far as we know, no data are available for the scientific community. Only one of the studies aiming to provide reference data of the MTS and the MLS, using the IOPI device and considering the ethnicity or the language [7,8,[16][17][18][19][20][21] has been conducted in Europe, specifically in Belgium [7]. ...
... In the present study, in consistency with other studies [16,18,21], the sample has been divided according to the age groups proposed by the IOPI (young, middle-aged, and older adults) [3]. Other studies establish 10-year age groups [7,8], including a group for over 80 [7] or an age group for over 71 [8] or only 2 age groups (young adults and elders) [20]. ...
... MTS is age-dependent and independent of sex, while MLS is higher in men than in women but independent of age. the young adults. However, the influence of age on MTS in the Korean population is not clear [20,21]. ...
Adequate tongue and lip strengths are needed for normal speech, chewing, and swallowing development. The aim was to evaluate the influence of sex and age on maximum anterior tongue strength (MTS) and maximum lip strength (MLS) in healthy Spanish adults to establish reference values that can be used in clinical practice.
This cross-sectional study comprises 363 subjects (mean age 47.5 ± 20.7 years) distributed by sex (258 women and 105 men) and across three age groups: Young (18–39 years), middle-aged (40–59 years), and older adults (> 59 years). MTS and MLS were determined using the Iowa Oral Performance Instrument (IOPI). The mean MTS was 49.63 ± 13.81 kPa, regardless of sex, and decreased with age. The mean MLS was statistically higher for men (28.86 ± 10.88 kPa) than for women (23.37 ± 6.92 kPa, p = 0.001), regardless of age.
This study provides the first reference values for the standardized measurement of MTS and MLS in a healthy adult Spanish-speaking population using the IOPI.
... Studies have been conducted to measure and record tongue pressure data in the field of dentistry owing to the increasing interest in oral frailty in recent years [12][13][14][15] . However, most previous studies have collected data regarding maximum tongue pressure or improvements following oral rehabilitation training. ...
Background: Oral frailty has garnered considerable interest following its identification as a risk factor for physical frailty. The Korean
oral frailty diagnosis criteria have emphasized the need for extensive research on oral frailty diagnostic items and interventions.
Our study performed an in-depth analysis of the tongue-palate pressure patterns in healthy community-dwelling older adults.
Methods: Of the 217 older adults aged ≥60 years who visited a senior center in Wonju, 205 participants who completed tongue
pressure measurement were included in the final analysis. Pressure changes over time were recorded by instructing the
participants to press their tongue against the hard palate with for 7 seconds per cycle. The participants were divided into the
normal and abnormal tongue pressure (NTP and ATP, respectively) groups based on whether they achieved the target tongue
pressure at least once; tongue pressure patterns were compared between the groups. Furthermore, the average time taken to
achieve the standard tongue pressure value was calculated for the participants in the NTP group and used to evaluate the decrease
in tongue pressure in the ATP group.
Results: Among the 205 participants, 40.5% had ATP. The tongue pressure graph revealed a gentle and consistent incline that was
maintained even after achieving standard tongue pressure in the NTP group. The graph was more extreme in the ATP group, and
the changes in the pressure type varied across individuals; the tongue pressure was only 48.4%, 40.7%, 31.9%, and 22.6% of the
NTP in the participants in their 60s, 70s, 80s, and ≥90s, respectively (p＜0.05).
Conclusion: Tongue pressure weakness was observed in 40.5% of the healthy community-dwelling older adults. Furthermore,
ATP graphs were observed in the patients with tongue pressure weakness. Thus, activities improving the oral function in
community-dwelling older adults and systematic oral rehabilitation programs should be devised to promote normal swallowing.
... As people age, the quantity and quality of skeletal muscle decline, which is also observed in the oral and maxillofacial areas [8,9]. Orofacial generally refers to areas such as the lips, cheeks, and tongue, and the strength of these areas is called orofacial strength. ...
... Then, complex sample linear regression analysis was conducted to confirm the effect of strength training on the perceived oral health problems and HINT-8. In terms of the effect on health-related HINT-8, no adjustment was made in Model 1, demographic characteristics were adjusted in Model 2, and Model 3 was adjusted after adding oral health status to Model 2. Don't know, non-applicable, and missing values were excluded in 8,9,88, and 99. The number of subjects in all tables was presented as an unweighted frequency, and the significance level of the statistical test (p-value) was 0.05. ...
Objectives:
The purpose of this study is to confirm the importance of muscular strength exercise by confirming the relationship between strength exercise, oral health, and quality of life.
Methods:
Using the 2019 and 2021 of the Korean National Health and Nutrition Examination Survey (KNHANES), 6535 people were selected as subjects. Complex sampling analysis was applied to all analyses; 2267 people were in the muscular strength training group (MSG), and 5841 people were in the non-muscular strength training group (NMSG). A multi-sample linear regression analysis was conducted to confirm the effect of muscular strength training on oral health and quality of life.
Results:
As a result of confirming the effect of muscular strength training on oral health status, problems with chewing decreased by 0.105, and problems with speaking decreased by 0.028 with MSG compared to NMSG. In addition, compared to NMSG, it was confirmed that MSG reduced chewing discomfort by 0.047, while self-perceived oral health improved by 0.0123. Finally, as a result of confirming the effect of muscular strength training on oral health and quality of life in Korean adults, there was a significant effect on quality of life despite adjusting for sociodemographic characteristics and oral-health-related factors (p < 0.05).
Conclusions:
In this study, the relationship between muscular strength training and quality of life was confirmed. Therefore, efforts should be made to make oral health management and muscular strength training a part of life in relation to quality of life.
... In fact, the effects of child characteristics, such as age and gender, on skeletal muscle strength have been well established [21]. Although inconclusive, findings on the effects of demographic variables on tongue strength have been found to be nonstatic [21][22][23][24][25]. For instance, replication studies comparing the tongue strength data of English speakers with those of Portuguese, French, and Korean speakers have found cultural differences. ...
... For instance, Vitorino [25] reported that healthy Portuguese speakers had lower tongue endurance scores compared with English speakers. Jeong et al. [22] compared the tongue strength data of a Korean population with those of American and Belgian populations and found a difference of 15 kPa between the three populations; however, the authors indicated that this difference was caused by an error in measurement rather than a cultural difference. In another study, Vanderwegen [23] found a difference in tongue strength among Belgian children, with the comparison revealing statistical differences across age. ...
Background
Tongue strength and endurance in adults have been extensively studied, but data on these parameters in young children remain largely unavailable.
Aims
This study aimed to collect normative objective tongue strength and endurance data from a pediatric population in the United Arab Emirates (UAE) and to examine the effects of age and sex on these parameters.
Methods
This normative study included a total of 65 typically developing (TD; n = 36) children and children with idiopathic speech sound disorders (ISSDs; n = 29). The participants were assigned to four age groups (range: 3–8 years) and stratified by sex. Data on their tongue strength and endurance were collected using the Iowa Oral Performance Instrument.
Results
Tongue strength scores and endurance time increased with age in both the TD and ISSD groups. Sex had no statistically significant effects on tongue strength or endurance in either group. Furthermore, tongue strength and endurance time scores were higher in the TD group than in the ISSD group.
Conclusions
The data obtained in this study would add important normative data to the database of standardized measurements for maximal strength and endurance scores in the pediatric population of the UAE. Future research is encouraged to collect additional data that can help healthcare professionals objectively evaluate children with feeding, swallowing, and speech sound production difficulties.
... Sample size G-Power® version 3.1 was used for a priori sample size calculation (Institute for Experimental Psychology, University of Düsseldorf, Düsseldorf, Germany). A sample size of 93 subjects was calculated, based on the results of a previous study (Jeong et al. 2017), considering the variance of the same lip seal strength using IOPI in the older adult population, setting type I error of 5%, a sensitivity of 3 and a statistical power of 80%. ...
Background:
Alterations in oral health have a negative impact on the quality of life of persons with intellectual disabilities (PwIDs). Chewing is a process that influences and determines optimal oral health. However, little is known about how intellectual disability (ID) affects masticatory performance. This study aimed to analyse the differences in masticatory performance between young adults with IDs, young adults without IDs and older adults without IDs.
Methods:
A cross-sectional analytical design was used. The masticatory performance was evaluated with a chewing gum validated instrument. In addition, the labial and tongue strength was assessed with the Iowa Oral Performance Instrument. We compared the masticatory performance between groups using one-way analysis of covariance. Body mass index, muscle mass, missing teeth, lip strength and tongue strength were included as separate covariates. A multivariate regression analysis was performed to identify which independent variables could explain masticatory performance in each group.
Results:
Thirty-two PwIDs, 31 young adults without IDs and 32 older adults without IDs were recruited. PwIDs showed poorer masticatory performance compared with older adults (mean difference: -3.06, 95% confidence interval: -3.87 to -2.26) and healthy controls (mean difference: -2.38, 95% confidence interval: -3.19 to -1.57). The analysis of covariance showed significant difference between groups in the masticatory performance (F = 47.35, P < 0.001, ηp 2 = 0.507). Missing teeth (P < 0.001), right lip strength (P = 0.025) and tongue strength (P = 0.007) as covariables showed a significant interaction with the model. In the PwID group, lip strength and lack of teeth explained 58% of the variance in masticatory performance (R2 = 0.580, standard error = 1.12, P < 0.001).
Conclusions:
Persons with intellectual disabilities have a poorer masticatory performance than adults without IDs. Our findings indicate that the primary determinants of optimal masticatory function in PwIDs are the strength of the lip seal and the number of missing teeth.
... Age-related increase in maximum perioral muscle pressure in subjects with normal occlusion was also observed by Posen et al. [47], but their research only included participants <18 years old. Results from other studies cannot be compared since they focus on patients with malocclusion and do not include different age groups [32,[48][49][50][51][52]. Since bite force and perioral muscle pressure can change during the development of occlusion, our goal was to understand the subtle differences in oral muscle pressure during mixed dentition period. ...
Objectives
(1) To investigate the effect of age and diet consistency on maximum lips, tongue and cheek pressure of orthodontically treated and untreated subjects with normal, Class I dental occlusion, (2) to find out whether there is a muscle imbalance between anterior tongue and lip pressure in the same subjects at different ages and (3) to compare the 3D facial shape of treated and untreated individuals.
Material and methods
Subjects with normal occlusion were prospectively grouped into orthodontically treated/untreated and in children/adolescents/adults. Iowa Oral Performance Instrument was used to record the maximum muscle pressure. Two-way ANOVA and Tukey post hoc test analysed age-specific differences in muscle pressure. Two-way ANCOVA analysed the effect of diet consistency on muscle pressure. Lips and tongue imbalance was analysed using z-scores and 3D faces using a generalized Procrustes analysis.
Results
One hundred thirty-five orthodontically untreated and 114 treated participants were included. Muscle pressure was found to increase with age in both groups, except for the tongue in treated subjects. No differences in the balance between lips and tongue muscle pressure were found, but a higher cheek pressure in untreated adults (p<0.05) was observed. 3D facial shapes showed subtle differences. Untreated subjects with soft diet consistency showed lower lip pressure (p<0.05).
Conclusion
Oral muscle pressure of orthodontically treated patients without relapse does not differ from that of untreated patients with Class-I occlusion.
Clinical relevance
This study provides normative lip, tongue and cheek muscle pressure in subjects with normal occlusion, which can be used for diagnosis, treatment planning and stability.
... I will tell you when to stop". A timer recorded how long each participant maintained anterior tongue pressure at or above 50% of her maximum strength, as indicated by the LED light staying illuminated at or above the fifth light in the array [7,18]. Enthusiastic verbal encouragement was provided during this task. ...
Fatigue is widely accepted as a clinically relevant factor in the diagnosis, treatment, and management of dysphagia. Despite the relative importance that is placed on swallowing-related fatigue, the occurrence and effects of fatigue during swallowing is unclear. The goal of this study was to explore effects of eating a meal on measures of tongue strength, endurance, and other parameters of swallowing function under normal conditions compared to when the tongue is intentionally fatigued. Thirty healthy females, 15 “Young” (18–35 years old), and 15 “Old” (70 + years old) were seen for two data collection sessions one week apart. On both days, pre-meal measures were collected, then participants consumed a standardized meal based on a previously published protocol (half a bagel with peanut butter and 8 baby carrots) followed by post-meal measures. An additional pre-meal fatigue task was included on one of the test days (counterbalanced), involving maximal tongue presses until participants could not achieve 40% of baseline maximum pressure. Pre- and post-meal measures included anterior and posterior maximum tongue pressures, saliva swallow pressure, tongue endurance, surface electromyography (sEMG), the modified Borg scale, and the Test of Mastication and Swallowing of Solids (TOMASS). Linear mixed effects regressions compared pre- and post-meal outcome measures (1) on the non-fatigue day and (2) between fatigue and non-fatigue days while controlling for participant and age. The fatigue task caused significant reductions in maximum anterior and posterior tongue pressure. After a normal meal (i.e., without fatigue), we found decreased anterior pressures in the older group only. Older participants also had decreased saliva swallow pressures after the meal compared to pre-meal, while this measure increased post-mean in the young participants. When compared to the non-fatigue meal, eating a meal after tongue fatigue resulted in significantly lower post-meal posterior pressures, regardless of age group. The same pattern was observed with posterior functional reserve. Our results demonstrate that a systematic, participant-specific tongue fatigue task induced measurable changes in maximum tongue pressure. A meal by itself was observed to reduce anterior tongue strength and saliva swallow pressures only in older participants. Overall, it appears that older adults may be more vulnerable to fatigue-induced changes in tongue strength, though the relationship between these measures and changes to functional swallowing remains unknown.
... [5]. However, compared with this study, the overall measurements of maximal tongue strength in a Korean population were lower by approximately 10 kPa [32]; the mean E ant was 13.86 s (CI: 12.64-15.07), which is lower than that recorded by Vanderwegen et al. (mean: 22.39 s; CI: 20.78-24.12) ...
... while Vanderwegen et al. [20] observed a mean of 14.90 s (CI: 13.96-15.90). In contrast, the overall measurements of tongue endurance across different age decades in the Korean population were found to be higher than those revealed by our study [32]. ...
... Although the average age of participants in the current study was the lowest one, the tongue endurance value was the lowest one. In terms of gender ratio, the male to female ratio of the current study and the studies conducted by Stierwalt and Youmans [13], Clark and Solomon [5], Vanderwegen et al. [20], and Jeong et al. [32] was 49:101, 80:20, 88:83, 210:210, and 60:60, respectively. Data on the effects of age and gender on tongue endurance are relatively scarce, and most often indicate no effects with advanced age and gender [13,20,32]. ...
This study collected 11 parameters regarding the labial and lingual strength for maximum isometric and swallowing tasks among 150 healthy Chinese adults in Taiwan. Measurements were performed using the Iowa Oral Performance Instrument (IOPI). All of the labial and lingual strength parameters were measured three times. The maximal value of three trials represents the pressure of every parameter. The overall mean (±standard deviation) and maximum isometric pressures of the lips, anterior tongue, and posterior tongue were 24.81 ± 5.64, 55.95 ± 14.13, and 53.23 ± 12.24 kPa, respectively. The mean value of posterior tongue strength was less than that of the anterior tongue by approximately 5%. The percentages of maximum isometric tongue pressure during the swallowing of saliva and water were 85% and 80% for the anterior tongue and 90% and 81% for the posterior tongue, respectively. The average endurances for the anterior tongue and posterior tongue were 13.86 ± 7.08 and 10.06 ± 5.40 s, respectively. The maximum isometric pressures were greater than both the saliva and water swallowing pressures, and the saliva swallowing pressures were greater than the water swallowing pressures. A value of 33 kPa in maximum isometric pressure could serve as a demarcation of weak tongue strength for healthy Chinese adults. As for the repeated trials of labial and lingual strength, there were no statistically significant differences for any of the pressures obtained from the 11 labial and lingual strength parameters. The normative data can be used for the objective assessment of labial and lingual strength in healthy Chinese adults.
... Amanda Valentim [27] and Doto N [16] proposed the same. Contrary to it, some researchers found significance among different malocclusion while comparing the maximum tongue force exerted on the dentition [28][29][30]. ...
... Dworkin [18] on the contrary found an increased tongue force at rest among men than women. Mortimore [31] and Jeong [30] found a significant difference of maximum tongue force exerted on dentition among gender (males=26 +/-8 N; females=20 +/-7 N). Similarly, in our study we found a significant relationship (p=0.00) of maximum tongue force among gender with a mean force value of 193.4 in males and 177.2 in females. ...
Objectives: To evaluate the tongue forces exerted on the mandibular incisors in various malocclusions and also compare it among genders. Methods: The study was conducted on 512 subjects (340 females and 172 males). The subjects were divided into three groups according to the molar relation of the subjects. Molar relation and the tongue forces exerted on the mandibular incisor of the subjects were recorded using a diagnostic kit and a Flexi force resistive sensor respectively. Tongue Force at Rest (TFR), Tongue Force during Swallowing (TFS) and Maximum Tongue Force (MTF), were measured and statistically analyzed. Results: MTF was a significantly more among males than females. A significant relationship while comparing TFR and TFS among the three groups was also found. Conclusion: TFR and TFS were found to be influential in the malocclusion of an individual and also a stronger tongue musculature among males was concluded while comparing MTF.
