TONGUE POSITION AND POSTURAL CONTROL

DOUBLE BLIND RANDOM STUDY IN 360 POST-PUBERAL SUBJECTS

Dott. Antonio Ferrante, spec. Odontostomatology, Chairman IMA International Myofunctional Association
Teacher Masters Degree Course in Posturology (Director: Prof. G. Amabile)
Tel/fax +39 0815174158
e-mail antonio.ferrante12@tin.it
Prof. Fabio Scoppa, Professor of post-surgical rehabilitation,
Scientific and Educational coordinator, Master's Degree Course in Posturology, Ist Faculty of Medicine and Surgery,
University La Sapienza in Rome,
Tel.+39 06 97274138 fax +39 06 5819860
KEY WORDS
Tongue posture, swallowing, nose-palatal sensory ending
INTRODUCTION
Over the last few years, posture and tongue movement during the swallowing process have become increasingly important due to the knowledge of the presence of five types of
esteroceptors where the nose-palatal nerve emerges in the palate. The discovery of these receptors has lead researchers to try to understand the reason why they are in that
position, which even the discoverers, professors Halata e Baumann of the Istitute of Functional Anatomy at the Hamburg University, did not know.
The tongue at rest touches the palate behind the papilla (Pitc.. 1) and , during swallowing, presses this point, called by myofunctional therapist the spot. It has been found that
patients, who do not have the tip of the tongue on the spot, very frequently have postural problems and incorrect distribution of weight on the foot. The here presented research
derives from the desire to know how important the tongue actually is in the stimulation of these sensory nerve endings present at the Spot..
Pitc. 1: Tongue to the Spot

METHODS

A group of 180 post-puberal people aged between 14 and 24 were analized, having already been diagnosed as having incorrect swallowing processes. 20 people of the group had shortened tongue frenulum
(meaning an impediment to be able to reach the spot opening the mouth more than 3 cm.).
A baropodometer e stabilometer Diagnostic Support of Roma was used. .
The group was analized with the tongue in its usual position and after with the tongue on the spot. The time used for the stabilometric exam was necessarily reduced to 10 seconds due to the inability to keep the tip of
the tongue on the spot for longer.
Tongue to Spot test
For every one of the different measurements are listed the average measurement and the relative standard deviations, the parameter t and the probability P associated with it, in usual position and with the tongue on
the spot. The probability P allows us to establish the level of significance of the test at 5 or at 1%.
S usual position
S ab
34,86
Ellipse area S
S tongue on the spot
S spot
14,14
2
The parameter S, misured in square millimetres (mm ), represents the area of the ellipse of confidence containing 90% of the sample positions from centre of
Difference Sab-Sspot
d
20,72
pressure. The Student Test for the parameter S provides a reading of t to which is associated a probability P <<1%. This probability is too low , therefore the
S
Standard
Deviation
57,99
d
hypothesis that the two average samples belong to the same population is to be refused. Particularly, being S ab > di S spot, we can afferm that tongue position
had an enormous effect on the parameter S and, thus, on the precision of the system. (table 1 pitc. 2)
Sample Dimension
N
160
Test
t
4,32
Ball Length
Probability
P
<< 1%
The variable L measured in millimetres, allows us to estimate the length of the statokinesigramme, or rather the length of the graph covered from the centre
of pression during the stabilometric finding. The tongue position does not significantly alter the ball.

Table 1: Student Test for area S of the ellipse

highly significant

Baropodometric Exam

A baropodometric exam was done for the distribution percentage of weight on the heel (relationship between the ball and the heel of the foot is 40/60) and on the distribution percentage of the load between the left
and right foot.
RabD

54,48

RD tongue to the spot

RD spot

55,73

- 1,03

Difference R Dab-R Dspot

- 1,24

S -d

4,23

Standard Deviation

S -d

4,17

Sample Dimension

160

Sample Dimension

160

Test

- 3,09

Test

- 3,78

Probability

0,2%

Probability

<< 1%

RS usual position

RabS

54,36

RS tongue to the spot

RS spot

55,39

Difference R Sab-R Sspot

Standard Deviation

Table 2

RD usual positiion

The reading RS (left heel) e RD (right heel) are both less 1%. This means that the differences
between the two average samples, for both the heels, cannot be attributed to the statistic
fluctuations, but to the fact that the tongue position influences very significantly these
parameters. (Table 2,3)

Table 3
CabS

52,03

CD usua lposition

CabD

48,00

CS tongue to the spot

CS spot

51,37

CS tongue to the spot

CD spot

48,36

Difference C Sab-C Sspot

0,66

Difference C Sab-C Sspot

0,63

Standard Deviation

S -d

2,43

Standard Deviation

S -d

2,46

CS usual position

Sample Dimension

160

Test

3,44

Probability

0,1%

Table 4

Sample Dimension

160

Test

- 3,24

Probability

0,1%

Pitc.3: Load in usual tongue position

Pict. 4: Load with tongue to the spot

Also in the case of the Load the Student Test provides us with readings t which are associated
with the probability readings less than 1%. For this reason we can conclude that the tongue
position influences very significantly the percentage of the Load C. ( table 4,5 pict. 3,4)

Table 5

Test of 20 patients with shortened tongue frenulum (13 females, 7 males)

The readings relative to variables S and L are both less than 5%. This means that the variations of these parameters cannot be attributed to the statistical fluctuations, but at the significant influence of the tongue
position. In particular, being Sab < di S spot and Lab < Lspot , the positioning of the tongue to the Spot, causes a deterioration both of the area of the ellipse and the ball. Concerning the parameters of the Heel and Load,
the test provides readings more than the level of confidence of 5%, which leads us to conclude that the tongue position has no influence on them.
Placebo Test
Shut eyes

Shut eyes
Tongue to the Spot

We tested a group of 180 people with the same postural analysis, but putting the tongue in various positions, distant from the spot (having told the subject that it
is a correct, therapeutical position). The Student Test provided probability readings more than the level of confidence of 5%. This indicates that the average
samples of the studied variables (S ed L) belong to the same population. In other words, the differences between the averages are due to statistic fluctuations,
thus, as was expectesd, the placebo didnt have any effect on either the area of ellipse S, or on the ball L.
CONCLUSIONS
The data which emerges from the research gives the tongue, due to its position and its mobility during swallowing, an important role in the determination of the
posture of the subject. Whatever event that leads to an altered mobility or position of the tongue seems to be able to obviously condition some of the postural
findings of the subject.

Pitc. 2: Ellipse change with tongue to the spot

REFERENCES
1. Ferrante A. Terapia Miofunzionale, Futura ed. S. Benedetto del Tronto , 1997
2. Ferrante A., E.Reed-Knight, Bello A.,Comentale C.;Variazioni posturali conseguenti a cambiamento della posizione della lingua e a trattamento miofunzionale; Ortognatodonzia
Italiana vol.11, 3-2002
3. Guaglio G., Catani F.: Influenza della deglutizione atipica sulla Cifo-scoliosi, ICAK-E Meeting,Pisa, 4/1993
4. Guaglio G.:La lingua e le sue disfunzioni in rapporto alla postura di profilo: rapporto tra alterata postura e funzione linguale e distribuzione dei carichi sui piedi,Attualit
dentale, n 4-1998
5. Guaglio G.: Ortodonzia dinamica e ripristino delle funzioni,Euroedizioni Umbertide (PG)
6. Halata Z., Baumann K.I. Sensory nerve endings in the hard palate and papilla incisive of the rhesus monkey. Anat. Embriol. (Berl) 1999;199: 427-37