Tongue strength as a clinical feature of oral health in neurological patients: a systematic review / La fuerza lingual como una característica clínica de la salud oral en pacientes neurológicos: una revisión sistemática

Objective:Current oral health assessment has a comprehensive view of the relationship between hard and soft tissues of the mouth as seen by orthodontics and prosthodontics in a healthy population. Despite knowing the influence this relationship has on functional outcomes such as swallowing and mastication, motor evaluation of soft tissue such as the tongue is still scarce. This lack of knowledge is even greater in individuals with a neurological condition. In this sense, the measurement of lingual strength has been addressed by some research as a key element accompanying oral rehabilitation in healthy populations. Acknowledging the importance of tongue strength in oral biomechanics, the Iowa Oral Performance Instrument (IOPI) has become a gold standard instrument. The purpose of this article was to search for scientific studies on tongue strength using the IOPI as a research tool in populations with neurological conditions, to know about its inclusion in the clinical practice and comprehensive oral health rehabilitation in this population. Material and Methods: A systematic search in five major databases was carried out based on the PRISMA Protocol. Searches were conducted in the PubMed, Medline, Lilacs, Web of Science and MedCarib databases including articles from 2007 to 2020. To generate the search in each database, three main constructs were developed: (1) "tongue strength IOPI"; (2) "Swallowing Disorders"; (3) "Neurological Diseases". Results:152 studies were identified, 14 were included in the final review. The PEDro scale showed great heterogeneity in the level of evidence between the studies with only 5 RCTs and only two of them on lingual strength training. Conclusion: The IOPI was used mainly to measure tongue strength and only 36% as a clinical training device, which could contribute to improving oral health. The stroke was the most represented (79%).IIIISU.

Objetivo: La evaluación actual de la salud bucal tiene una visión integral de la relación entre los tejidos duros y blandos de la boca según se observa en práctica de la ortodoncia y la prostodoncia en la población sana. Apesar de conocer la influencia que tiene esta relación en resultados funcionales como la deglución y la masticación, la evaluación motora de los tejidos blandos como la lengua es aún escasa. Esta falta de conocimiento es aún mayor en personas con una condición neurológica. En este sentido, la medición de la fuerza lingual ha sido abordada por algunas investigaciones como un elemento clave que acompaña a la rehabilitación oral en población sana. Reconociendo la importancia de la fuerza lingual en la biomecánica bucal, el Iowa Oral Performance Instrument (IOPI) se ha convertido en un instrumento estándar de medición. El propósito de este artículo fue buscar estudios científicos sobre la fuerza lingual en pacientes neurológicos utilizando el IOPI como herramienta de investigación, para conocer su inclusión en la intervención clínica y rehabilitación integral de la salud bucal en esta población. Material y Métodos: Se realizó una búsqueda sistemática en cinco grandes bases de datos basada en el Protocolo PRISMA. Las búsquedas fueron realizadas en las bases PubMed, Medline and Lilacs, Web of Science y MedCarib incluyendo artículos desde 2007 al 2020. Para generar la búsqueda en cada base de datos, se desarrollaron tres constructos: (1) "tongue Strength IOPI"; (2) "Swallowing Disorders"; (3) "Neurological Diseases". Resultados: Se identificaron 152 estudios, 14 se incluyeron en la revisión final. La escala PEDro se evidenció gran heterogeneidad en el nivel de evidencia entre los estudios con sólo 5 RCT y únicamente dos de ellos sobre entrenamiento de fuerza lingual. El IOPI se utilizó principalmente para medir la fuerza lingual y sólo en un 36% como dispositivo de entrenamiento clínico, lo cual pudiese contribuir a mejorar la salud oral. Conclusion: El ACV fue el más representado (79%). Se necesita adicionar evidencia sobre el entrenamiento de la fuerza lingual en individuos con afecciones neurológicas como la enfermedad de Parkinson dada la creciente prevalencia reportada por la literatura científica.

Maximal strength and endurance scores of the tongue, lip, and cheek in healthy, normal Koreans

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: young (20-39 years), middle-aged (40-59 years), and older (over 60 years); and by gender. Measurements were taken using the Iowa Oral Performance Instrument (IOPI). RESULTS: The mean maximal tongue strengths were as follows: young men (46.7±10.2 kPa) and women (32.1±7.9 kPa), middle-aged men (40.9±9.3 kPa) and women (36.9±8.6 kPa), and older men (35.2±9.0 kPa) and women (34.5±6.9 kPa). The mean tongue endurance scores were: young men (28.8±12.6 seconds) and women (20.8±13.5 seconds), middle-aged men (17.0±8.5 seconds) and women (15.3±5.2 seconds), and older men (15.8±6.7 seconds) and women (17.9±8.1 seconds). The mean maximal lip strengths were: young men (11.6±3.0 kPa) and women (11.4±3.8 kPa), middle-aged men (11.4±4.2 kPa) and women (11.1±5.1 kPa), and older men (14.5±3.9 kPa) and women (11.7±2.6 kPa). The mean lip endurance scores were: young men (41.1±23.9 seconds) and women (22.4±21.7 seconds), middle-aged men (24.3±10.3 seconds) and women (30.5±13.4 seconds), and older men (24.9±11.0 seconds) and women (12.8±7.6 seconds). The mean maximal cheek strengths were: young men (24.5±4.6 kPa) and women (20.5±4.3 kPa), middle-aged men (25.2±6.4 kPa) and women (21.2±5.5 kPa), and older men (22.4±5.3 kPa) and women (18.0±4.8 kPa). The mean cheek endurance scores were: young men (47.8±24.4 seconds) and women (43.9±25.0 seconds), middle-aged men (27.3±11.3 seconds) and women (20.0±14.6 seconds), and older men (21.7±14.5 seconds) and women (17.2±11.4 seconds). CONCLUSION: The data collected in this study will provide an important database of standardized measurements for maximal strength and endurance scores of the tongue, lip and cheek in healthy, normal Koreans.