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Application of A Barometer For Assessment of Oral Functions: Donders Space
Application of A Barometer For Assessment of Oral Functions: Donders Space
Oral Health Science Center, Tokyo Dental College, Tokyo, Division of Oral Physiology, Niigata University Graduate School of Medical and
Dental Sciences, Niigata, Department of Geriatric Dentistry, Tsurumi University School of Dental Medicine, Yokohama, and Department
of Physiology, Tokyo Dental College, Tokyo, Japan
SUMMARY We developed a barometer applicable to a swallowing, the pressure in STP showed more
small space, to assess oral and pharyngeal functions. negative value ( 050 059-kPa). There is a
Negative oral pressure during rest and pressure significant difference between the values in open
changes during swallowing were measured in a condition and after swallowing (P < 0001) and
space between the palate and tongue (STP). Twenty between values after swallowing and final open
volunteers were asked to sit in a chair in a relaxed condition (P < 005). Twin sensor showed almost the
upright position. A sensor was placed on the same trajectories of pressure changes for all the
posterior midline of hard palate. Recording recordings. Obtained negative pressure might
commenced just before subjects closed their lips generate about 071-N of force and would be enough
and continued. Subjects were asked to swallow to keep the tongue in the palatal fossa at rest. The
saliva and keep the apposition. Finally, subjects system detected large negative/positive pressure
were asked to open their mouth. Recordings were changes during swallowing. We conclude this
performed five times, and 5 s of continuous data in system may be a tool to evaluate oral functions.
each phase was averaged. To verify the reliability of KEYWORDS: barometric pressure, swallowing, jaw
the system, the same procedure was accomplished position, velopharyngeal insufficiency, Donders space
with twin sensors. When the jaw and lips were
closed, the pressure slightly decreased from Accepted for publication 6 November 2016
atmospheric pressure ( 017 024-kPa). After
to determine the position. The tip of the tongue Recent technology has produced a factory calibrated
touches the incisive papilla or lingual surface of the absolute pressure sensor small enough to fit into a
maxillary incisor and acts as an anchor for the tongue very low volume, have enough resolution both in
posture. More than one hundred years ago, Donders time and in pressure measurement and equipped with
claimed that there was a space in the upper part of a compensation circuit for temperature. The aim of
the dorsum of the tongue when the mandible is at this study was to evaluate this barometer as a tool for
rest (10). Recently, Bourdiol et al. (8) successfully oral pressure and to measure the pressure in STP at
evaluated the volume of the space (in-mouth air cav- rest.
ity) at rest as nominally 12-mL with a range of 10
18 mL.
Methods
Donders described the mechanism of negative pres-
sure in a space built between tongue and palate while
Barometer
the jaw was at rest (10). The pressure was measured
using a manometer and flexible tube. He reported 2 We have developed a barometer to assess oral and
4 mmHg of negative pressure in the space and specu- pharyngeal functions that can measure atmospheric
lated that the space might be surrounded by the root pressure in a small space with a 3-ms sampling inter-
of tongue and hard palate. As the pressure was small val. The system consists of a sensor (Freescale Semi-
in value, he estimated the space might be small in conductor: MPL115A1), flexible cables, a
volume. The space might be completely closed at the microprocessor to control the sensor and a PC for data
anterior part of oral cavity with tongue and hard collection. The absolute pressure sensor is
palate. The phenomenon might be emphasised by 15 9 3 9 5 mm in size and provides accurate pres-
changing the tongue shape flat and then bending the sure measurements from 50 to 115-kPa. An integrated
tongue tip backwards. Finally, he considered that the analog-to-digital converter (10-bits resolution) con-
jaw at rest was supported by the negative pressure verts pressure and temperature sensor readings to
generated in the small space (10). In this study, we digitised outputs via a serial peripheral interface (SPI)
call the space STP (a space formed between the dor- port. Factory calibration data are stored internally in
sum of tongue and the palate). an on-board Read Only Memory. Utilising the raw
Faigenblum explored the pressure in STP with a sensor output and calibration data, the host micropro-
manometer for four subjects. He reported cessor executes a compensation algorithm to render
97 05 mmHg of negative pressure on average after compensated absolute pressure with 1-kPa of accuracy
swallowing (14). He then calculated a possible force and 015-kPa of resolution. The microprocessor can
of about 300-g from the value of negative pressure handle up to three sensors simultaneously.
and the area of the palate. The negative pressure was Two types of sensor were fabricated: a single type
definite after a swallow with larger changes (positive and a twin type. The single type consists of one sensor
and negative) in pressure; however, the change dur- as seen in Fig. 1a. The twin type is composed of two
ing swallowing was rather small in amplitude and had sensors, arranged side by side in point symmetry so
a short duration compared with those of recent that the distance between sensing windows is 4 mm
reports (3, 7). as seen in Fig. 1b.
Pressure in the oral cavity has been measured by
many studies (3, 7, 1416); however, most of the
Subjects
methods employed were conventional in that the
pressure in a space was measured with a tube con- Twenty young volunteers (aged 2636 years) were
nected to a sensor placed outside of the oral cavity. recruited from the postgraduate student body at
Inconveniently, the tube may resist air flow during Tokyo Dental College. This study was conducted with
measurement, and thus, the response resolution the approval of the Ethics Committee of the Tokyo
may be low. In this respect, Woda et al. (17) sug- Dental College (approval number: 659). Subjects were
gested in their review that the nature of the space asked to sit in a chair in a relaxed upright position
might need to be confirmed in a modern scientific without head support. Measurements were taken in a
context. space between the tongue dorsum and posterior hard
(a) (b)
20 kPa
Swallow
0 10 20 30 40 50 60 (s)
Fig. 3. An example of pressure recording measured in STP. Calibration signals were added into the waveform at start and end of
recordings (filled arrow head: 90 and 110 kPa). Ordinate axis represents pressure changes in kPa. One recording is composed of four
recording phases (15 s each). Dashed line indicates the time point of postural change of lips. Dotted line indicates onset and offset of
saliva swallowing task.
Experiment 1 Fig. 4. Effect of lip position and swallow task on averaged pres-
sure. Pressure changes in STP divided into four phases: lips open
Figure 3 shows a typical recording of pressure change (phase-1), lips closed (phase-2), lips closed after swallowing
in STP. When the mouth is open (phase-1), pressure (phase-3) and final lips open (phase-4). ***P < 0001 *P < 005.
should be equivalent to that of the atmosphere.
Therefore, the reference pressure was set at phase-1.
The pressure value slightly decreased accompanying interval (Fig. 3). A typical swallowing event was char-
with jaw and lips closing (phase-2: 017 024- acterised by a negative pressure followed by a positive
kPa). These negative pressures in phase-2 did not pressure. Many of the pressure peaks were more than
show significant differences between those in phase-1 15-kPa. After swallowing (phase-3), the pressure
(Fig. 4, P > 005). When subjects swallowed saliva, value changed to more negative direction compared
large pressure changes were observed in a short to phase-2. The average pressure in phase-3 was
Sensor-1 20 kPa
Sensor-2 20 kPa
Swallow
0 10 20 30 40 50 60 (s)
Fig. 5. An example of pressure recording in STP with twin sensor. Recordings were carried out with two sensors (upper and lower
traces) simultaneously. Calibration signals were added into the waveform at start and end of recordings (filled arrow head: 90 and
110 kPa). Ordinate axis represents pressure changes in kPa. One recording is composed of four recording phases (15 s each). Dashed
line indicates the time point of postural change of lips. Dotted line indicates onset and offset of saliva swallowing task.
Using indirect methods, pressure changes may be saliva (i.e. phase-3), the average negative pressure
transmitted by the movement of air/liquid in the was measured as 050 059-kPa. The negative
tube. As the tube is soft and thin, it acts as a capacitor value might be enhanced by the tongue reposition-
and a resistor for the measurement system, dampen- ing during swallowing. The negative value was simi-
ing high-frequency components in the pressure lar to that described by Donders (10), that is 2
changes. Therefore, large positive pressure changes 4 mmHg (=027053 kPa). In 2011, Engelke et al.
occurring in a short time may not be detected by the reported negative pressure of about 82 kPa in the
system. In fact, Faigenblum (14) could not record space equivalent to STP of this study when the jaw
large negative and positive pressure changes in the is at rest (7). They employed the method with a
short time associated with swallowing as seen in our tube and electrical sensor. The negative pressure
results (Figs 3 and 5). One other concern with the during rest is stable for a while, and thus, pressure
indirect method is a rectifying function of the tube. in the space and the manometer may reach equilib-
This will be discussed later. rium. As a result, the signal dampening properties
Although the sensor we employed in this experi- of the tube did not disturb the measurement even
ment has excellent characteristics for pressure mea- with the indirect method.
surements in an oral cavity, its drawback is that it Donders theorised that the jaw at rest was supported
is likely to be affected by mechanical disturbance by the negative pressure generated in the space (10).
such as by food. The sensor is enclosed in a small Faigenblum confirmed the negative pressure of
case, and pressure changes reach the sensing ele- 97 mmHg (= 129 kPa) and estimated the negative
ment through a small hole (1 mm in diameter) in pressure acting over the area of the subjects hard
the case. When adhesive substance contacts the palate would be capable of exerting forces ranging
sensing element, the measurements may be dis- between 100 and 350-g (14). The force can be calcu-
torted. Saliva, which has a slight adhesive character, lated with the negative pressure and the area of palate.
may have a minor effect on the sensor. Adhesives We did not measure the area of palate; however, we
used to fix the sensor on palatal mucosa may dis- have found literature in which the average palate area
solve in saliva and thus the sensor output may be in the Asian population is reported as 142 cm2 (18).
distorted. This problem can be eliminated easily by Therefore, 050-kPa of negative pressure might gener-
covering the sensor with thin rubber. The larger ate about 071-N (=71 gf) of force to support the tongue
pressure changes during mastication and swallowing while the jaw is at rest. This would be enough to keep
can be accurately measured by our system. How- the tongue in the palatal fossa.
ever, in this experiment we did not use the rubber
cover, as the pressure change in STP is so small that
Pressure changes during swallowing
even thin rubber may affect the measurements. For-
tunately, this error can be recognised when the We did not measure pressure changes during swal-
value of phase-4 is far from that of phase-1. We lowing as it was not a focus of this experiment. We
excluded data when difference in values of phase-1 did, however, observe gross negative/positive pressure
and phase-4 exceeded 015-kPa (the resolution of changes during saliva swallowing. Engelke et al. and
the sensor) even though the incidence was limited. Santander et al. (7, 16) reported only negative pres-
We concluded that the sensor employed in this sure during swallowing. We agree that negative pres-
study could effectively measure the small pressure sure could be generated in the space during
changes in STP during the jaw at rest. swallowing (as seen in Figs 3 and 5). However, we
cannot explain why they could not record positive
pressure. As swallowing starts with propelling of food
Verification of the Donders report
by the tongue (19), there must be positive pressure
As shown in Fig. 4, we obtained statistically signifi- between the tongue and palate. Kieser et al. (3) mea-
cant negative pressures in STP when the jaw is at sured pressure changes at the palatal vault (anterior
rest. Just after the jaw and lips were closed (phase- and posterior) during swallowing. They recorded not
2), the pressure slightly decreased 017 024-kPa only a large positive pressure but also significant neg-
from the reference (phase-1). After swallowing ative peak amplitude, before both rise to their
15. Geddes DT, Kent JC, Mitoulas LR, Hartmann PE. Tongue swallowing are determined more by bolus consistency than
movement and intra-oral vacuum in breastfeeding infants. by age or gender. Physiol Behav. 2012;106:285290.
Early Hum Dev. 2008;84:471477. 20. Kennedy D, Kieser J, Bolter C, Swain M, Singh B, Waddell
16. Santander P, Engelke W, Olthoff A, Volter C. Intraoral pres- JN. Tongue pressure patterns during water swallowing.
sure patterns during swallowing. Eur Arch Otorhinolaryn- Dysphagia. 2010;25:1119.
gol. 2013;270:10191025. 21. Bolter C, Raniga N, Waddell JN, Kiesser J. Conservation of
17. Woda A, Pionchon P, Palla S. Regulation of mandibular pos- intraoral pressure changes during swallowing. J Dent Sci.
tures: mechanisms and clinical implications. Crit Rev Oral 2012;7:324329.
Biol Med. 2001;12:166178.
18. Kaku S. Comparison of morphology of the tongue space Correspondence: Yoshiaki Yamada, Oral Health Science Center,
between dentulous and edentulous jaws. J Kyushu Dent Tokyo Dental College, 2-9-18 Misaki-cho Chiyoda-ku, Tokyo, 101-
Soc. 1987;41:481493. 0061, Japan.
19. van den Engel-Hoek L, de Groot IJ, Esser E, Gorissen B, E-mail: yoyamada@tdc.ac.jp
Hendriks JC, de Swart BJ et al. Biomechanical events of