GOOD MORNING

TONGUE
PRESENTED BY:
DEVENDRA PAL SINGH
CONTENTS
 INTRODUCTION
 GROWTH AND DEVELOPMENT
 GROSS ANATOMY OF TONGUE
 ---- MUSCLES OF TONGUE
 ---- BLOOD SUPPLY
 ---- INNERVATION OF TONGUE
 ---- TASTE BUDS
 HISTOLOGICAL FEATURES 
 AGE CHANGES
 PATHOLOGY OF TONGUE
 APPLIED ANATOMY
 SUMMARY AND CONCLUSION
 REFERENCES
 

INTRODUCTION

 Tongue is a mobile muscular organ situated

in the floor of mouth and is associated with

functions of stomatognathic system like

taste, speech, mastication and deglutition.

 it bulges upwards from the floor of mouth and

its posterior part forms the anterior wall of the

oral part of pharnyx. It is covered by stratified

squamous epithelium and consist of mass of

striated muscles interspersed with a little fat and

numerous glands.
 It is separated from teeth by alveolingual sulcus
which is filled in by the palatoglossal fold posterior
to last molar tooth and extends beneath its free
anterior third. Smooth mucous membrane in sulcus
passes from the root of tongue across the floor of
mouth on to the internal aspect of mandible and
becomes continuous superiorly with gums.
 Functions

 It acts as an organ of taste, and helps in

mastication, deglutition and speech.
 In some lower animals (e.g. dog) it is used for
thermo-regulation by panting.
 Sometimes tongue-prints displaying the pattern of
lingual papillae are used in medico­legal purposes
for personal identification.
 Clinically, it acts as a mirror in various
disturbances of alimentary tract.
 It is sometimes utilised in gestures and postures of
facial expression.
 Knowledge of anatomy and functions of
tongue is essential to understand morphological
and functional changes in tongue associated with
partial and complete edentulism

 Recognition, understanding and incorporation of

mechanical, biological and physical factors are
necessary for optimal prosthetic success,as
tongue plays one of the significant key role in
affecting stability and retention in prosthesis
fabrication.
DEVELOPMENT OF TONGUE

 The anterior 2/3rd of the tongue is formed by the fusion of

 1. Tuberculum impar

 2. Two lingual swellings.

 The posterior 1/3rd is formed from the cranial part of the

hypo branchial eminence , it is a swelling seen in medial
relation to the second, third, and fourth arches.
FOURTH WEEK

 The tongue develops at about 4 weeks of intrauterine

life in relation to the branchial arches in the floor of the
mouth
 The medial most part of the mandibular arch
proliferates to form two lingual swellings .
 These swellings are separated by another swelling ,
tuberculum impar , which appears in the midline
 Immediately behind the tuberculum impar the
epithelium proliferates to form a downward growth
 The site of this growth is marked by an depression
called foramen caecum
 The mesenchyme of 3rd arch rapidly grows over 2nd ,so
2nd arch is excluded from further involvement.
 The hypobrachial eminence gives rise to mucosa
covering the root or posterior third of tongue.
 The tongue separates from floor of mouth by a down
growth of ectoderm around its periphery, which
subsequently degenerates to form the lingual sulcus
and gives mobility to the tongue.
GROSS ANATOMY OF TONGUE

 DORSUM
 VENTRAL SURFACE
 PAPILLAE
 MUSCLES
 BLOOD SUPPLY
 LYMPHATICS
 NERVE INNERVATION
 TASTE BUD
ANATOMY OF TONGUE

DIVIDED INTO TWO PARTS-

 SUPERIOR( DORSAL)

 INFERIOR ( VENTRAL)
EXTERNAL FEATURES CONTAINS

 TIP

 BODY

 ROOT
BODY IS FUTHER DIVIDED INTO:

 Curved upper surface or Dorsum (with oral

and pharyngeal part)

 
 Inferior surface(confined to oral part only)
 DORSUM OF TONGUE
 Extends from tip of tongue to anterior surface of
the epiglottis. It is separated into palatine and
pharyngeal part by a v shaped sulcus terminalis,
the apex of which points posteriorly and is
marked by a pit foramen caecum.
 Thick mucous membrane of palatine part is
roughened by the presence of papillae. In the
pharyngeal part it is smooth, thin and finely
nodular due to lymph follicles
 ORAL PART ALSO KNOWN AS PAPILLARY
PART

 PHARYNGEAL PART ALSO KNOWN AS

LYMPHOIDAL PART
Oral or pappilary part of tongue is placed

on the floor of mouth. Its margins are free and in

contact with gums and teeth. The superior surface
shows a median furrow and is covered with papillae
which makes it rough , whereas the inferior surface
is covered with smooth mucous membrane
 which shows a median furrow called frenulum
linguae and on either side of frenulum is a
prominence produced by deep lingual veins.
More laterally to this fold is plica fimbriata that is
directed forwards and medially towards tip of
tongue.
 PHARYNGEAL PART

 It constitutes the base and lies posterior to the

palatoglossal arches.
 The pharyngeal part of the tongue is devoid of
papillae, and exhibits low elevations. There are
underlying lymphoid nodules which are
embedded in the submucosa and collectively
termed the lingual tonsil.
LINGUAL PAPILLAE

 Are discrete structures or appendages

of keratinized epithelium and lamina
propria.
The four types of papilla are :

 FILIFORM
 FUNGIFORM
 FOLIATE
 CIRCUMVALLATE

First three are associated with taste buds.

 All except the filiform papillae bear taste
buds.


Papillae are best observed when the tongue
is dry
FILIFORM PAPILLAE
 These are most common lingual papillae located on
the body of dorsal surface of tongue. They are shaped
like fine pointed cones of 2 to 3 mm,with tips
naturally turned towards the pharynx. They give
dorsal surface of tongue a velvety appearance and are
present in rows parallel to sulcus teminalis posteriorly.
These are sensitive to changes in the body.
 Histologically Increased amount of keratin is noted
and also no taste buds are present in epithelium of
these papillae
FUNGIFORM PAPILLAE
 These are smaller, numerous,reddish dots that on
closer inspection reveals slightly elevated
mushroom shaped appearance. Though they are
less numerous than filiform papillae but are
present on tip and margins of tongue.
 Histologicaly: a thin layer of ortho and
parakertinisation of epithelium overlying a highly
vascular lamina propria, with taste buds located
in the superficial portion of epithelial layer.
FOLIATE PAPILLAE
 These are 4 to 11 vertical ridges parallel to
one another on the lateral surface of tongue
CIRCUMVALLATE PAPILLAE
 These are large sized;1-2 mm diameter; these
are situated immediately in front of sulcus
terminalis. Each papillae is like a cylindrical
projection and is surrounded by trough into
which ducts of serous Von Ebner’s gland open
MUSCLES OF TONGUE

DIVIDED INTO TWO GROUPS: 

 EXTRINSIC GROUP
 INTRINSIC GROUP
INTRINSIC MUSCLES(muscles that occupy
upper part of tongue and are attached to
submucous fibrous layer)

• Superior longitudinal
• Inferior longitudinal
• Transverse
• Verticalis
EXTRINSIC MUSCLES

 (connect tongue to :mandible)

 hyoid bone
 styloid process
 Palate

Extrinsic muscles-
 Genioglossus
 Hyoglossus
 Paltoglossus
 stlyloglossus
 Tongue is divided into right and left halves by
a middle fibrous septum. Each half has four
intrinsic and four extrinsic muscles.
 Intrinsic muscles are located wholly within
the tongue
 Extrinsic muscles have attachments outside
the tongue
 Basic tongue movements are controlled by its
attached extrinsic musculature
INTRINSIC MUSCLES

 Superior longitudinal: It shortens the

tongue and makes the dorsum
concave,this muscle lies beneath mucous
membrane.
 Inferior longitudinal: It shortens the
tongue and makes the dorsum
convex,this muscle lies between
genioglossus and hyoglossus.
 Transverse: It helps in narrowing and
elongation of tongue(increase in height of
tongue) ,this muscle extends from median
fibrous septum towards margins.
 Verticalis: It broadens the tongue and
causes flattening of tongue,this muscle is
present at the borders of tongue in anterior
part.
EXTRINSIC GROUP
Basic tongue movements are controlled by its attached
extrinsic muscules and to a certain extent by
mandibular movements. The intrinsic muscles creates
change in form and shape of tongue, such as
elevation or depression of the blade or tip. The
intrinsic musculature has the potential to make
discrete changes in the shape and position of tongue
independent of either mandibular movements or
contraction of extrinsic musculature.(
Genioglossus:

 It connects tongue to the mandible. It is a fan

shaped muscle and forms the main bulk of tongue.
It arises from genial tubercle of mandible,from
here fibres fan out and run backwards.
 The upper fibres are inserted into tip of tongue and
helps in retracting the tip. Middle fibres are
inserted into dorsum of tongue and helps in
depressing the tongue. Lower fibres inserts into
hyoid bone and pulls the posterior
PART(protrusion of tongue)
Hyoglossus:

 Fibres of this muscle arise from greater cornu

and lateral part of body of hyoid bone, these
run upward and forward to insert on side of
tongue. It depresses tongue makes the
dorsum convex and specifically it retracts the
protruded tongue.
Styloglossus:

 This muscle arises from the tip and anterior

surface of styloid process as well as from
upper end of stylohyoid ligament. It passes
downward forward to insert into side of
tongue intermingling with fibres of
hyoglossus. During swallowing it pulls the
tongue upwards and backwards.
Palatoglossus:

 Its fibres originates from oral surface of

palatine aponeurosis and inserts into side of
tongue at junction of oral and pharyngeal
part. This muscle pulls up the root of the
tongue, approximates the palatoglossal
arches and thus closes the oropharyngeal
isthmus.
INFERIOR SURFACE OF TONGUE

Inferior surface and sides of tongue

are covered with smooth, thin mucous
membrane. In the midline anteriorly
the mucosa is raised into a sharp fold
which joins the inferior surface of
tongue to the floor of mouth(frenulum linguae)
On each side of the frenulum:

deep lingual vein is seen through

mucous membrane and lateral to it is

a fringed fimbriated fold of mucous

membrane.

On the floor of mouth is opening of

submandibular duct on the sublingual papilla.

Passing posterolaterally from this is the rounded sublingual

fold on which opens number of ductules of sublingual gland.

SIDES OF TONGUE(blade)
 On the side of tongue , anterior to lingual
attachement of the palatoglossal arch are five
short vertical folds of mucous membrane
(folia linguae). These carry taste buds and are
much better developed in animals like rabbit ,
hare.
BLOOD SUPPLY OF TONGUE

ARTERIAL SUPPLY:
 is from lingual artery, which is branch of
External Carotid Artery. Root of tongue also
get supply from tonsillar and ascending
pharyngeal arteries.
 VENOUS DRAINAGE:

 is by Deep Lingual Vein.

 Two venae comitantes accompany the
lingual artery and one vena comitantes
accompany the hypoglossal nerve. All veins
unite at posterior border of hyoglossus to
form lingual vein, which ends either in
Common Facial Vein or Internal Jugular
Vein.
LYMPHATIC DRAINAGE:

 Tips drain bilaterally to submental nodes

 Anterior 2/3rd drains unilaterally into right and
left Submandibular nodes.
 Posterior 1/3rd drains bilaterally to Jugulo
omohyoid nodes
 . Lymphatics do not accompany the blood
vessels.
 Tip of the tongue presents richest lymph
drainage. A cancer affecting the tip spreads
to all cervical lymph nodes of both sides.
NERVE SUPPLY

 MOTOR : All intrinsic and extrinsic muscles

are supplied by Hypoglossal nerve, except
palatoglossus which is supplied by cranial
accesory part of pharyngeal plexus.
 SENSORY :
 General sensory
 Special sensory
General sensory:

 Lingual nerve carries the general sensation.

Special sensory:

 Chorda tympani carries taste sensation of

anterior 2/3rd of tongue(except circumvallate
papillae)
 Glossopharyngeal nerve carries both general
and taste sensation of posterior 1/3rd of
tongue(also circumvallate papillae)
 Vagus nerve through its Internal Laryngeal
branch innervates posterior most part of
tongue.
TASTE BUDS
 Taste buds are small ovoid or barrel shaped
intraepithelial organs about 80 micron high and 40
micron thick. They extend from basal lamina to the
surface of epithelium. Their outer surface is almost
covered by a few flat epithelial cells, which
surrounds a small opening, the taste pore. A taste
bud may have more than one taste pore, it leads
into a narrow space lined by supporting cells,
between these cells are present 10 to 12
neuroepithelial cells,the receptor of taste stimuli.
 Rich plexus of nerves is found below the taste buds.
Taste buds are numerous on the inner wall of

trough surrounding the vallate papillae, in the

folds of foliate papillae,on the posterior surface

of fungiform papillae, at the tip and lateral

borders of tongue.
CLASSICAL VIEW:

Bitter taste : Vallate papillae

Sour taste : Folliate papillae

Sweet taste : Fungiform papillae at tip of tongue.

Salty taste : Fungiform papillae at borders of tongue.

 RECENT VIEW :
 According to recent concepts, it is stated that
taste can not be broken into four primary
components, i.e.
sweet, salt, sour and bitter. But each taste
sensation is consisting of range of stimuli that
form a spectrum of sensations making up all
taste senses and this all is precieved by receptor
cells in taste bud which is supplied by nerve
fibres.
AGE CHANGES

 There is tendency of taste buds to dimnish in

number in old age. Bald tongue, one in which
filliform papillae are atrophic is not an
uncommon finding in elderly people. Atrophy
of lingual papillae may occur in patient with
iron deficiency or vitamin b12 def., but in
many cases no satisfactory explanation can
be given for the presence of smooth tongue.
ROLE IN MASTICATION AND DEGLUTITION

 During mastication food after being

adequately mixed with saliva and chewed ,is
converted into bolus and is placed on tongue
in its central depression, series of muscular
waves travelling posteriorly along the
tongue,passes the food over epiglottis into
the oesophagus.
DEVELOPMENTAL
ANOMALIES AND PATHOLOGIES

 Microglossia
 Macroglossia
 Ankyloglossia
 Bifid tongue
 Fissured tongue
 Median rhomboid glossitis
 Geographic tongue
Microglossia

 This is due to the failure of lingual swellings

of the first arch to develop, the tongue which
is present in the posterior most part develops
from the copula ie the hypobranchial
eminence of third arch only.
MICROGLOSSIA
macroglossia
too large tongue seen in
Downs syndrome &
Beckwith-Wiedemann syndrome
 MACROGLOSSIA
ETIOLOGY:

PSEUDOMACROGLOSSIA
1. Hypertrophied tonsil and adenoid
2. Low palatal vault
3. Transverse, vertical or antero- posterior
Defects of max. & mand. Arch
4. Severe mandibular deficiency
5. Cyst and tumor displacing tongue.
Congenital causes :
a. muscular hyper trophy
b. Glandular hyperplasia
c. Hemangioma
d. Lymphangioma

Also seen in, down syndrome, Bechwith- Wiedman syndrome,

acromegaly, tertiary syphilis, etc.
 ANKYLOGLOSSIA

 The apical part of the tongue may be anchored

to the floor of the mouth by an overdeveloped
frenulum. This condition is called ankyloglossia
or tongue-tie. It interferes with speech.
Occasionally, the tongue may be adherent, to
the palate (ankyloglossia superior).
ANKYLOGLOSSIA
 Bifid tongue

 The tongue may

be bifid because of

non-fusion of the two

lingual swellings.
 Fissured tongue/Scrotal tongue:

 seen as grooves that vary in depth & are noted

along lateral & dorsal aspects of the tongue seen
in Down syndrome & Melkersson-Rosenthal
syndrome
Median Rhomboid Glossitis:
 Presents in the posterior midline of the
dorsum of the tongue ,just anterior to the V-
shaped grouping of the circumvalate papilla.
This is due to failure of fusion of lingual
swellings with tuberculum impar.
GEOGRAPHIC TONGUE

 Benign migratory glossitis is a psoriasiform mucositis

of the dorsum of the tongue .its dominant characterstics
is a constantly changing pattern of serpiginious white
lines surrounding the area of smooth,depappilated
mucosa ,with the depappilated areas have reminded
others of continental outlines on a globe ,hence the
popular term “geographic tongue” is used
GEOGRAPHIC TONGUE
ORAL MANIFESTATION OF IRON
DEFICIENCY AND PERNICIOUS
ANAEMIA
 
 The dimming of taste results from
degeneration of taste buds and reduction in
their number. Sense of taste for salty and
sweet food disappears first. Bitter taste
receptors persist much longer. As age and
xerostomia progress in senescent person, the
tongue sheds its epithelial coats and become
smooth(bald) and atrophic(shriveled).
XEROSTOMIA

 Dry mouth, also called xerostomia (ZEER-oh-

STOH-mee-ah), is the condition of not having
enough saliva, or spit, to keep the mouth wet.  Dry
mouth can happen to anyone occasionally—for
example, when nervous or stressed.  However,
when dry mouth persists, it can make chewing,
eating, swallowing and even talking difficult.  Dry
mouth also increases the risk for tooth decay
because saliva helps keep harmful germs that
cause cavities and other oral infections in check
 Hairy tongue
 In hairy tongue the lesion does not consist simply of a
coating on the surface of the tongue but represents
an elongation of the filiform papillae, often to many
times their original length. With this elongation the
papillae often take on a dark colour, black or brown
being common . hairy tongue frequently follows a
course of antibiotic therapy and may resolve quite
rapidly on completion of treatment. the presence of
hairy tongue was often ascribed to candidal and HIV
infections but, again, it has never been shown that
there is any true association between candidosis and
the production of the elongated papillae
Hairy tongue
Raspberry tongue

   a red, uncoated tongue, with elevated

papillae, as seen a few days after the onset of
the rash in scarlet fever
Tongue symptoms in various
conditions
 (1)Tongue pain-

Tongue injury , oral infections , canker sore , herpes simplex , tongue

cancer , angina

(2)Swollen Tongue-

Hyperthyroidism , neurological disorders , multiple sclerosis

(3)Smooth Tongue-

Nutriotional disorders
 (4)Coated Tongue-

Candidiasis ,

Dehydration ,

Antibiotic side effect

(5)Color change-

Jaundice- yellow color

Anaemia-dull in color

Cyanosis-blue discoloration
APPLIED ANATOMY OF TONGUE

 Injury to the hypoglossal nerve produces paralysis of

the muscles of the tongue on the side of the lesion.

 The lesion may be either infranuclear or supranuclear.

 Infranuclear:- gradual atrophy of the affected half of

the tongue.

 Muscular twitching are also observed

 Seen typically in motor neuron disease & in
syringobulbia.

 Supranuclear lesions:- produce paralysis without wasting.

 Seen in pseudobulbar palsy where the tongue is stiff &

small
 Glossitis is usually a part of generalized ulceration of the
mouth cavity.

 The presence of a rich network of lymphatic & of loose

areolar tissue,in the substance of the tongue is responsible
for enormous swelling of the tongue in acute glossitis.

 The tongue fills up the mouth cavity & protrudes out.

 The under surface of the tongue is a good site (along with the
bulbar conjunctiva) for observation of jaundice.

 In unconscious patients the tongue may fall back & obstruct

air passages.

 This can be prevented by lying the patient on one side with

head down (the ‘ tonsil position’) or by mechanically pulling
the tongue out.
 In patients with grand mal epilepsy the tongue is commonly
bitten between the teeth during the attack.

 This can be prevented by hurriedly putting a mouth gag at

the onset of the seizure.

 Carcinoma of the tongue is quite common.

 It is treated by radiotheraphy than by surgery.

 Carcinoma of the posterior 1/3rd of tongue is more dangerous

due to bilateral lymphatic spread.
PROSTHODONTIC
CONSIDERATIIONS OF
TONGUE
APPLIED ANATOMY
 CLINICAL EXAMINATION
 CHANGES ASSOCIATED WITH PARTAIL AND
COMPLETE EDENTULISM
 AGE CHANGES
 CLASSIFICATION OF TONGUE
 TONGUE AND STABILITY OF COMPLETE
DENTURES
 NEUTRAL ZONE
 TONGUE PROSTHESIS
INSPECTION & EXAMINATION

 Inspection begins with dorsum of tongue(while it is

at rest) for any swelling, ulcer, coating or variation
in size, colour and texture. Observing the margins
of tongue is next step, also along side other points
to be noted is distribution of filiform and fungiform
papillae, crenations and fasciculations, depapilated
areas, fissures, ulcers, and keratotic areas.
 Note the frenal attachment and any deviations as
the patient pushes out the tongue and attempts to
move it right and left.
Inspection can be done as under:

 Wrap a piece of gauze (4*4cm) around the tip of the

protruding tongue to steady it and press warm
mirror against uvula to observe the base of tongue
and vallate papillae; check for any ulcer or
significant swelling. Holding the tongue with gauze,
gently guide the tongue to one side and retract the
cheek of opposite side to observe foliate papillae
and entire lateral border of tongue for ulcers,
keratotic areas, red patches and then have the
patient touch the tip of tongue to the palate,
 so as to display the ventral surface of tongue
and also floor of mouth; note if any variation
like varicosites, tight frenal attachment, stones
in wharthon’s duct, ulcer, swelling and white
patches. Gently palpate muscles of tongue for
nodules or tumour like growths by extending
the finger onto the base of tongue and pressing
forward. Also take into consideration presence
of tongue thrust and swallowing pattern along
with movements and muscular coordinations
 Tongue size and position at times is the most
crucial and unavoidable dictating factor in
fabrication of prostheses.
 
 If patient has been without teeth or prostheses
for a long time or has worn maxillary denture
against lower anterior teeth only, then the
tongue can become enlarged and powerful
causing instability of dentures.
 AGE CHANGES OF THE TONGUE

 A common nodular varicose enlargement of

superficial veins on the undersurface of the tongue is
seen.

 Becomes smooth &glossy or red &inflamed in

appearance.

 Lingual mucosa – soreness, burning or abnormal

taste sensations. (in elderly &postmenopausal
women)
 AGE CHANGES OF THE TONGUE

 The presence of a retracted tongue affects the

complete denture construction; however, its effect
on denture function remains questionable.

 Focal collections of chronic inflammatory cells are

common, because of the infiltration of
microorganisms or toxins through the thin
epithelium of this region.
AGE CHANGES OF THE TONGUE

 As the age increases the motor skills of the

tongue decreases.

 For complete denture wearers, the tongue

plays an important role in the retention and
stability of dentures.
CLASSIFICATION OF TONGUE
According to House classification:
 Class 1: Normal in size, development and function.
Sufficient teeth are present to maintain normal form
and function.
 Class2: Teeth have been absent long enough to permit
a change in the form and function of the tongue.
 Class3: Excessively large tongue. All teeth have been
absent for an extended period of time, allowing for
abnormal development of the size of tongue.
Inefficient dentures sometimes can lead to the
development of class3 tongue
According to wright’s classification:
 Class1 : The tongue lies in the floor of mouth with
tip forward and slightly below the incisal edges of
the mandibular anterior teeth
 Class2 : The tongue is flattened and broadened,
but the tip is in normal position.
 C lass3 : The tongue is retracted and depressed
into the floor of mouth with the tip curled
upwards, downwards or assimilated into body of
tongue.
 ROLE OF TONGUE DURING
FABRICATION AND SUCCESS OF
PROSTHESES
 A small tongue can facilitate impression making but may
jeopardise the lingual seal.
 A relatively large tongue may act as hinderance while
making impression, but a good lingual seal is always
expected out of it
 Whereas a very large tongue prevents tray placement
while making impression or causes difficulty in the same
and latter on contributes to the instability of the denture.
 Also tongue movements and muscular coordination are
important for a number of reasons. As proper tongue
movements are necessary for border molding impressions.
Tongue movements and muscular coordination are necessary
in controlling the denture in mouth during normal physiological
activities such as speech, deglutition, mastication.
 Tongue position is important to the prognosis of mandibular
denture.
 DENTURE STABILITY

RESISTANCE TO HORIZONTAL DISPLACEMENT

OF A PROSTHESES (G.P.T 8th EDITION)
If patient has been without teeth or prostheses
for a long time or has worn maxillary denture
against lower anterior teeth only, then the
tongue can become enlarged and powerful
causing instability of dentures
 ANY CHANGE IN MAGNITUDE OF
HORIZONTAL FORCE OCCURING DUE TO
LATERAL ENLARGEMNT OF TONGUE ADDS TO
DISTURBANCE OF EQUILIBRIUM.
Role of lingual slope of mandibular denture in determining stability

 MANDIBULAR LINGUAL FLANGE

 The most desirable feature of lingual slope of the
mandible is that it approaches 90 degree to the occlussal
plane. This enables it to effectively resist horizontal
forces, as action of the musculature on denture base
generally result in lateral and vertical dislodging forces.
 Inclination of mandibular flange
 Anatomic influence of muscles
 Mandibular denture generally presents the major
problem with regard to retention.
:Reasons

 Movable floor of mouth causing lack of lingual seal

 Lack of ideal ridge height thereby decreasing

stability.
 Border seal along the lingual flange requires
understanding of anatomy and dynamic muscle
physiology
 Anatomic influence of muscles
 For evaluating lingual borders Sorenson’s plastic sore spot
indicator( 2mm layer paste is applied) 
 During border molding impressions, excess pressure while
molding leads to underextension and inadequate force will
result in overextension.
 Lingual flange in mandibular denture terminates in space at the
distal end of the alveolingual sulcus. This extension maintains
peripheral contacts and avoids a disturbing action of the lateral
border of tongue upon the inferior termination of lingual flange
of the denture. The distolingual portion of the flange is
influenced by the glossopalatine and superior constrictor
muscles which constitutes the retromylohyoid curtain
INFLUENCE AND ACTION OF FLOOR OF THE MOUTH
Anatomic influence of muscles

 Suprahyoid muscles are the digastric, stylohyoid,

mylohyoid and the geniohyoid.

 The mylohyoid and geniohyoid may influence the

borders of the mandibular denture.

 The right and left mylohyoid muscles together

form the floor of the mouth.
 The mylohyoid muscle

• Origin:
• From the whole length of mylohyoid line.

• Insertion:
• Posterior fibers to the body of the hyoid bone.
• Middle and anterior fibers to the median raphae that
unites the right and left muscles.
• Nerve supply: mylohyoid nerve.
• Actions :
• Elevates the floor of the mouth during swallowing.
• Depress the mandible and elevate the hyoid bone.
The mylohyoid muscle

 The muscle lies deep to the sublingual gland in the region

of 2 premolar. The posterior part of the muscle in the
molar region affects the lingual impression border in
swallowing and moving tongue.

 If the denture flange is extended below and under the

mylohyoid line, it will impinge on mylohyoid muscle and
the action of the muscle can unseat the denture.
the distal-lingual extension should
extend over the retro –molar pad
and about 3 mm below the
mylohyoid ridge.

The thick lingual flange can

dislodge the denture.
 The mylohyoid muscle

 If the flange stops above the ridge, vertical forces will

still cause soreness, and the seal will be broken easily.

 The denture flange can extend below, but not under the
mylohyoid line.

 In cases of extensive bone loss, mylohyoid can be

surgically detached and reattached inferiorly.
 LATERAL THROAT FORM
The lateral throat form is that part of the mouth in contact with the
disto-lingual extension of the denture. This area serves as the limiting
factor in the downward and backward extension of the lingual flange.
It is formed by the styloglossus and palatoglossus muscles as they
pass from the lateral walls of the throat into the sides of the tongue.
The lateral throat form, like the floor of the mouth, moves with the
tongue, and therefore, the tongue controls all of the positions that the
lateral throat form assumes.

1.mylohyoid muscle, 2.palatoglossus

muscle 3.superior constrictor,
4.pterigomandibular raphae
5.buccinator muscle.
 RETROMYLOHYOID FOSSA

 This is an area posterior to mylohyoid muscles.

 Bounded by retromylohyoid curtain.

 Posterolateral- overlies the superior constrictor muscle.

 Posteromedial- covers the palatoglossal muscle.

 Inferior- overlies submandibular gland.

RETROMYLOHYOID FOSSA

 The denture border should extend posteriorly to

contact retromylohyoid curtain when the tip of the
tongue is placed against the front part of upper
residual ridge.
 RETROMYLOHYOID FOSSA

Protrusion of the tongue

causes the retromylohyoid

curtain to move forward.

 Alveololingual sulcus

 The space between the residual ridge and the tongue which extends
from lingual frenum to the retromylohyoid curtain.

 Can be considered in 3 regions.

 1. Anterior region : This extends from lingual frenum to where

the mylohyoid curves down below the level of the sulcus. This
depression is called premylohyoid fossa.
Anterior region

 This results from the concavity of the mandible joining

the convexity of the mylohyiod ridge.

 The lingual border of the impression in this anterior

region should extend down to make definite contact with
the mucous membrane floor of the mouth when the tip of
the tongue touches the upper incisors
 The middle region

 Extends from the premylohyoid fossa to the distal

end of mylohyoid ridge curving medially from body
of the mandible. The curvature is caused by
prominence of mylohyoid ridge.

 When the mylohyoid muscle and the tongue are

relaxed, the muscle drapes back under the mylohyoid
ridge. If the impression is made under these
conditions,the muscle will be trapped under the ridge
when the tongue is placed against upper incisors
The middle region

 A slope of the lingual flange towards the tongue in the

molar region allows the mylohyoid muscle to contract and
raise the floor of the mouth without displacing the
denture.
 The posterior region

 This part is the retromylohyoid space or fossa.

 It extends from the end of the mylohyoid ridge to the

retromylohyoid curtain ( glossopalatine and superior
constrictor muscles).

 The denture border should extend posteriorly to contact the

retromylohyoid curtain( the posterior limit of alveololingual
sulcus) when the tip of the tongue is placed against the front
part of upper residual ridge.
 The posterior region

 The distal end of the lingual

flange turns buccally to fill
the retromylohyoid fossa.

 When the lingual flange is

developed in this manner the
border has a typical ‘s’
shaped curve
 If the floor is too low ,so the dentist tends to over extend
the denture flange, which leads to loss of retention
because the denture flange impinges on the tissue & gets
dislodged during the activation of the floor of the mouth.

 The mandibular denture should be stable enough to resist

a gentle push on the mandibular incisors by the tongue.
 Tongue position has an important bearing on impression
making and subsequent ability of the patient to manage
with the mandibular denture.

 All procedures leading to completing a lower impression

should be done with tongue in its normal position.
OCCLUSAL PLANE

 According to Fenn to obtain maximum stability

of lower denture, the occlusal plane of the
lower teeth should be very slightly below the
bulk of tongue, so that tongue performs the
majority of its movements above the denture
and thus keep the denture down.
 According to winkler at the time of try in
tongue is a guide evaluating the height of
occlusal plane. At rest after swallowing with
its tip touching the lingual surface of lower
anterior teeth, tongue assumes a position in
which its lateral border (at the junction of
keratinised and non keratinised mucosa) is at
the level of lingual contour of lower natural
posterior teeth, so same should be simulated
while fabricating prostheses.
OCCLUSAL PLANE:

 If too high------ then teeth can bite papillae during

function. And tongue touches upper incisors and
hence leads to upper and anterior emission during
speech.
 If too low-------then tongue can overlap the lower
teeth and can cause tongue bitting and during
speech s will be pronounced as sh.
NEUTRAL ZONE
 Neutral zone is the area in the mouth where
outward pressing functional forces of tongue are
neutralized by forces of lips, cheeks pressing
inwards. These forces are developed during
functions, chewing, speaking ,swallowing.
 The soft tissue that form internal and external
boundaries of denture base influences the
denture stability. It is to understand and
determine the peripheral borders, tooth position
and external contours of denture.
 According to Dr. Wilfred fish (1948), Denture has
three surfaces, each surface is playing
independent and important role in fit and stability
and comfort of denture, the three surfaces being:
 TISSUE SURFACE

 POLISHED SURFACE

 OCCLUSAL SURFACE
 For a muscular forces to be of a stabilising

nature, Dr. Fisch (1948) described cross section

of a stable denture in molar area to be in

triangular in shape, with tooth being at apex and

denture periphery as the base.

 If the inclined planes of the external surface of denture
are properly fashioned and forces are of equal
magnitude, then resultant force will be in seating
direction.
 If denture are triangular but not properly located within
the neutral zone, then the lateral force will be unequal,
hence compromising the stability of the denture.
 Inclination of polished surfaces

 The buccal flanges of the lower denture must slope inferiorly

and laterally.it shld extedn below the fold of buccinator
muscle very definitely in the molar region.

 The lingual flanges also must extend inferiorly and medially

below the anterior and lateral parts of the tongue, and as far
as posteriorly by the range of the action of tongue and
internal pterygoid muscle.
Position of the polished surfaces

 The position of the polished surfaces should be such

that it can be wedged between the supporting
structures.

 It should be in equilibrium with the forces acting on

both side.
 EFFECT OF LINGUAL FRENUM
 Lingual frenum: It is a fibrous band of tissue that
overlies the centre of genioglossus muscle, usually it
is narrow single band of tissue, but may be broad
and exist as two or more frenums.
 In case of hypertrophic frenum: lingual frenectomy
is done.
 In case ankyloglossia exist with a heavy alveolar
attachment, then detachment of fibres may be
necessary to ensure clearance. In patients of lingual
frenectomy, the denture should be made before the
surgery, to prevent relapse, as this denture acts as a
stent.
 Careful clearance is needed in this area of
impression, as well as in the finished denture, as
lingual frenum is attached to tongue and
inadequate clearance may result in LOSS OF SEAL
and a loose UNSTABLE denture
 Frenum is basically a fibrous connective tissue and
do not contract or expand like muscles. In some
patients lingual frenum may be so short that
patient can hardly protrude tongue, in these
situations surgical intervention is required(tongue
tie). On contrary subsequent scarring after surgical
correction may do more harm than good
USE OF TONGUE FOR RECORDING CENTRIC
RELATION IN EDENTULOUS
 One of the most difficult and important task to
accomplish on complete denture fabrication is
retruding the mandible to its centric relation, the
tongue can be helpful, however some patients
do not have the neuromuscular ability to control
the movements. In those patients a rectangular
strip of baseplate wax with four circular holes can
be adapted and sealed to the midline of palatal
surface of the maxillary record base. Using these
holes as guide patient can practice untill the
desired CR is can be habitually repeated
 ROLE OF TONGUE IN SPEECH
 Articulation of speech sounds is accomplished by discrete and precise

positional changes of tongue, lips and cheeks in relation to the palate,

teeth and other oral structures. Tongue is principal structure responsible
for these articulations

 Basic tongue movements are controlled by its attached extrinsic

musculature and to a certain extent by mandibular movements. The

intrinsic musculature creates change in form and shape of tongue, such
as elevation or depression of the blade or tip.

 The intrinsic musculature has the potential to make

discrete changes in the shape and position of tongue independent of either

mandibular movements or contraction of extrinsic musculature
EDUCATION OF THE PATIENT
Every patient should be informed regarding the care and proper use of
his dentures. There are many patients who will disregard reasonable
limitations in the use of their dentures, and this often results in
considerable inconvenience and the need for adjustments.
Patients who have a retracted tongue position present the dentist with
the added responsibility of guiding the patient through a retraining
period. This can be accomplished by showing the patient the normal
tongue position and demonstrating its significance. Those failing to
respond to this simple treatment can be given a series of tongue
exercises.
TONGUE EXERCISES
These exercises tend to strengthen the larger muscles
responsible for keeping the tongue in its normal position
The dentures should be removed and the exercises
practiced twice daily for periods of five to ten minutes.
Exercise No. 1.—Thrusting the tongue out and in, in
rapid succession. This causes an alternating action of the
posterior and anterior fibers of the genioglossus muscles
Exercise No. 2.—Swinging the tongue sideways with
great rapidity. The tongue should be out beyond the
lower lip about one-half inch. This causes an
alternating activation of the styloglossus muscles while
the tongue is held in its narrowed high position by the
transversus muscles.
Exercise No. 3.—Thrusting the tongue out to its most extended
position and pulling it back quickly. On extension, this action is
produced by the posterior fibers of the genioglossus muscles,
and, on retraction, it is the action of the anterior fibers of the
genioglossus with assistance from the styloglossus and
hyoglossus muscles.
Exercise No. 4.—Raising the tongue to its highest position well forward in
the mouth through the articulation of ‘‘eeyuh’’. To get the full benefit of
this exercise the ‘‘ee’’ should be spoken on as high a pitch as possible
before saying the ‘‘yuh.’’ This produces an action of the styloglossus,
stylohyoid, stylopharynegeus, the levators and palatopharyngi, the
tensors and the palatoglossi, the posterior fibers of the genioglossus as
well as the intrinsic muscles of the tongue shaping the ‘‘ee’’ vowel

The tongue is first raised to its highest position well forward in the
mouth (left) as the sound ‘‘ee’’ is articulated and dropped down (right)
as the sound ‘‘yuh’’ is articulated.
 PROSTHETIC RECONSTRUCTION OF TONGUE

 A total glossectomy or laryngectomy results in loss of basic vital

functions and loss of speech.

 In these patients fabrication of a mandibular tongue prosthesis

can be done.

 Procedure:
Diagnostic casts are made and articulated.
Mandibular RPD is constructed with a chrome cobalt alloy mesh
work which extends to the floor of the mouth.
 Superior portion of the tongue is concave in form to permit food
and liquid to pass posteriorly towards the pharynx.

 This tongue prosthesis is effective in improving esthetics and

function of the patient.
Tongue prosthesis is constructed from soft
medical grade silicon rubber with a flexible
tip.
↓
Mesh openings in the alloy meshwork
mechanically lock the silicone tongue
prosthesis in position.

When teeth comes in contact the tip of the

tongue touches the rugae area of the ↓
maxilla.
 Superior portion of the tongue is concave in form to
permit food and liquid to pass posteriorly towards the
pharynx.

 This tongue prosthesis is effective in improving

esthetics and function of the patient.
SUMMARY AND CONCLUSION

 Knowledge of anatomy, physiology and functions of

tongue is an essence to understand the complex
morphological and functional changes in the tongue
with aging or with complete and partial edentulism.
 This knowledge will help us to reach optimal
prosthetic success, as tongue plays significant and
perhaps the dictating role in affecting stability and
retention of prostheses.
 So we can conclude that a proper diagnose of tongue
is must before proceeding and planning any type of
dental procedures.
REFRENCES

 JOHN J. SHARRY Complete Denture Prosthodontics

3rd edition, Mc Graw Hill Book Company.
 ZARB-BOLENDER Prosthodontics Treatment For
Edentulous Patients 12th edition, Elsevier.
 BERNARD LEVIN Impressions for Complete
Dentures, Quintessence Publishing Company.
 SHELDON WINKLER Essentials of Complete
Denture Prosthodontics 2nd edition, A.I.T.B.S
Publishers
REFRENCES

 FENN, LIDDELOW & GIMSON’S Clinical Dental

Prosthetics. Mosby.
 JOHN BEUMER, Maxiollfacial rehabilitation. Mosby
 Cunningham’s manual of practical anatomy,
Oxford.
 Inderbir Singh ,Textbook of Human Embryology, 6th
edition.1996, Macmillan India ltd.
 Orban’s, Oral Histology & Embryology, 10th edition,
C.B.S Publishers & Distributors.
THANK YOU