THE

TONGUE


 BY :- DR.MOHIT
DHAWAN


M.D.S 1ST YEAR

 PG. DEPT. OF PROSTHODONTICS
 B.R.S DENTAL COLLEGE
 SULTANPUR(PANCHKULA)

CONTENTS
introduction
Functions
External features
Mucous membrane
Muscles
Arterial supply
Venous supply
Nerve supply
Lymphatic drainage

Prosthodontic
 considerations
Influence and action of floor
of the mouth
Applied anatomy


introduction
Tongue is always the most integral
part of oral anatomy.
 every prosthodontist should have
a proper knowledge of its anatomy to
implement it for delivering a
retentive denture.

 FUNCTIONS
OF THE
TONGUE
 Functions Of Tongue

Taste , mastication and deglutition .

The tongue takes part in the functions of
sucking , swallowing , receiving food into
the mouth , mastication , vocalization and
speech .

In speech , this is the most accurate and
fastest mechanisms of the body .

It plays an intrinsic part in the
formation of sounds of vowels and
consonants .

Control guide to direct the
flow of the food and liquids
to the pharynx .

Its a contributing factor in
aiding normal positioning of
erupting teeth in the dental
arches as a counter pressure
to facial muscles on the
labial and buccal side of the
teeth .

Acts as an additional thermal
guide

 DEVELOPMENT
EPITHELIUM


 Anterior 2/3:- I st brachial arch.

 Posterior 1/3:- III rd brachial arch .
 Posterior most :- 4th brachial arch.


MUSCLES from Occipital myotomes




CONNECTIVE TISSUES from the local mesenchyme

 EXTERNAL
FEATURES
 Diagram showing
external features .
 External features
Body has 2 surfaces :

 The dorsum , convex , curved upper
surface .
 The ventral surface , inferior
surface .

The dorsum of the tongue is divided into :
 1 . an oral part ( anterior two third )
 2 . A pharyngeal part ( posterior one
third )

The parts are separated by a faint v
shaped groove , the sulcus terminalis .

 ORAL OR PAPILLARY PART
It is placed on the floor of the
mouth .

It is covered by mucous membrane which
consists of a layer of connective
tissues & lined by stratified
squamous epithelium .

it ’ s margins are free & are in contact
with the gums & teeth .
in front of the palatoglossal
arch each margin show 4 - 5
vertical folds – foliate
papillae .

SUPERIOR SURFACE of the oral
part shows a median furrow
which is rough and covered
with papillae .

 INFERIOR
SURFACE
INFERIOR SURFACE
•It is covered with a smooth mucous
membrane , which shows a median fold
called frenulum lingulae .
•
•On either side – prominence by deep lingual
veins
•
•Laterally – fold called plica fimbriata
directed towards the tip of the tongue .
•
•The folds converge anteriorly & terminate on
either side of the lingual frenum in a small
elevation called the sublingual caruncula or
papilla . ( warton ’ s duct opens here ).
•
PHARYNGEAL ( LYMPHOID ) PART
Lies beneath the palatoglossal
arches and the sulcus
terminalis .

The mucous membrane has no
papillae , but has many lymphoid
follicles – collectively
constitute the lingual tonsil .

posterior part of
the tongue
The posterior part of the tongue is
connected to the epiglottis by three
folds of mucous membrane .

These are the median , right and left
glossoepiglotic folds .

On either side of the median fold
there is a pouch called the
Vallecula .

 PAPILLAE OF
THE TONGUE
PAPILLAE OF THE TONGUE
  VALLATE PAPILLAE:

•Large 1 - 2mm diameter .

•8 - 12 in no .
•Situated in front of sulcus terminalis .
•Cylindrical projection .
•Walls raised above the surface .
•
FUNGIFORM PAPILLAE :
•Numerous
•Near tip and margins
•Smaller than vallate but larger than filliform .
•Narrow peduncle and rounded head
•Bright red colour .
•
 FILLIFORM PAPILLAE:

 Cover the presulcular area of the dorsum .
 Velvety appearance .
 Smallest and numerous .
 Pointed and covered with keratin .

 MUCOUS MEMBRANE

The mucous membrane of the tongue
contains the receptors for the
special sensory modality of
taste .

Other sensory nerve endings
permit the tongue to detect
particle size of food , pain ,
temperature , pressure & even
defects on natural teeth or a
denture .

Mucous membrane forms papillae ,& is
adherent to the muscles .

Numerous glands , both serous & mucous
lie deep to the mucous membrane .

Numerous taste buds are distributed
throughout the mucous membrane .

Taste buds are not present in the
middle of the tongue .

 MUSCLES OF
THE TONGUE
MUSCLES OF THE TONGUE
It contains 4 intrinsic and 4
extrinsic muscles .
Intrinsic –
 ( I ) superior
longitudinal
 ( II ) inferior
longitudinal
 ( III )
transverse
 ( IV ) vertical

extrinsic muscles

Extrinsic muscles :
( I ) genioglossus
( II ) hyoglossus
( III ) styloglossus
( IV ) palatoglossus .
MEDIAN section AND LATERAL VIEW
 INTRINSIC MUSCLES
Superior Shortens & makes the dorsum concave. lies beneath
longitudinal mucous membrane.

Inferior Shortens &makes the dorsum convex. Close to inferior

longitudinal surface between genioglossus and hyoglossus.

Transverse Makes the tongue narrow & elongated. Extends from

median septum to margins.

Vertical Makes the tongue broad & flattened. Found in the

borders of anterior part of tongue.
 Genioglossus muscle


 Origin
 Upper genial tubercle

 Insertion
 Upper fibers : tip
 middle : dorsum
 Lower : hyoid bone


 Action
 Retract the tip ,
 Depress tongue ,
 Protrude the tongue
 ACTION OF THE MUSCLE
( prosthodontic view)
 It is a “ lingual fixing muscle of the lower
denture ”.


 The movements of the tongue espthe contraction is in
conjunction with the lingual vertical and the
genioglossus muscle that helps in the drawing of the
tongue anteriorly towards the floor of the muscle .


 Hence , it increases the pressure which the tip of the

tongue can exert on the floor of the oral cavity and
the alveolar process .



Genioglossus muscle

→
→
 Hyoglossus

muscle
Origin
 Greater cornu & lateral part of body of hyoid bone



 Insertion
Side of the tongue between

styloglossus & inferior

longitudinalmuscle of

the tongue

 Action
Depress the tongue,

Retrudes the tongue



 Styloglossus muscle


 Origin
Tip and anterior surface of the styloid


process


 Insertion
Side of the tongue


 action
Pull the tongue upward and forward

 Action of the styloglossus
muscle ( prosthodontic view )
 When the muscle contract

 ↓


 Terminating part of Alveolingual

 sulcusis lifted alongwith
 the mucousa .


 ↓


 Dislocating the denture




 Generally , it ’ s a LINGUAL DISLOCACTING MUSCLE .



 palatoglossus

 Origin
 Oral surface of palatine aponurosis.

 Insertion
Side of the tongue at the junction of oral and


pharyngeal part of palatoglossal arch.


 Action
Touches the palate. thus preventing the bolus from


coming out.

 Action of palatoglossus
( prosthodontic view)


It is also a lingual dislocating
muscle .

It is having the same action as that
of the styloglossus muscle .





 Nerve supply
 MOTOR NERVES:
 Intrinsic & extrinsic muscles except palatoglossus-
Hypoglossal nerve.
 Palatoglossus –Cranial part of Accessory n. through
Pharyngeal plexus.
 SENSORY NERVES
 Anterior 2/3 –Chorda Tympani (Facial Nerve).
 General sensation -Lingual nerve.

 Nerve supply

•
•Posterior 1/3 –general taste &sensation-
Glossopharyngeal nerve.
•
•Posterior most- Vagus nerve.
 Arterial supply

Lingual artery which is a

branch of external carotid
artery .

The root is supplied by

tonsillar & ascending
pharyngeal arteries.
 VENOUS DRAINAGE

 Deep lingual vein is the

principal vein.

 Runs backwards &unite to
form lingual vein.

 Ends in either common
facial vein or internal
jugular vein.

 LYMPHATIC DRAINAGE
Tip –bilaterally to Submental nodes.

The remaining right & left halves of anterior 2/3s drain

unilaterally to submandibular nodes.

Posterior 1/3 drains bilaterally into jugulo-omohyoid nodes.

(lymph nodes of the tongue).
 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)

 The presence of a retracted tongue affects the
complete denture construction; however, its effect
on denture function remains questionable. (J.Oral
Rehab:2005 jun397-402)

 Focal collections of chronic inflammatory cells are
common, because of the infiltration of
microorganisms or toxins through the thin
epithelium of this region.
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.

ACTIVE MUSCULAR FIXATION
 Here , BRODIE spoke about the “ Antagonistic ”
muscle groups .


 It can be used to stabilize the dentures .

→
↑↑
→
 PASSIVE MUSCULAR FIXATION
The resting muscles can be made to fix
a denture by 2 condtions :-


By the inclination of the polished

surfaces of the dentures .


By the polished surfaces of the denture

between the cheeks and the lower lip
on the one side and the tongue on the
other side .
 Inclination of polished surfaces


 The buccal flanges of the lower denture must
slope inferiorly and laterally .


 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 .

Inclination of polished
surfaces
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.



“ Prosthodontic
considerations ”
Tongue thrusting habit tend to displace
mandibular denture and sometimes maxillary
denture also.


Measurement of the tongue force and fatigue
indicate that long span edentulous state
effects the musculature of the tongue. The
tongue becomes stronger and this increase in
strength must be considered.


 (JPD 1963,,VOL 13,857-865, by Philip Rinaladi )

IMPRESSIONS:

Small narrow tongue –easy to make impressions.
Poor border seal.

Broad thick tongue –makes impression making
tough but provides good lingual seal.

 TONGUE SIZE
HOUSE’S CLASSIFICATION OF TONGUE SIZES.

Class I: normal in size ,development &
function.

Class II: teeth have been absent long enough
to permit a change in form & function of
the tongue.
HOUSE ’ S CLASSIFICATION OF TONGUE SIZES .

 Class III: the tongue is retracted & depressed into

the floor of the mouth ,with the tip curled upward,
downward or assimilated into the body of tongue.

 Class I is ideal for prostheses .


 Class II & III – Unfavorable

 POSITION OF THE TONGUE
WRIGHT ‘S CLASSIFICATION OF TONGUE POSITION.

Class I: Tongue lies in the floor of the mouth
with the tip forward & slightly below the
incisal edges of the mandibular anterior
teeth.

Class II : The tongue is flattened & broadened
but the tip is in a normal position.

 Class III: the tongue is retracted & depressed into
the floor of the mouth ,with the tip curled upward,
downward or assimilated into the body of tongue.


 Class I is ideal for prostheses .

 Class II & III – Unfavorable.

 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.

 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.

FUNCTIONAL TONGUE CLASSIFICATION
 According to the degree of activity and functional
type:
 1.occupational tongue.

 2. Still tongue.

 3.normal tongue.

 4.habitual tongue.


 JPD 1955,vol.5,629-635,by Barnett

kessler.

 Apply to those whose activities require increased
tongue action: jurist, teachers. Lecturers.

 This implies that the organ has developed a greater
range of power movements which may results in trauma
where flexibility in range is interfered with or
restricted by prosthetic appliance.

2. Still:Limited activity due to injury or deformity.

 Can not project the tongue forward much.

 Passive tongue: tongue- tie.

 3. Normal :Welcomed by prosthodontists as they give a range within
limit2. s in effecting desirable rehabilitation.

 4. Habitual: describes those disturbing power movements developed
by habit.

 The base of the tongue is thick and powerful and
dislodging force is most offending to prosthetic
denture.


 It is suggested that the lower 2 molar in the
prosthesis may be reduced buccolingually and may
be set buccal to the ridge crest for stability
 TEETH SETTING
 The actions of the tongue & cheek along with the
esthetics ,primarily determine the lateral limits
of the mandibular posterior teeth.

 The teeth shouldn’t be placed more lingual than the
extent of the ridge, since elevation of the tongue
may dislodge the prosthesis.

 TEETH SETTING
 At rest after swallowing the tip gently touches the
lingual surface of the lower anterior teeth.

 The anterior teeth must not be set too far labially
as the tongue normally rests on the anterior
teeth.

 The tongue assumes a position in which it’s lateral
border is at the level of lingual contour of the
lower natural posterior teeth.
 The dorsal surface is nearly at the level of the
occlusal plane of posterior teeth.

 It can be used as a good guide for the height of
occlusal plane of artificial posteriors.

 In prolonged edentulous patients the tongue is
hypertrophied.





“ Applied
anatomy ”
 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.






 APPLIED ANATOMY JPD 1960,vol 10,42-46,by Joseph.s.Landa



 Lingual cusps of upper premolars protrude lingually
and restrict lateral border of anterior 3rd of the
tongue- needs reduction and trimming of premolars.


 Positioning of lower posteriors lingually off the
ridge causes restriction of tongue movement- lack of
space for the tongue to stretch and relax- tongue
extend towards the throat- difficulty in breathing.

APPLIED ANATOMY JPD 1960,vol 10,42-46,by Joseph.s.Landa

 Insufficient vertical dimension causes excessive
friction of the dorsum against the palatal vault
and occlusal surfaces of upper teeth- Affects
phonetics an deglutition.

 When dentures are worn for many years with
insufficient vertical dimension, papillae in the
anterior 3rd and middle 3rd are obliterated leading
to smooth and shiny tongue.

 PROSTHETIC RECONSTRUCTION OF
MANDIBULAR 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.
 REFERENCES
 B.D.Chaurasia’s-Human anatomy

 Boucher’s-Prosthodontic treatment for edentulous patients.

 Clinically oriented anatomy- Moore and Dalley.

 Winkler’s-Essentials of complete denture
prosthodontics.

 Wikipedia
 Gray,s anatomy
 REFERENCES
 JPD-1955,VOL 5,629-635.

 JPD-1963,VOL 13,857-865.

 JPD-1978,VOL 39,652-655.

 (J.Oral Rehab:2005 jun397-402 )
Hps online .com

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