Tipper and dipper types of oral swallows.

We characterized the normal patterns relating to the onset of the oral-swallowing phase in patients with normal oral motor function. The main pattern of swallowing was of the tipper type, in which swallowing is initiated with the tip of the tongue against the incisors and the bolus is in a supralingual position. However, a second pattern of a dipper-type swallow occurred, in which part of the bolus initially is positioned beneath the anterior part of the tongue. This circumstance requires that the tongue dip beneath the bolus in order to elevate the bolus above the tongue. Dipper swallows occurred in all age groups, but were more prevalent in subjects 60 years or older. Recognition of this component in normal swallowing patterns is essential for optimal evaluation of normal subjects and patients with an abnormal oral phase of swallowing.