Clin Oral Invest (1998) 2: 310

Springer-Verlag 1998

REVIEW

Reinhilde Jacobs Charbel Bou Serhal Daniel van Steenberghe

Oral stereognosis: a review of the literature

Received: 19 September 1997 / Accepted: 2 February 1998

Abstract Stereognosis is the ability to recognise and discriminate forms. Oral stereognostic ability has been studied in different reports. The experimental design of the test is of primary importance as both the method used and the material applied may influence the results dramatically. The form, size and surface characteristics of the test piece, the presentation order, subject-related factors and the method of scoring all have their effect on the results. With regard to subject-related factors, ageing has a negative influence on stereognostic ability; gender is considered of no importance. Another influencing factor is dental status. A healthy natural dentition offers a very good oral stereognostic ability. Edentulous subjects usually show a decreased oral stereognostic ability, depending on the rehabilitation form. A number of questions have been addressed, especially with regard to the perception itself. Receptors mainly involved in oral stereognostic ability are located in various oral structures and form perception results from an association of more than one group of receptors. The following review tries to deal with these questions and attempts to provide clear guidelines for further research on oral stereognosis. Key words Stereognosis Dental status Oral sensory function Periodontal mechanoreceptors

Introduction

Oral tactile information is conveyed through the trigeminal nerve. Neurophysiological investigations of the trigeminal system in man are extremely scarce. Indeed, it is difficult to isolate peripheral bundles except, perhaps, for the mandibular nerve. Needle recordings of the latter have
R. Jacobs ( ) C. Bou Serhal D. van Steenberghe 1 Laboratory of Oral Physiology, Department of Periodontology, Faculty of Medicine, Catholic University of Leuven, Kapucijnenvoer 7, B-3000 Leuven, Belgium Fax +32-16332484; e-mail: reinhilde.jacobs@med.kuleuven.ac.be
1

been rarely performed because these are painful. Therefore, psychophysical approaches have been used, which imply that subjects are questioned about their perception of the stimulus applied and eventually about how they sense it. Psychophysical tests have been developed to assess the tactile function of the hand and fingers in particular. When these psychophysical methods are carried out in a standardised way, the results seem to match the neurophysiological receptor function [34]. One should make a distinction between proprioceptive and exteroceptive receptors responding to mechanical stimuli (mechanoreceptors). Proprioceptors [muscles spindles, tempero-mandibular joint (TMJ) receptors] provide information about the relative positions and movements of the limbs. They are activated by stimuli from inside the body. Exteroceptors, located in the periodontal ligament, alveolar mucosa, gingiva and jaw bone, inform the central nervous system of external loading. Mucosal mechanoreceptors serve in a variety of functional capacities including sensation, composite sensory experiences (e.g. oral kinaesthesia and oral stereognosis), reflex initiation and modulation of patterned motor behaviour. In addition, mechanoreceptors in the periodontal ligament are primarily responsible for the tactile function of teeth [14, 33]. The latter receptors can also contribute to the coordination of jaw muscles during biting or chewing. The oral stereognostic ability test has a special interest when comparing patients with different dental status. Changes in oral sensation occur after the loss of natural teeth and edentulous patients show difficulties, most of the time, in adaptation to their new dentures. Many previous studies used the stereognostic ability test to evaluate such problems but also to evaluate differences in oral sensation when changes in the oral cavity take place.

Methodological factors

Holder of the P-I. Brnemark Chair in Osseointegration

Stereognostic ability is defined as ones ability to recognise and discriminate forms presented as a stimulus [6].

4 Table 1 Test piece characteristics in different studies Reference Form Size Thickness (mm) Berry and Mahood [1] Shelton et al. [30] 6 ? Length (mm) 12 ? Acrylic resin Plastic Material

Litvak et al. [22]

Metal alloy

Landt and Fransson [20] Lundqvist [23]

10

Acrylic resin

Van Aken et al. [35] Garrett et al. [9]

1 5

1012

Plastic Raw carrot

Mller et al. [28]

1.54

Acrylic resin

Jacobs et al. [15]

10

Acrylic resin

Stereognosis is a more complex process than the simple detection of tactile stimuli and involves different components. Manual stereognosis is used in neurology, neuropsychology and hand therapy to evaluate the functional performance of the hand [5, 17]. Oral stereognosis can be applied as a measure of oral functioning. This test can be used especially to test oral dysfunction or to evaluate the effect of therapy. Berry and Mahood [1] introduced the oral stereognosis test and tried to develop a standardised test procedure (e.g. shape, size, number, material). After this pioneering work, oral stereognostic ability, also denoted as oral form recognition, received further attention in the literature [10, 20, 24, 26, 27, 30, 36] and has been performed in different ways with a different outcomes. An appropriate psychophysical methodology has often been neglected. Furthermore, a variety of materials, forms and sizes has been applied (Table 1). Oral stereognostic ability has been investigated in relation to other oral functions to measure impairments due to the presence of general or local pathology (e.g. speech pathology, blindness, deafness, cleft lip and palate, temporary sensory ablations). Regardless of the tests used, one must keep in mind that many variables contribute to the subjective nature of psy-

chophysical sensory testing. Some variables are controllable, others are more difficult to deal with. The influencing factors are found in the different components of the experimental set-up (Table 2). Environment Background noise is distracting to the patient and the examiner. A test administered in a noisy environment is not reliable. To minimise the effect of noise, all testing should be done in a quiet, comfortable room and with stable illumination. The examiner must be alert for sounds made by a testing instrument before or during the application of a stimulus. These sounds may cue the patient to a change in stimulus. Such extraneous noises, and other sources of noise, must be carefully eliminated during the psychophysical experiment [7]. Examiner Inter-examiner variability is a critical parameter in general psychophysical testing. There is no doubt that a multitude

5 Table 2 Observations from previous studies (NT natural teeth, FD full denture, FPi fixed prosthesis on implants, ODi overdenture on implants) Reference Dental status NT FD Siiril and Laine [31] Litvak et al. [22] NT NT NT FD Number of subjects 15 15 12 12 20 21 21 48 Age (years) 1550 5171 5285 4084 2025 2031 5072 5075 Number of pieces 10 Number of tests 1 Test conditions Results (% correct) 52.3 39.6 36.5 63.5 82.5 69.5 62.9 55.0 55.5 50.5 42.1 37.4 40.0 40.3 42.3 44.9 70.0 86.4 59.5 90 79 57 68.5 68.5 66.0 70.5 52 56 75

Berry and Mahood [1]

Free manipulation Free manipulation, age effect Successful denture Unsuccessful denture Free manipulation Using teeth Not using teeth Wax covering teeth Using teeth Not using teeth Wax covering teeth No teeth Maxillary denture only Mandibular denture only Both dentures (teeth not used) Both dentures (teeth used) Free manipulation Free manipulation Free manipulation Oral: with teeth Oral: without teeth Dentures removed FD FPi (immediately after placement) FPi (36 months after rehabilitation) Free manipulation With dentures Without dentures Free manipulation Test piece with toothpick to allow placement of the piece between antagonistic teeth

10 10

1 2

Williams and La Pointe [36] Landt and Fransson [20] Landt [19]

NT NT NT NT

15 20 20 10 86 19

2033 2126 6070 1718 3179 4166

10 12

1 3 3 30 30 1 3 (2) 3 (2) 3 (2) 2 1 1 3 1

20 10 12

Van Aken et al. [35] Lundqvist [23]

FD FD FPi NT FD FD ODi FPi NT

Garrett et al. [9]

71 64 54 20 20 20

4885 4885 3987 4676 4074 3971

10

Mller et al. [28] Jacobs et al. [15]

12 10

of examiners leads to a lack of standardisation. In oral stereognosis, most deviations occur when recording the identification time. In spite of a training programme in stereognostic tasks, inter-examiner agreement remains weak [21]. One examiner may be faster than another when giving the test pieces or even when recording the results. To solve this problem and to assure the reproducibility of the data, observations must be carried out by only one examiner. Furthermore, instructions to the patient before each test should be standardised. Finally, the examiners and the subjects level of concentration should be taken into account. Pieces The form of a test piece not only has a great influence on the quality of the responses but also on the time needed for a given test. Forms should be of familiar patterns on which there is universal agreement among people [27]. The items should sample a wide variety of characteristics such as

straight lines, angles, concave and convex curves and easily perceived ratios of length and width [1]. Two equally important factors are the intelligibility (ease of recognition) and confusability (degree of confusion with regard to form similarity) of every individual form. Indeed, an ideal form for testing form perception should have both a moderate intelligibility and confusability value. The difficulty in identifying a piece can vary widely between pieces and tests. Of course, an increase in difficulty also implies more time is required for correct or incorrect identification [18]. As to the shape, pieces with rounded corners are preferred to sharp corners [1] because they are more comfortable during manipulation. When manipulating pieces made out of a strange material, it may be perceived as harmful, provoking an impaired appreciation (e.g. metal instead of acrylic resin). It is recommended that different forms and sizes are used, with a thickness of about 4 mm and a length of maximally 10 mm (Fig. 1). Furthermore, a toothpick should be inserted in each test piece to allow a standardised place-

ered correct if the subject identifies a given piece as precisely the one presented. In contrast, an incorrect response is scored when the subject puts forward an object without any similarity with the piece presented. In between these two poles, an answer is considered as partially correct when an object resembling the shape of the proposed piece is chosen. The correct, partially correct and wrong responses receive the respective scores of 2, 1 and 0 [31]. A slightly different point scale consists of counting every correct answer as 1, 2 for a partially correct response and 3 for wrong identifications [35]. Average identification of errors
Fig. 1 Set of test pieces made in acrylic resin, consisting of five different forms and two different sizes for stereognostic ability testing

The examiner records the responses as correct or incorrect. The evaluation is done by calculating the average or the percentage of correct or incorrect responses [1820, 22, 28, 36]. Average identification time The examiner notes down the time required for identifying a test piece, no matter whether it is right or wrong. An important factor is not only the time consumed for every piece but also for the whole identification process [18, 19]. Patient Patient-related variables may be of psychological or physical orders. Psychological factors include patient attitude, level of concentration and, possibly, anxiety level. Each patient brings his own perceptions to sensory tests; some are more motivated than others for the test; some are suggestible and may imagine a stimulus when there is none; others admit a sensation only if they are absolutely positive it was felt. Other patient-related factors are of physical origin, age, gender, dental status and dexterity. Age In general, motor changes occur with age inducing, among others, impairment of balance and unsteadiness of hand motion. In addition, deterioration of most sensory modalities in the distal extremities appears to occur almost inevitably with advanced age in humans [25]. Neurophysiologically, it is observed that the conduction velocity of the nerve impulse in sensory and motor fibres decreases with age [25]. A slight decline occurs after the age of 80 years with regard to oral sensory function; the ability to differentiate tactile and vibratory stimuli on the lip decreases, the two-point discrimination deteriorates on the upper lip, on the cheeks and on the lower lip, but not on the tongue or the palate [3].

Fig. 2 Manipulation of a test piece in an oral stereognostic ability test by using the hand to hold a toothpick. The toothpick is inserted in the test piece to allow standardised placement between antagonistic teeth and to avoid lip or tongue contact

ment of the test piece between two antagonistic teeth. This may help to avoid lip as well as tongue contact and to improve easy handling (Fig. 2). To facilitate the response process, a chart can be presented in front of the subjects illustrating all test pieces in their normal and proportionally enlarged size. Scoring Different procedures are followed for recording stereognostic ability. In general, three types are reported, a threepoint scale, average identification of errors or average identification time. Three-point scale This consists of classifying responses as one of three kinds, correct, incorrect and half-correct. A response is consid-

Older (6070 years) subjects need over 80% more time than younger (2126 years) ones to identify test pieces [20]. Identification errors are about three times more frequent among older than among younger individuals. In younger subjects, there is also a higher learning effect, which is expressed by the reduction in time and errors between the first and the third trial. Time is reduced by 22% in younger but only 5% in older subjects, and errors by 54% and 16% for younger and the older subjects, respectively [20]. A similar deterioration with age is also noted for oral motor ability [20]. Other authors also reported a decline with age [1, 19, 26, 28, 36]. When investigating the influence of age, one needs to compare younger and older subjects with a healthy natural dentition. Conversely, when studying the influence of dental status, the influence of age should be minimised. Age- and gender-matched groups should be adopted or statistical age correction performed. The latter solution might be needed because it is often difficult to select for comparison a group of edentulous patients (usually being older) and a group of subjects of the same age with a healthy natural dentition. Gender Few authors consider this factor important. Gender, indeed, does not show any significant influence on stereognostic ability [31]. Gender also does not affect lingual vibrotactile function. The tactile sensory systems of men and women operate similarly at both threshold and suprathreshold levels of stimulation [8]. However, females seem to have a greater ability to discern subtle changes in lip, cheek and chin position than males [4]. Dental status A change in the oral cavity by means of partial or complete loss of dentition certainly creates certain changes in oral function. To evaluate the influence of dental status on oral stereognostic ability, a number of cross-sectional studies have been carried out (Table 2). In such studies, patients with a full natural dentition are most often used as a control [1, 22]. Other cross-sectional studies only consider one type of dental status. When comparing teeth with full dentures, a far better stereognostic ability is noted for natural teeth when freely manipulating the test pieces [22]. However, significant differences were no longer noted after the age of 60 years, which may be due to a decrease in sensory abilities in general [25]. Essential in dentate subjects seems the role of periodontal neural receptors and of the tongue. After bilateral mandibular block, stereognostic ability decreases by about 20% [24]. When removing the denture(s) in complete denture wearers, a considerable reduction in stereognostic ability is noted [22]. Furthermore, edentulous subjects who expe-

rienced a lot of problems after inserting their new denture and those who show the lowest level of satisfaction demonstrate higher levels of oral perception than those subjects having few or no problems. Mller et al. [28] could not detect a clear relationship between satisfaction and adaptation to full denture and oral stereognosis. Lundqvist [23] was the first to investigate longitudinally stereognostic ability before and after rehabilitation with oral implants. Both the identification time and the error score decreased significantly after rehabilitation with implant-supported fixed prostheses, offering a better stereognosis than full dentures. Jacobs et al. [15] compared different prosthetic superstructures and noted no significantly different stereognostic ability with implant-supported fixed or removable prostheses, even when eliminating the involvement of tongue and lip receptors. When selecting only subjects with full dentures, one may compare the stereognostic ability for different conditions (e.g. adaptation to dentures) [9, 28, 35]. The best way to investigate the influence of dental status is to consider a patient group which will change its dental status and to observe patients longitudinally before and after treatment. Unfortunately, only one study applied this longitudinal design [23]. Dexterity Although there is some relationship between masticatory performance and hand dexterity [12], this is not the case for stereognosis [27]. Oral versus manual stereognosis In manual stereognosis, identification times are generally shorter and identification errors lower than in oral stereognosis. The correlation between identification errors and identification times is moderate in oral and absent in manual tests. In general, there is no clear relationship between manual and oral stereognosis [19]. An oral stereognostic ability test cannot be regarded as a measure of stereognostic ability in general. A learning effect is obvious for most test pieces regarding identification time and for about half of the test pieces regarding identification errors. Oral motor ability An oral stereognostic test is frequently performed in conjunction with an oral motor ability test in order to correlate the outcome of both tests [1, 31]. The reason is probably the similarity between both tests with regard to the use of pieces in the mouth, one to identify (oral stereognostic ability) and the other to fit two pieces complementary in form together (oral motor ability). Combining these tests provides an expression of the oral sensorimotor function of an individual [23].

It should be mentioned that there is also a clear relationship between stereognostic ability and interdental weight discrimination [36]. Subjects who are able to detect very small differences in weight interdentally also perform very well when recognising forms in the mouth. Masticatory performance There is no relationship between stereognostic ability and masticatory performance, either in dentate persons or in denture wearers [9]. On the other hand, when comparing stereognostic ability among denture wearers, significantly higher scores were noted in subjects with high masticatory performance [9]. Speech A test for oral stereognosis may help the speech pathologist in the treatment of an individual patient. Knowledge of kinaesthetic feedback in speech behaviour could indeed contribute to a better understanding of speech production and perception [2, 30]. Stutterers and speakers with articulation problems have an impaired stereognostic ability in comparison to normal speakers [27, 32], requiring more time for the test than normal speakers. Other factors

pieces; between the tongue and the hard palate, between the tongue and the teeth or between the tongue and the lips. During normal test conditions, the anatomical areas involved are lingual palatal and lingual dental manipulations. With unilateral anaesthesia, subjects continue to rotate the objects on the anterior two-thirds and tip of the tongue. With bilateral anaesthesia, manipulations are not only lingual palatal and lingual dental, but also lingual labial [24]. When investigating the outcome of the oral stereognostic ability test with or without using teeth, confusion between test pieces rises from 10 to 21% and the mean identification time increases from 17 to 26 s [19]. From these findings, one may assume that a major role is played by three groups of receptors, the tongue mucosa, the palate and, to a lesser extent, by the teeth with their periodontal ligament. The role of the TMJ receptors is less clear since most of the studies mentioned the role of different intra-oral receptors. In fact, in studies on tactile function, an interocclusal thickness of 5 mm and more seems able to activate receptors in the TMJ and the jaw muscles [14]. In stereognostic ability tests, pieces are mostly manipulated inside the mouth and seldom kept between two antagonistic teeth, which frequently excludes the need for a mouth opening of 5 mm or even more. When excluding other receptors, osseous mechanoreceptors come into play but not to a large extent [16].

General discussion

Hemiplegic subjects make approximately three times as many errors as normal subjects in oral stereognosis tests. Other pathological conditions in the perioral area have no direct influence on stereognostic ability [29, 32]. Cleft lip and palate is not accompanied by a sensory deficit of the oral area. There is also no overall sensory impairment following tissue manipulation in cleft lip and palate surgery [24]. The stereognostic ability of patients with burning mouth syndrome is not significantly different from normal subjects [11]. Cerebrally palsied speakers have an impaired stereognostic ability [27]. A surgical reduction of the tongue in cases of macroglossia has a minor influence on the subjects performance in the test for oral stereognosis [13].

Receptors involved in oral stereognosis

To assess stereognostic ability, test pieces are inserted in the oral cavity and in most experimental set-ups free manipulation of the test pieces is allowed. The latter implies activation of a large number of receptor groups (periodontal, mucosal, muscular, articular). Since the tip of the tongue is one of the most densely innervated areas of the human body, it plays an important role in stereognosis of objects inserted in the mouth [31]. Oral stereognosis tests give different results according to the location of the test

The majority of methods designed for neurophysiological and psychophysical sensory testing are unable to identify the specific receptor groups involved in the mechanisms of oral sensation or perception. It is obvious that differences and even some contradictions are noted when comparing the results of numerous studies. This is partially caused by the multiplicity of receptor types involved in many oral structures due to free manipulation of the pieces, but also by the lack of direct recording from sensory afferents, which is not common in psychophysical testing. Stereognostic ability testing is indeed not designed to detect specific receptor groups, rather, it reflects an overall sensory ability. A good result in a stereognosis test should indicate that the subject receives full and accurate information about what is going on in the mouth. Even if some manipulation is allowed to identify the test piece, the identification itself is a sensory rather than a motor accomplishment [1]. It has been established that this kind of sensory testing is an indicator of functional sensibility, including the synthesis of numerous sensory inputs in higher brain centres [31]. Some authors tried to limit the involvement of certain structures in order to localise other receptor groups involved, e.g. by covering the palate or the upper or lower teeth with wax [22], or by simply not allowing the teeth to be used for manipulation [18, 19]. Oral stereognosis, or recognition of forms, necessitates perfect reception of the impulses set up by the stimuli. The

sensations produced are synthesised in the cortex and compared with previous sensory memories. Presumably, oral stereognosis involves a certain amount of motor activity, manipulating the test piece within the mouth and feeling its surface with lips, tongue, teeth and palate. The information obtained must be associated with sensory memories derived from visual and tactile (finger-tip) experience when available. It can thus be stated that abilities other than the purely oral sensory function influence the identification of test pieces in the mouth. Two important parameters for evaluating stereognostic ability are the time consumed for identification of the pieces and the accuracy of the responses. With regard to the latter, large variations are often noticed among studies, and this is due to a lack of similarity in experimental setups. Many factors play a role, mainly the multiplicity in the form and size of the test pieces (different degrees of difficulty). In addition, the time also varies and that can be related to experimental variables as well as to the patient himself.

Continuous efforts should be made to use an appropriate experimental design to allow comparisons. Prospective studies are needed to evaluate how changes in dental status may alter oral stereognostic ability.
Acknowledgements This research was supported by the Fund for Scientific Research, Flanders, Belgium (FWO-Flanders-Belgium). R. Jacobs is a postdoctoral research fellow of the FWO.

References
1. Berry DC, Mahood M (1966) Oral stereognosis and oral ability in relation to prosthetic treatment. Br Dent J 120: 179185 2. Bishop ME, Ringel RL, House AS (1973) Orosensory perception, speech production, and deafness. J Speech Hear Res 16: 257266 3. Calhoun K, Gibson B, Hartley L, Minton J, Hokanson J (1992) Age-related changes in oral sensation. Laryngoscope 102: 109 116 4. Chen CC, Essick GK, Kelly MG, Nestor JM, Masse B (1995) Gender-, side- and site-dependent variations in human perioral spatial resolution. Arch Oral Biol 40: 539548 5. Dannenbaum RM, Jones LA (1993) The assessment and treatment of patients who have sensory loss following cortical lesions. J Hand Ther 6: 130138 6. Dorland WA (1981) Dorlands illustrated medical dictionary, 26th edn. Saunders, Philadelphia 7. Falmagne J-C (1985) Elements of psychophysical theory, 1st edn. Clarendon Press, Oxford 8. Fucci D, Petrosino L, Schuster SB, Wagner S (1990) Comparison of lingual vibrotactile suprathreshold numerical responses in men and women: effects of threshold shift during magnitude estimation scaling. Percept Mot Skills 70: 483492 9. Garrett NR, Kapur KK, Jochen DG (1994) Oral stereognostic ability and masticatory performance in denture wearers. Int J Prosthodont 7: 567573 10. Grossman R (1967) Methods of determining oral tactile experience. In: Bosma JF (ed) Second symposium on oral sensation and perception. Charles C Thomas Publisher, Springfield, Ill, pp 161181 11. Grushka M, Sessle B, Howley T (1987) Psychophysical assessment of tactile, pain and thermal sensory functions in burning mouth syndrome. Pain 28: 169184 12. Hoogmartens MJ, Caubergh MA (1987) Chewing side preference in man correlated with handedness, footedness, eyedness and earedness. Electromyogr Clin Neurophysiol 27: 293300 13. Ingervall B, Schmoker R (1990) Effect of surgical reduction of the tongue on oral stereognosis, oral motor ability, and the rest position of the tongue and mandible. Am J Orthod Dentofacial Orthop 97: 5865 14. Jacobs R, Steenberghe D van (1994) Role of periodontal ligament receptors in the tactile function of teeth: a review. J Periodont Res 29: 153167 15. Jacobs R, Bou Serhal C, Steenberghe D van (1997) The stereognostic ability of natural dentitions versus implant-supported fixed prostheses or overdentures. Clin Oral Invest 1: 8994 16. Jacobs R, Steenberghe D van, Brnemark P-I, Rydevik B (1997) Evaluation of osseoperception following mechanical stimulation of osseointegrated implants (abstract 375). J Dent Res 76: 1141 17. Joseph R (1988) The right cerebral hemisphere: emotion, music, visualspatial skills, body-image, dreams, and awareness. J Clin Psychol 44: 630673 18. Landt H (1976) Oral and manual recognition of forms. Part I. Test results based on the test pieces. Swed Dent J 69: 1523 19. Landt H (1976) Oral and manual recognition of forms. Part II. Test results based on the subjects. Swed Dent J 69: 6977 20. Landt H, Fransson B (1975) Oral ability to recognise forms and oral muscular coordination ability in young and elderly adults. J Oral Rehabil 2: 125138

Conclusions

The mechanism of oral stereognosis is determined by a variety of neural receptors belonging to many oral structures and by the functioning of higher coordination centres. Some structures (oral mucosa, tongue) are more involved than others (bone). The experimental design and the use of a standardised method are of primary importance and should be taken into account in future investigations, since both the method used and the material applied may influence the results dramatically. Guidelines are necessary to reach this purpose: 1. A standardised set should be used with regard to the form, size and surface characteristics of the test piece. 2. The use of one order of presentation helps for accurately comparing the results. This is not advised when repeating the test on the same subject. In addition, one method of scoring should be followed. 3. The insertion of a toothpick in each test piece allows a standardised placement between two antagonistic teeth. This may help to eliminate the involvement of lip and tongue receptors and to improve easy handling. On the other hand, subject-related factors should also be considered: 1. Ageing has a negative influence on stereognostic ability. Gender is considered of no importance. 2. Dental status is usually dependent on the aim of the study. Subjects with a healthy natural dentition or denture wearers patients with oral implants can be tested. The oral stereognostic ability test can be used to evaluate patients after therapy (e.g. oral implants) and especially in a longitudinal design. Further studies are needed to more clearly define the role of periodontal mechanoreceptors in oral stereognosis.

10 21. Landt H, Ahlin L, Lindquist L (1975) The experimenter effect on results with the oral form recognition tests and with tests measuring oral muscular ability. J Oral Rehabil 2: 235248 22. Litvak H, Silverman SI, Garfinkel L (1971) Oral stereognosis in dentulous and edentulous subjects. J Prosthet Dent 25: 139151 23. Lundqvist S (1993) Speech and other oral functions. Swed Dent J Suppl 91: 139 24. Mason R (1967) Studies on oral perception involving subjects with alterations in anatomy and physiology. In: Bosma JF (ed) Second symposium on oral sensation and perception. Charles C Thomas Publisher, Springfield, Ill, pp 295301 25. Masoro EJ (1986) Physiology of aging. In: Holm-Pederson P, Le H (eds) Geriatric dentistry. Munksgaard, Copenhagen, pp 3455 26. McDonald ET, Aungst LF (1967) Studies on sensory oral motor function. In Bosma JF (ed) Second symposium on oral sensation and perception. Charles C Thomas Publisher, Springfield, Ill, pp 202220 27. Moser H, LaGourgue J, Class L (1967) Studies of oral stereognosis in normal, blind and deaf subjects. In: Bosma JF (ed) Second symposium on oral sensation and perception. Charles C Thomas Publisher, Springfield, Ill, pp 245286 28. Mller F, Link I, Fuhr K, Utz K-H (1995) Studies on adaptation to complete dentures. Part II: Oral stereognosis and tactile sensibility. J Oral Rehabil 22: 759767 29. Nemcovsky CE, Gross MD (1991) A comparative study of the stereognathic ability between patients with myofascial pain dysfunction syndrome and a control group. Cranio 9: 3538 30. Shelton R, Arndt W, Hetherington J (1967) Testing oral stereognosis. In: Bosma JF (ed) Second symposium on oral sensation and perception. Charles C Thomas Publisher, Springfield, Ill, pp 221243 31. Siiril H, Laine P (1967) The relation of periodontal sensory appreciation to oral stereognosis and oral motor ability. Suomi Hammaslaak Toim 63: 207211 32. Speirs RL, Maktabi MA (1990) Tongue skills and clearance of toffee in two age-groups and children with problems of speech articulation. ASDC J Dent Child 57: 356360 33. Steenberghe D van (1979) The structure and function of periodontal innervation. A review of the literature. J Periodont Res 14: 185203 34. Vallbo B, Johansson RS (1984) Properties of cutaneous mechanoreceptors in the human hand related to touch sensation. Hum Neurobiol 3: 314 35. Van Aken AAM, Waas M van, Kalk W, Rossum GMJM van (1991) Differences in oral stereognosis between complete denture wearers. Int J Prosthodont 4: 7579 36. Williams WN, La Pointe LL (1972) Relationships among oral form recognition, interdental thickness discrimination and interdental weight discrimination. Percept Motor Skills 35: 191194