Factors Influencing Oral Bolus Hold Type: Tipper or Dipper.
Kendrea L Focht Garand, Mary Catherine Reilly, Dahye Choi and 3 others
PMID 37274942WHAT IT FOUND
Most healthy adults hold a liquid bolus on the tongue tip (tipper), but holding it under the tongue (dipper) is also normal.
Dipper patterns were more common in men and adults over 50. Clinicians should not label a dipper hold as abnormal if the patient moves the bolus effectively.
Key findings
01In the total cohort, 86% of swallows were classified as tipper and 14% as dipper, showing that while tipper is dominant, dipper is a frequent normal variant.
02Older individuals (>50 years) and males were significantly more likely to demonstrate a dipper bolus hold type during specific liquid tasks.
03There was no significant association between bolus hold type and MBSImP scores for oral transit or lingual strength, suggesting experienced clinicians do not rate dippers as functionally impaired.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample was heavily skewed toward younger adults and women, with fewer participants in the oldest age categories (60+), limiting generalizability to very elderly populations. Each swallow task was performed only once, so the study could not assess if an individual switches hold types randomly or consistently within the same task. The study relied on normative data from healthy adults; it did not include patients with dysphagia to compare how often they use dipper patterns or if the clinical implications differ. Sex differences were observed but not explained by the study design; the authors note the biological mechanism (e.g., lingual strength differences) remains unclear.
Declared interests
The authors declared no competing financial or nonfinancial interests.
The easy way to misread this
Do not assume a dipper bolus hold indicates pathology or weakness. While it is less common than a tipper hold, it is a normal variant found in healthy adults, especially in men and older individuals. Labeling it as 'abnormal' without considering these demographic factors may lead to over-diagnosis of oral phase deficits.