The tongue is mainly composed of muscles. It is covered with a mucous membrane. Small bumps (papillae) cover the upper surface of the tongue. Between the papillae are the taste buds, which provide the sense of taste. In addition to taste, the tongue functions in moving food to aid chewing and swallowing, and it is important in speech.
The tongue is considered a good reflection of general health status of the human body. Tongue disorders could be due to local causes or manifestation of systemic disease. Alteration in: size, shape, color, moisture, coating, nature of papillae and movements.Some of these disorders can be diagnosed easily by its clinical presentation. Other conditions required further investigation to identify their exact etiology, like:
diabetes mellitus, anemia, gastrointestinal disease, stress, alcoholic, long term antibiotics, nutritional deficiency, tongue movement disorders, and Bell’s palsy. Tongue disorders were more common among males, non smokers, and patients with bad oral hygiene and increased with increasing age. Fissured tongue and geographic tongue were more common than other diseases. Dentist can diagnose systemic diseases from tongue status.
Tongue disorders • 1-Sore tongue: • Ulcers of any type • Herpes simplex, • Lichen planus, • Carcinoma • Fissured tongue • Glossitis • Anaemia, • Vit.B group (B12) deficiencies, • Candidosis, • Antibiotic stomatitis, • Sjogrens syndrome. • Burning mouth syndrome. • Geographical tongue • The foliate papillae. 2-Lingual varicosities 3-Hairy tongue ,Black tongue, Furred tongue 4-Median rhomboid glossitis 5-Macroglossia: Congenital (haemangeoma or lymphangeoma) Downs syndrome Critinisim Acromegaly Amyloidosis Lingual thyroid 6-Taste abnormalities. 7-Speech impairment. 8-Ankyloglossia.
Tongue disorders 1-Sore tongue: A-Ulcers of any type Traumatic ulcer of the tongue. Erosions on the dorsum of the tongue caused by very hot food.
Lichen planus, reticular form, of the tongue. Fissured tongue Early squamous cell carcinoma of the lateral border of the tongue
B- Redness smoothness, andsoreness. • Causes: • Anaemia (iron deficiency, pernicious anaemia) • Vit.B group (B12) deficiencies. • Candidosis • Acute antibiotic stomatitis • Sjogrens syndrome • Lichen planus.
Iron deficiency anemia redness and atrophy of tongue papillae, smooth dorsal surface of the tongue.
Antibiotic-induced stomatitis, diffuse erythema and desquamation of the filiform papillae of the tongue. Sjogren's syndrome (oral and ocular dryness), dry and lobulated tongue.
C-Burning tongue Cranial nerves damage. dental trauma, a yeast infection of the mouth, anemia, diabetes, hormonal changes, physiological conditions such as anxiety and depression, and deficiencies of certain vitamins and minerals (vitamin B-12, niacin, iron, or folic acid), oral cancer. medications, such as diuretics, oral diabetes medications, and some blood pressure medications, Allergies (contact stomatitis), can be caused by allergy to toothpastes, mouthwashes, or chewing gums.
D-Geographic tongue An irregular smooth red area with a sharply- defined edges, extends for a few days, then heals, only to appear again in another area. Unknown etiology but some times there is a clear family history of its presence in several generations, and In many patients seems to be a developmental anomaly, There also appear to be associated with: Psoriasis, Stress, and Nutritional deficiency.
E-Hypertrophy of foliate papillae. Bilateral pinkish soft nodules on the lateral borders of the tongue they enclose lymphoid follicles which some times become hyper plastic or inflamed and sore. Hypertrophy of circumvallate papillae. Hypertrophy of fungiform papillae.
2-Sublingual varices 3-Hairy tongue Filliform papillae elongated and become hair like on the dorsum of the tongue. The cause is unknown but Heavy smoking, Antiseptic mouth washes, Defective diet have been blamed. Dilated veins seen along the ventral surface of the tongue and tend to become more prominent with age. HIV infection, typical hairy leukoplakia on the lateral border of the tongue.
Discoloration caused by pigment producing bacteria and fungi. Black hairy tongue. Dorsum of the tongue become black due to Drugs such as iron (in treatment of anemia) or sucking antiseptic lozenges.
Tongue coated with desquamating cells and debris In those who smoke heavily, Gastro intestinal tract problem, Infections, and Childhood fevers especially scarlet fever. Furred tongue These conditions are typically asymptomatic, Both conditions may be associated with halitosis. Scarlet fever, red and edematous tongue, partially covered by a thick white coating.
4-Median rhomboid glossitis Suggested that it is developmental but it is not seen in children and no longer accepted. Symptomless, red area of depapillation in the midline of the dorsum of the tongue. It is associated with chronic candidiasis, and if associated with corresponding palatal inflammation, may actually be suggestive of an immunocompromised state.
5-Macroglossia Macroglossia describes a tongue enlarged out of proportion to the size of the jaw. The pressure of the teeth on the enlarged tongue can produce scalloping along the border and patients may complain of tongue biting. Important causes: A-Congenital (haemangeoma or lymphangeoma). B-Downs syndrome C-Critinisim D-Acromegaly E-Amyloidosis F-Lingual thyroid Other causes of macroglosia: hypothyroidism, tongue inflammation, tongue infection, syphilis, amebic dysentery, Ludwig angina, pneumonia, pemphigus vulgaris, rheumatic fever, small pox, typhoid, tuberculosis, actinomycosis, giant cell arteritis, candidiasis, scurvy, pellagra, diabetes, uremia, myxedema, radiation therapy, neoplasm, carcinoma, plasmacytoma, neurofibromatosis, sarcoidosis, tongue trauma.
Hemangioma: Is a common benign lesion of the oral cavity, characterized by the proliferation of blood vessels. It is not a true neoplasm, but rather a developmental abnormality. The biopsy has to be taken very cautiously because of the danger of hemorrhage.
Lymphangioma of the tongue. The dorsum of the tongue is the most frequent site of involvement. Less often, it may be found on the lips, buccal mucosa, floor of the mouth and soft palate, but it is extremely rare on the gingiva.
B-Down's syndrome. Down syndrome: is a chromosome abnormality, this syndrome usually, although not always, results in mental retardation and other conditions. Small mouth with protruding tongue Broad short hands Retarded growth and development Small skull (microcephaly)
C-Acromegaly Is a syndrome that results when the pituitary gland produces excess growth hormons Acromegaly is often also associated with gigantism . Oral manifestations include: Macroglossia, Wide spacing of the teeth, Jaw overgrowth, mainly of the mandible (prognathism), and Enlargement of the lips.
D-Amyloidosis Associated with life threating disease multiple myeloma, MM is neoplasm of plasma cells, causes multiple foci of bone destruction, proliferation of myeloma cells in marrow cause anaemia and thrombocytopenia. Primary systemic amyloidosis, macroglossia, ecchymoses, and ulcer on the tongue.
E-Lingual thyroid It presents as an asymptomatic nodular mass of the posterior lingual midline, usually less than a centimeter in size but sometimes reaching more than 4 cm. in size.Larger lesions can interfere with swallowing and breathing , Up to 70% of patients with lingual thyroid have hypothyroidism and 10% suffer from cretinism. The lingual thyroid is four times more common in females than in males. Raised asymptomatic mass about 2 cm in diameter. Hemorraghe, dysphagia, dysphonia, sympotoms of hypothyroidism can be associated with this condition.
Ehlers-Danlos syndrome, ability to touch the tip of the nose with the tongue tip. Tongue_pierce Taste abnormalities: This can be caused by damage to the taste buds, neurologic abnormalities, side effects of medications, infections, and many other conditions.
Speech impairment • Common Causes: • Dysarthria • Poorly fitting dentures. • Alcohol intoxication and excess medications such as narcotics, phenytoin, or carbamazepine. • Any degenerative neurological disorder. • Stroke • Aphasia • Head trauma • Alzheimers disease • Stroke • Transient ischemic attack (TIA) Dysarthria is difficult, poorly articulated speech, such as slurring. Aphasia is impaired expression or comprehension of written or spoken language.
Ankyloglossia Ankyloglossia, commonly known as tongue tie, is a congenital which may decrease mobility of the tongue and is caused by an unusually short, thick lingual frenulum.
Treatment Treatment depends on the cause of the tongue problem. Cranial nerve paralysis is usually treated by treating the cause of the disorder if possible. Therapy may be needed to improve speech and swallowing ability. Ankyloglossia (tongue-tie) may not require treatment unless speech or swallowing difficulties occur. Surgical cutting of the frenulum will release the tongue and relieve the problem. Mouth ulcers, leukoplakia, oral cancer, and other lesions can be treated by surgical removal of the lesion and/or various medications. Glossitis and geographic tongue are treated by treating the cause of irritation or inflammation. Medications prescribed may include corticosteroids to reduce inflammation, and antibiotics or antifungal medications. Other treatments may include treatment for anemia and other disorders, and removal of the source of irritation.