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1. Diseases of the tongue GROUP 1 ODONTOLOGY PRESENTATION

2. Group members Mohamoud jimcale dirir Noradin ibrahim omar Nimco nasir H. mohamed Omar abdirahman dahir Riham rashid abdalle Sadam yonis ismail Shafici ismail ahmed Yasmin isahak muhumed Zakarie abdirahman abdillahi Zakarie abdirahman ahmed Ifrah bade osman Sumaya hussien dahir

3. Topics we are going to cover 1 Glossitis 2 Vascular and lymphatic lesions Infantile hemangiomas Oral varices 3 Reactive and inflammatory processes hairy tongue Fissured tongue 4. Infectious conditions Oral hairy leukoplakia Candidiasis 5 systemic disease Pernicous anemia 6. Malignant neoplasms Squamous cell carcinoma 7 strawberry tongue

4. Introduction The tongue is a complex organ involved in speech and expression as well as in gustation, mastication, and deglutition. The oral cavity and the tongue are sites of neoplasms, reactive processes, and infections and may be a harbinger of systemic diseases

5. Functions of the tongue Speech Sucking Taste Digestion Maintenance of oral hygiene

6. Glossitis Glossitis is the term used for the red, smooth and sore tongue particularly characteristic of anaemia. These features are a combination of signs (redness and smoothness) and a symptoms (soreness) which are not always associated.

7. Important causes of glossitis • Anaemia • Vitamin B group (especially B12) deficiencies • Candidosis

8. Inx Detailed haematological examination is essential. Treatment treatment of specific causes quickly relieves the symptoms.

9. Vascular and lymphatic lesions (Infantile hemangiomas) Infantile hemangiomas (IHs) are benign vascular neoplasms and are the most common soft tissue tumors in childhood They are more prevalent in girls and most commonly affect the head and neck region The majority of growth of IHs is seen in the first 2 months of life

10. Clinical features Although oral IHs are rare relative to the skin, they represent one of the most common lesions in the oral cavity of children and often affect the tongue , buccal mucosa, lips (soft tissue mass, pain, swelling and/or discoloration) the clinical differential diagnosis is dependent on the tumor depth and includes pyogenic granuloma, angiosarcoma, and other vascular tumors

11. Treatment The treatment of IHs is dependent on the risk of compromise of vital organs and structures as well as cosmesis. Oral propranolol is now Food and Drug Administration approved for IHs and has become the gold standard for treatment Response rates for propranolol are 98% with a goal dose of 2mg/kg/day and 6 months of therapy

12. Oral varices Oral varices are a common developmental anomaly noted in older adults. The etiology of oral varicosities remains unknown. Although the data are controversial, there may be an association with old age, smoking, and cardiovascular disease

13. Oral varicosities most commonly involve the ventral tongue and are characterized by tortuous, asymptomatic, compressible veins

14. Oral varices are commonly seen on the lip, as venous lakes, but are rare on the buccal mucosa. Treatment is not necessary; however, conservative excision of cosmetically concerning varices is often effective.

15. HAIRY TONGUE The filiform papillae which are the cone-shaped structures that don't contain taste buds, so have no taste function These filiform papillae can become elongated and hair-like forming a thick fur on the dorsum of the tongue. The filaments may be up to half a centimetre long and pale brown to black in colour Adults are affected but the cause is unknown.

16. HAIRY TONGUE

17. Risk factors Heavy smoking, excessive use of antiseptic mouthwashes, and defective diet have been blamed, but their effect is questionable Treatment The measure most likely to succeed is to persuade the patient to scrape off the hyperplastic papillae and vigorously cleanse the dorsum of the tongue with a firm toothbrush. Surgical removal by electrodessication

18. Fissured tongue Fissured tongue (FT) is a normal variant seen in up to 20-30% of the population, characterized by an increased number of fissures and grooves at the central and lateral aspects of the tongue This condition is idiopathic, more common in older individuals, and thought to be a reactive process FT is the most common tongue finding, seen in up to one third of patients with psoriasis

19. Clinically, FT is characterized by multiple, asymptomatic 2- to 3-mm grooves and fissures on the dorsal surface of the tongue There is no effective treatment for FT; however, we recommend good oral hygiene with brushing deep into the fissures to remove debris, lessen the microbial burden, and reduce halitosis .

20. Infectious conditions Oral hairy leukoplakia OHL is a corrugated white lesion seen on ventral and lateral surfaces of the tongue Commonly associated with HIV EBV is the causative agent

21. Clinical features Lesions are shaggy and frayed Plaque like and often bilateral Microscopy reveals viral nuclear inclusions

22. Treatment No treatment is required usually but…. Resolves with Zidovudine, Acyclovir, gancyclovir Topical application of podophyllin and tretinion OHL is highly predictive of AIDS development.

23. Oral candidiasis Oral candidiasis is most commonly caused by Candida albicans. Median rhomboid glossitis is a unique form of candidiasis that is characterized by large rhomboidal, atrophic plaques on the posterior-central tongue anterior . The surface of the tongue may be lobulated or smooth, and the lesions .

24. Clinical presentation are always anterior to the circumvallate papillae The plaques are often asymptomatic Treatment with topical or oral antifungals is effective .

25. Pernitious anemia Chronic hematologic disease Caused by lack of intrinsic factor used for gastric sectretions Triad of symptoms Generalized weakness Sore painful tongue Tingling of extremities

26. Treatment Adminstration of vit b12 Follic acid delayed treatment causes anemia and neurological symptoms

27. Malignant neoplasms (Squamous cell carcinoma) SCC is the most common oral malignancy and is a significant worldwide health issue. Oral SCC is more common in men and in those older than age 40 . Extrinsic risk factors include tobacco, alcohol, and sun exposure (if on the lip). Intrinsic risk factors include immunosuppression, longstanding inflammation, LP, HPV infection, HIV infection, and nutritional deficiencies

28. clinical presentation The clinical presentation of oral SCCs is highly variable; therefore, one should maintain a high index of suspicion , perform a biopsy early in the disease course, and perform repeat biopsies in refractory oral inflammatory diseases Clues to the diagnosis include longstanding lesions, irregular and ulcerated papules, nodules, and plaques that extend above the normal epithelium

29. The most common sites are the posterior lateral and ventral surface of the tongue. The floor of the mouth is the second most common location, whereas SCC of the dorsal surface of the tongue is rare.

30. Treatment Multimodal therapy with surgical excision, chemotherapy, Or radiation remains the standard of care. Recurrence is high in oral SCC; therefore, long-term monitoring is required

31. Strawberry tongue Strawberry tongue is a term for a tongue that is swollen and bumpy. It is not a health condition but rather a symptom of another disease.

32. Causes Kawasaki Disease Scarlet Fever Toxic Shock Syndrome Yellow Fever Recurrent Toxin-Mediated Perianal Erythema Recalcitrant Erythematous Desquamating Disorder

33. symptoms Strawberry  tongue  typically presents with the following symptoms Tongue rash Swollen tongue Increased tongue size Small bumps on the tongue that look like strawberry seeds Redness on the tongue

34. Treatment How to treat strawberry tongue depends on the cause Antibiotics  (for bacterial infections) IV immune globulin  and aspirin (for Kawasaki disease) IV fluids Pain relievers and fever reducers  (for yellow fever) 9 Antihistamines  (for allergies) Typically, the symptoms will also disappear when the condition causing strawberry tongue resolves .