Tongue disorders

Oral Medicine Lecture from my NOTES

1. Tongue disorders Sarang Suresh hotchandani

2. Introduction In generalized stomatis, tongue can also be affected… Examples Generalized stomatitis in Herpes Tongue can also shows signs or lesions for indication of other systemic diseases. Examples Hairy leukoplakia in AIDS Anemia

3. Classification of tongue disorders Developmental Acquired

4. Sore tongue Sore = tender to touch, painful, inflamed, sensitive. CAUSES Ulcers of tongue due to any cause Glossitis Sore tongue but physically normal tongue Geographic tongue Etc……….

5. Ulceration of tongue CAUSES Apthous ulcers Herpes stomatitis Lichen planus Carcinoma Mostly lateral border of tongue is affected with ulcer. If ulcer is on dorsum of tongue then don’t consider carcinoma at first because carcinoma on dorsum of tongue is rare.

6. glossitis It is a term used for; Red Smooth Sore tongue CAUSES Anemia Iron deficiency anemia Pernicious anemia Vitamin deficiency Candidiasis Antibiotic use

7. Clinical features WOMEN are more frequently affected in glossitis due to anemia Tongue appears SMOOTH, RED & SORE. Smoothness of tongue is due to ATROPHY OF FILIFORM PAPILLA

8. Vitamin deficiency In RIBOFLAVIN DEFICIENCY and sometimes NICOTINIC ACID DEFICIENCY GLOSSITIS can occur along with ANGULAR STOMATITIS. However diagnosis of glossitis in an healthy patient can not be made on basis of cause of vitamin deficiency alone. Although vitamin B group drugs are given for relieve of soreness in glossitis but these are frequently ineffective and this thing make it clear that VITAMIN DEFICIENCY ALONE IS NOT CAUSE OF GLOSSITIS

9. Candidiasis (fungal infection) Candidiasis causes tongue to be RED, SORE AND EDEMATOUS Cause of this fungal infection is ANTIBIOTICS which causes ANTIBIOTIC STOMATITIS along with ANGULAR STOMATITIS. Acute antibiotic induced stomatitis occurs due to LONG TERM USE of broad spectrum antibiotics Example; Tetracycline

10. In SJOGREN SYNDROME , tongue becomes; Red Cobblestone appearance Lichen planus SMOOTH TONGUE due to atrophy of tongue papilla SORENESS NO ERYTHEMA BLUISH WHITE SHINING on tongue

11. Sore but physically normal tongue This title means there is soreness but no other lesion or pathology is visible on tongue. This type of soreness creates difficulty in diagnosis This type of condition is mostly PSYCHOGENIC and is sometime called BURNING MOUTH SYNDROME which is type of ATYPICAL FACIAL PAIN. Diagnosis is by EXCLUSION OF ORGANIC DISEASE

12. INTRODUCTION It is common BENIGN CONDITION mostly affecting DORSAL SURFACE OF TONGUE. Characterized by RECURRENT APPEARANCE & DISAPPEARANCE OF RED AREAS ON TONGUE

13. etiology Cause is UNKNOWN but sometimes there is FAMILY HISTORY Sometimes due to PSORIASIS.

14. Clinical features…. Lesion appears IrR E g uL a R , Smooth RED AREA with SHARPLY DEFINED MARGINS. RED AREA is due to shortening of FILIFORM PAPILLA These lesions increase for few days and then disappear and then reappear in another area . Sometimes the lesion is ANULAR with slightly raised pale margins and then after sometimes these rings join to form a scalloped pattern. Mostly ASYMPTOMATIC but some patients complain of soreness.

15. Sometimes children with geographic tongue complain that TONGUE IS HYPERSENSITIVE and this hypersensitivity prevents them from eating their food. The reason for this is that some areas of tongue have normal epithelium while at some areas these is inflamed epithelium.

16. Histological features Thinning Of Epithelium At Center Of Lesion HYPERPLASIA & HYPERKERATOSIS AT PERIPHERY Chronic inflammatory cells in underlying connective tissue Loss Of Filiform Papillae At The Center Of Ring.

17. Differential diagnosis

18. Treatment As the lesion is benign and asymptomatic, usually there is no treatment required. However studies showed successful treatment with following drugs. Cyclosporine Topical and systemic antihistamine Topical retinoid Topical corticosteroids Mouth rinses Zinc supplements

19. introduction It is commonly observed condition characterized by ABNORMAL COATING on DORSAL SURFACE of tongue, due to DEFECTIVE DESQUAMATION of FILLIFORM PAPILLA.

20. ETIOLOGY CUM PREDISPOSING FACTORS

21. PATHOLOGY In hairy tongue HYPERTROPHY OF FILIFORM PAPILLA occurs which then becomes elongated and then forms thick fur on dorsum of tongue. These elongated papilla then covered by CHROMOGENIC BACTERIA.

22. Clinical features Lesion is mostly on DORSUM OF TONGUE. Mostly Adults Males. Mostly ASYMPTOMATIC but sometimes Burning During Swallowing HALITOSIS and GAGGING SENSATION because of retention of debris in between filiform papilla.

23. Treatment Brushing tongue with Tongue Scrapper.

24. Median rhomboid glossitis It is abnormality in the MIDLINE OF TONGUE at the junction of anterior 2/3 with posterior 1/3 characterized by RHOMBOID SHAPED SMOOTH ERYTHEMATOUS AREA LACKING LINGUAL PAPILLA AND TASTE BUDS. It is thought to be developmental but is not seen in children. Erythematous appearance is due to absence of filiform papilla. This lesion of MRG is susceptible to candida infection. Normally median rhomboid glossitis lesion is pink in color but sometime due to fungal infection its surface can appear white.

25. Clinical features Mostly in ADULTS and is ASYMPTOMATIC. Appear as NODULAR, RED or PINK area of depapillation Usually flat or slightly elevated.

26. Differential diagnosis Lingual thyroid Granuloma TB Tertiary syphilis Deep fungal infection Granular cell Tumor

27. management No treatment necessary.. Antifungal drugs if candidiasis… Palliative…

28. MACROGLOSSIA

29. Systemic……. ACROMEGALY

30. THANKS!!