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Tongue Disorders




The tongue is made up almost entirely of muscle fibres. It can be divided into an oral portion (tip, blade, front, centre and back) and a pharyngeal (throat) portion. The movement of the tongue against the roof of the mouth, teeth and lips helps us to shape vocal sounds into words, as well as to eat and drink effectively. The taste buds located on the tongue membrane contribute to the experience of food flavour.

The dense network of nerves and muscle fibres in the tongue means that we can chew food without (usually) chewing on our tongue as well. Some of the disorders that affect the tongue include sore tongue, black hairy tongue and tongue-tie.

Types of Tongue Disorders

Tongue disorders are
  • Loss of taste
  • Sore Tongue (Glossitis)
  • Black Hairy Tongue
  • Glossodynia
  • Tongue-tie (Ankyloglossia)
  • Geographic Tongue
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Loss Of Taste

Loss of taste can also be caused by exposure to certain chemicals such as insecticides and by some medicines. Taste disorders may result from oral health problems and some surgeries (e.g. third molar extraction and middle ear surgery). Many patients who receive radiation therapy for cancers of the head and neck develop chemosensory disorders.

Some people are born with chemosensory disorders, but most develop them after an injury or illness. Upper respiratory infections are blamed for some chemosensory losses, and injury to the head can also cause taste problems. The extent of a chemosensory disorder can be determined by measuring the lowest concentration of a chemical that a person can detect or recognize. A patient may also be asked to compare the tastes of different chemicals or to note how the intensity of a taste grows when a chemical's concentration is increased.

Scientists have developed taste testing in which the patient responds to different chemical concentrations. This may involve a simple "sip, spit, and rinse" test, or chemicals may be applied directly to specific areas of the tongue.

A person with a taste disorder is challenged not only by quality-of-life issues, but also deprived of an early warning system that most of us take for granted. Taste helps us detect spoiled food or beverages and, for some, the presence of food to which we're allergic. Perhaps more serious, loss of the sense of taste can also lead to depression and a reduced desire to eat.

Abnormalities in chemosensory function may accompany and even signal the existence of several diseases or unhealthy conditions, including obesity, diabetes, hypertension, malnutrition, and some degenerative diseases of the nervous system such as Parkinson's disease, Alzheimer's disease, and Korsakoff's psychosis.

If a certain medication is the cause of a taste disorder, stopping or changing the medicine may help eliminate the problem. Some patients, notably those with respiratory infections or allergies, regain their sense of taste when the illness resolves. Often the correction of a general medical problem can also correct the loss of taste. Occasionally, recovery of the chemosenses occurs spontaneously.

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Sore Tongue (Glossitis)

Glossitis is an abnormality of the tongue that results from inflammation.

Causes
Changes in the appearance of the tongue may be a primary tongue disorder, or it may be a symptom of other disorders. Glossitis occurs when there is acute or chronic inflammation of the tongue. It causes the tongue to swell and change color. Finger-like projections on the surface of the tongue (papillae) are lost, causing the tongue to appear smooth.

The causes of glossitis include:
  • Bacterial or viral infections (including oral herpes simplex)
  • Mechanical irritation or injury from burns, rough edges of teeth or dental appliances, or other trauma
  • Exposure to irritants such as tobacco, alcohol, hot foods, or spices
  • Allergic reaction to toothpaste, mouthwash, breath fresheners, dyes in candy, plastic in dentures or retainers, or certain blood-pressure medications (ACE inhibitors)
  • Disorders such as iron deficiency anemia, pernicious anemia and other B-vitamin deficiencies, oral lichen planus, erythema multiform, aphthous ulcers, pemphigus vulgaris, syphilis, and others

    • Occasionally, glossitis can be inherited.
Symptoms
  • Tongue swelling
  • Smooth appearance to the tongue
  • Tongue color usually dark "beefy" red
    • Pale, if caused by pernicious anemia
    • Fiery red, if caused by deficiency of B vitamins
  • Sore and tender tongue
  • Difficulty with chewing, swallowing, or speaking
Causes
The goal of causes is to reduce inflammation. Causes usually does not require hospitalization unless tongue swelling is severe.

Good oral hygiene is necessary, including thorough tooth brushing at least twice a day, and flossing at least daily. Corticosteroids such as prednisone may be given to reduce the inflammation of glossitis. For mild cases, topical applications (such as a prednisone mouth rinse that is not swallowed) may be recommended to avoid the side effects of swallowed or injected corticosteroids.

Antibiotics, antifungal medications, or other antimicrobials may be prescribed if the cause of glossitis is an infection. Anemia and nutritional deficiencies must be treated, often by dietary changes or other supplements. Avoid irritants (such as hot or spicy foods, alcohol, and tobacco) to minimize the discomfort.

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Black Hairy Tongue

The surface of your tongue has hundreds of tiny fingerlike projections called papillae. Your taste buds are scattered among these projections. The papillae grow constantly, and the top layer of cells normally wears away. In some people, these cells do not wear away and the papillae grow unusually long.

When this occurs, the papillae easily trap debris and bacteria that are normally in the mouth. The bacteria multiply, producing a dark area on the tongue.

Black hairy tongue refers to the color of the bacteria (which can appear dark or black) and the overgrown papillae, which give the tongue a hairy or furry appearance. The condition is noncancerous (benign) and is not an infection; it's something like moss growing on a rock.

The cause of black hairy tongue is not known. The condition is not common in healthy people and is very mild when it does occur in healthy people.

However, some people are at higher risk of developing the condition. Poor oral hygiene is by far the most common factor associated with black hairy tongue. You also are at higher risk of developing black hairy tongue if you:

  • Smoke
  • Are taking certain types of antibiotics (which can upset the balance of oral bacteria)
  • Are undergoing chemotherapy and/or radiation therapy for head and neck cancer
  • Have uncontrolled diabetes or other systemic conditions (those that affect the entire body)
Symptoms
Bad breath (halitosis) is the only symptom associated with black hairy tongue. The condition is not painful. The obvious sign of black hairy tongue is a coating of bacteria and debris on the tongue. The coating is usually located in the middle to back of the tongue, and can be green, brown, black, white or yellow.

Prevention
Good oral hygiene is critical to help prevent black hairy tongue. Brushing your tongue will wear away the papillae and prevent them from overgrowing. It also can help to freshen your breath. Not smoking also helps to prevent black hairy tongue. If you have a systemic disease such as diabetes, see your doctor regularly to keep it under control.

People being treated for head and neck cancer should be aware that good oral hygiene is important during chemotherapy and radiation therapy. During your cancer causes, visit your dentist regularly so he or she can detect any oral conditions or infections associated with your cancer therapy.

Causes
The common causes for black hairy tongue is simply to brush your tongue whenever you brush your teeth - at least twice a day. For severe cases, your dentist may recommend using a tongue scraper twice a day. It should be wetted with Dakin's solution, a very diluted bleach solution that kills the bacteria. Grocery stores and drugstores sell tongue scrapers over the counter. Because there is no internal infection, you will not receive antibiotics for black hairy tongue. If taking antibiotics helped the condition to establish itself, stopping the causes will help it go away.

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Tongue-tie (Ankyloglossia)

Tongue tie occurs when free movement of the tongue is restricted.

Causes
Tongue tie is a condition in which tissue attached to the base of the tongue (lingual frenum) is positioned too far forward on the tongue, making it difficult to move the tongue. If the tissue extends to the tip of the tongue, a V-shaped notch may be seen. Tongue tie may cause feeding problems, tooth problems, and speech problems.

Symptoms
    Inability to protrude tongue
    V-shaped notch in tip of tongue
    Excessive attachment of tongue to floor of the mouth by the lingual frenum membrane
Treatment
Surgery is seldom necessary. If it is necessary, it should be postponed until the child is approximately 9 months old. Surgery involves cutting of the abnormally placed tissue. This may be done in the doctor's office (mild cases), or an operating room (more advanced cases). A surgical reconstruction (z-plasty closure) may be required to prevent scar tissue formation. Surgery, if performed, is usually successful. The complications are rare, but recurrence of tongue tie, tongue swelling, bleeding, infection, and damage to the ducts of the salivary glands may occur.

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Geographic Tongue

The tongue is normally covered with a layer of small bumps (papillae). Geographic tongue results when these projections are missing in certain areas of the tongue. The papillae loss creates smooth, red patches on the tongue, giving it a map-like, or geographic, appearance.

Geographic tongue can cause tongue discomfort and increased sensitivity to hot or spicy foods. But most people, besides seeing a change in their tongue's appearance, experience no other signs or symptoms.

Geographic tongue isn't triggered by an infection or another disease, and it's not related to mouth cancer. It doesn't have long-term health implications and occurs in otherwise healthy people. Though persistent and sometimes uncomfortable, geographic tongue resolves without treatment.

Signs and symptoms of geographic tongue include:

  • Smooth, bright red patches of various shapes and sizes on the top surface of the tongue
  • Map-like, or geographic, appearance of the tongue
  • Patches that change size and location from day to day
  • Tongue discomfort
  • Soreness or burning sensation that may worsen with hot, spicy or acidic foods

Most people with geographic tongue notice the change in their tongue's appearance but don't experience any other problems. But some people encounter soreness and irritation, especially when eating certain foods.

The condition often cycles through periods of improvement followed by periods of increased irritation. Alcohol, tobacco and some types of toothpaste can aggravate geographic tongue.

Causes

Small bumps called papillae normally cover the tongue's upper surface. Geographic tongue results from the loss of papillae on certain areas of the tongue. Why the tongue loses papillae isn't known. The condition tends to run in families, so genetics may play a role.

Some people who have geographic tongue also have psoriasis, but doctors are unsure why this is the case. Also, geographic tongue often occurs in conjunction with fissured tongue - a condition in which deep grooves form on the tongue's surface. Fissured tongue, like geographic tongue, isn't a serious medical condition but at times can be seen with other skin conditions.

Other factors that may trigger geographic tongue include stress, hormonal changes and allergies.

Treatment

Medical treatment isn't necessary for geographic tongue. The condition usually resolves on its own within months, but it can last a year or more. After which time, the tongue returns to its normal appearance. Though sometimes uncomfortable, the condition is harmless.

If you're bothered by soreness or a burning sensation, it may help to avoid the following items that can aggravate the condition:

  • Hot or spicy foods
  • Acidic foods and beverages
  • Alcohol
  • Tobacco

In addition, some types of toothpaste that contain tartar-control additives, heavy flavoring or teeth whitening agents may worsen geographic tongue. You may consider using toothpaste made for sensitive teeth.

If you're extremely bothered by soreness or irritation, talk to your doctor. He or she can prescribe medications, such as anti-inflammatory drugs or topical analgesics, to help reduce your discomfort.


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Information obtained from National Institute of Health
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