local disorder of tongue

1. GUIDED BY
 Dr. Dipti Singh (professor , HOD). Presented by.
 Dr. Mobeen Khan(reader). Dr. Navendu Singh.(intern)
 Dr. Uzma Khan (jr. lecturer). Batch: (2018-19)
 Dr. Sankalp Sankrityayan (jr. lecturer).

2. CONTENT.
CLASSIFICATION.
INTORDUCTION.
ETIOLOGY.
CLINICAL FEATURE.
DIAGNOSIS.
TREATMENT.

3. CLASSIFICATION
Fissured tongue
Median rhomboidal glossitis
Benign migratory glossitis.
Hairy tongue.
Crenated tongue.
Foliate papillitis.
leukokeratosis nicotine glossitis.

4. FISSURED TONGUE
Fissured tongue is also called
as scrotal tongue or lingua
dissecta.
A tongue is characterized by
Ferrows, one extending
antero-posteriorly and others
laterally over the entire
anterior surface of the tongue.

5. Type :
1. Foliaceous
2. Cribriform
3. Plicated.
 Etiology
1. Genetic.
2. Psychological : mentally retarded person.
3. Trauma : Due to chonic trauma
4. Nutritional deficiency and vitamin
deficiency.

6. Clinical feature:
1. characterized by groove that vary in
depth.
2. Seen on dorsal and lateral aspect of
the tongue.
3. Debris can be present in fissure.
4. Depth of the fissure can varies.
5. often seen in melkersson Rosenthal
syndrome.

8. DIAGNOSIS
Clinical diagnosis: fissure can be easily
diagnosed on clinical diagnosis.
TREATMENT
 it does not have any symptoms, and a person may
not know they have a condition until dentist discover
it during routine checkup.
 maintenance to tongue hygiene - patient should
clean Debris with brush

9. MEDIAN RHOMBOID
GLOSSITIS
It is a benign lesion of tongue.
which present anterior to foramen
cecum & circumvallate papilla.
It is smooth, red, flat, or raised
nodular area on the dorsum of tongue.
It is a developmental defect resulting
from an incomplete decent of
tuberculum impar.
And entrapment of a portion between
fusing lateral halves of the tongue.

10.  Pathogenesis :
1. Due to failure of tubercular impar.
2. It is congenital abnormality of the tongue.
 Etiology
1. Developmental: the persistent tuberculum
impar.
2. Fungal infection: candida albicans.
3. Metabolic condition : it is more common in
diabetic person.

11. CLINICAL FEATURE
1. Central papillary atrophy of tongue
defective fusion of lingual tubercles
at the midline.
2. Susceptibility for candidiasis.
3. Absence of filiform & fungiform
papillae.
4. Present at posterior midline of
dorsum of tongue
5. Soft palate erythema at the area of
contact with the underlying tongue-
kissing lesion

12. TREATMENT
In general no treatment is necessary for MRG for those with
the symptoms such as burning sensation and pain
antifungal medication can be given to reduce the symptoms.
Antifungal agent: reduce clinical erythema and
inflammation in candida infection. Such as .
 fluconazole(200mg on day 1 ,then 100mg qd for 7-10days).
Itraconazole(200mg qd for 7-10 days).
posaconazole(400mg qd for 7-14 days).
Long standing cases: only in long standing cases
cryosurgery or excisional biopsy is indicated.

13. BENIGN MIGRATORY
GLOSSITIS.
It is also called geographic
tongue, erythema migrans.
Geographical tongue is an
annular lesion affecting the
Dorsum and margin of tongue.
Geographic tongue is an
inflammatory but harmless
condition affecting the surface of
tongue. The tongue is normally
covered with tiny, pinkish-white
bump.

14. ETIOLOGY
Hypersensitive patient: if there is high
frequency of asthma ,eczema ,hay fever.
Other factors:
1. Immunological reaction
2. Emotional stress
3. Hereditary factor
4. Nutritional deficiencies.

15. CLINICAL FEATURE
•Frequent changes in the location, size and
shape of lesions
•Discomfort, pain or burning sensation in
some cases, most often related to eating
spicy or acidic foods.
• Smooth, red, irregularly shaped patches
(lesions) on the top or side of your tongue.

16. DIAGNOSIS
 clinical diagnosis: multiple area of
desquamation on dorsal surface of tongue.
Laboratory diagnosis: biopsy shows loss of
filiform papillae with hyperparakeratosis
and acanthosis.
Presence of munro’s abscess near the
surface.

17. TREATMENT
1. For control of burning: topical local
anesthetic agents like lidocaine or
diphenhydramine(antihistamine) can be given.
2. Topical therapy: topical corticosteroid and
topical application of salicylic acid and retinoic
acid and vit A for external use.
3. Zinc supplement: it is effective in symptomatic
geographic tongue.

18. HAIRY TONGUE
 it is also called as lingua villosa nigra or black hairy
tongue.
It is designated an overgrowth of the filiform papillae.
There is marked accumulation of keratin on filiform
papillae of the dorsal tongue.
 In some cases, the length of these papillae can become quite long,
giving a hair-like appearance to the top of the tongue .
when the papillae don’t properly shed, food, bacteria, and sometimes
yeast can accumulate in the hair-like mesh.

19. HAIRY TONGUE

20. ETIOLOGY
Use of certain drugs: oral use of sodium perborate,
sodium peroxide and antibiotic like penicillin.
 Radiation: extensive x-ray radiation around head
and neck for the treatment of tumor.
 It may also develop in persons with no teeth because
their soft food diet does not aid in the normal shedding
of the papillae
Fungal and bacterial overgrowth: ex candida albicans.

21. CLINICAL FEATURE
The lesion involve dorsum particularly the middle
and posterior one third.
There is hypertrophy of filiform papillae the papillae
may reach a length of 2cm
Papillae can be elevated by dental instrument .
The elongated papillae have an appearance of hair.
Then become pigmented by the colonization of
chromogenic bacteria.
It is heavily coated with bacteria and fungi and
forms a thickened malted layer.

22. DIAGNOSIS
Clinical Diagnosis: hyperplastic papillae with
green to brown color.
Laboratory diagnosis: there is elongated papillae
with mild hyperkeratosis and inflammatory cell.

23. TREATMENT
Practicing good oral hygiene and eliminating factors that
may contribute to the condition — such as avoiding
tobacco use or irritating mouthwashes — help resolve
black hairy tongue.
Topical keratolytic application: such as podophyllum in
acetone and alcohol suspension seems to be quite
effective.

24. CRENATED TONGUE
Crenated Tongue is a term used to describe the
tongue when there are indentations along the
sides of the tongue.
This is caused when the tongue is larger than
normal, which causes an impression of the teeth
on the sides of the tongue.
This is generally a harmless condition, however, if
it is paired with other symptoms, it can be
indicative of other underlying diseases such as
anemia, hypothyroidism, or an oral cavity
infection.

25. CRENATED TONGUE

26. FOLIATE PAPILLITIS
Hypertrophy of lymphoid tissue may be followed by
secondary traumatization resulting in so called as
foliate papillitis.
One papillitis present in newborn at each side of the
tongue, consisting of 4-8 leaves and located at the
junction of anterior two-third of the tongue and base.

27. FOLIATE PAPILLITIS

28. CLINICAL FEATURE
It is more common in women usually in second
half of life.
Symptoms may be partly due to upper
respiratory tract infection. But partly due to
irritation soreness tenderness, pain, occasionally
metallic test.
Inflamed and enlarged foliate papillae with pain.

29. TREATMENT
Patient reassurance: must to relieve stress.
Promote proper oral hygiene: Patient was
instructed to maintain good oral hygiene by
regular brushing.
 chlorhexidine mouth wash (0.12%concentration).
 Patient was advised to avoid hot and spicy food.
Topical application of anesthetic and local
analgesic paste at the site three-four times daily.
Iron, folic acid, vitamin supplements were given
to address it.

30. LEUKOKERATOSIS
NICOTINA GLOSSI
It is also called smoker’s tongue.
It is homogenous like leukoplakia with evenly
distributed, pinpoint, hemispherical depression
showing so called Golf ball appearance.
As a result of heavy smoking there is loss of
papillae.
No othere clinical feature found in these patients.

31. LEUKOKERATOSIS NICOTINA
GLOSSI
Leukoplakia is a predominantly white lesion of the oral
mucosa that cannot be clinicopathologically
characterized as any other definable lesion.
The term leukoplakia is a clinical descriptor only and
should not be used once histological information is
available.

32. LEUKOKERATOSIS NICOTINA
GLOSSI

33. CLINICAL FEATURE
Leukoplakia can be either solitary or multiple.
 Leukoplakia may appear on any site of the oral cavity, the most common sites
being: buccal mucosa, alveolar mucosa, floor of the mouth, tongue, lips and
palate
 Classically two clinical types of leukoplakia are recognised: homogeneous and
nonhomogeneous.
Homogeneous leukoplakia: it is defined as a predominantly white lesion of
uniform flat and thin appearance that may exhibit shallow cracks and that has a
smooth, wrinkled or corrugated surface with a consistent texture throughout.
This type is usually asymptomatic.

34. Non-homogeneous leukoplakia: it has been defined as a
predominant white or white-and-red lesion . that may
be either irregularly flat, nodular ("speckled
leukoplakia).
•Diagnosis:
• Provisional Clinical Diagnosis: clinical evidence from a
single visit, using inspection and palpation as the only
• Definitive Clinical Diagnosis: clinical evidence obtained by
lack of changes after eliminating suspected etiologic
period of 2-4 weeks

35. TREATMENT
Initial treatment of a white oral lesion is the
elimination of the possible etiological factors:
e.g. trauma, Candida, tobacco use etc.
Complete and definitive cessation of tobacco is
obligatory in patients with leukoplakia.
Non surgical treatment.
1. Beta-carotene(vitminA)
2. Lycopene( potent antioxidant in treatment
modality).

36. 3. Retinoids
4. Vitamin E( Alpha tocopherol)
5.Vitamin C( L- ascorbic acid)
6. Curcumin
 Surgical Treatment
1. Conventional surgical excision
2. Electrocoagulation
3. Cryosurgery
4. Laser surgery( excision & evaporation)