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Tongue disorders

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Oral Medicine Lecture from my NOTES

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Tongue disorders

  1. 1. TONGUE DISORDERS SARANG SURESH HOTCHANDANI
  2. 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. 3. CLASSIFICATION OF TONGUE DISORDERS DEVELOPMENTAL Microglossia Ankyloglossia Cleft tongue Fissured tongue Median rhomboid glossitis Benign migratory glossitis Hairy tongue ACQUIRED
  4. 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. 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. 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. 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. 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. 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. 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. 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. 12. INTRODUCTION • It is common BENIGN CONDITION mostly affecting DORSAL SURFACE OF TONGUE. • Characterized by RECURRENT APPEARANCE & DISAPPEARANCE OF RED AREAS ON TONGUE
  13. 13. ETIOLOGY •Cause is UNKNOWN but sometimes there is FAMILY HISTORY •Sometimes due to PSORIASIS.
  14. 14. CLINICAL FEATURES…. • Lesion appears IrREguLaR, SmoothRED 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. 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. 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. 17. DIFFERENTIAL DIAGNOSIS Chemical Burn Candidiasis Squamous Cell Carcinoma Psoriasis Lichen Planus Contact Stomatis
  18. 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. 19. Hairy Tongue Black Hairy Tongue Lingua Villus Nigra
  20. 20. INTRODUCTION •It is commonly observed condition characterized by ABNORMAL COATING on DORSAL SURFACE of tongue, due to DEFECTIVE DESQUAMATION of FILLIFORM PAPILLA.
  21. 21. ETIOLOGY CUM PREDISPOSING FACTORS
  22. 22. PATHOLOGY
  23. 23. • 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.
  24. 24. Brushing tongue with Tongue Scrapper.
  25. 25. 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.
  26. 26. CLINICAL FEATURES •Mostly in ADULTS and is ASYMPTOMATIC. •Appear as NODULAR, RED or PINK area of depapillation •Usually flat or slightly elevated.
  27. 27. DIFFERENTIAL DIAGNOSIS
  28. 28. MANAGEMENT No treatment necessary.. Antifungal drugs if candidiasis… Palliative…
  29. 29. MACROGLOSSIA
  30. 30. • Hypothyroidism • Cretinism • Diabetes Metabolic Systemic……. ACROMEGALY

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