The document describes various normal anatomical structures and abnormalities that can present on the tongue, including different types of papillae, taste buds, and developmental variations. It then discusses many potential clinical findings involving the tongue related to deficiencies, infections, tumors, and other oral diseases. Specific conditions covered in detail include hairy tongue, leukoplakia, geographic tongue, candidiasis, macroglossia, ulcers, deviations and ties. Multiple images are also provided to illustrate key pathologies.

1. Chairperson – Dr. GAYATRI B H
Student – Dr. SUMANT BALGANDI

2. INTRODUCTION
 The tongue is a complex set of sensory papillae and
muscles.
3 forms of taste buds:
• Fungiform (edges and tip)
• Circumvallate (posteriorly in V shape )
• Foliate papillae (posterolateral)
 The filiform papillae - devoid of sensory fibers and are
not true taste buds.

4.  APPEARANCE AND COLOUR
 SURFACE
 SIZE
 ULCERS
 MOVEMENTS OF TONGUE
 DEVELOPMENTAL ANOMALIES
 MISCELLANEOUS CONDITIONS

6. Dry tongue

7. • Prolonged fever
• Dehydration
• Mouth breathing
• Belladona or atropine effect
• Anxiety state
• Sjogrens syndrome-Bone dry tongue
• Sarcoidosis

8. Excessive moist tongue(sialorrhea)
 Organophosphorous poisoning
 Post encephalitic parkinsonism
 Drugs-pilocarpine,clozapine
 Heavy metals-mercury,copper,arsenic
 GERD
 Rabies

9. BALD TONGUE
 Iron deficiency anemia
 B12 deficiency
 Folate deficiency
 Riboflavin deficiency
 Pellagra
 Tropical sprue
 Syphilis-sclerosing glossitis

10. SCARLET RED TONGUE
Niacin deficiency
Irritants – sodium or potassium hydroxide
Acute infections like scarlet fever

11. SCARLET RED TONGUE

12.  MAGENTA COLOUR TONGUE
 Riboflavin deficiency
BLUE TONGUE
 Central Cyanosis
 Methhemoglobinemia
 sulphemoglobinemia
YELLOW TONGUE
 Jaundice
 Irritants- nitric or hydrochloric acid

13. WHITE TONGUE
 Centrally coating
 Leukoplakia
 Irritant substances-mercuric bichloride,carbolic
acid,sulphuric acid
 BROWN TONGUE
• Uremia
• Acute liver necrosis
• PURPLE TONGUE
• polycythemia

14.  EXCESSIVE COATED TONGUE(FURRED TONGUE)
 Mouth breathing
 Tobacco consumption
 Acute exanthematous fever
 Cirrhosis liver
 CENTRAL FURRING
 Enteric fever

15.  BLACK TONGUE
 Iron supplements
 Bismuth
 Charcoal
 Liquorice
 actinomycosis
 Antibiotics like penicillin

16. MAGENTA COLOUR TONGUE

17. BLUE TONGUE

18. HAIRY TONGUE(lingua villosa)
• Also called as furred tongue
• Defective desquamation of the filiform papillae leading
to the retention hyperkeratosis.

19. HAIRY TONGUE
• Poor oral hygiene
• Smokers
• Mouth breathers low fiber diets
• Febrile patients.
• HIV infection
• Radiation treatment to head and neck
• Graft-versus host disease
• Drugs - most common being antibiotics-tetracyclines
atypical antipsychotics
antidepressants
anti-cholinergics.

20. BLACK HAIRY TONGUE
• Black hairy tongue seen as the complication of hairy
tongue
• Occurs when bacteria are trapped in the filiform papillae
and produce pigments causing a brown/black colour.
• The presence of other microbes such as candida, can
exacerbate this condition.

21. Black hairy tongue

22. Pseudo black hairy tongue - bismuth
salicylate

23. DD of Hairy tongue
• Pseudo-hairy black tongue,
• Oral hairy leukoplakia
• Premalignant leukoplakia
• Squamous cell carcinoma
• Acanthosis nigricans
• Hypertrophic herpes simplex virus infections

24. Workup for hairy tongue
• Unless there are stigmata of underlying disease or
symptoms, such as pain, no additional workup is needed.
• In refractory or atypical cases, a biopsy and cultures or
PCR for bacteria, fungus, and HSV may be warranted.

25. TREATMENT OF HAIRY TONGUE
• Regular brushing of the tongue using 1.5% hydrogen
peroxide (5 to 10 strokes daily) with a hard toothbrush.
• Topical retinoids, antifungals, and keratolytics.
• Oral therapy with antifungals, antibiotics and antivirals
for refractory cases with positive cultures.

26. STRAWBERRY TONGUE
 Hypertrophy of fungiform papillae and then
desquamation
 Papillae appear as large red knobs giving the
appearance of stawberry tongue(rasberry tongue)
Seen in
Scarlet fever
Toxic shock syndrome
Kawasaki disease

27. Strawberry tongue

28. Scarlet fever

29. LEUKOPLAKIA
• It is a white patch in the mucosa of oral cavity that cannot
be characterised clinically or pathologically to any other
diseases.
• It is a premalignant condition
• Dysplasia and of dyskeratosis leading to formation of
thick , white and pearly raised plaques giving whitish
appearance of part of tongue.
• Predisposing factors
 Spices, betel nut chewing
 Smoking, tobacco chewing
 Infective or mechanical (dental irritation)

30. Leukoplakia

31. Erythroplakia

32. ORAL HAIRY LEUKOPLAKIA
• Seen on lateral margins of tongue as several white areas
• Cannot be wiped off with gauze.
• Immuno-compromised patients-AIDS
• Associated with Epstein Barr virus

33. Oral Hairy leukoplakia

34. • It is painless
• Has no malignant potential.
• First line topical treatment includes topical retinoids,
podophyllin, and acyclovir
• The underlying HIV infection should be treated or the
immunosuppressed states should be modified.

35. PIGMENTATION OF TONGUE
 Dark brown or black patches on tongue
1. Addisons
2. Nelsons syndrome
3. Peutz jeghers
4. Malabsorption
5. Acanthosis nigricans

36.  YELLOWISH WHITE PATCHES
 Leucoplakia
 xanthelasma

37. Addison’s disease

39. Fissured Tongue(scrotal tongue)
• A normal variant seen in up to 20% to 30% of the
population
• Characterized by an increased number of fissures and
grooves at the central and lateral aspects of the tongue.
• Very severe fissuring is often referred to as “lingua
plicata.”

40. Fissured tongue
 Down’s syndrome
 Acromegaly
 Melkersson-Rosenthal syndrome
 Pernicious anemia
 Pachyonychia congenita
 Cowden’s syndrome
 Idiopathic

41. Fissured tongue

42. • Treatment
• Good oral hygiene with brushing deep into the fissures
in order to remove debris, lessen the microbial
burden, and reduce halitosis.
• If pain is present- therapy should be targeted at
reducing inflammation or eradication of the
infection.

43. COBBLESTONE TONGUE
Due to hyperemic and hypertrophied papillae with
thickened epithelium
• Ariboflavinosis(with magenta colour)
• Syphilis
CROCODILE SKIN TONGUE
• In Sjogren’s syndrome, there is dorsal papillary
atrophy & furring of the tongue

44. Cobblestone tongue

45. SMOKER’S PATCH
• Small, raised, smooth, congested area frequently
covered with a crust on the dorsum of tongue
• White umbilicated papules with a central brown spot
on palatal mucosa
LEPROTIC NODULES
• May develop on anterior 2/3rd of tongue especially
near tip

46. CORLIN SIGN- Ehler danlos
syndrome

47. Benign Migratory Glossitis
• = GEOGRAPHIC TONGUE.
• Benign, inflammatory condition
• Prevalence-1 to 2% of the population ,more common in
young patients.
• Etiology-rapid loss and regrowth of filiform papillae
leading to denuded red patches wandering across the
tongue surface.
• It is more common in Psoriasis(14%), and some argue
that it is an oral manifestation of psoriasis

48.  It is characterized by an annular arrangement of
alternating raised, hyper keratotic plaques and smooth,
atrophic red patches.
 Red- atrophic filiform papillae
 White-hypertophic filiform papillae
 Dynamic and change over time creating a “migratory
pattern”


49. Geographic tongue

50. Treatment of geographic tongue
• Generally no treatment required.
• If burning pain or sensitivity to foods present -topical
corticosteroids as well as topical calcineurin inhibitors.

51. MEDIAN RHOMBOID GLOSSITIS
• Red depapillated area in the centre of dorsum of
tongue
• Believed to be associated with candidiasis and a
marker of underlying immunosuppression.
• Biopsy may show pseudo-epitheliomatous hyperplasia
• Responds to antifungal treatment

52. Median rhomboid glossitis

53. Oral candidiasis
 Creamy white curdlike patches that reveal a raw, bleeding
surface when scraped.
• Debilitated elderly patients
• High-dose glucocorticoids, broad-spectrum antibiotics
• Patients with AIDS

54. Candidiasis

56. MACROGLOSSIA
• Acromegaly
• Hypothyroidism
• Cretinism
• Down’s syndrome
• Hurler’s syndrome
• Mucopolysaccharidosis
• Beckwith–Wiedemann syndrome
• Amyloidosis
• Glycogen storage disease
• Angio edema
• Acute inflammation of tongue/abscess
• Haemangioma,lymphangioma

57. Macroglossia

58. MICROGLOSSIA
• Starvation
• Atrophic glossitis
• Motor neuron disease
• Pseudobulbar palsy
• Cerebral diplegia

59. Microglossia

61. SINGLE ULCER
• Carcinomatous
• TB
• Syphilitic
• Ill fitted dentures
• Aphthous ulcer

62. CARCINOMATOUS ULCER
• Usually single
• Common on side or tip of tongue
• Hard, indurated
• Irregular ,deep, raised everted margins
• Associated with slough
• Impaired mobility of tongue
• Regional lymphnode enlargement

63. Tongue malignancy

64. TUBERCULOUS ULCER
• Usually at or near tip
• Painful
• Small with a granulated base
• Thin undermined edges

65. MULTIPLE ULCERS
• Dyspepsia
• Ulcerative stomatitis
• Secondary syphilis
• Herpes
• Chickenpox
• Eczema
• Vit B complex deficiency

66. Multiple ulcers

67. RECURRENT ULCERS
• Aphthous ulcer
• Lichen planus, pemphigus, eythema multiforme
• SLE
• Behcet’s syndrome (mouth ulcers, genital ulcers,
uveitis)

69. TREMOR
• Parkisonson disease
• Delirium tremens
• Thyrotoxicosis
• Anxiety neurosis

70.  LIZARD TONGUE(Jack-in-box tongue)
• chorea
 CHEWING TONGUE
• Athetosis
 FASCICULATION
• Motor neuron diseases
• Syringobulbia

71. DEVIATED TONGUE
• Involvement of hypoglossal nerve
• Malignant infiltration of the tongue
• Scarification after burns
• Severe ulceration

72. Deviated tongue

74. • TONGUE TIE(ANKYLOGLOSSIA)
• Pierre Roboin syndrome
• Oral facial digital syndrome
• Meckel syndrome
• Patau syndrome
• Beckwith widerman syndrome

75. BIFID OR TRIFID TONGUE
• Orofacialdigital syndrome
• Klippel feil anomaly
• AGLOSSIA
• Pierre robin syndrome
• Moebius syndrome
• Aglossia adactyly syndrome

76. Aglossia

77. Bifid tongue

78. Tongue tie

79. MISCELLANEOUS CONDITIONS
 AMYLOID TONGUE
• Appears enlarged & presents as mottling of dark purple areas with
translucent matter
 MUCOSAL NEUROMA OF TONGUE
 MEN II b syndrome
 ALLIGATOR TONGUE
• Dry, thick, furrowed & irregular tongue
• Seen in Diabetes mellitus
 CAVIAR TONGUE
• Varicosities of the sublingual veins on the under surface of the tongue
• Seen in Cirrhosis liver, Superior vena cava syndrome

80. Caviar tongue

81. REFRENCES
• A text book of symptoms and physical diagnosis. ASPI F
GOLWALLA - 5TH Edition
• HARRISON’S Principles of Internal Medicine - 20th
edition
• DAVIDSON principles and practice of medicine - 23rd
edition
• Manual of Practical medicine by R.Alagappan 4th edition
• SRB’s manual of surgery 4th edition
• Mangold Aaron R., Torgerson Rochelle R., Rogers Roy S.,
Diseases of the Tongue, Clinics in Dermatology (2016)
• Internet