Tongue finali/ dental crown & bridge courses

TONGUE
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

 Part 1:Part 1:
 Anatomy And Functions Of TongueAnatomy And Functions Of Tongue
 Part 2:Part 2:
 Histology and Diseases Of TongueHistology and Diseases Of Tongue

ContentsContents
 INTRODUCTIONINTRODUCTION
 DEVELOPMENT OF TONGUEDEVELOPMENT OF TONGUE
 EXTERNAL FEATURESEXTERNAL FEATURES
 PAPILLAE OF TONGUEPAPILLAE OF TONGUE
 STRUCTURES OF TONGUESTRUCTURES OF TONGUE
 BLOOD & NERVE SUPPLY, LYMPHATIC DRAINAGEBLOOD & NERVE SUPPLY, LYMPHATIC DRAINAGE
 FUNCTIONSFUNCTIONS
 APPLIED ANATOMYAPPLIED ANATOMY
 CONCLUSIONCONCLUSION

INTRODUCTIONINTRODUCTION
INTRODUCTION

•Muscular organ situated in theMuscular organ situated in the
floor of the mouthfloor of the mouth
Associated with functions of theAssociated with functions of the
taste, speech, mastication andtaste, speech, mastication and
deglutitiondeglutition

Development:Development:
- Tongue appears in embryo in the 4th week of intra- Tongue appears in embryo in the 4th week of intra
uterine life in form of three lobes.uterine life in form of three lobes.
- Two lateral lingual swellings and one medial swelling.- Two lateral lingual swellings and one medial swelling.
This are developed from the 1st pharyngeal arch.This are developed from the 1st pharyngeal arch.
- Two lingual swellings are separated each other by the- Two lingual swellings are separated each other by the
medial swellings called tuberculam impar, which forms amedial swellings called tuberculam impar, which forms a
down growth, which develops into thyroid gland.down growth, which develops into thyroid gland.

DEVELOPMENT OF TONGUEDEVELOPMENT OF TONGUE

- This site of down growth is subsequently marked by aThis site of down growth is subsequently marked by a
depression called foramen caecum.depression called foramen caecum.
- Second swelling is formed later by 2nd, 3rd, 4thSecond swelling is formed later by 2nd, 3rd, 4th
mesoderm called hypobranchial eminence.mesoderm called hypobranchial eminence.
- This hypo bronchial eminence soon subdivides intoThis hypo bronchial eminence soon subdivides into
two parts they are,two parts they are,
Cranial part or copula,Cranial part or copula,
Caudal part.Caudal part.
- Cranial part is formed related to 2nd and 3rd arch andCranial part is formed related to 2nd and 3rd arch and
caudal part is formed related to 4th arch. Then it givescaudal part is formed related to 4th arch. Then it gives
rise to epiglottisrise to epiglottis www.indiandentalacademy.comwww.indiandentalacademy.com

- Anterior two third of the tongue is formed byAnterior two third of the tongue is formed by
fusion of tuberculam impar. So it is derived fromfusion of tuberculam impar. So it is derived from
mandibular arch.mandibular arch.
- Posterior one third is formed by cranial part of- Posterior one third is formed by cranial part of
hypobranchial eminence.hypobranchial eminence.
- In this situation second arch mesoderm gets- In this situation second arch mesoderm gets
buried below the third and first arch.buried below the third and first arch.
- Posterior most part is formed by fourth arch- Posterior most part is formed by fourth arch
Keeping this embryological origin, anterior twoKeeping this embryological origin, anterior two
third of the tongue is supplied by lingual branchthird of the tongue is supplied by lingual branch
of mandibular nerve and chorda tympanic whichof mandibular nerve and chorda tympanic which
is a post and pre trematic nerve.is a post and pre trematic nerve.www.indiandentalacademy.comwww.indiandentalacademy.com

 Posterior one-third by glassopharyngeal nerve, whichPosterior one-third by glassopharyngeal nerve, which
is a fourth arch derivative. And posterior most part isis a fourth arch derivative. And posterior most part is
supplied by superior laryngeal nerve is a fourth archsupplied by superior laryngeal nerve is a fourth arch
derivative.derivative.
 Musculature of the tongue is deriving from occipitalMusculature of the tongue is deriving from occipital
myotomes supplied by hypoglossal nerve. Epitheliummyotomes supplied by hypoglossal nerve. Epithelium
of the tongue is at first made up of a single layer ofof the tongue is at first made up of a single layer of
cells later becomes stratified and papillae becomescells later becomes stratified and papillae becomes
evident.evident.

EXTERNALEXTERNAL
FEATURESFEATURES
EXTERNAL FEATURESwww.indiandentalacademy.comwww.indiandentalacademy.com

EXTERNAL FEATURESEXTERNAL FEATURES

External Features:External Features:
TongueTongue
RootRoot tip bodytip body
Dorsum surface inferior surfaceDorsum surface inferior surface
Pharyngeal part oral partPharyngeal part oral part

 Tip:Tip:
 Free end remains unattached lies behind the upper incisor teethFree end remains unattached lies behind the upper incisor teeth
 Root:Root:
 Attach to mandible above and hyoid bone belowAttach to mandible above and hyoid bone below
 DorsumDorsum
 Oral part and pharyngeal part is separated by a faint v-shaped groove calledOral part and pharyngeal part is separated by a faint v-shaped groove called
sulcus terminals.sulcus terminals.
 V-shaped groove meet at a median pit called foramen caecum.V-shaped groove meet at a median pit called foramen caecum.
 Foramen caecum represents the site from which the thyroid diverticulum’sForamen caecum represents the site from which the thyroid diverticulum’s
grows down to thyroid gland in embryo.grows down to thyroid gland in embryo.

 Oral Part Or Anterior Two Third OrOral Part Or Anterior Two Third Or
Papillary Part:Papillary Part:
 Present in the floor of the mouth.Present in the floor of the mouth.
 Margins are free and it can contact with theMargins are free and it can contact with the
gums and teeth.gums and teeth.
 Superior surface is rough and the inferior isSuperior surface is rough and the inferior is
smooth.smooth.

 Pharyngeal Part Or Lymphoid Or Posterior OnePharyngeal Part Or Lymphoid Or Posterior One
Third Or Base Of The Tongue:Third Or Base Of The Tongue:
 Behind the sulcus terminalis.Behind the sulcus terminalis.
 Posterior surface forms the anterior wall ofPosterior surface forms the anterior wall of
oropharynx, no papilla, lymphoid follicles areoropharynx, no papilla, lymphoid follicles are
present they are called lingual tonsil.present they are called lingual tonsil.
 Mucous gland is present.Mucous gland is present.
 Posterior part connected to the epiglottis by threePosterior part connected to the epiglottis by three
folds of mucous membrane that is,folds of mucous membrane that is,
 Median glasso epiglottis fold,Median glasso epiglottis fold,
 Right and left lateral glasso epiglottis fold,Right and left lateral glasso epiglottis fold,
 Either side of the median fold there is a pouchEither side of the median fold there is a pouch
called vallecula.called vallecula.
 Lateral folds are separated by piriform fossa.Lateral folds are separated by piriform fossa.www.indiandentalacademy.comwww.indiandentalacademy.com

 Papillae Of The Tongue:Papillae Of The Tongue:
 This are projection present in anterior twoThis are projection present in anterior two
thirds of tongue gives the roughness of thethirds of tongue gives the roughness of the
tongue. There are four types of papillaetongue. There are four types of papillae
 Foliate papillaeFoliate papillae
 Vallate papillaeVallate papillae
 Fungi form papillaeFungi form papillae
 Filliform papillaeFilliform papillae

 Foliate PapillaeFoliate Papillae
 Present in front of platoglossal arch, 5 to 4 fold are present.Present in front of platoglossal arch, 5 to 4 fold are present.
 Vallate Papillae:Vallate Papillae:
 Large in size (1-2 mm in dia), 8 to 12 in number.Large in size (1-2 mm in dia), 8 to 12 in number.
 Situated immediately in front of sulcus terminalis, cylindricalSituated immediately in front of sulcus terminalis, cylindrical
projections surrounded by a circular sulcus, wall are raisedprojections surrounded by a circular sulcus, wall are raised
above the surface.above the surface.
 Fungi Form Papillae:Fungi Form Papillae:
 Numerous near the tip and margins of the tongue, some may beNumerous near the tip and margins of the tongue, some may be
scattered in the dorsum of the tongue.scattered in the dorsum of the tongue.
 Smaller then vallete but larger then filliform, narrow pedicle,Smaller then vallete but larger then filliform, narrow pedicle,
large round head, bright red colour.large round head, bright red colour.
 Filiform PapillaeFiliform Papillae
 Covers large area of the dorsum of the tongue, small in sizeCovers large area of the dorsum of the tongue, small in size
gives the tongue velvety appearance.gives the tongue velvety appearance.
Pointed and covered with keratin.Pointed and covered with keratin.

STRUCTURES OF THESTRUCTURES OF THE
TONGUETONGUE
 MUSCLESMUSCLES
 MUCOUS MEMBRANEMUCOUS MEMBRANE
 GLANDSGLANDS
 TASTE BUDSTASTE BUDS

MUSCLES OF THEMUSCLES OF THE
TONGUETONGUE
 EXTRINSIC MUSCLESEXTRINSIC MUSCLES
1) GENIOGLOSSUS1) GENIOGLOSSUS
2)HYOGLOSSUS2)HYOGLOSSUS
3)STYLOGLOSSUS3)STYLOGLOSSUS
4)CHONDROGLOSS4)CHONDROGLOSS
5)PALATOGLOSSUS5)PALATOGLOSSUS
 INTRINSIC MUSCLESINTRINSIC MUSCLES
1)SUPERIOR1)SUPERIOR
LONGITUDINALLONGITUDINAL
2)INFERIOR2)INFERIOR
LONGITUDINALLONGITUDINAL
3)TRANSVERSE3)TRANSVERSE
4)VERTICAL4)VERTICAL

Muscles Origin Insertion Nerve
supply
Action
Intrinsic muscles
1.superior
longitudinal
Median
septum
and
submuco
sa
Mucosa
membra
ne
Hypoglassal
nerve
Shortens the tongue and
makes the dorsum
concave
2.inferior longitudinal Between
genioglo
ssus
and
hyogloss
us
Mucous
membra
ne
Hypoglossal
nerve
Shortens the tongue and
makes the dorsum
concave
3. Transverse Medium
septum
Margins of
the
tongue
Hypoglossal
nerve
Makes the tongue narrow
and elongated

Extrinsic muscles
1.genioglossus
Fan shaped
muscle
Superior genial
spine of the
mandible
Upper
fibres in
to tip,middle
fibres in to
dorsum,low
er fibres in
to hyoid
Hypoglossal nerve Protrusion
2.hyoglossus Body of greater
cornu of hyoid
bone
Side
of the
tongue
Hypoglossal nerve Depression
3.styloglossus Styloid process of
temporal bone
Side
of the
tongue
Hypoglossal nerve Upward and
backward
4.palatoglossus Palatine
aponeurosis
Side of the
tongue,descen
ds in to
palatoglossal
arch.
Pharyngeal plexus Upward and
backward
movement.
Narrows the
oropharyngeal
isthmus
MusclesMuscles OriginOrigin InsertionInsertion Nerve supplyNerve supply ActionAction

MUCOUS MEMBRANEMUCOUS MEMBRANE
 THE LINGUAL MUCOSA IS THIN SMOOTH IN THETHE LINGUAL MUCOSA IS THIN SMOOTH IN THE
INFERIOR SURFACE OF TONGUEINFERIOR SURFACE OF TONGUE
 THE MUCOSA ON THE PHARYNGEOUS OF DORSUMTHE MUCOSA ON THE PHARYNGEOUS OF DORSUM
CONTAINS MANY LYMPHOID FOLLICLES,EACHCONTAINS MANY LYMPHOID FOLLICLES,EACH
FOLLICLE TERMING A ROUNDED EMINENCEFOLLICLE TERMING A ROUNDED EMINENCE
 IN ORAL PART THE DORSUM MUCOSA IS SOMEWHATIN ORAL PART THE DORSUM MUCOSA IS SOMEWHAT
THICKER THAN VENTRAL & IS ADHERENT TOTHICKER THAN VENTRAL & IS ADHERENT TO
MUSCULAR TISSUE COVERED BY NUMEROUSMUSCULAR TISSUE COVERED BY NUMEROUS
PAPILLAEPAPILLAE

GLANDSGLANDS
 MUCOUS GLANDS ARE NUMEROUS IN THEMUCOUS GLANDS ARE NUMEROUS IN THE
PHARYNGEAL PART BUT ALSO PRESENT AT APEX &PHARYNGEAL PART BUT ALSO PRESENT AT APEX &
MARGINSMARGINS
 SEROUS GLANDS OF VON EBNER NEAR THE TASTESEROUS GLANDS OF VON EBNER NEAR THE TASTE
BUDS THEIR DUCTS OPEN MOSTLY INTO SULCI OFBUDS THEIR DUCTS OPEN MOSTLY INTO SULCI OF
VALLATE PAPILLAE.THEIR SECRETION IS WATERYVALLATE PAPILLAE.THEIR SECRETION IS WATERY
 MIXED GLANDS LIE IN THE VERTICAL SURFACE OFMIXED GLANDS LIE IN THE VERTICAL SURFACE OF
APEX, ONE ON EACH SIDE OF FRENUCLUM WHICHAPEX, ONE ON EACH SIDE OF FRENUCLUM WHICH
ARE COVERED BY THE MUCOUS MEMBANEARE COVERED BY THE MUCOUS MEMBANE

TASTE BUDSTASTE BUDS
TASTE BUDS

BITTER
SALTY
SOUR
SWEET
DISTRIBUTIONwww.indiandentalacademy.comwww.indiandentalacademy.com

MECHANISM OF ACTIONMECHANISM OF ACTION
 THE SUBSTANCE CONCERENED MUST BE INTHE SUBSTANCE CONCERENED MUST BE IN
SOLUTION & WILL ATTACH ITSELF WITH THESOLUTION & WILL ATTACH ITSELF WITH THE
MOLECULAR RECEPTORS OF THEMOLECULAR RECEPTORS OF THE
MICROVILLI.THIS COMBINATION LEADS TOMICROVILLI.THIS COMBINATION LEADS TO
SOME ELECTROPHYSIOLOGICAL CHANGESSOME ELECTROPHYSIOLOGICAL CHANGES
SO AS TO CAUSE STIMULATION OF THESO AS TO CAUSE STIMULATION OF THE
RECEPTOR CELL & THEN THE NERVE FIBERSRECEPTOR CELL & THEN THE NERVE FIBERS
WHICH EMERGE FROM THE TASTE BUDS AREWHICH EMERGE FROM THE TASTE BUDS ARE
STIMULATED –THESE IMPULSE THENSTIMULATED –THESE IMPULSE THEN
REACHES THE APPROPRIATE PART OF THEREACHES THE APPROPRIATE PART OF THE
BRAIN.BRAIN.

BLOOD SUPPLYwww.indiandentalacademy.comwww.indiandentalacademy.com

 Arterial Supply:Arterial Supply:
 Lingual artery a branch of external carotidLingual artery a branch of external carotid
artery supplies the major part of the tongue.artery supplies the major part of the tongue.
 Root of the tongue is also supplied byRoot of the tongue is also supplied by
tonsilllar and ascending pharyngeal arteries.tonsilllar and ascending pharyngeal arteries.

 Venous Supply:Venous Supply:
 Deep lingual vein is the largest and main vein, whichDeep lingual vein is the largest and main vein, which
supplies the tongue.supplies the tongue.
 The vein is visible in the inferior surface of theThe vein is visible in the inferior surface of the
tongue.tongue.
 Runs backwards and crosses the geionglossus andRuns backwards and crosses the geionglossus and
hyoglossus muscle.hyoglossus muscle.
 Veins unit posterior border of the hyoglossus to formVeins unit posterior border of the hyoglossus to form
lingual vein.lingual vein.
 Which ends in common facial vein or internal jugularWhich ends in common facial vein or internal jugular
vein.vein.

NERVE SUPPLY

 Nerve Supply:Nerve Supply:
 Motor nerveMotor nerve::
 Intrisinsic and extrinsic muscles expect palatoglossus musclesIntrisinsic and extrinsic muscles expect palatoglossus muscles
supplied by hypoglossus nerve.supplied by hypoglossus nerve.
 Palotoglossus muscles is supplied by pharyngeal plexus.Palotoglossus muscles is supplied by pharyngeal plexus.
 Sensory nerveSensory nerve::
 Anterior two third:Anterior two third:
 General sensation is supplied by lingual nerve.General sensation is supplied by lingual nerve.
 Taste buds are supplied by chorda tympanic.Taste buds are supplied by chorda tympanic.
 Posterior one third:Posterior one third:
 General sensation and taste buds are supplied byGeneral sensation and taste buds are supplied by
glassopharyngeal nerve.glassopharyngeal nerve.

SENSORY NERVEwww.indiandentalacademy.comwww.indiandentalacademy.com

LYMPHATIC DRAINAGEwww.indiandentalacademy.comwww.indiandentalacademy.com

 Lymphatic Drainage:Lymphatic Drainage:
 Tip of the tongue drains into sub mental nodes.Tip of the tongue drains into sub mental nodes.
 Right and left half’s of anterior two thirdRight and left half’s of anterior two third
drains into submandibular nodes.drains into submandibular nodes.
 Posterior one third drains into jugulo omoPosterior one third drains into jugulo omo
hyoid nodes.hyoid nodes.

 Movements:Movements:
 ProtrusionProtrusion – by the action of genioglossus muscle on– by the action of genioglossus muscle on
both the sides acting together.both the sides acting together.
 RetractionRetraction – by the action of styloglossus and– by the action of styloglossus and
hyoglossus on the both sides acting together.hyoglossus on the both sides acting together.
 DepressionDepression – by the action of hygoglossus and– by the action of hygoglossus and
genioglossus on both sides acting together.genioglossus on both sides acting together.
 Retraction and elevationRetraction and elevation of posterior one third ofof posterior one third of
the tongue is caused by the action of styloglossus andthe tongue is caused by the action of styloglossus and
palatoglossus muscles acting together.palatoglossus muscles acting together.

FUNCTIONSFUNCTIONS
 INGESTIONINGESTION
 SUCKLINGSUCKLING
 SWALLOWINGSWALLOWING
 PHONATIONPHONATION
 PERCEPTIONPERCEPTION
 JAW DEVELOPMENTJAW DEVELOPMENT
 FACIAL EXPRESSIONFACIAL EXPRESSION
 THERMOREGULATIONTHERMOREGULATION

APPLIED ANATOMYAPPLIED ANATOMY
 DEVELOPMENT DISTRUBENCES OF TONGUEDEVELOPMENT DISTRUBENCES OF TONGUE
 GLOSSODYNIAGLOSSODYNIA
 GLOSSITIS ASSOCIATED WITH CERTAIN DISEASESGLOSSITIS ASSOCIATED WITH CERTAIN DISEASES
 MALIGNMENT TUMOURS OF TONGUEMALIGNMENT TUMOURS OF TONGUE

MACROGLOSSIAMACROGLOSSIA
 E.g._ DOWNS SYNDROME , CONGENITALE.g._ DOWNS SYNDROME , CONGENITAL
LYMPHONGIOMA, FETAL FACE SYNDROME ,LYMPHONGIOMA, FETAL FACE SYNDROME ,
CHRONIC SYSTEMIC DISEASESCHRONIC SYSTEMIC DISEASES
 IT IS CONGENITAL BUT USUALLY ACQUIRED ALSOIT IS CONGENITAL BUT USUALLY ACQUIRED ALSO
 THE SURFACE OF TONGUE IS NODULAR & VERYTHE SURFACE OF TONGUE IS NODULAR & VERY
IRREGULARIRREGULAR

AGLOSSIAAGLOSSIA
 AGLOSSIA IS A RARE CONGENITAL ANAMOLYAGLOSSIA IS A RARE CONGENITAL ANAMOLY
USUALLY ASSOCIATED WITH SEVEREUSUALLY ASSOCIATED WITH SEVERE
DEFORMATION OF LIMBS & DIGITS,IN WHICH ADEFORMATION OF LIMBS & DIGITS,IN WHICH A
ONLY TINY NODULE OF TONGUE TISSUE DEVELOPSONLY TINY NODULE OF TONGUE TISSUE DEVELOPS

FISSURED TONGUEFISSURED TONGUE
 TWIN STUDIES SUGGEST THAT IT IS PROBABLYTWIN STUDIES SUGGEST THAT IT IS PROBABLY
GENETICALLY DETERMINEDGENETICALLY DETERMINED
 OCCURS AS A NORMAL VARIANT AFFECTING LESSOCCURS AS A NORMAL VARIANT AFFECTING LESS
THAN 10% OF THE POPULATIONTHAN 10% OF THE POPULATION
 MENTALLY RETARDED & PSYCHOTICMENTALLY RETARDED & PSYCHOTIC
INDIVIDUALS----MOREINDIVIDUALS----MORE

MEDIAN RHOMBOID GLOSSITISMEDIAN RHOMBOID GLOSSITIS
 THE CONGENITAL ABNORMALITY OF TONGUE DUETHE CONGENITAL ABNORMALITY OF TONGUE DUE
TO FAILURE OF TUBERCULUM IMPAR TO RETRACTTO FAILURE OF TUBERCULUM IMPAR TO RETRACT
OR WITHDRAW BEFORE FUSION OF LATERALOR WITHDRAW BEFORE FUSION OF LATERAL
HALVES OF THE TONGUEHALVES OF THE TONGUE
 THE AREA IS DEVOID OF FILIFORM OR ANYTHE AREA IS DEVOID OF FILIFORM OR ANY
PAPILLAE ALTHOUGH IT MAY BE FISSURED ORPAPILLAE ALTHOUGH IT MAY BE FISSURED OR
LOBULATEDLOBULATED

BENING MIGRATORY GLOSSITISBENING MIGRATORY GLOSSITIS
 GEOGRAPHIC TONGUE REFERS TO IRREGULARLYGEOGRAPHIC TONGUE REFERS TO IRREGULARLY
SHAPED,REDDISH AREAS OF DEPAPILLATION &SHAPED,REDDISH AREAS OF DEPAPILLATION &
THINNING OF THE DORSAL TONGUE EPITHELIUMTHINNING OF THE DORSAL TONGUE EPITHELIUM
THAT ARE USUALLY SURROUNDED BY A NARROWTHAT ARE USUALLY SURROUNDED BY A NARROW
ZONE OF REGENERATING PAPILLAE THAT IS WHITEZONE OF REGENERATING PAPILLAE THAT IS WHITE
THAN THE SURROUNDING TONGUE SURFACETHAN THE SURROUNDING TONGUE SURFACE
 SPONTANEOUS DEVELOPMENT & REGENERATIONSPONTANEOUS DEVELOPMENT & REGENERATION
OF AFFECTED AREAS ACCOUNTS FOR THE TERMSOF AFFECTED AREAS ACCOUNTS FOR THE TERMS
WANDERING TONGUE, MIGRATORY GLOSSITIS, &WANDERING TONGUE, MIGRATORY GLOSSITIS, &
GEOGRAPHIC TONGUEGEOGRAPHIC TONGUE

HAIRY TONGUEHAIRY TONGUE
 IT IS AN UNUSUAL CONDITION THAT IS NOTIT IS AN UNUSUAL CONDITION THAT IS NOT
SPECFICIALLY A DEVELOPMENT DISTRUBENCE BUTSPECFICIALLY A DEVELOPMENT DISTRUBENCE BUT
IS CONSIDERED WITH OTHER TONGUE LESIONSIS CONSIDERED WITH OTHER TONGUE LESIONS
 CONDITION CHARACTERIZED BY HYPERTROPHY OFCONDITION CHARACTERIZED BY HYPERTROPHY OF
FILIFORM PAPILLAE OF TONGUE.WHICH FORMS AFILIFORM PAPILLAE OF TONGUE.WHICH FORMS A
MATTED LAYER ON THE DORSAL SURFACE.MATTED LAYER ON THE DORSAL SURFACE.

GLOSSODYNIA OR BURNINGGLOSSODYNIA OR BURNING
TONGUETONGUE
 DIABETESDIABETES
 GASTRIC DISTRUBENCEGASTRIC DISTRUBENCE
 PSYCHOGENICPSYCHOGENIC
FACTORSFACTORS
 TRIGEMINALTRIGEMINAL
NEURALGIANEURALGIA
 XERSTOMIAXERSTOMIA
 HYPOTHYRODISMHYPOTHYRODISM
 ORAL HABITSORAL HABITS
 ANTIBIOTICANTIBIOTIC
THERAPYTHERAPY
 LOCAL DENTALLOCAL DENTAL
CAUSESCAUSES
 DEFICIENCYDEFICIENCY
STATUSSTATUS

CHRONIC TRAUMACHRONIC TRAUMA
 LOCALIZED AREAS OF DEPAPILLATION OFTEN ARELOCALIZED AREAS OF DEPAPILLATION OFTEN ARE
NOTED ON THE TONGUE IN ASSOCIATION WITHNOTED ON THE TONGUE IN ASSOCIATION WITH
JAGGED TEETH OR ROUGH RESTORATIONJAGGED TEETH OR ROUGH RESTORATION
 IN PATIENT HYPERSENSITIVE TO EUGENOL ORIN PATIENT HYPERSENSITIVE TO EUGENOL OR
PHENOL COMPOUND THERE WILL BEPHENOL COMPOUND THERE WILL BE
DEPAPILLATION NEAR THE TEMPORARY DRESSINGDEPAPILLATION NEAR THE TEMPORARY DRESSING

NUTRITIONAL DEFICIENCIESNUTRITIONAL DEFICIENCIES
 REDNESSREDNESS
 LOSS OF PAPILLAELOSS OF PAPILLAE
 PAINFUL SWELLING OF TONGUEPAINFUL SWELLING OF TONGUE
 ATROPIC GLOSSITISATROPIC GLOSSITIS

MEDICATIONSMEDICATIONS
 DEPAPILLATION OF TONGUE HAS BEEN DESCRIBEDDEPAPILLATION OF TONGUE HAS BEEN DESCRIBED
AS A SIDE EFFECT OF NUMBER OF MEDICATIONS.AS A SIDE EFFECT OF NUMBER OF MEDICATIONS.
 ANTIBIOTICS, CANCER CHEMOTHERAPATICANTIBIOTICS, CANCER CHEMOTHERAPATIC
AGENTS, ANTI-CHLINERGIC AGENTSAGENTS, ANTI-CHLINERGIC AGENTS

TERTIORY SYPHILISTERTIORY SYPHILIS
 TONGUE IN TERTIORY SYPHILIS MAY BE AFFECTDTONGUE IN TERTIORY SYPHILIS MAY BE AFFECTD
BY GUMMA FORMATION & MORE DIFFUSE CHRONICBY GUMMA FORMATION & MORE DIFFUSE CHRONIC
GRANULOMATOUS LESION REFERRED TO ASGRANULOMATOUS LESION REFERRED TO AS
INTERSTITIAL GLOSSITISINTERSTITIAL GLOSSITIS

MALIGNANT TUMOURS OF THEMALIGNANT TUMOURS OF THE
TONGUETONGUE
 OVER 90% OF MALIGNANT TUMOURS OF TONGUE AREOVER 90% OF MALIGNANT TUMOURS OF TONGUE ARE
EPIDERMOID CARCINOMAS OCCURING ON EITHEREPIDERMOID CARCINOMAS OCCURING ON EITHER
ANTERIOR OR POSTERIOR OF THE ORGANANTERIOR OR POSTERIOR OF THE ORGAN
 SQUAMOUS CELL CARCINOMA OF THE TONGUE IS THESQUAMOUS CELL CARCINOMA OF THE TONGUE IS THE
MOST COMMON ORAL CARCINOMAMOST COMMON ORAL CARCINOMA
 APPROXIMATELY 60% OF THE LESION ARISES IN THEAPPROXIMATELY 60% OF THE LESION ARISES IN THE
ANTERIOR 2/3ANTERIOR 2/3rdrd
OF THE TONGUEOF THE TONGUE

CONTD..CONTD..
 THE MAJORITY OF CARCINOMA OCCURS ON THETHE MAJORITY OF CARCINOMA OCCURS ON THE
LATERAL BORDERS OF THE ANTERIOR 2/3LATERAL BORDERS OF THE ANTERIOR 2/3rdrd
OF THEOF THE
TONGUETONGUE
 RADIOTHERAPHYRADIOTHERAPHY
 SURGERYSURGERY

miscellaneousmiscellaneous
 Injury to hypoglossual nerve – causes paralysis of the muscleInjury to hypoglossual nerve – causes paralysis of the muscle
 Two typesTwo types
 Infranuclear lesionInfranuclear lesion
 Supra nuclear lesionSupra nuclear lesion
 Infra nuclear lesion (hemi trophy)Infra nuclear lesion (hemi trophy)
 Present in motor neuron diseasePresent in motor neuron disease
 Atrophy of the affected side of the tongue and muscularAtrophy of the affected side of the tongue and muscular
twitchingtwitching

 Supranuclear lesionSupranuclear lesion
 Present in pesudobulabar palsyPresent in pesudobulabar palsy
 Paralysis of the affected side with stiffness, small andParalysis of the affected side with stiffness, small and
moves very slow resulting in difficult in articulation.moves very slow resulting in difficult in articulation.
 Atrophy of fill form papillae is seen in certain causes ofAtrophy of fill form papillae is seen in certain causes of
anemia.anemia.
 In unconscious patients the tongue may fall back andIn unconscious patients the tongue may fall back and
obstruct the air passage so it will lead toobstruct the air passage so it will lead to
 Serious fatal death of the patients, so to prevent it makeSerious fatal death of the patients, so to prevent it make
the patient to lie laterally with head down or bythe patient to lie laterally with head down or by
Pulling the tongue outside mechanically.Pulling the tongue outside mechanically.
 In grand mal epilepsy the patient may bit his tongue,In grand mal epilepsy the patient may bit his tongue,
which will be present between the teeth during the episode.which will be present between the teeth during the episode.

 PartPart 22::
 Histology and Diseases Of TongueHistology and Diseases Of Tongue
 Histology Of TongueHistology Of Tongue
 Inferior Surface Of The TongueInferior Surface Of The Tongue
 Dorsal Surface Of The Tongue:Dorsal Surface Of The Tongue:
 Taste BudsTaste Buds

 Disease of the tongueDisease of the tongue
 LocalLocal
 Developmental defectsDevelopmental defects
 MacroglossiaMacroglossia
 MicroglossiaMicroglossia
 AglossiaAglossia
 AnkyloglossiaAnkyloglossia
 Fissured TongueFissured Tongue
 Median Rhomboid GlossitisMedian Rhomboid Glossitiswww.indiandentalacademy.comwww.indiandentalacademy.com

 Acquired DiseasesAcquired Diseases
 Geographic TongueGeographic Tongue
 Hairy TongueHairy Tongue
 BlackBlack
 WhiteWhite
 GlossodyniaGlossodynia
 GlossitisGlossitis
 CandidialCandidial
 DeficiencyDeficiency
 LeukoplakiaLeukoplakia
 HairyHairy
 SyphiliticSyphilitic
 Granular Cell TumorGranular Cell Tumor
 Tongue PiercingTongue Piercing
 Taste BudTaste Bud
 Systemic Condition Show Symptoms In The TongueSystemic Condition Show Symptoms In The Tongue

Histology Of TongueHistology Of Tongue
 Inferior Surface Of The TongueInferior Surface Of The Tongue
 Mucous membrane is thin and loosely attached to theMucous membrane is thin and loosely attached to the
underlying surface for free mobility.underlying surface for free mobility.
 Made of non-keratinized epithelium.Made of non-keratinized epithelium.
 Sub-mucosa contains adipose tissue.Sub-mucosa contains adipose tissue.
 Sub lingual glands lie close to the sublingual fold.Sub lingual glands lie close to the sublingual fold.
 Mucous membrane is smooth and thin.Mucous membrane is smooth and thin.
 Papillae of connective tissue are numerous but short.Papillae of connective tissue are numerous but short.

Dorsal Surface Of The Tongue:Dorsal Surface Of The Tongue:
 Made of Specialized mucosa.Made of Specialized mucosa.
 It is rough and irregular.It is rough and irregular.

 Anterior Two Third Of The Tongue:Anterior Two Third Of The Tongue:
 Filliform papillae:Filliform papillae:
 Contains core of connective tissue from which secondary papillaeContains core of connective tissue from which secondary papillae
protrude towards the epithelium.protrude towards the epithelium.
 It does not have taste buds.It does not have taste buds.
 Fungiform papillae:Fungiform papillae:
 Mushroom shaped papillae.Mushroom shaped papillae.
 Round, reddish prominences.Round, reddish prominences.
 Red colour is because of rich capillary network.Red colour is because of rich capillary network.
 Contains few taste buds on their dorsal surface.Contains few taste buds on their dorsal surface.

Vallate papillae:Vallate papillae:
 Contains numerous secondary papillae covered by thin,Contains numerous secondary papillae covered by thin,
smooth epithelium.smooth epithelium.
 Lateral surface contains numerous taste buds.Lateral surface contains numerous taste buds.
 Van ebner’s glands open through these papillae by aVan ebner’s glands open through these papillae by a
duct to wash out the soluble elements of food.duct to wash out the soluble elements of food.
Posterior One Third Of The Tongue:Posterior One Third Of The Tongue:
 Sharp parallel clefts of varying length can be observed.Sharp parallel clefts of varying length can be observed.
 Narrow folds of mucous membrane contain taste buds.Narrow folds of mucous membrane contain taste buds.

Taste Buds:Taste Buds:
 Small ovoid or barrel shaped intraepithelialSmall ovoid or barrel shaped intraepithelial
organs about 80 um height and 40 um thickness.organs about 80 um height and 40 um thickness.
 Outer surface has flat epithelial cells,Outer surface has flat epithelial cells,
surrounded by a small opening called taste pore.surrounded by a small opening called taste pore.
 Taste pore leads to narrow space linedTaste pore leads to narrow space lined
supporting cellssupporting cells
 Two supporting cells,Two supporting cells,
 Outer supporting cellOuter supporting cell
 Inner supporting cellInner supporting cell

 Outer supporting cells arranged like the stoves of barrel.Outer supporting cells arranged like the stoves of barrel.
 Inner supporting cells are shorter and spindle shaped.Inner supporting cells are shorter and spindle shaped.
 Between this two neuroepithelial cells are arranged, they are theBetween this two neuroepithelial cells are arranged, they are the
receptors of taste stimuli.receptors of taste stimuli.
 They are slender, dark- staining, rich plexus of nerves is foundThey are slender, dark- staining, rich plexus of nerves is found
below the taste buds.below the taste buds.
 Taste buds are numerous on the inner wall of vallate papillae,Taste buds are numerous on the inner wall of vallate papillae,
folds of foliate papillae and posterior surface of epiglottis.folds of foliate papillae and posterior surface of epiglottis.
 Taste buds contain sensitive microscope hair called microvilli.Taste buds contain sensitive microscope hair called microvilli.

Taste sensationTaste sensation::
 Taste receptor cells found in taste buds opensTaste receptor cells found in taste buds opens
through taste pores detect these.through taste pores detect these.
Five primary tastes,Five primary tastes,
 SaltSalt
 SourSour
 SweetSweet
 BitterBitter
 UmamiUmami

 Sensation:Sensation:
 Sweet- tip of the tongue.Sweet- tip of the tongue.
 Salt-lateral border of the tongue.Salt-lateral border of the tongue.
 Bitter and sour- palate and posterior one third.Bitter and sour- palate and posterior one third.
Nerve supply:Nerve supply:
 Bitter and sour – glassophryngeal nerve,Bitter and sour – glassophryngeal nerve,
 Sweet and salt- chorda tymphani.Sweet and salt- chorda tymphani.

 Umami:Umami:
 It’s a response to salts of glutamic acid –It’s a response to salts of glutamic acid –
monosodium glutamate.monosodium glutamate.
 MSG is a flavor used in Asian dishes.MSG is a flavor used in Asian dishes.
 It is readily available in processed meet andIt is readily available in processed meet and
cheese.cheese.

 Common facts:Common facts:
 Average person has about 10,000 taste buds.Average person has about 10,000 taste buds.
 It is replaced every 2 weeks.It is replaced every 2 weeks.
 Age increases the replaced of taste budsAge increases the replaced of taste buds
decreases. So adults have less taste sensation.decreases. So adults have less taste sensation.
 Smoking reduces number of taste buds.Smoking reduces number of taste buds.
 Taste buds perform well when it combines withTaste buds perform well when it combines with
nose, so in cold and allergies your food doesn’tnose, so in cold and allergies your food doesn’t
seem to have much taste.seem to have much taste.

Fun facts:Fun facts:
 Insect have high taste sense, taste organ areInsect have high taste sense, taste organ are
present in their feet, antennae and mouthpart.present in their feet, antennae and mouthpart.
 Fish can taste with their fins and tails.Fish can taste with their fins and tails.
 Girls have more taste buds than boys.Girls have more taste buds than boys.

Disease Of The TongueDisease Of The Tongue

TongueTongue

 LocalLocal Systemic Condition ShowSystemic Condition Show
 Symptoms In The tongueSymptoms In The tongue
 Developmental DefectsDevelopmental Defects Acquired DiseasesAcquired Diseases
 MacroglossiaMacroglossia
 MicroglossiaMicroglossia
 AglossiaAglossia Taste BudTaste Bud OthersOthers
 AnkyloglossiaAnkyloglossia
 Fissured TongueFissured Tongue 1) Geographic Tongue1) Geographic Tongue
 Median Rhomboid GlossitisMedian Rhomboid Glossitis 2) Hairy Tongue2) Hairy Tongue
BlackBlack
WhiteWhite
3) Glossodynia3) Glossodynia
4) Glossitis4) Glossitis
CandidialCandidial
DeficiencyDeficiency
5) Leukoplakia5) Leukoplakia
HairyHairy
SyphiliticSyphilitic
6) Granular Cell Tumor6) Granular Cell Tumor

Developmental DefectsDevelopmental Defects
MacroglossiaMacroglossia
- Enlargement of tongue.- Enlargement of tongue.
Etiology:Etiology:
 Congenital or hereditary,Congenital or hereditary,
 Acquired.Acquired.

Congenital or hereditary:Congenital or hereditary:
 Vascular malformationVascular malformation
 LymphangiomaLymphangioma
 HemangiomaHemangioma
 CretinismCretinism
 Down syndromeDown syndrome
 Neuro fibromatosisNeuro fibromatosis
 Multiple endocrine neoplasiaMultiple endocrine neoplasia

Acquired:Acquired:
 Edentulous patientsEdentulous patients
 AmylodosisAmylodosis
 AcromegalyAcromegaly
 AngioedemaAngioedema
 Carcinoma or tumorCarcinoma or tumor
 Incidence:Incidence:
 Most common in children,Most common in children,
 Mild to severe in infants.Mild to severe in infants.
Clinical Features:Clinical Features:
 Enlarged, diffuse, smooth and drooling tongue.Enlarged, diffuse, smooth and drooling tongue.
 Difficulty in eating and speech.Difficulty in eating and speech.
 Noisy breathing and open bite.Noisy breathing and open bite.

Management:Management:
 Depends on the severity and etiology.Depends on the severity and etiology.
 In mild cases speech therapy can be done.In mild cases speech therapy can be done.
 In sever cases glossectomy, a surgical removalIn sever cases glossectomy, a surgical removal
of excess tongue can be advised.of excess tongue can be advised.

MicroglossiaMicroglossia
 Small tongueSmall tongue
Etiology:Etiology:
 Developmental causes unknownDevelopmental causes unknown
 Commonly associated with oro mandibular limb hypogenesisCommonly associated with oro mandibular limb hypogenesis
syndrome which characterized by limb anomalies and cleftsyndrome which characterized by limb anomalies and cleft
palatepalate
Incidence:Incidence:
 Most commonly in childrenMost commonly in children

Clinical Feature:Clinical Feature:
 Small tongue, mild cases may leave unnoticedSmall tongue, mild cases may leave unnoticed
 Depends on nature and severity.Depends on nature and severity.
 Speech therapy.Speech therapy.

Aglossia:Aglossia:
 Absence of tongueAbsence of tongue
Etiology:Etiology:
 Developmental cause unknownDevelopmental cause unknown
 Very rare in childrenVery rare in children

 Absence of tongueAbsence of tongue
 No specific treatment , speech therapy mayNo specific treatment , speech therapy may
be triedbe tried

Ankyloglossia(Tongue-Tie)Ankyloglossia(Tongue-Tie)
 Short or tight lingual frenumShort or tight lingual frenum
Etiology:Etiology:
 Genetic in most cases.Genetic in most cases.
 Occasional present cocaine addicted mother, Pierre robinOccasional present cocaine addicted mother, Pierre robin
syndromesyndrome
 and trisomy 13.and trisomy 13.
 1.7% of population.1.7% of population.
 Male equal female.Male equal female. www.indiandentalacademy.comwww.indiandentalacademy.com

 Frenum is short.Frenum is short.
 Difficult in cleansing food away from teeth andDifficult in cleansing food away from teeth and
vestibule.vestibule.
 Breast-feeding will be a problem.Breast-feeding will be a problem.
 Surgery if needed.Surgery if needed.

Fissured Tongue (Scrotal or Plicated Tongue)Fissured Tongue (Scrotal or Plicated Tongue)
 Grooves and fissures on the dorsum of theGrooves and fissures on the dorsum of the
tonguetongue
Etiology:Etiology:
 Developmental .Developmental .
 Rarely it may associate with erythema migrans,Rarely it may associate with erythema migrans,
melkersson Rosenthal syndrome, Downmelkersson Rosenthal syndrome, Down
syndrome and psoriasis.syndrome and psoriasis.
 5% of the population.5% of the population.www.indiandentalacademy.comwww.indiandentalacademy.com

 Multiple fissures on the dorsum of the tongue.Multiple fissures on the dorsum of the tongue.
 Complicate to geographic tongue.Complicate to geographic tongue.
 Mostly a symptomaticMostly a symptomatic
Differential DiagnosisDifferential Diagnosis::
 Sjogren’s syndrome, candidasis.Sjogren’s syndrome, candidasis.
ManagementManagement::
 No specific treatmentNo specific treatment
 Encourage brushing the tongue in order to remove the food andEncourage brushing the tongue in order to remove the food and
debris entrapped.debris entrapped. www.indiandentalacademy.comwww.indiandentalacademy.com

Median Rhomboid GlossisitisMedian Rhomboid Glossisitis
 Depapillated rhomboidal area in the dorsum of the tongueDepapillated rhomboidal area in the dorsum of the tongue
anterior to circumvallate papillae.anterior to circumvallate papillae.
Etiology:Etiology:
 DevelopmentalDevelopmental
 Due to failure of embryological tuberculum impar to be coveredDue to failure of embryological tuberculum impar to be covered
by the lateral process of the tongue.by the lateral process of the tongue.
 Rare,Rare,
 Males are most commonly affected.Males are most commonly affected.

 Depapillated rhomboidal area anterior to sulcusDepapillated rhomboidal area anterior to sulcus
terminalis.terminalis.
 Flat or nodular.Flat or nodular.
 Red or reddish white in colour.Red or reddish white in colour.
 Mostly a symptomatic.Mostly a symptomatic.
 Antifungal drugs for several weeksAntifungal drugs for several weeks
 Cryosurgery may be requiredCryosurgery may be requiredwww.indiandentalacademy.comwww.indiandentalacademy.com

Acquired DiseasesAcquired Diseases
 Geographic TongueGeographic Tongue
 Erythema Migrans, Benign Migratory GlossitisErythema Migrans, Benign Migratory Glossitis..
 Red patches that changes in size and shape, which resemble like a map soRed patches that changes in size and shape, which resemble like a map so
called geographic tongue.called geographic tongue.
Etiology:Etiology:
 Unknown,Unknown,
 It may associate with genetics, psoriasis, and reiter’s syndrome, HIV infection.It may associate with genetics, psoriasis, and reiter’s syndrome, HIV infection.
 1% to 3% of the population.1% to 3% of the population.
 Females are affected more in 2:1 ratio.Females are affected more in 2:1 ratio.

 Dorsal surface of the tongue mostly anterior two third of the tongue isDorsal surface of the tongue mostly anterior two third of the tongue is
affected.affected.
 Atrophy of filliform papillae.Atrophy of filliform papillae.
 Irregular demarcated areas with red patches with yellow border.Irregular demarcated areas with red patches with yellow border.
 Red areas that change in shape, size and spread or move to other areas withRed areas that change in shape, size and spread or move to other areas with
in hours.in hours.
 Soreness to acidic foods like tomatoes.Soreness to acidic foods like tomatoes.
 Sometimes same lesion may appear elsewhere on the oral mucosa.Sometimes same lesion may appear elsewhere on the oral mucosa.
Differential diagnosis:Differential diagnosis:
 Lichenplanus, lupus erythematosusLichenplanus, lupus erythematosus
 No specific treatment.No specific treatment.
 Zinc 200 mg thrice daily for 3 months.Zinc 200 mg thrice daily for 3 months.

Hairy tongue:Hairy tongue:
Black Hairy TongueBlack Hairy Tongue
 Blackish discoloration of the tongue with marked accumulation ofBlackish discoloration of the tongue with marked accumulation of
keratin on filliform papillae result hair like appearance.keratin on filliform papillae result hair like appearance.
Etiology:Etiology:
 Poor oral hygiene,Poor oral hygiene,
 Edentulous patients,Edentulous patients,
 Soft non-abrasive diet,Soft non-abrasive diet,
 Smokers, alcohol and drug users,Smokers, alcohol and drug users,
 Radiation therapy and xerosotomia,Radiation therapy and xerosotomia,
 Fungal and bacterial growth,Fungal and bacterial growth,
 Antibiotic therapy.Antibiotic therapy.

 0.5% of adult,0.5% of adult,
 Appears normally in midline just anterior to vallateAppears normally in midline just anterior to vallate
papillae.papillae.
 The papillae are elongated, usually yellow or black inThe papillae are elongated, usually yellow or black in
colour result of pigmentation.colour result of pigmentation.
 Tongue will be thick and matted appearance.Tongue will be thick and matted appearance.
 A symptomatic.A symptomatic.
 Some time patient may complaints of bad taste andSome time patient may complaints of bad taste and
breath.breath.

 Improve oral hygiene.Improve oral hygiene.
 Treatment for the etiology.Treatment for the etiology.
 Scrap or brush the tongue.Scrap or brush the tongue.
 Trim the hair with a scissors.Trim the hair with a scissors.
 Sodium bicarbonate and hydrogen peroxideSodium bicarbonate and hydrogen peroxide
mouthwash.mouthwash.
 Keratolytic agents like podophyllum can be useKeratolytic agents like podophyllum can be use
full sometimes.full sometimes.

White Hairy TongueWhite Hairy Tongue
 White coat over the tongue due to collectionWhite coat over the tongue due to collection
of epithelial, food and microbial debris.of epithelial, food and microbial debris.
Etiology:Etiology:
 Poor oral hygiene,Poor oral hygiene,
 Edentulous patients,Edentulous patients,
 Xerostomia,Xerostomia,
 Soft non-abrasive diet.Soft non-abrasive diet.

- Common- Common
 Appears in the dorsal surface of the tongue,Appears in the dorsal surface of the tongue,
mostly in the anterior two third of the tongue.mostly in the anterior two third of the tongue.
 White patches present in the tongue, which isWhite patches present in the tongue, which is
scrabble.scrabble.
 Mostly a symptomatic.Mostly a symptomatic.
 Some patient may complaints of bad taste andSome patient may complaints of bad taste and
breathbreath www.indiandentalacademy.comwww.indiandentalacademy.com

 Improve oral hygiene,Improve oral hygiene,
 Brush the tongue,Brush the tongue,
 Treat the underlying condition,Treat the underlying condition,
 Hydrogen peroxide mouthwash can be used.Hydrogen peroxide mouthwash can be used.

GlossodyniaGlossodynia
 Burning Mouth Syndrome, Glosso Pyrosis, OralBurning Mouth Syndrome, Glosso Pyrosis, Oral
DysaesthesiaDysaesthesia
 Burning sensation of the mouthBurning sensation of the mouth..
Etiology:Etiology:
 Local and systemic factors 50: 50Local and systemic factors 50: 50
Local factorsLocal factors
 Tongue thrusting.Tongue thrusting.
 Restricted tongue space because of poor dentureRestricted tongue space because of poor denture
construction.construction. www.indiandentalacademy.comwww.indiandentalacademy.com

Systemic factorsSystemic factors
 Mucosal disorders:Mucosal disorders: geographic tongue, lichen planus,geographic tongue, lichen planus,
xerostomia, and infectionsxerostomia, and infections
 Systemic disorders:Systemic disorders: vitamin b, folic acid, ironvitamin b, folic acid, iron
deficiency, diabetic mellitus, tertiary syphilis anddeficiency, diabetic mellitus, tertiary syphilis and
hematological problems.hematological problems.
 Psychogenic:Psychogenic: depression and anxietydepression and anxiety
 Food and drink:Food and drink: peanuts and sorbic acidpeanuts and sorbic acid
 Incidence:Incidence: CommonCommon

 Bilateral ,Bilateral ,
 No clinical signs of diseases,No clinical signs of diseases,
 Relieve by eating and drinking,Relieve by eating and drinking,
Three types of symptoms patternThree types of symptoms pattern
 1. No burning mouth on walking but increases during1. No burning mouth on walking but increases during
the day,the day,
 2. Burning on walking and through out the day,2. Burning on walking and through out the day,
 3. No regular pattern.3. No regular pattern.

Other Investigation:Other Investigation:
 Complete hospital anxiety and depression scale.Complete hospital anxiety and depression scale.
 Lab investigation for anemia, diabetes andLab investigation for anemia, diabetes and
blood pictureblood picture
 Treat the etiology factorTreat the etiology factor

GlossitisGlossitis
 Candidal GlossitisCandidal Glossitis
 Sore tongue due to candidial infectionSore tongue due to candidial infection
Etiology:Etiology:
 Opportunistic infection with candida mostly c.Opportunistic infection with candida mostly c.
albicans,albicans,
 Xerostomia,Xerostomia,
 Immune defectsImmune defects
- uncommonuncommon

 Diffuse erythema,Diffuse erythema,
 Soreness of the tongue,Soreness of the tongue,
 White patches on the tongue,White patches on the tongue,

 Smear for candidal growth.Smear for candidal growth.
 Treat the etiology,Treat the etiology,
 Anti fungal drugs.Anti fungal drugs.

Deficiency GlossitisDeficiency Glossitis
 Soreness of tongue due to deficiency ofSoreness of tongue due to deficiency of
vitamins and mineralsvitamins and minerals
Etiology:Etiology:
 Deficiency of iron, folic acid and vitamin b12Deficiency of iron, folic acid and vitamin b12
Incidence:Incidence: uncommonuncommon

 Linear patchy or red lesion,Linear patchy or red lesion,
 Depapillated tongue,Depapillated tongue,
 Oral ulcer and angular stomatitis may associate.Oral ulcer and angular stomatitis may associate.
 Investigation for anemia and vitamin levelsInvestigation for anemia and vitamin levels
 Replacement therapyReplacement therapywww.indiandentalacademy.comwww.indiandentalacademy.com

LeukoplakiaLeukoplakia
 Hairy LeukoplakiaHairy Leukoplakia
 Bilateral white lesion on the tongue usually present inBilateral white lesion on the tongue usually present in
immunocompromised individual.immunocompromised individual.
Etiology:Etiology:
 HIV infectionHIV infection
 Herpes virusHerpes virus
 Epstein bar virusEpstein bar virus

 White lesion on both sides of the tongue, vertically corrugatedWhite lesion on both sides of the tongue, vertically corrugated
 Appears to be benign and self-limitingAppears to be benign and self-limiting
 Investigation for HIV infection, hepex virus and Epstein barInvestigation for HIV infection, hepex virus and Epstein bar
virusvirus
 Treatment for etiologyTreatment for etiology
 Antiviral drugsAntiviral drugs

Syphilitic LeukoplakiaSyphilitic Leukoplakia
 White mucosal lesion in tertiary syphilisWhite mucosal lesion in tertiary syphilis
 Etiology:Etiology: Tertiary SyphilisTertiary Syphilis
 IncidenceIncidence:: RareRare

 No distinctive featureNo distinctive feature
 Affect the dorsum of the tongue.Affect the dorsum of the tongue.
 Irregular outline and surfaceIrregular outline and surface
Diagnosis:Diagnosis:
 ClinicalClinical
 VDRL test for syphilisVDRL test for syphilis
Management:Management: AntibioticsAntibioticswww.indiandentalacademy.comwww.indiandentalacademy.com

Granular Cell TumorGranular Cell Tumor
 Solitary tumor in which granular cells areSolitary tumor in which granular cells are
prominent.prominent.
Etiology:Etiology: IdiopathicIdiopathic

 Solitary, slow growing a symptomatic swellingSolitary, slow growing a symptomatic swelling
 Appears to have a small malignant predispositionAppears to have a small malignant predisposition
 Biopsy shows granular cellsBiopsy shows granular cells
Management:Management: Surgical ExcisionSurgical Excision

Tongue Piercing:Tongue Piercing:
 Studs, hoops or barbell shaped ring that are hookedStuds, hoops or barbell shaped ring that are hooked
in the tonguein the tongue
Types:Types:
 Multiple centre-tongue piercingMultiple centre-tongue piercing
 Off-center tongue piercingOff-center tongue piercing
 Large gauge tongue piercingLarge gauge tongue piercing
 Centre tongue piercingCentre tongue piercing
 Horizontal tongue piercingHorizontal tongue piercing
 Vertical tongue piercingVertical tongue piercing

Materials used:Materials used:
 Bar or large needle used to pierce the tongueBar or large needle used to pierce the tongue
 Gold, silver, metal or plastic are material usedGold, silver, metal or plastic are material used
to prepare the jewellary hooked in the tongue.to prepare the jewellary hooked in the tongue.

Complication:Complication:
 PainPain
 Post-placement swellingPost-placement swelling
 Prolonged bleedingProlonged bleeding
 Gum injuryGum injury
 Permanent numbnessPermanent numbness
 Loss of tasteLoss of taste
 HIV and hepatitis infectionHIV and hepatitis infection
 Oral hygiene problemsOral hygiene problems
 Avoid piercingAvoid piercing

If piercedIf pierced
 Use chlorhexidine mouthwash every half an hourUse chlorhexidine mouthwash every half an hour
immediately after tongue piercing for 8 hours.immediately after tongue piercing for 8 hours.
 Tongue swelling will, subside within 7 to 8 days, andTongue swelling will, subside within 7 to 8 days, and
complete healing within 2 weekscomplete healing within 2 weeks
 Advice not to take hot and spicy foods.Advice not to take hot and spicy foods.
 Rinse mouth before and after food.Rinse mouth before and after food.
 Don’t take the bar or needle before healingDon’t take the bar or needle before healing
 Sterilize the jewellary before placingSterilize the jewellary before placing
 Improve and maintain oral hygieneImprove and maintain oral hygiene
 Regular visit to dentist at least once in 3 monthsRegular visit to dentist at least once in 3 monthswww.indiandentalacademy.comwww.indiandentalacademy.com

Taste BudTaste Bud
 Loss of taste sensationLoss of taste sensation
Etiology:Etiology:
 Old age,Old age,
 Smoking,Smoking,
 Radiation therapy,Radiation therapy,
 Central nervous system problem,Central nervous system problem,
 Injuries to the tongue,Injuries to the tongue,
 Obstruction or problem in the nasal cavity,Obstruction or problem in the nasal cavity,www.indiandentalacademy.comwww.indiandentalacademy.com

Incidence:Incidence: Most common in old patientsMost common in old patients
Clinical featureClinical feature::
 Loss of taste sensationLoss of taste sensation
 It may be complete or partialIt may be complete or partial

 Tests: sip, spit and rinse testTests: sip, spit and rinse test
 Chemical test for specific areas of the tongueChemical test for specific areas of the tongue
 No specific treatment,No specific treatment,
 Treat the etiology,Treat the etiology,
 Anti allergic drugs may sometimes use full.Anti allergic drugs may sometimes use full.

Systemic Condition Show Symptoms In TheSystemic Condition Show Symptoms In The
TongueTongue
 Conditions listing symptoms: TongueConditions listing symptoms: Tongue
symptoms:symptoms: The following list of conditions hasThe following list of conditions has
'Tongue symptoms' .'Tongue symptoms' .
AA
 Acromegaly ... enlarged tongueAcromegaly ... enlarged tongue
 Anemia ... tongue inflammationAnemia ... tongue inflammation
 AngioedemaAngioedema ... swollen tongue... swollen tongue

CC
 Candidiasis ... white patches on tongueCandidiasis ... white patches on tongue
 Canker sores ... tongue ulcersCanker sores ... tongue ulcers
 Congenital hypothyroidism ... enlarged tongueCongenital hypothyroidism ... enlarged tongue
DD
 DehydrationDehydration ... dry tongue... dry tongue
 Down SyndromeDown Syndrome ... enlarged tongue... enlarged tongue

GG
 GingivostomatitisGingivostomatitis ... tongue ulcers... tongue ulcers
 GlossitisGlossitis ... sore tongue, red tongue, swollen tongue... sore tongue, red tongue, swollen tongue
 GlucagonomaGlucagonoma ... smooth tongue... smooth tongue
 Grand mal seizuresGrand mal seizures ... biting the tongue... biting the tongue
HH
 Hand, Foot, & Mouth DiseaseHand, Foot, & Mouth Disease ... tongue ulcers... tongue ulcers
 Herpes stomatitisHerpes stomatitis ... tongue swelling... tongue swelling
 HivesHives ... tongue swelling... tongue swelling
 HypocalcemiaHypocalcemia ... tongue paresthesias... tongue paresthesias
 HypoparathyroidismHypoparathyroidism ... tongue paresthesias... tongue paresthesias
 Iron deficiency anemiaIron deficiency anemia ... tongue inflammation... tongue inflammation
JJ
 JaundiceJaundice ... furry tongue... furry tongue
 Joubert Syndrome ... tongue abnormalities, abnormal tongue movementsJoubert Syndrome ... tongue abnormalities, abnormal tongue movements

KK
 Kawasaki disease ... strawberry tongueKawasaki disease ... strawberry tongue
MM
 Machado-Joseph Disease ... twitching tongueMachado-Joseph Disease ... twitching tongue
 Melkersson-Rosenthal Syndrome . tongueMelkersson-Rosenthal Syndrome . tongue
abnormalities, tongue furrows, tongue foldsabnormalities, tongue furrows, tongue folds
 Mobius syndrome ... tongue deformitiesMobius syndrome ... tongue deformities
 Mouth ulcers ... tongue pain, tongue ulcersMouth ulcers ... tongue pain, tongue ulcers
 Mucopolysaccharidosis II ... enlarged tongueMucopolysaccharidosis II ... enlarged tongue

OO
 Oral cancer ... lump on tongueOral cancer ... lump on tongue
 Oral thrush ... white patches on tongueOral thrush ... white patches on tongue

PP
 Pernicious anemia ... sore tongue, burning tongue, red tongue,Pernicious anemia ... sore tongue, burning tongue, red tongue,
TongueTongue
symptomssymptoms
 Primary Lateral Sclerosis ... tongue weaknessPrimary Lateral Sclerosis ... tongue weakness
 Progressive Spinobulbar muscular atrophy ... tongue weaknessProgressive Spinobulbar muscular atrophy ... tongue weakness
RR
 Riboflavin deficiency ... sore tongueRiboflavin deficiency ... sore tongue
SS
 Sjogren's Syndrome ... smooth tongue, tongue ulcersSjogren's Syndrome ... smooth tongue, tongue ulcers
 Spinal Muscular Atrophy type II ... twitching tongueSpinal Muscular Atrophy type II ... twitching tongue
 Sprue ... sore tongue, red inflamed tongue, red inflamed tongueSprue ... sore tongue, red inflamed tongue, red inflamed tongue

TT
 Tardive Dyskinesia ... tongue protrusionTardive Dyskinesia ... tongue protrusion
 Tetany ... burning tongue, tingling tongueTetany ... burning tongue, tingling tongue
 Trichinosis ... bleeding under tongueTrichinosis ... bleeding under tongue
 Typhoid fever ... tongue changesTyphoid fever ... tongue changes
YY
 Yellow fever ... furry tongueYellow fever ... furry tongue

REFERENCESREFERENCES
1)Human anatomy
Vol: head, neck and brain 3 rd edition
B D Chaurasia
2)Text Book Of Physiology, Chattergee
4)Internet source:
Site www.google .com
3)Text book of medicine:
K V Krishna Das 4th edition jaype

Reference:Reference:
 Orban’s oral histologyOrban’s oral histology
 Tencate oral histologyTencate oral histology
 Oral medicine by burketOral medicine by burket
 Differential diagnosis by white and goazDifferential diagnosis by white and goaz
 Clinical medicine by navealClinical medicine by naveal
 Oral pathology by shafersOral pathology by shafers
 www.worldmedicallibrary.comwww.worldmedicallibrary.com
 www.tongue-diseses.comwww.tongue-diseses.com
 www.bodypiercing.comwww.bodypiercing.com
 www.bodyjewellary.comwww.bodyjewellary.com

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