Seminar on tongue /prosthodontic courses

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

TONGUETONGUETONGUETONGUE
Introduction
Anatomy/Structure
Papillae
Muscles
Blood supply/
lymphatics
Nerve supply
Histology of tongue
Development of Tongue
Applied Anatomy
Tongue Piercing

INTRODUCTION
Tongue is a freely movable muscular organ situated
in the floor of the mouth,partly associated with the
pharynx.
It is mainly concerned with speech , mastication ,
deglutition and taste.
EXTERNAL FEATURES :
A root
A tip
A body www.indiandentalacademy.com

ANATOMY
• A ROOT- Attached to the mandible above, hyoid bone below
• A TIP – Forms anterior free end at rest lies behind upper incisor
teeth
• A BODY – Dorsum (superior surface)
Ventrum (inferior surface)
Dorsum: Oral part
Pharyngeal part
Ventrum: Is confined to oral part only

DORSUM
 Oral part and pharyngeal
part is separated by a faint
v-shaped groove called
sulcus terminals.
 V-shaped groove meet at a
median pit called foramen
caecum.
 Foramen caecum
represents the site from
which the thyroid
diverticulum’s grows down
to thyroid gland in
embryo.

It is located in the oral cavity and placed on the floor
of the mouth
It has An apex : touching the incisor teeth.
Margins : which are in contact with the gums
and teeth
Surfaces : superior surface
Inferior surface
Oral Part /Anterior Two Third /
Papillary Part:

 Superior surface is related to the hard and soft
palate. It shows a median furrow and covered with
papillae which makes it rough.
 Inferior surface is covered with mucous membrane,
that is smooth, purplish and connected to the floor
by the median frenulum linguae (lingual fernum)
lateral to which is deep lingual vein on either side.
More laterally there is a fold called the plica
fimbriata that is directed forwards and medially
towards the tip of the tongue. Posterior to it
sublingual fold is present near the floor of the mouth,
it contains an orifice of submandibular duct

Pharyngeal Part / Lymphoid / Posterior One
Third / Base Of The Tongue:
 Behind the palatoglossal arches and sulcus
terminalis.
 Posterior surface forms the anterior wall of
oropharynx, no papilla, lymphoid follicles are
present they are called lingual tonsil.
 Mucous gland is present.
 Posterior part connected to the epiglottis by three
folds of mucous membrane that is,

Median glossoepiglottic fold,
Right and left lateral glossoepiglottic fold,
Either side of the median fold there is a pouch
called vallecula.
Lateral folds separate vallecula from pirriform
fossa.

Papillae Of Tongue

Projections on anterior 2/3rd
of tongue,gives
roughness to the tongue.
• FOLIATE
• VALLATE
• FUNGIFORM
• FILLIFORM

Foliate Papillae
In front of palatoglossal arch,
4 to 5 vertical folds are
present called foliate papillae.
They are red leaf like
projections.
Vallate Papillae :
Large in size (1-2mm in dia),
8-12 in no.
Situated immediately in front
of sulcus terminalis, each
papillae is cylindrical
projection surrounded by a
circular sulcus, walls are
raised above the surface.www.indiandentalacademy.com

FUNGI FORM PAPILLAE:
 Numerous near the tip and margins of the tongue, some
may be scattered in the dorsum of the tongue.
 Smaller then vallate but larger then filliform, narrow
pedicle, large round head, bright red colour
FILIFORM PAPILLAE
 These are conical papillae that cover the presulcal area of the
dorsum of the tongue and give it a characteristic velvety
appearance.
 They are the smallest and most numerous of the lingual
papillae.
 Each is pointed and covered with keratin.
 The apex is often split into filamentous processes.www.indiandentalacademy.com

Taste buds
 These are most numerous
on the sides of the vallate
papillae and on the walls
of surrounding sulci.
 Taste buds are also present
over the foliate papillae
and over the posterior one
third of the tongue and
sparsely distributed on the
fungiform papillae, the
soft palate, the epiglottis
and the pharynx.
 There are no taste buds on
the mid-dorsal region of
the oral part of the tongue.www.indiandentalacademy.com

STRUCTURE OF THE TONGUE:
 Tongue is made up of muscles.
 Mucous membrane is a layer of connective
tissue lined by stratified squamous epithelium.
 On oral part dorsal surface is a thin and it forms
papillae.
 Pharyngeal part is rich in lymphoid follicles.
 Numerous serous and mucous glands lie deep
to the mucous membrane.www.indiandentalacademy.com

MUSCLES OF THE TONGUE
The tongue is divided into right and left halves by a
median fibrous septum. Each half contains two sets of
muscles which are intrinsic and extrinsic.
Extrinsic muscles
include
 Genioglossus
 Hyoglossus
 Styloglossus
 Palatoglossus
 Chondroglossus
Intrinsic muscles
include
 Superior
longitudinal
 Inferior longitudinal
 Transverse and
 Vertical

THE INTRINSIC MUSCLES
The intrinsic muscles occupy the upper part of the
tongue, and are attached to the submucous fibrous layer
and to the median fibrous septum. These muscles alter
the shape of the tongue.
SUPERIOR LONGITUDINAL
This muscle arises from the submucous fibrous layer
close to epiglottis and from the median fibrous septum.
Action
It shortens the tongue and makes it dorsum concave.www.indiandentalacademy.com

INFERIOR LONGITUDINAL MUSCLE
It is a narrow band of muscle close to the inferior surface of the tongue
between the genioglossus and hyoglossus.
Action
It shortens the tongue and makes it dorsum convex.
TRANSVERSE
It extends form the median fibrous septum and pass laterally to be
inserted into the submucous fibrous tissue at the margins.
Action
It makes the tongue narrow and elongated.
VERTICAL
It is found at the borders of anterior part of the tongue.
Action
It makes the tongue broad and flattened.www.indiandentalacademy.com

THE EXTRINSIC MUSCLES
These muscles connect the tongue to the mandible, the hyoid bone, the
styloid process and the palate.
GENIOGLOSSUS
It is a triangular muscle. It arises by a short tendon from the upper
genial tubercle. From here the fibres fan out and run backwards. The
upper fibres are inserted into the tip, the middle fibres into the dorsum
and lower fibres into the hyoid bone.
Actions:
The upper fibres retract the tip. The middle fibres depress the tongue.
The lower fibres pull the posterior part of the tongue forwards and thus
protrude the tongue.
THE HYOGLOSSUS
Arises from the greater cornu of hyoid bone and the front of lateral part
of its body and passes almost vertically upwards and enters the side of
tongue.
Actions
It depresses the tongue. www.indiandentalacademy.com

THE CHONDROGLOSSUS
Described as the part of hyoglossus but it is separated from that
muscle by fibres of genioglossus which pass to side of pharynx.
It arises from medial side and base of lesser cornu of hyoid and
contiguous part of body of hyoid bone. It ascends and blends
with intrinsic muscle fibres.
Actions:
It assists the hyoglossus in depressing the tongue.
THE STYLOGLOSSUS
It arises from the tip and adjacent part of the anterior surface of
the styloid process as well as from the upper end of stylohyoid
ligament. It passes downwards and forwards and is inserted into
the side of the tongue intermingling ewith the fibers of
hyoglossus
Action
During swallowing it pulls the tongue upwards and backwards.

Palatoglossus :
It descends in the palatoglossal arch, to the side of the
tongue at the junction of its oral and pharyngeal parts.
Action : It pulls up the root of the tongue, approximates
the palatoglossal arches, and thus closes the oropharyngeal
isthmus .

Arterial Supply:
 Lingual artery a branch of external carotid artery supplies the
major part of the tongue.
 Root of the tongue is also supplied by tonsillar and ascending
pharyngeal arteries.
Venous Supply:
 Deep lingual vein is the largest and main vein, which supplies
the tongue.
 The vein is visible in the inferior surface of the tongue.
 Runs backwards and crosses the genioglossus and hyoglossus
muscle.
 Veins unite at posterior border of the hyoglossus to form
lingual vein.
 Which ends in common facial vein or internal jugular vein.

LYMPHATIC DRAINAGE:
 The tip of the tongue drains bilaterally to submental
nodes.
 The right and left halves of the remaining part of
anterior 2/3rds of the tongue drain unilaterally to
submandibular nodes and ultimately the lymph reaches
the jugulo-omohyoid nodes.
 Posterior one third of the tongue drain bilaterally to the
jugulo-omohyoid nodes.
 Since most of the lymph from the tongue ultimately
drains into the jugulo-omohyoid nodes, these are known
as lymph nodes of tongue.www.indiandentalacademy.com

Nerve Supply:
Motor nerve:
 Intrisinsic and extrinsic muscles expect
palatoglossus muscles supplied by
hypoglossus nerve.
 Palotoglossus muscles is supplied by
pharyngeal plexus.

Sensory nerve:
Anterior two third:
 General sensation is supplied by lingual nerve.
 Taste buds are supplied by chorda tympanic.
Posterior one third:
 General sensation and taste buds are supplied
by glossopharyngeal nerve.

 Tongue appears in embryo in the 4th week of intra
uterine life in form of three lobes.
 Two lateral lingual swellings and one medial swelling.
 These are developed from the 1st pharyngeal arch.
 Two lingual swellings are separated each other by the
medial swellings called tuberculam impar, which forms
a down growth (thyroglossal duct), which develops into
thyroid gland.
 This site of down growth is subsequently marked by a
depression called foramen caecum.

 Another midline swelling is formed later by 2nd, 3rd, 4th
mesoderm called hypobranchial eminence. This hypo
branchial eminence soon subdivides into two parts
they are,
• Cranial part or copula,
• Caudal part.
 Cranial part is formed related to 2nd and 3rd arch and
caudal part is formed related to 4th arch. Then it gives
rise to epiglottis

 Anterior two third of the tongue is formed by fusion of
two lingual swellings and tuberculam impar. So it is
derived from mandibular arch.
 Posterior one third is formed by cranial part of
hypobranchial eminence.
 In this situation second arch mesoderm gets buried
below the third and first arch.
 Posterior most part is formed by fourth arch

Development of tongue

 Keeping this embryological origin, anterior two third of
the tongue is supplied by lingual branch of mandibular
nerve and chorda tympanic which is a post and pre
trematic nerve of first arch.
 Posterior one-third by glossopharyngeal nerve, which is
nerve of third arch. And posterior most part is supplied
by superior laryngeal nerve which nerve of fourth arch.
 Musculature of the tongue is deriving from occipital
myotomes supplied by hypoglossal nerve. Epithelium of
the tongue is at first made up of a single layer of cells
later becomes stratified and papillae becomes evident.

Histology
Of
Tongue

Histology Of Tongue
 Inferior Surface Of The Tongue
 Dorsal Surface Of The Tongue
 Taste buds

Inferior Surface Of The Tongue

 Mucous membrane is thin and loosely attached to the
underlying surface for free mobility.
 Made of non-keratinized epithelium.
 Sub-mucosa contains adipose tissue.
 Sub lingual glands lie close to the sublingual fold.
 Mucous membrane is smooth and thin.
 Papillae of connective tissue are numerous but short.

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

Anterior 2/3rd
of tongue

Vallate papillae
 They do not protrude above the surface of the tongue
but are bounded by deep circular furrow, so that their
only connection to the tongue is at their narrow base.
 Contains numerous secondary papillae covered by thin,
smooth epithelium.
 Lateral surface contains numerous taste buds.
 Von ebner’s glands open through these papillae by a
duct to wash out the soluble elements of food, and are
main source of salivary lipase.

Fungiform papillae
 Mushroom shaped papillae.
 Round, reddish prominences.
 Red colour is because of rich capillary
network, visible through relatively thin
epithelium.
 Contains few taste buds on their dorsal
surface. www.indiandentalacademy.com

Filliform papillae:
 They are cone shaped
papillae, give tongue
velvetty appearance
 They are epithelial
projections containing
core of connective tissue
from which secondary
papillae protrude towards
the epithelium.
 Epithelium is keratinized.
 It does not have taste
buds.

Posterior One Third Of The Tongue
 On the lateral borders sharp parallel clefts of
varying length can be observed.
 Narrow folds of mucous membrane contain
taste buds.

Taste Buds
 Small ovoid or barrel shaped intraepithelial organs
about 80 µm high and 40 µm thick.
 Outer surface has flat epithelial cells, surrounded by a
small opening called taste pore.
 Taste pore leads to narrow space lined by supporting
cells
 Two supporting cells,
•Outer supporting cell
•Inner supporting cell

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

Taste sensation
Taste receptor cells found in taste buds opens
through taste pores detect these.
Four primary tastes –
 Salt
 Sour
 Sweet
 Bitter

Sensation
 Sweet- tip of the tongue.
 Salt-lateral border of the tongue.
 Bitter and sour- palate and posterior one third.
Nerve supply
 Bitter and sour – glossopharyngeal nerve,
 Sweet and salt- chorda tympani and inter
medio facial nerve.

Taste sensations

Distribution of Receptors for Taste
Sensation in Relation to Papillae
 Vallate – with bitter
 Foliate – with sour
 Fungiform – at the tip of the tongue with sweet
- at lateral border with salt

How does taste occur ?
Taste occurs when a chemical substance
contacts a receptor cell in the taste bud. Each
taste bud is innervated by many nerve fibers
hence reception of chemical substance fires the
nerve fibers.

TASTE BUD
Loss of taste sensation
Etiology:
Old age,
Smoking,
Radiation therapy,
Central nervous system problem,
Injuries to the tongue,
Obstruction or problem in the nasal cavity,
Incidence: Most common in old patients
Clinical feature:
Loss of taste sensation
It may be complete or partial

Other Investigation:
Tests: sip, spit and rinse test
Chemical test for specific areas of the tongue
Management:
 No specific treatment,
 Treat the etiology,
 Anti allergic drugs may sometimes use full.

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

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

Applied Anatomy

APPLIED ANATOMY
 The congenital cysts and fistulae may develop
from persistent remains of thyroglossal duct.
 The attachment of genioglossus to the genial
tubercles behind the mandibular symphysis
prevents the tongue from sinking back and
obstructing respiration therefore anesthetists pull
forward the mandible to obtain the full benefit of
this connection.

 Injury to the hypoglossal nerve produces paralysis of the
muscles of the tongue on the side of lesion. If the lesion
is infranuclear, there is gradual atrophy of the affected
half of the tongue( hemiatrophy). Muscular twitchings
are also observed. Infranuclear lesions of the hypoglossal
nerve are also seen typically in motor neuron disease
and in syringobulbia. Supranuclear lesions of the
hypoglossal nerve produce paralysis without wasting.
This is best seen in pseudobulbar palsy where the tongue
is stiff, small and moves very sluggishly resulting in
defective articulation.
 Glossitis is usually a part of generalized ulceration of the
mouth cavity (stomatitis). In certain anaemias the tongue
becomes bald due to atrophy of the filliform papillae.

 The presence of a rich network of lymphatics and of loose
aerolar tissue of the substance of the tongue is
responsible for enormous swelling of the tongue in acute
glossitis. The tongue fills up the mouth cavity and then
protrudes out of it.
 The undersurface of the tongue is a good site ( along with
the bulbar conjuctiva) for observation of jaundice.
 In unconscious patients the tongue may fall back and
obstruct the air passages. This can be prevented either by
lying the patient on one side with head down (the ‘tonsil
position’ ) or by keeping the tongue pulled out
mechanically.

 In patients with grand mal epilepsy the tongue is
commonly bitten between the teeth during the attack.
This can be prevented by hurriedly putting in a mouth
gag at the onset of the seizure.
 Carcinoma of the tongue is quite common. It is better
treated by radiotherapy than by surgery. But facilities
for irradiation are not always available, the affected side
of the tongue is removed surgically. All the deep
cervical lymph nodes are also removed ( block
dissection of neck) because recurrence of malignant
disease occurs in lymph nodes. Carcinoma of the
posterior one third of the tongue is more dangerous due
to bilateral lymphatic spread.www.indiandentalacademy.com

Abnormalities
Of
Tongue
Immunologic diseases
Congenital/Developmental
Traumatic
Infections
Neoplastic
IdiopathicRelated to
Systemic Diseases
Related to
Blood Dyscrasias
Related to
Metabolic

Congenital
Development
Hemangioma
Macroglossia
Microglossia
Ankyloglossia
Fissured Tounge
Lingual ThyroidThyroglossal duct cyst
Dermoid Cyst
Lymphangioma
Median Rhomboid
glossitis

Developmental Defects
Macroglossia
(Enlargement of tongue )

Congenital or hereditary,
 Vascular malformation
 Lymphangioma
 Hemangioma
 Cretinism
 Down syndrome
 Neuro fibromatosis
 Multiple endocrine
neoplasia
Etiology:
Acquired:
 Edentulous patients
 Amylodosis
 Acromegaly
 Angioedema
 Carcinoma or tumor

Incidence:
 Most common in children,
 Mild to severe in infants.
Clinical Features:
 Enlarged, diffuse, smooth and drooling tongue.
 Difficulty in eating and speech.
 Noisy breathing and open bite.
 Persistent enlargement of tongue also results in pressure
deformity of the dentition and dental arches, a feature often noted
in down’s syndrome.
Management:
 Depends on the severity and etiology.
 In mild cases speech therapy can be done.
 In sever cases glossectomy, a surgical removal of excess tongue
can be advised. www.indiandentalacademy.com

Microglossia.
(Small tongue )
Etiology:
 Developmental causes unknown
 Commonly associated with oro mandibular limb
hypogenesis syndrome which characterized by limb
anomalies and cleft palate
Incidence:
 Most commonly in children
Clinical Feature:
 Small tongue, mild cases may leave unnoticed
Management:
 Depends on nature and severity.
 Speech therapy. www.indiandentalacademy.com

Aglossia
(Absence of tongue )
Etiology:
 Developmental cause unknown

Incidence:
 Very rare in children

Clinical Feature:
 Absence of tongue

Management:
 No specific treatment , speech therapy may be tried

Ankyloglossia

Ankyloglossia(Tongue-Tie)
Short or tight lingual frenum
Etiology:
 Genetic in most cases.
 Occasional present cocaine addicted mother, Pierre robin syndrome
 and trisomy 13.
Incidence:
 1.7% of population.
 Male equal female.
Clinical Feature:
 Frenum is short.
 Difficult in cleansing food away from teeth and vestibule.
 Recurrent tongue biting
 Breast feeding will be a problem.
Management:
 Surgery if needed.

Fissured Tongue

Fissured Tongue (Scrotal or Plicated Tongue)
Grooves and fissures on the dorsum of the tongue
Etiology:
 Developmental .
 Rarely it may associate with erythema migrans, melkersson Rosenthal
syndrome, Down syndrome and psoriasis.
Incidence:
 5% of the population.
Clinical Feature:
 Multiple fissures on the dorsum of the tongue
 Burning sensation
 Mostly a symptomatic, unless the furrows are deep and become irritated and
inflamed from food debris trapped in the crevices.

Differential Diagnosis:
 Sjogren’s syndrome, candidiasis.

Management:
 No specific treatment
 Encourage brushing the tongue, and use of effervescent mouth washes in order
to remove the food and debris entrapped.www.indiandentalacademy.com

Bald tongue (depapillated tongue)
Atrophy of filliform paillae
 congenital anomaly
Diminished pain and taste sensations.

Lingual thyroid

LINGUAL THYROID
Thyroid gland originates as a midline endothelial outgrowth at the junction of the
anteriors 2/3rd
and base of the tongue in the region of future foramen caecum. From
there, the thyroid tissue normally descends through the tongue and cervical tissues to
reach its final position in the region of larynx. When this migration fails persistent
thyroid tissue may be found in the tongue.
Clinical features:
 It generally appears as a firm midline mass in the region of foramen caecum.
Symptoms:
 Dysphagia, difficulty with speech, and a feeling of fullness in the throat.
Management:
 Radioactive iodine uptake scan can be used to diagnose.
 If mass is causing functional impairment partial or total excision and thyroid
hormone supplementation may be necessary.

THYROGLOSSAL DUCT CYST
Embryologically, as the thyroid gland descends from the
base of the tongue to its cervical location, it brings with it a
tract of epithelial tissue ( thyroglossal duct ) that normally
involutes by 10th
week of gestation. However, remnants may
remain giving rise to cyst formation in the base of the
tongue.
Symptoms:
 Asymptomatic unless they become very large or are
secondarily infected.

Dermoid cyst:
 Entrapment of epithelium during
development of tongue can give rise to cyst
formation.
 The lesion is usually located in body of the
tongue more anteriorly.

Lymphangioma:
Arise from a proliferation of lymphatic vessels and appear at birth.
 Superficial lesions are papillomatous in nature and may have
normal mucosal covering or a reddish to purple hue.
 Deeper lesions are diffuse and appear as grape like structured
covered by normal coloured mucosa.
Treatment:
 Unless lesion is causing functional problems, no treatment is
necessary.

Hemangioma
Etiology
 Congenital
 Vascular malformation
(in tongue )
Clinical Features
 The lingual vascular
malformation appears as
distinctly reddish, purplish or
bluish lesion.
Treatment
 Small lesions may require no
treatment but those causing
functional problems, and
causing profuse bleeding
require surgical treatmentwww.indiandentalacademy.com

Median Rhomboid Glossitis

Median Rhomboid Glossitis
Depapillated rhomboidal area in the dorsum of the tongue anterior to circumvallate
papillae.
Etiology:
Developmental
 Resulting from tuberculum impar failing to retract and then becoming trapped by
fusion of two lateral halves of the development tongue.
Incidence:
 Rare,
 Males are most commonly affected.
Clinical Features:
 Depapillated rhomboidal area anterior to sulcus terminalis.
 Flat or nodular.
 Red or reddish white in colour.
 Mostly a symptomatic.
Management:
 Antifungal drugs for several weeks
 Cryosurgery may be requiredwww.indiandentalacademy.com

Traumatic
Lesions
Traumatic Ulcer
Pyogenic
granuloma
Focal fibrous
Hyperplasia
Neuroma
(Traumatic Neuroma )
Thyroglossal
duct cyst

TRAUMATIC LESIONS
Traumatic ulcer:
 Irritation of lateral borders of tongue from sharp
areas on teeth or restorations can cause chronic
ulcers but patient is unaware.
 Lesion may resemble neoplasm and thus early
treatment is essential.
 If a local source of irritation can be identified and
removed, the lesion can be observed for a week to
see if healing occurs. If healing does not occur,
biopsy, is indicated for treatment.

PYOGENIC GRANULOMA:-
 Sometimes dorsal trauma appears to be hyper-response and
pyogenic granuloma forms.
 Lesion may be sessile or pedunculated.
 Surface can vary from smooth to irregular and lobulated.
 Often, there is central ulceration.
 Lesion is usually painless, but tends to bleed easily.
 Treatment consists of surgical excision.

Focal fibrous hyperplasia: ( Fibroma, irritation fibroma,
traumatic fibroma )
 Lesion develops on anterior and dorsal surface of tongue.
 It is raised, often pedunculated, smooth, non painful.
 Biopsy is indicated for diagnosis because lesion resembles other
serious lesions.
Neuroma ( Traumatic neuroma )
 This lesion represents a reactive hyperplasia caused by injury to a
nerve.
 Located on dorsal surface, appears a sessile nodule covered by smooth,
pink mucosa.
 Patient gives history of injury to the area.
 Treatment consists of surgical excision.

Mucous extravasations cyst
 These pseudocysts results from injury to an excretory duct
of a minor salivary gland leading to accumulation of
mucous in the adjacent connective tissue.
 In tongue they are associated with Blandin and Nuhn and
are located on ventral surface near the tip.

Infections
Herpes Simplex
Aphthous
Ulcers
Focal fibrous
Hyperplasia
Foliate papillitis )
Candidiasis

INFECTIONS
Herpes simplex infection:
 Primary herpetic gingivostomatitis is typically a childhood
disease characterized by formation of vesicles that rupture
and form generalized small, shallow, punctuate, yellowish
ulcers with an erythematous halo located on oral mucosa and
tongue.
 Treatment involves soft, bland diet, adequate fluid intake, an
antipyretic analgestic for pain and chlorhexidine mouth
rinses.

Aphthous ulcers:
( Recurrent aphthous stomatitis canker sores )
Etiology is unknown
It is of two types minor and major
Minor ulcers appear on ventral and lateral surfaces of tongue
Clinically they are shallow, whitish yellow based craters surrounded by
erythematous border.
Usually less than 10mm in diameter.
Lasts for 10-14 days
Major ulcers range from 5 to 20mm in diameter, develop on dorsum of the
tongue.
Treatment involves topical anesthetics, topical steroids, chlorhexidine rinses.

APHTHOUS ULCERS OF TONGUE

Folliate papillitis
 Folliate papillae becomes enlarged and slightly
painful and tender due to lymphoid tissue ( lingual
tonsil ) reaction to upper respiratory infection or due
to mechanical irritation.
 No treatment, other than use of chlorhexidine
mouthrinses, removal of any irritating factors.

Candidiasis

CANDIDIASIS ( MONILIASIS, THRUSH ):
Etiology:
 Opportunistic infection with candida mostly c. albicans,
 Xerostomia,
 Immune defects
Oral manifestations of candidiasis
Acute candidiasis usually seen in infants and young children.
Appears as creamy, white patches on dorsum of the tongue .

CHRONIC CANDIDIAS
is mostly commonly seen on the palate of the elderly edentulus patients,
appearing as bright red lesion with a velvety surface ( denture sore mouth.)
However chronic hyper plastic form can occur on tongue, appearing as
persistent, firm, white plaques located any where on the tongue called
CANDIDAL LEUKOPLAKIA
Management consists of treating the predisposing cause and using antifungal
drugs such as nystatin.

Neoplastic
Benign
tumors
Malignant
Tumors

TUMORS
 Benign tumors of epithelium, connective
tissue, muscle and nerve can all occur in
the tongue.
 Malignant tumors : about one third of oral
malignancies occur in the tongue.

BENIGN TUMORS
Papilloma- can be sessile or pedunculated pink to white color depending on degree of
epithelial keratinization.
Lipoma- located on borders of tongue . They are soft, sessile lesions that have
yellowish color.
Rhabdomyoma- very rare, when appear are asymptomatic Submucosal mass.
Leiomyoma – present as small, single or multiple, circumscribed lesions.
Neurilemmoma: Tongue may show multiple nodules or there may be a more diffuse
involvment causing unilateral macroglossia
Neurofibroma
Granular cell tumor:-Appear as painless, firm, Submucosal nodules with yellowish or
pinkish color treatment consists of conservative surgical removal.

Fibroma of tongue

SQUAMOUS CELL CARCINOMA

Malignant tumors:-
Squamous cell carcinoma
 Surface lesion on the tongue with a predilection for the lateral
borders.
 Lesion is initially painless, ulcerated appearance with rolled
borders around a necrotic center.
 If lesion does not show signs of healing within one week
biopsy should be performed.

Malignant salivary gland tumors
Common sites are ventral tip of tongue and posteriors part of
dorsum and base of the tongue.
Lesions begin as slow growing, asymptomatic, Submucosal
mass that may ulcerate in later stages.
Sarcoma of tongue extremely rare.
Metastatic tumors:
Most lingual metastases are located in base of the tongue.
Lesions are painful, when large cause dysphagia.
Treated palliative.

Idiopathic
Hairy Tongue
Geographic
Tongue
Glossodynia

GEOGRAPHIC TONGUE

Geographic Tongue
Erythema Migrans, Benign Migratory
Glossitis.

Red patches that changes in size and shape, which
resemble like a map so called geographic tongue.

Etiology:
Unknown,
It may associate with genetics, psoriasis, and reiter’s
syndrome, HIV infection.

Incidence:
1% to 3% of the population.
Females are affected more in 2:1 ratio.

Clinical Features:
Dorsal surface of the tongue mostly anterior two third of the tongue is
affected.
Atrophy of filliform papillae.
Irregular demarcated areas with red patches with yellow border.
Red areas that change in shape, size and spread or move to other areas with
in hours.
Soreness to acidic foods like tomatoes.
Sometimes same lesion may appear elsewhere on the oral mucosa.
Differential diagnosis:
Lichen planus, lupus erythematosus

Management:
No specific treatment.
Zinc 200 mg thrice daily for 3 months

BLACK HAIRY TONGUE

Hairy tongue
Black Hairy Tongue

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

Incidence:
 0.5% of adult,


Clinical Feature:
 Appears normally in midline just anterior to vallate papillae.
 The papillae are elongated, usually yellow or black in colour result of
pigmentation.
 Tongue will be thick and matted appearance.
 A symptomatic.
 Some time patient may complaints of bad taste and breath.

Management:
 Improve oral hygiene.
 Treatment for the etiology.
 Scrape or brush the tongue.
 Trim the hair with a scissors.
 Sodium bicarbonate and hydrogen peroxide mouthwash.
 Keratolytic agents like podophyllum can be use full sometimes.www.indiandentalacademy.com

WHITE HAIRY TONGUE

White coat over the tongue due to collection of
epithelial, food and microbial debris.

Etiology:
 Poor oral hygiene,
 Edentulous patients,
 Xerostomia,
 Soft non-abrasive diet.

Incidence: Common


Clinical Feature:
 Appears in the dorsal surface of the tongue, mostly in the anterior
two third of the tongue.
 White patches present in the tongue, which is scrapable.
 Mostly a symptomatic.
 Some patient may complaints of bad taste and breath

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

Related to
Systemic diseases
Syphilis
T.B.
AIDS
Scarlet fever

LINGUAL CHANGES ASSOCIATED
WITH SYSTEMIC DISEASES.
CONDITIONS CAN BE DIVIDED INTO
 SYSTEMIC INFECTIONS
 BLOOD DYSCRASIAS
 METABOLIC DISORDERS
 IMMUNOLOGIC DISORDERS

SYSTEMIC INFECTIONS
Syphilis:-
Tongue can be involved in any of three stages of this disease.
In primary stage, lingual chances is solitary, painless, slightly
raised, well demarcated ulcers, and generally heals within 3-12
weeks.
In second stage, mucous patches are slightly raised, grayish
white and surrounded by red halo.
In tertiary stage, tongue may undergo chronic interstitial changes
characterized by atrophy of papillae and a bald appearance. This
is called as syphilitic leukoplakia which has a tendency to
undergo malignant transformation.

Tuberculosis:
The most common site of oral TB is the dorsum of the tongue
TB ulcer is painful, has irregular outline and indurated borders and is
covered with yellowish gray, fibrinous layer.
AIDS:
Lingual manifestations of AIDS are
Herpes infection
Candidiasis
Aphthous ulcers
Kaposis sarcoma
Hairy leukoplakia
Lesions are well demarcated unilateral or bilateral, corrugated, white areas on
lateral borders of the tongue.
Management is treatment for etiology, antiviral drugs.

SCARLET FEVER :( SCARLATINA )
 Predominantly in children
 Caused by group A
streptococcal infection
 Lesions on tongue have
heavy gray white coating,
enlargement of fungi form
papillae which appear as
multiple red dots
( STRAWBERRY
TONGUE ).
 Later the coating is lost
giving the tongue beefy red
appearance.

BLOOD DYSCRASIAS
ANEMIA: IRON deficiency anemia
Predominantly affects women
Tongue becomes red, painful, smooth
Atrophy of papillae all over the tongue
PERNICIOUS ANEMIA:
Tongue becomes fiery red, because of papillary atrophy, and
lobulated.
Pain and burning sensation are present and later disturbance in
taste.
LEUKEMIA:
In later stages, superficial ulcerations of tongue are seen.

METABOLIC DISEASES:
Diabetes mellitus:
 Feeling of burning and dryness of tongue
 Central lingual papillary atrophy may occur
Hypothyroidism:
 Dry mouth
 Macroglossia caused by infiltration of the tongue with mucoproteins and
muco polysaccharides.
Acromegaly:
 Macroglossia: due to increase in size of muscle fibres and hyperplasia of
epithelium and connective tissue.www.indiandentalacademy.com

Vitamin B deficiency:
 Tip and margins of tongue become red and swollen.
 Papillae are lost is advance cases
Amyloidosis: ( Accumulation of fibrillar protein )
 Enlarged tongue leads to decreased lingual mobility due to
infiltration of amyloid.
 This gives rise to difficulty in chewing, swallowing and
speaking.
 Yellowish modules may also be present along the lateral
borders of the tongue.

IMMUNOLOGIC DISORDERS
PEMPHIGUS
Lesions on tongue, take form of bullae, which rupture after
formation to produce ulcers ( PEMPHIGUS VULGARIS)
ERYTHEMA MULTIFORME:-
Lesions appear as small, erythematous plaque then become a
vesicle, which rupture and become shallow erosions.
LICHEN PLANUS:
Early lichen planus appear as depapillated areas with an irregular,
whitish border located on the dorsum.
Treatment:
Topical cortico steroid, good oral hygiene and stopping smoking.

TONGUE PIERCING
Studs, hoops or barbell shaped ring that are hooked in the
tongue

Types:
 Multiple center-tongue piercing
 Off-center tongue piercing
 Large gauge tongue piercing
 Center tongue piercing
 Horizontal tongue piercing
 Vertical tongue piercing

Materials used:
 Bar or large needle used to pierce the tongue
 Gold, silver, metal or plastic are material used to prepare the
jewellary hooked in the tongue.www.indiandentalacademy.com

CENTRIC AND DOUBLE
TONGUE PIERCING

MULTIPLE AND HORIZONTAL
TONGUE PIERCING

VERTICAL TONGUE PIERCING

Complication:
 Post-placement swelling
 HIV and hepatitis infection
 Oral hygiene problems

Management:
 Avoid piercing
If pierced

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

GUM DISEASES DUE TO
TONGUE PIERCING

References:
1. Chaurasia B.D., Human Anatomy, 2rx1 Ed, 1991, India,
Pg.,130,167,180, 211-214, 313.-314.
2. Gray H, Gray’s Anatomy, 37111 Ed, 1989, London.
3. Singh I, Textbook of Anatomy with Colour Atlas, 21x1 Ed, 1998,
India, Pg. 838, 1001.
4. Grant J.C.B., Grant’s Atlas of Anatomy, 10th Ed, U.S.A, Pg. 681
5. Orban’s oral histology
6. Tencate’s oral histology
7. Oral medicine by burket

References:
8. Laskin D.M. Differential diagnosis of tongue lesions. Quintessence
International, 2003; 34: 331-342.
9. Oral pathology by shafers
10. www.worldmedicallibrary.com
11. www.pubmed.com

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