Oral Medicine Lecture from my NOTES

1. TONGUE DISORDERS
SARANG SURESH HOTCHANDANI

2. INTRODUCTION
• In generalized stomatis, tongue can also be
affected…
• Examples
• Generalized stomatitis in Herpes
• Tongue can also shows signs or lesions for indication
of other systemic diseases.
• Examples
• Hairy leukoplakia in AIDS
• Anemia

3. CLASSIFICATION OF TONGUE DISORDERS
DEVELOPMENTAL
Microglossia
Ankyloglossia
Cleft tongue
Fissured tongue
Median rhomboid glossitis
Benign migratory glossitis
Hairy tongue
ACQUIRED

4. SORE TONGUE
• Sore = tender to touch, painful, inflamed, sensitive.
• CAUSES
• Ulcers of tongue due to any cause
• Glossitis
• Sore tongue but physically normal tongue
• Geographic tongue
• Etc……….

5. ULCERATION OF TONGUE
• CAUSES
• Apthous ulcers
• Herpes stomatitis
• Lichen planus
• Carcinoma
• Mostly lateral border of tongue is affected with ulcer.
• If ulcer is on dorsum of tongue then don’t consider
carcinoma at first because carcinoma on dorsum of tongue
is rare.

6. GLOSSITIS
•It is a term used
for;
•Red
•Smooth
•Sore tongue
•CAUSES
• Anemia
• Iron deficiency anemia
• Pernicious anemia
• Vitamin deficiency
• Candidiasis
• Antibiotic use

7. CLINICAL FEATURES
• WOMEN are more frequently affected in
glossitis due to anemia
• Tongue appears SMOOTH, RED & SORE.
• Smoothness of tongue is due to ATROPHY
OF FILIFORM PAPILLA

8. VITAMIN DEFICIENCY
• In RIBOFLAVIN DEFICIENCY and sometimes
NICOTINIC ACID DEFICIENCY GLOSSITIS can occur
along with ANGULAR STOMATITIS.
• However diagnosis of glossitis in an healthy patient can not
be made on basis of cause of vitamin deficiency alone.
• Although vitamin B group drugs are given for relieve of
soreness in glossitis but these are frequently ineffective and
this thing make it clear that VITAMIN DEFICIENCY
ALONE IS NOT CAUSE OF GLOSSITIS

9. CANDIDIASIS (FUNGAL INFECTION)
• Candidiasis causes tongue to be RED, SORE AND EDEMATOUS
• Cause of this fungal infection is ANTIBIOTICS which causes ANTIBIOTIC
STOMATITIS along with ANGULAR STOMATITIS.
• Acute antibiotic induced stomatitis occurs due to LONG TERM USE of broad
spectrum antibiotics
• Example; Tetracycline

10. •In SJOGREN
SYNDROME,
tongue becomes;
•Red
•Cobblestone
appearance
LICHEN PLANUS
• SMOOTH TONGUE due to atrophy of tongue papilla
• SORENESS
• NO ERYTHEMA
• BLUISH WHITE SHINING
on tongue

11. SORE BUT
PHYSICALLY NORMAL TONGUE
• This title means there is
soreness but no other
lesion or pathology is
visible on tongue.
• This type of soreness
creates difficulty in
diagnosis
• This type of condition is
mostly PSYCHOGENIC
and is sometime called
BURNING MOUTH
SYNDROME which is type
of ATYPICAL FACIAL PAIN.
• Diagnosis is by EXCLUSION
OF ORGANIC DISEASE

13. INTRODUCTION
• It is common BENIGN CONDITION mostly affecting
DORSAL SURFACE OF TONGUE.
• Characterized by RECURRENT APPEARANCE &
DISAPPEARANCE OF RED AREAS ON
TONGUE

14. ETIOLOGY
•Cause is UNKNOWN but
sometimes there is FAMILY HISTORY
•Sometimes due to PSORIASIS.

15. CLINICAL FEATURES….
• Lesion appears IrREguLaR, SmoothRED AREA with SHARPLY
DEFINED MARGINS.
• RED AREA is due to shortening of FILIFORM PAPILLA
• These lesions increase for few days and then disappear and then reappear in
another area.
• Sometimes the lesion is ANULAR with slightly raised pale margins and then after
sometimes these rings join to form a scalloped pattern.
• Mostly ASYMPTOMATIC but some patients complain of soreness.

16. • Sometimes children with geographic
tongue complain that TONGUE IS
HYPERSENSITIVE and this
hypersensitivity prevents them from
eating their food.
• The reason for this is that some areas of
tongue have normal epithelium while at
some areas these is inflamed
epithelium.

17. HISTOLOGICAL FEATURES
• Thinning Of Epithelium At Center Of Lesion
• HYPERPLASIA & HYPERKERATOSIS AT
PERIPHERY
• Chronic inflammatory cells in
underlying connective tissue
• Loss Of Filiform Papillae At The Center Of Ring.

18. DIFFERENTIAL DIAGNOSIS
Chemical Burn
Candidiasis
Squamous Cell Carcinoma
Psoriasis
Lichen Planus
Contact Stomatis

19. TREATMENT
• As the lesion is benign and asymptomatic, usually there is no
treatment required.
• However studies showed successful treatment with following drugs.
• Cyclosporine
• Topical and systemic antihistamine
• Topical retinoid
• Topical corticosteroids
• Mouth rinses
• Zinc supplements

20. Hairy
Tongue
Black
Hairy
Tongue
Lingua
Villus
Nigra

21. INTRODUCTION
•It is commonly observed condition
characterized by ABNORMAL
COATING on DORSAL SURFACE
of tongue, due to DEFECTIVE
DESQUAMATION of FILLIFORM
PAPILLA.

22. ETIOLOGY CUM
PREDISPOSING FACTORS

23. PATHOLOGY

24. • Lesion is mostly on DORSUM OF TONGUE.
• Mostly Adults Males.
• Mostly ASYMPTOMATIC but sometimes
Burning During Swallowing
•HALITOSIS and GAGGING SENSATION
because of retention of debris in between
filiform papilla.

25. Brushing tongue
with Tongue
Scrapper.

26. MEDIAN RHOMBOID GLOSSITIS
• It is abnormality in the MIDLINE OF TONGUE at the
junction of anterior 2/3 with posterior 1/3 characterized by
RHOMBOID SHAPED SMOOTH ERYTHEMATOUS AREA
LACKING LINGUAL PAPILLA AND TASTE BUDS.
• It is thought to be developmental but is not seen in children.
• Erythematous appearance is due to absence of filiform
papilla.
• This lesion of MRG is susceptible to candida infection.
• Normally median rhomboid glossitis lesion is pink in color
but sometime due to fungal infection its surface can appear
white.

27. CLINICAL FEATURES
•Mostly in ADULTS and is
ASYMPTOMATIC.
•Appear as NODULAR, RED or PINK
area of depapillation
•Usually flat or slightly elevated.

28. DIFFERENTIAL DIAGNOSIS

29. MANAGEMENT
No treatment necessary..
Antifungal drugs if candidiasis…
Palliative…

30. MACROGLOSSIA

34. • Hypothyroidism
• Cretinism
• Diabetes
Metabolic
Systemic……. ACROMEGALY