TONGUE

4 main types of papillae : 1. Circumvallate papillae - 8 - 12 in number - posterior dorsum of the tongue - do not participate in atrophic tongue change - a large propotion of the taste buds

 2. The foliate papillae

- along the lateral margin of posterior part - do not participate in atrophic changes - some taste perception 3. The fungiform papillae - entire dorsal surface - more near the tip & lateral margin

- participate in atrophic change - contain most of the taste buds 4. The filliform papillae - most numerous papillae of the tongue - distributed over the dorsal surface - atrophic changes are indicator of disturbances in intracellular oxidation process

The Sore Tongue

1. Ulcers (of any type ) 2. Glossitis (red and sore tongue ) 3. The sore , physically normal tongue 4. Geographical Tongue (erythema migrans)

Ulceration of the tongue

Various type of stomatitis such as - herpes simplex - lichen planus - etc Also be the site of solitary ulcers particularly - carcinoma ! ! ! ! ! !

Glossitis

Term used for the red, smooth, sore tongue Particularly characteristic of anaemia Combination of signs (redness, smoothness) and symptom (soreness) not always associated sore without visible changes smooth but asymptomatic Important causes of glossitis : Anaemia Vitamin B group ( especially B 12 ) def. Candidosis

Glossitis
Iron def & pernicious the main cause Women >>> Detail haematologic examination is essential Treatment quickly relieves symptoms

Glossitis

Glossitis + angular st. riboflavin deficiency sometime + nicotinic acid deficiency ( rare)

Glossitis

Candidosis can cause red, sore, oedematous typical of acute antibiotic stomatitis Often associated with angular stomatitis

Glossitis

Lichen Planus can produce a smooth tongue due to atrophy of papillae no soreness no erythema bluish white sheen other sign of LP

The sore, physically normal tongue

Most difficult problems Psychogenic Haematologic deficienc.

Lesion of the tongue

1. Developmental anomalies 2. Benign migratory glossitis (BMG) 3. Black Hairy tongue 4. Glossodynia & glossopyrosis 5. Changes in tongue coating 6. Identation marking 7. Traumatic injuries

1.Developmental anomalies

1. Ankyloglossia - a shortened lingual frenulum - cause of speech impairment - if severe ----- surgical

 2.

Bifid tongue

- incomplete fusion of halves relate - rare - clinical curiosity

3. Scrotal tongue=fissured t. - commonest development anomalies - the length, depth and number is increased - inflammation occurs in the fissure

 4.

Median Rhom boid Glossitis - erythematous lesion

in the center of the posterior dorsum of the tongue

- red, atrophy of filiform ,

oval, lobulated - etiology is not clarified - biopsies:candida >85%

Smokers , denture wearers , inhalation steroid increased risk Asymptomatis No risk for malignancy Management : - reduction in predisposing factors

5. Macroglossia - true : creatinism mongolism - may arise from limphangiomatous & hemangiomatous process - radiation-surgery

2.Benign Migratory Glossitis (BMG)

= Geographic tongue = Erythema migrans

etiologi : unknown Localized area of filiform p. are lost erythematous area No age (most middle-age) or sex predilection Appear suddenly, remaining for 1-2 weeks, disappearing, arising in another region of the tongue Appears to be an association with psoriasis

BMG
Usually multiple, wide variation from patient to patient, from day to day in the same patient Asymptomatic, some complain of soreness haematologic deficiency ??

a burning for spicy or acidic food

BMG

50% have a fissured tongue Characterized by period of exacerbation and remition with different duration over time A negative relationship with smoking

Etiologi

-Unknown -Heredity? Genetic factors Epidemiology -prevalence 1 to 2,5% -Equal gender distribution Diagnosis : -clinical futures : characteristic -biopsy is rarely needed

Irregular outline, nonindurated pink to red macular spot margin are well defined, slightly raised, yellow no treatment, self limiting symptoms? Topical anaesthetics

Histophatology

If biopsy is considered, involve the peripherial zone to capture the lesions typical These include parakeratosis, acanthosis, subepithelial inflamation of T lymphocytes, and transepithelial migrating neutrophilic granulocytes.

3.Black Hairy Tongue = Lingua Nigra

growth of a blck pigment producing fungus

True BHT : elonga

tion of filiform p.

Pseudo BHT : dis coloration from fruits, candy, drugs

Etiology

Unknown Predisposing : - neglecting OH - antibiotics, immunosuppressive drugs - oral candidiasis - oral inactivity - radiation

Glossodynia - glossopyrosis

Oral burning that has no detectable cause Do not follow anatomic pathways, no mucosal lesion , neurologic or systemic disorders Most dificult problem Psychogenic disease Soreness psychogenic burning mouth syndrome

1. Associated with clinical change

Less than 25% local or systemic causation or combination local irritation : tongue habits, allergy prosthetic/orthodontic appliances systemic disordes : vit Bc deficiency uncontrolled diabetes pernicious anemia Fe-deficiency anemia

General change in color & papillary atrophy ----- systemic factors

-pernicious

anaemia : tip & lateral margins have bright, red color , painful -Vit Bc def. : exten sive generalized atrophy, raw red or purplish-red color

 -uncontrolled

diabetes : red color, burning -Fe def. : general atrophy of papillary coating, burning

2. Without observable clinical change

-

larger group, between 4th - 7th decade - predominantly postmenopausal women - insomnia - psychologic stress

5. Changes in tongue coating

The

filliform & fungiform papillae with food debris, desquamated epithelial cells, bacteri and saliva comprise the coating tongue The amount of tongue coating varies in different individuals and during different period of the day.

1. Atrophy in tongue coating

atrophy

of the filliform and fungiform

papillae deficiency of oxidase enzym systems iron deficiency, nutritional dificiency

2.

Increase in tongue coating local or general condition

 Febrile

illness, soft or liquid diet, poor O.H, deminished salivary flow due to fever and general body dehidration. Result halitosis

6. Identation Marking
Along

the margin of the tongue associated with systemic diseases any inflamatory process-----enlargement of the tongue macroglossia vit. Bc hyponutrition, uncontrolled diabetes, myxedema