Tongue and systemic diseases
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Tongue and systemic diseases
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Tongue and systemic diseases
- 1. Chairperson – Dr. GAYATRI B H Student – Dr. SUMANT BALGANDI
- 2. INTRODUCTION The tongue is a complex set of sensory papillae and muscles. 3 forms of taste buds: • Fungiform (edges and tip) • Circumvallate (posteriorly in V shape ) • Foliate papillae (posterolateral) The filiform papillae - devoid of sensory fibers and are not true taste buds.
- 4. APPEARANCE AND COLOUR SURFACE SIZE ULCERS MOVEMENTS OF TONGUE DEVELOPMENTAL ANOMALIES MISCELLANEOUS CONDITIONS
- 6. Dry tongue
- 7. • Prolonged fever • Dehydration • Mouth breathing • Belladona or atropine effect • Anxiety state • Sjogrens syndrome-Bone dry tongue • Sarcoidosis
- 8. Excessive moist tongue(sialorrhea) Organophosphorous poisoning Post encephalitic parkinsonism Drugs-pilocarpine,clozapine Heavy metals-mercury,copper,arsenic GERD Rabies
- 9. BALD TONGUE Iron deficiency anemia B12 deficiency Folate deficiency Riboflavin deficiency Pellagra Tropical sprue Syphilis-sclerosing glossitis
- 10. SCARLET RED TONGUE Niacin deficiency Irritants – sodium or potassium hydroxide Acute infections like scarlet fever
- 12. MAGENTA COLOUR TONGUE Riboflavin deficiency BLUE TONGUE Central Cyanosis Methhemoglobinemia sulphemoglobinemia YELLOW TONGUE Jaundice Irritants- nitric or hydrochloric acid
- 13. WHITE TONGUE Centrally coating Leukoplakia Irritant substances-mercuric bichloride,carbolic acid,sulphuric acid BROWN TONGUE • Uremia • Acute liver necrosis • PURPLE TONGUE • polycythemia
- 14. EXCESSIVE COATED TONGUE(FURRED TONGUE) Mouth breathing Tobacco consumption Acute exanthematous fever Cirrhosis liver CENTRAL FURRING Enteric fever
- 15. BLACK TONGUE Iron supplements Bismuth Charcoal Liquorice actinomycosis Antibiotics like penicillin
- 17. BLUE TONGUE
- 18. HAIRY TONGUE(lingua villosa) • Also called as furred tongue • Defective desquamation of the filiform papillae leading to the retention hyperkeratosis.
- 19. HAIRY TONGUE • Poor oral hygiene • Smokers • Mouth breathers low fiber diets • Febrile patients. • HIV infection • Radiation treatment to head and neck • Graft-versus host disease • Drugs - most common being antibiotics-tetracyclines atypical antipsychotics antidepressants anti-cholinergics.
- 20. BLACK HAIRY TONGUE • Black hairy tongue seen as the complication of hairy tongue • Occurs when bacteria are trapped in the filiform papillae and produce pigments causing a brown/black colour. • The presence of other microbes such as candida, can exacerbate this condition.
- 22. Pseudo black hairy tongue - bismuth salicylate
- 23. DD of Hairy tongue • Pseudo-hairy black tongue, • Oral hairy leukoplakia • Premalignant leukoplakia • Squamous cell carcinoma • Acanthosis nigricans • Hypertrophic herpes simplex virus infections
- 24. Workup for hairy tongue • Unless there are stigmata of underlying disease or symptoms, such as pain, no additional workup is needed. • In refractory or atypical cases, a biopsy and cultures or PCR for bacteria, fungus, and HSV may be warranted.
- 25. TREATMENT OF HAIRY TONGUE • Regular brushing of the tongue using 1.5% hydrogen peroxide (5 to 10 strokes daily) with a hard toothbrush. • Topical retinoids, antifungals, and keratolytics. • Oral therapy with antifungals, antibiotics and antivirals for refractory cases with positive cultures.
- 26. STRAWBERRY TONGUE Hypertrophy of fungiform papillae and then desquamation Papillae appear as large red knobs giving the appearance of stawberry tongue(rasberry tongue) Seen in Scarlet fever Toxic shock syndrome Kawasaki disease
- 28. Scarlet fever
- 29. LEUKOPLAKIA • It is a white patch in the mucosa of oral cavity that cannot be characterised clinically or pathologically to any other diseases. • It is a premalignant condition • Dysplasia and of dyskeratosis leading to formation of thick , white and pearly raised plaques giving whitish appearance of part of tongue. • Predisposing factors Spices, betel nut chewing Smoking, tobacco chewing Infective or mechanical (dental irritation)
- 30. Leukoplakia
- 31. Erythroplakia
- 32. ORAL HAIRY LEUKOPLAKIA • Seen on lateral margins of tongue as several white areas • Cannot be wiped off with gauze. • Immuno-compromised patients-AIDS • Associated with Epstein Barr virus
- 34. • It is painless • Has no malignant potential. • First line topical treatment includes topical retinoids, podophyllin, and acyclovir • The underlying HIV infection should be treated or the immunosuppressed states should be modified.
- 35. PIGMENTATION OF TONGUE Dark brown or black patches on tongue 1. Addisons 2. Nelsons syndrome 3. Peutz jeghers 4. Malabsorption 5. Acanthosis nigricans
- 36. YELLOWISH WHITE PATCHES Leucoplakia xanthelasma
- 39. Fissured Tongue(scrotal tongue) • A normal variant seen in up to 20% to 30% of the population • Characterized by an increased number of fissures and grooves at the central and lateral aspects of the tongue. • Very severe fissuring is often referred to as “lingua plicata.”
- 40. Fissured tongue Down’s syndrome Acromegaly Melkersson-Rosenthal syndrome Pernicious anemia Pachyonychia congenita Cowden’s syndrome Idiopathic
- 41. Fissured tongue
- 42. • Treatment • Good oral hygiene with brushing deep into the fissures in order to remove debris, lessen the microbial burden, and reduce halitosis. • If pain is present- therapy should be targeted at reducing inflammation or eradication of the infection.
- 43. COBBLESTONE TONGUE Due to hyperemic and hypertrophied papillae with thickened epithelium • Ariboflavinosis(with magenta colour) • Syphilis CROCODILE SKIN TONGUE • In Sjogren’s syndrome, there is dorsal papillary atrophy & furring of the tongue
- 45. SMOKER’S PATCH • Small, raised, smooth, congested area frequently covered with a crust on the dorsum of tongue • White umbilicated papules with a central brown spot on palatal mucosa LEPROTIC NODULES • May develop on anterior 2/3rd of tongue especially near tip
- 46. CORLIN SIGN- Ehler danlos syndrome
- 47. Benign Migratory Glossitis • = GEOGRAPHIC TONGUE. • Benign, inflammatory condition • Prevalence-1 to 2% of the population ,more common in young patients. • Etiology-rapid loss and regrowth of filiform papillae leading to denuded red patches wandering across the tongue surface. • It is more common in Psoriasis(14%), and some argue that it is an oral manifestation of psoriasis
- 48. It is characterized by an annular arrangement of alternating raised, hyper keratotic plaques and smooth, atrophic red patches. Red- atrophic filiform papillae White-hypertophic filiform papillae Dynamic and change over time creating a “migratory pattern”
- 50. Treatment of geographic tongue • Generally no treatment required. • If burning pain or sensitivity to foods present -topical corticosteroids as well as topical calcineurin inhibitors.
- 51. MEDIAN RHOMBOID GLOSSITIS • Red depapillated area in the centre of dorsum of tongue • Believed to be associated with candidiasis and a marker of underlying immunosuppression. • Biopsy may show pseudo-epitheliomatous hyperplasia • Responds to antifungal treatment
- 53. Oral candidiasis Creamy white curdlike patches that reveal a raw, bleeding surface when scraped. • Debilitated elderly patients • High-dose glucocorticoids, broad-spectrum antibiotics • Patients with AIDS
- 54. Candidiasis
- 56. MACROGLOSSIA • Acromegaly • Hypothyroidism • Cretinism • Down’s syndrome • Hurler’s syndrome • Mucopolysaccharidosis • Beckwith–Wiedemann syndrome • Amyloidosis • Glycogen storage disease • Angio edema • Acute inflammation of tongue/abscess • Haemangioma,lymphangioma
- 57. Macroglossia
- 58. MICROGLOSSIA • Starvation • Atrophic glossitis • Motor neuron disease • Pseudobulbar palsy • Cerebral diplegia
- 59. Microglossia
- 61. SINGLE ULCER • Carcinomatous • TB • Syphilitic • Ill fitted dentures • Aphthous ulcer
- 62. CARCINOMATOUS ULCER • Usually single • Common on side or tip of tongue • Hard, indurated • Irregular ,deep, raised everted margins • Associated with slough • Impaired mobility of tongue • Regional lymphnode enlargement
- 64. TUBERCULOUS ULCER • Usually at or near tip • Painful • Small with a granulated base • Thin undermined edges
- 65. MULTIPLE ULCERS • Dyspepsia • Ulcerative stomatitis • Secondary syphilis • Herpes • Chickenpox • Eczema • Vit B complex deficiency
- 66. Multiple ulcers
- 67. RECURRENT ULCERS • Aphthous ulcer • Lichen planus, pemphigus, eythema multiforme • SLE • Behcet’s syndrome (mouth ulcers, genital ulcers, uveitis)
- 69. TREMOR • Parkisonson disease • Delirium tremens • Thyrotoxicosis • Anxiety neurosis
- 70. LIZARD TONGUE(Jack-in-box tongue) • chorea CHEWING TONGUE • Athetosis FASCICULATION • Motor neuron diseases • Syringobulbia
- 71. DEVIATED TONGUE • Involvement of hypoglossal nerve • Malignant infiltration of the tongue • Scarification after burns • Severe ulceration
- 72. Deviated tongue
- 74. • TONGUE TIE(ANKYLOGLOSSIA) • Pierre Roboin syndrome • Oral facial digital syndrome • Meckel syndrome • Patau syndrome • Beckwith widerman syndrome
- 75. BIFID OR TRIFID TONGUE • Orofacialdigital syndrome • Klippel feil anomaly • AGLOSSIA • Pierre robin syndrome • Moebius syndrome • Aglossia adactyly syndrome
- 76. Aglossia
- 77. Bifid tongue
- 78. Tongue tie
- 79. MISCELLANEOUS CONDITIONS AMYLOID TONGUE • Appears enlarged & presents as mottling of dark purple areas with translucent matter MUCOSAL NEUROMA OF TONGUE MEN II b syndrome ALLIGATOR TONGUE • Dry, thick, furrowed & irregular tongue • Seen in Diabetes mellitus CAVIAR TONGUE • Varicosities of the sublingual veins on the under surface of the tongue • Seen in Cirrhosis liver, Superior vena cava syndrome
- 80. Caviar tongue
- 81. REFRENCES • A text book of symptoms and physical diagnosis. ASPI F GOLWALLA - 5TH Edition • HARRISON’S Principles of Internal Medicine - 20th edition • DAVIDSON principles and practice of medicine - 23rd edition • Manual of Practical medicine by R.Alagappan 4th edition • SRB’s manual of surgery 4th edition • Mangold Aaron R., Torgerson Rochelle R., Rogers Roy S., Diseases of the Tongue, Clinics in Dermatology (2016) • Internet
Editor's Notes
- Normal papillae are 1 mm in length; however, in HT there is defective desquamation of cells in the central column of the filiform papillae, causing an increase in length 10 to 20 times normal