Introduction:
Tongue is a muscular organ associated with the functions of deglutition, taste, and speech. It acts as an easily accessible organ for the assessment of an individual's health and shows the state of the body's hydration. It is said that the tongue is the mirror of the gastrointestinal system, and any abnormal functioning of the stomach and intestines will be reflected on the tongue.
Certain diseases cause specific changes in the tongue. This is why examining the tongue is crucial and can provide valuable clues for diagnosis. All doctors examine the tongue, and they consider the changes in size, shape, color, moisture,coating,nature of papillae, movements, et cetera.
The appearance of the tongue in certain abnormal conditions can be observed.
1) Movements of the tongue:
a) In one-sided paralysis of the body (hemiplegia), tongue moves towards the parylized side when protruded.
b) Diseases such as thyrotoxicosis, delirium tremens, and parkinsonisum cause the tongue to move tremulously. Nervous patients also exhibit tremor.
c) In progressive bulbar palsy, there will be wasting and paralysis of the tongue with fibrillation. The tongue eventually shrivels and becomes functionless on the floor of the mouth. This condition is associated with dribbling saliva and loss of speech.
d) In chorea (involuntary rhythmic movements), the patient may not be able to keep the protruded tongue in rest; it will be moving involuntarily.
2) Moistness of the tongue:
The tongue's moisture level provides some insight into the body's level of hydration. Water volume depletion leads to peripheral circulatory failure characterized by weakness, thirst, restlessness,anorexia,nausea,vomiting ,dry and parched tongue.
The following conditions result in tongue dryness:
a) Diarrhoea
b) Later stages of severe illness
c) Advanced uraemia.
d) Hypovolumic shock
e) Heat exhaustion.
f) Hyponatraemia
g) Acute intestinal obstruction
h) Starvation
i) Prlonged fasting.
3) Change in color of tongue:
a) Central cyanosis:
Cyanosis is the bluish discoloration of the mucus membrane due to a decrease in the amount of oxygen in the blood. Heart failure, respiratory failure, and anoxia can cause this condition. In cyanosis, the tongue, lips, etc. become pale blue.
b) Jaundice:-
The yellowish discoloration of all mucous surfaces of the body, including the tongue, is caused by an increase in bilirubin in the blood. Jaundice is seen in hepatitis, bile duct obstruction, increased destruction of RBCs, et cetera.
c) Advanced uremia:
This is caused by an increase in urea and other nitrogenous waste products in the blood, which is a result of kidney failure. Here the tongue becomes brown in color.
d) Keto acidosis:
This acidosis, characterized by the accumulation of ketone bodies, is primarily observed in individuals with diabetes mellitus. Here the tongue becomes brown with a typical ketone smell from the mouth.
e) Riboflavin deficiency:
Deficiency of this vitamin (vitamin B2) produces megenta color of the tongue with soreness and fissures of lips.
f) Niacin deficiency:
Deficiency of niacin (vitamin B3) and some other B-complex vitamins results in a bright scarlet or beefy red tongue.
g) Anaemia:-
It is the decrease in hemoglobin percentage of the blood. In severe anemia, the tongue becomes pale.
4) Coating on the tongue:
a) Bad breath:
The main cause of bad breath is the formation of a pasty coating (biofilm) on the tongue, which lodges thousands of anaerobic bacteria, resulting in the production of offensive gases. People who complain about bad breath may have a thick coating on the posterior part of their tongue.
b) Typhoid fever:
In typhoid fever, the tongue becomes white-coated like a fur.
c) Candidiasis;-
It is a fungal infection that affects the mucous surfaces of the body. On the tongue there will be sloughing white lesions.
d) In diabetes and hypoadrenalism, there will be sloughing white lesions.
e) Secondary Syphilis:
Syphilis is a sexually transmitted disease caused by trepenoma pallidum infection. In the secondary stage of this disease, we can see mucous patches that are painless, smooth white glystening opalescent plaques that cannot be scraped off easily.
f) Leokoplakia:-
The tongue and oral cavity display white keratotic patches. This is a precancerous condition.
g) AIDS:-
These patients exhibit hairy leukoplakia.
h) Peritonitis:-
It is the inflammation of the peritonium (the inner covering of the abdominal cavity, which also covers the intestines and keeps them in position). In this condition, there is white furring of the tongue.
i) Acute illness:
Furring is also seen in some acute diseases.
5) Papillae:-
These are tiny projections on the tongue that are connected to taste. There are different types of papillae on the healthy tongue. In some diseases there are some abnormal changes that are following.
a) Hairy tongue:
This condition is due to the elongation of filiform papillae, seen in poor oral hygiene, general debility, and indigestion.
b) Geographic tongue:
The tongue develops irregular red and white patches. These lesions look like a geographic map. The exact cause is not known.
c) Median rhomboid glossitis:
In this condition, there is a smooth nodular red area in the posterior midline of the tongue. This is a congenital condition.
d) nutritional deficiency:
In nutrional deficiency, there is glossitis (inflammation of the tongue), leading to papillary hypertrophy followed by atrophy.
e) Benign migratory glossitis:
It is an inflamatory condition of the tongue where multiple annular areas of desquamation of papillae appear on the tongue, which shift from area to area in a few days.
f) Thiamine and riboflavin deficiency:
Deficiency of these vitamins causes hypertrophied filiform and fungiform papillae.
g) Niacin and iron deficiency:
In this condition, there is an atrophy of papillae. Smooth tongue is encountered in iron deficiency.
h) Vitamin A deficiency:
This causes a furrowed tongue.
i) In nutritional megaloblastic anemia, the tongue becomes smooth.
j) Folic acid deficiency:
Here macrocytic megaloblastic anemia with glossitis is seen.
k) Cyanocoblamine deficiency:
Here glossitis with macrocytic megaloblastic anemia and peripheral neuropathy is encountered.
l) Scarlet fever;
In this streptococcal infection, there are bright red papillae standing out of a thick white fur; later,later the white coat disappears, leaving enlarged papillae on the bright red surface. This is called strawberry tongue.
6) Ulcers on the tongue:
a) Apthous ulcer:
These are round painful ulcers that appear in stressed individuals frequently. May be associated with food allergies. Usual sites are tongue, lips,oral mucosa, et cetera.
b) Herpes simplex:
It is an acute vesicular eruption produced by the herpes simplex virus. When these vesicles rupture, it forms ulcers.
c) Ulcer in cancer:
Cancerous ulcers have everted edges with a hard base. Bleeding is also seen. Cancer of the tongue is common in tobacco chewers.
d) Syphilitic ulcers:
Syphilitic fissures are longitudinal in direction. In primary syphilis, extra genital chancre is seen on the tongue. In secondary syphilis, multiple shallow ulcers are seen on the undersurface and sides of the tongue. In tertiary syphilis gumma may be seen on the midline of the dorsum of the tongue.
e) Dental ulcers:
These ulcers are produced by the sharp edges of carious teeth.
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