Introduction:
The tongue is a muscular
organ associated with the function of deglutition, taste and speech. It acts as
an easily accessible organ for the assessment of the health of an individual
and shows the state of hydration of the body. 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.
Some characteristic
changes occur in the tongue in some particular diseases. That is why the
examination of the tongue is very essential and will give some clues for
diagnosis. All doctors examine the tongue and they consider the changes in
size, shape, colour, moisture, coating, nature of papillae and movements etc.
The appearance of tongue in
some abnormal conditions:-
1) Movements of the
tongue:-
a) In one-sided
paralysis of the body(hemiplegia)tongue moves towards the paralysed side when
protruded.
b) Tremulous movement of
the tongue is seen in diseases like thyrotoxicosis, delirium tremens and
parkinsonism. Tremor is also seen in nervous patients.
c) In progressive bulbar
palsy, there will be wasting and paralysis of the tongue with fibrillation. Eventually
the tongue gets shrivelled and lies functionless in the floor of the mouth. This
condition is associated with dribbling of 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) The moistness of the
tongue:-
The moistness of the the tongue gives some indication about the state of hydration of the body. Water
volume depletion leads to peripheral circulatory failure characterised by
weakness, thirst, restlessness, anorexia, nausea, vomiting , dry and parched
tongue.
Dryness of the tongue is
seen in the following conditions.
a) Diarrhoea
b) Later stages of
severe illness
c) Advanced uraemia
d) Hypovolemic shock
e) Heat exhaustion
f) Hyponatraemia
g) Acute intestinal
obstruction
h) Starvation
i) Prolonged fasting.
3) Change in colour of the
tongue:-
a) Central cyanosis:-
Cyanosis is the bluish
discolouration of the mucus membrane due to a decrease in the amount of oxygen
in the blood. This is seen in heart failure, respiratory failure and in anoxia.
In cyanosis tongue, lips etc becomes pale bluish.
b) Jaundice:-
This is the yellowish
discolouration of all mucus surfaces of the body (including tongue)due to
increase of bilirubin in the blood. Jaundice is seen in hepatitis, bile duct
obstruction, increased destruction of RBCs, etc...
c) Advanced uremia:-
This is the increase of
urea and other nitrogenous waste products in the blood due to kidney failure. Here
the tongue becomes brown.
d) Ketoacidosis:-
This is the acidosis with
the accumulation of ketone bodies seen mainly in diabetes mellitus. Here the
tongue become brown with a typical ketone smell from the mouth.
e) Riboflavin
deficiency:-
Deficiency of this
vitamin (vitamin B2) produces magenta colour 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 bright scarlet or
beefy red tongue.
g) Anaemia:-
It is the decrease in
haemoglobin percentage of the blood. In severe anaemia tongue becomes pale.
4) Coating on the
tongue:-
a) Bad breath:-
The main cause for 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.
Those who complain about bad breath may have a thick coating on the posterior
part of the tongue.
b) Typhoid fever:-
In typhoid, fever tongue
becomes white-coated like a fur.
c) Candidiasis:-
It is a fungal infection
which affects the mucus 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 diseased caused by treponema pallidum infection. In the second
stage of this disease, we can see mucous patches which are painless, smooth
white glistening opalescent plaques which can not be scraped off easily.
f) Leukoplakia:-
Here white keratotic
patches are seen on the tongue and oral cavity. This is a precancerous
condition.
g) AIDS:-
In these patients, hairy
leukoplakia is seen.
h) Peritonitis:-
It is the inflammation
of the peritoneum(inner covering of the abdominal cavity which also covers the
intestines and keep 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 small
projections on the tongue associated with taste. There are different type of
papillae on the healthy tongue. In some diseases, there are some abnormal
changes which are following.
a) Hairy tongue:-
This condition is due to
elongation of filiform papillae seen in poor oral hygiene, general debility and
indigestion.
b) Geographic tongue:-
Here irregular red and
white patches appear on the tongue. 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 nutritional
deficiency, there is glossitis(inflammation of the tongue) leading to papillary
hypertrophy followed by atrophy.
e) Benign migratory
glossitis:-
It is an inflammatory
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 cause hypertrophied filiform and fungiform papillae.
g) Niacin and iron
deficiency:-
In this condition, there
is atrophy of papillae. Smooth tongue is encountered in iron deficiency.
h) Vitamin A
deficiency:-
This causes furrowed
tongue.
i) In nutritional
megaloblastic anaemia, the tongue becomes smooth.
j) Folic acid
deficiency:-
Here macrocytic
megaloblastic anaemia with glossitis is seen.
k) Cyano cobalamin
deficiency:-
Here glossitis with
macrocytic megaloblastic anaemia and peripheral neuropathy is encountered.
l) Scarlet fever;-
In this streptococcal
infection, bright red papillae are standing out of a thick white fur, later the
white coat disappear leaving enlarged papillae on the bright red surface and is
called strawberry tongue.
6) Ulcers on the
tongue:--
a) Aphthous ulcer:-
These are round painful
ulcers appear in stressed individuals frequently. May be associated with food
allergy. Usual sites are tongue, lips, oral mucosa, etc.
b) Herpes simplex:-
It is an acute vesicular
eruptions produced by herpes simplex virus. When these vesicles rupture it
forms ulcers.
c) Ulcer in cancer:-
Cancerous ulcers are
having 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 extragenital 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 sharp edges of carious teeth.