THIS submission is a continuation of last week’s treatise.
Have you ever visited the dentist for a quick and simple procedure, only to find them carefully examining not just your teeth or your gums, but every part of your mouth, including the tongue?
The reason is that every part of the mouth provides important details you might overlook and can only be discerned by the trained eye (dentist).
These seemingly minor signs may indicate underlying health problems.
Some oral health problems are painless and idiopathic, but this does not mean they are harmless.
Take tongue disorders for example
Many do not seem to pose a threat as some can even resolve on their own, but when do we know when to be alarmed and seek help?
Tongue diseases can be acquired (developed over time) or congenital (present at birth).
Acquired conditions are easily manageable since the solution involves removing the causative agent.
However congenital disorders often require surgery.
Acquired tongue diseases
These diseases appear throughout your life, due to different causes, they can have an infective, inflammatory, traumatic, degenerative, neurological, neoplastic or vascular origin.
Inflammatory conditions: Glossitis
Glossitis (inflammation of the tongue) is a condition described as a beefy tongue due to the redness and smoothness (caused by the flattening of the papillae that are responsible for the roughness effect of the tongue).
The changes on the tongue appearance and consistency are due to several factors.
Depending on the structure and shape of the glossitis a diagnosis can be given.
For example, glossitis can affect the entire tongue (atrophic) or it can affect only the back part of the tongue giving a rhomboid shape (median rhomboid glossitis).
Atrophic glossitis is common in patients with iron deficiency anaemia, the visual signs are not enough to confirm diagnosis unless a blood test is done.
To resolve this situation the treatment of the deficiency by taking supplements works like magic.
A smooth tongue can also be visualised in the late stages of lichen planus, though it causes no harm, but in order to understand what the causes may be, going to the dentist when you notice these changes is important to prevent further illness.
However median rhomboid glossitis anciently was believed to be developmental in origin, but it is now considered as a variant of oral candidiasis.
Candidiasis has many forms, but in this case, it appears on the middle surface of the tongue.
It is an opportunistic infection caused by a fungal species called Candida albicans.
It usually appears due to immunosuppression in patients with HIV or who have been predisposed to viral infections, patients who use corticosteroid sprays or inhaler and do not rinse after use and so many other factors.
Usually, patients who have shown signs of median rhomboid glossitis are treated with antifungals, however, the lesions could be less responsive to certain antifungal drugs, which many require alternative medication.
Infective tongue diseases: Scarlet fever and syphilis
Scarlet fever is manifested in the mouth by the appearance of a strawberry tongue (swollen and red, papillae enlargement which appear white and prominent).
This infection is common in children below 15 years of age.
It is caused by Streptococcus pyogenes; thus, it is not a dental issue but a systemic one.
How would parents know it is not a dental issue?
With scarlet fever there are other symptoms involved which include, a sudden onset of a sore throat, fever and malaise.
Hence going to the dentist in this case will only help parents with the diagnosis of this condition in early stages but not the treatment.
Syphilis can manifest on the tongue and it takes a trained specialist to know. Ulcers on the tongue should not be ignored.
In syphilis there is an ulcer described as a chancre, it mainly appears at the site of infection, the ulcer looks different from other normal ulcers because it is rounded, elevated as well as dense. Chancres can heal on their own after three to four weeks, but this is not an indication for the eradication of syphilis.
After a few days more prominent signs will begin to show, in this case many rounded or oval lesions will appear indicating the advancement of the disease.
Hence is it important to pay attention to any changes in your mouth, including the tongue for this could help you to prevent late outcomes of the disease.
Degenerative and vascular changes
Motor neuron disease (Lou Gehrig’s disease) can cause impaired control of tongue movement, affecting speech and swallowing.
Caviar tongue
The veins below the tongue could become enlarged and prominent, giving the undersurface of the tongue a caviar like appearance (caviar tongue).
This condition is usually benign but it could indicate underlying vascular issues, most common in adults.
It is usually harmless but a sudden and painful swelling warrants a checkup
Congenital tongue disorders
Aglossia and ankyloglossia
Conditions like aglossia which is the complete absence of the tongue at birth or ankyloglossia (tongue tie) are present from birth.
The latter condition makes it difficult to move the tongue freely, it is tethered to the floor of the mouth.
This is a very difficult situation as it complicates both feeding habits and oral hygiene.
Macroglossia
Some congenital disorders affect the tongue size, for example there are people who have an abnormally big tongue (macroglossia) that can pose problems like airway obstruction during sleep, speech difficulties, malocclusion as well as drooling.
These patients require speech therapy sessions, orthodontic care and in severe cases surgical reduction of the tongue.
Microglossia
Whereas microglossia can be defined as the underdevelopment of the tongue, this disorder is rarely encountered alone, but with other abnormalities (limb abnormalities) often encountered in Hanhart syndrome.
Patients with these conditions usually require supportive therapies for example feeding assistance and speech therapies.
Bifid tongue (split tongue)
Some patients may exhibit a bifid tongue (split tongue) that resembles a snake’s tongue.
This condition may occur in isolation or with other syndromes and it is usually asymptomatic (show no symptoms) besides impairment of speech in severe cases.
Hence surgery is rarely required unless functional and cosmetic issues are of concern.
If your condition is not congenital, please visit the dentist or any health specialist for early diagnosis of potentially more serious health issues.
- Patience Matambo (BSc Dental Surgery) champions the notion of improved dental literacy in Zimbabwe and Africa at large as an endeavour towards the realisation of the one health objectives. She can be reached at [email protected].
