Stick Out Your Tongue, Please

The tongue is a muscular organ associated with the function of deglutition, (swallowing), taste and speech.  It acts as an easily accessible organ for the assessment of  health of an individual and shows the state of hydration of the body.  Previously doctors would begin a diagnosis, with the request to ‘stick out your tongue’  It’s been said that tongue is the mirror of the gastrointestinal system and any abnormal functioning of the stomach and intestines will be reflected on the tongue.  However now to few orthodox doctors even bother to look at it!

There are characteristic changes that occur in the tongue in certain diseases, which  is why the examination of the tongue is essential and will give some clues for diagnosis and treatment. Those doctors who examine the tongue, consider the changes in size, shape, colour, moisture, coating, state of papillae and movements.

Appearance of tongue in some abnormal conditions:

1) Movements of the tongue:-

a) In one sided paralysis of the body(hemiplegia), the tongue moves towards the paralysed side when protruded.

b) Trembling movements of the tongue is seen in diseases like thyrotoxicosis (hyperthyroid), delirium tremens and Parkinson’s disease. Tremor is also seen in nervous and anxious patients.

c) In progressive bulbar palsy there will be wasting and paralysis of the tongue often  with fibrillation.  Eventually the tongue gets shrivelled and lies functionless in the floor of the mouth. This is the condition associated with dribbling of saliva and loss of speech.

d) In chorea,  which results in involuntary rhythmic movements, the patient may be unable to keep the protruded tongue at rest .

2) Moistness of the tongue:-

The moistness of the tongue gives an indication about the state of hydration of the body. Water depletion leads to peripheral circulatory failure characterised by thirst, weakness, restlessness, anorexia, nausea, vomiting, dry and parched tongue that causes difficulty in swallowing.

3) Dryness of the tongue is seen in following conditions:-

a) Diarrhoea
b) Later stages of severe illness
c) Advanced uraemia (following kidney failure)
d) Hypovolumic shock (decreased volume of blood plasma )
e) Heat exhaustion
f) Hyponatraemia (sodium concentration of blood serum)
g) Acute intestinal obstruction
h) Starvation
i) Prolonged fasting.

4) Change in colour of tongue:-

a) Central cyanosis:-
Cyanosis is the bluish discolouration of the mucus membrane due to decrease in the amount of oxygen in the blood. This is seen in heart failure, respiratory failure and in anoxia. In cyanosis tongue and lips  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, and increased destruction of red blood cells

c) Advanced uraemia:-
This is the increase of urea and other nitrogenous waste products in the blood due to kidney failure. Here the tongue become brown in colour.

d) Keto acidosis:-
This is the acidosis with 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 (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 the tongue becomes pale.

5) Coating on the tongue:-

a) Bad breath:-
The main cause for bad breath is formation of a pasty coating (plaque) on the tongue which lodges thousands of anaerobic bacteria resulting in the production of offensive gases. Those who complain about bad breath may have thick coating on the posterior part of the tongue.

b) Typhoid fever:-
In typhoid fever the tongue becomes white coated, like fur.

c) Candidacies;-
Is a fungal infection which affects the mucus surfaces of the body. On the tongue there will be white lesions.

d) In diabetes and hypoadrenalism there will be white lesions.

e) Secondary syphilis:-
Syphilis is a sexually transmitted diseased caused by trepenoma pallidum (bacterial) infection. In secondary stages of this disease there are mucous patches which are painless, smooth, opalescent plaques which can not be scraped off easily.

f) Leokoplakia:-
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 visible

h) Peritonitis:-
It is the inflammation of the peritoneum (inner covering of 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.

6) Papillae, Taste buds:-
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 looks like a geographic map. The exact cause is not known.

c) Median rhomboid glossitis:-
In this condition there is smooth nodular red area in the posterior mid line of the tongue. This is a congenital condition.

d) Nutritional deficiency:-
In nutrional deficiency there is glossitis (inflammation of tongue), leading to papillary hypertrophy followed by atrophy.

e) Benign migratory glossitis:-
Is an inflamatory condition of the tongue where many areas of papillae appear to be shedding layers cells which shift from area to area in few days.

f) Thiamine and riboflavin deficiency:-
Deficiency of these vitamins cause hypertrophied filiform and fungi form papillae.

g) Niacin and iron deficiency:-
In this condition there is atrophy of papillae. Smooth tongue is caused by iron deficiency.

h) Vitamin A deficiency:-
This causes a deeply  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 coblamine deficiency:-
Here glossitis with macrocytic megaloblastic anaemia 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 the white coat disappears leaving enlarged papillae on the bright red surface and is called strawberry tongue.

7) Ulcers on the tongue:–

a) Apthous ulcer:-

These are round painful ulcers which appear in stressed individuals frequently. It may be associated with food allergy. Usual sites are tongue, lips, and oral mucosa.

b) Herpes simplex:-
Is acute vesicular eruptions produced by herpes simplex virus. When these vesicles rupture it forms ulcers.

c) Ulcer in cancer:-
Cancerous ulcers, having raised edges with hard base and some bleeding . Cancer of the tongue is common in tobacco chewers.

d) Syphilitic ulcers:-
Syphilitic fissures are longitudinal in direction. In primary syphilis extra genital canker is seen on the tongue. In secondary syphilis multiple shallow ulcers are seen on and under and sides of the tongue surface . In tertiary syphilis soft non cancerous growth may be seen on the middle of the tongue.

e) Dental ulcers:-
These ulcers are produced by sharp edges of carious teeth.

The tongue can tell a lot about what is going on internally. So its vital to have a good look for any changes regularly yourself and contact a medical practitioner about any prolonged unusual changes. Of course its advisable to clean your teeth often and use a tongue scraper regularly. One school of thought has suggested that mouth plague may be instrumental in senility. You should certainly  also consider a toothpaste without fluoride. There are studies that show extensive prolonged use in water and toothpaste in fact accumulatively rots teeth and gums and is now effecting  people adversely.

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