Normal tongue
The tongue is a muscular organ located on the floor of the mouth. The healthy tongue has moist and pink mucous membrane.  There are two types of papillae that contain taste bud on the top of the tongue; filiform and fungiform. 

The function of the tongue is to assist in:
1.  Swallow
2.  Tasting
3.  Manipulate food for chewing
4.  Pronunciation
5.  Mixing food with saliva to begin digesting process by enzyme in saliva

Tongue condition:
1. Geographic tongue
(Benign Migratory Glossitis) or Geographic Stomatitis (if it appears other places in the mouth)

Single or multiple lesions may occur on the top of the tongue, buccal mucosa, lip, and the floor of the mouth.  In multiple lesions, they appear in irregular forms that gradually widen, change shape and migrate over the tongue.  The degree of migration is different in each person.  It is a painless condition, characterized by a small pink to red smooth, shiny patch, slightly depressed due to the loss of filiform papillae. 

The redness is more intense near the periphery, and it borders by a color gray to a white band. When there are multiple lesions on the tongue, it resembles the map. The pattern may change rapidly and persist for months. No treatment is necessary, but palliative treatment is helpful when a patient experiences pain.

The cause of Geographic tongue is unknown but tends to run in the family. Irritation from spicy food, alcohol may increase the risk of geographic tongue.  The symptom tends to associate with allergies, emotional stress, diabetes, vitamin deficiency, eczema, celiac disease, psoriasis, and change of hormone such as during pregnancy, taking birth control and ovulation.

The lesion occurs and resolves on its course and may persist for years. While it is a harmless condition, it can cause discomfort. Evaluation of the sensitivity to toothpaste,  foods, and other products, is beneficial; avoid using toothpaste that contains tartar control.  Avoid citrus fruits, strawberries, tomatoes, pineapples, alcohol drinks and sour candies and food that contains yeast. To discover the food that you are allergic to, leave all foods mentioned above from your diets and add back one item at a time.

Some of the remedies used to suppress the symptom are:
  • Use zinc lozenges (Zincum Gluconium 2x, 13.3 mg)  if you have zinc deficiency

  • Take vitamin B supplement (a synthetic form - folic acid or natural form - folate), 400 mcg per day (daily allowance recommended) if you have vitamin B deficiency

  • Consume food that contain water-soluble B vitamin (folate) such as are green leafy vegetables (lettuce, spinach), legumes

  • Place honey on the affected area for 10-15 minutes every day

  • Apply Benedryl paste to the affected area with a Q-tip.  Benedryl paste is a mixture of powder inside the capsule with water, mixed until it becomes a paste. This remedy causes a burn sensation at first and later, numb the area. The symptom seems to improve after few days.

  • Rinse with diluted hydrogen peroxide 50/50 solutions

  • Take Molybdenum100 mcg, 3 times a day

2. Hairy Tongue  

Hairy tongue is a benign and harmless condition with no symptom. Hairy tongue occurs on the top of the tongue.  It is a result of an imbalance between exfoliation and new epithelial growth with the color pickup from the color of food (it is normally white).  Hairy tongue may develop in people who associated with:

1. Poor oral hygiene
2. Prolong use of antibiotics (the most common cause), steroids, and birth control pills
3. Dry mouth
4. Tobacco Smoker
5. Taking Pepto-Bismol (Bismuth combine with sulfur in the saliva to become a black salt, bismuth sulfide)
6. Radiation therapy (head and neck area)
7. Antibiotics users: antibiotics change the natural balance between yeast (fungi) and bacteria, caused overgrowth of fungi.
8. Regular mouthwash users who use the solution that contains peroxide, peroxide-base, oxygenated or astringent agents, such as Witch hazel or menthol.  These mixtures contain an oxidizing agent that can kill bacteria causing imbalanced oral flora situation on the top of the tongue.

The black coating on top of the tongue persists for several days and frequently desquamates.   After removing the cause(s) or when the oral flora become balanced, the tongue returns to normal.  No treatment is necessary.

Symptom: A discoloration and hairy appearance tongue, metallic taste or altered taste in mouth, halitosis, gagging sensation in some people

  • Remove the causes or irritants
  • Use tongue scraper
  • Use saliva substitutes that are available over the counter (e.g., Biotene or Oasis mouthwash)
  • Maintain proper hydration through adequate fluid intake
  • Add the yogurt with lactobacilli in the diet to increase the number of good bacteria

 3 Smooth tongue 

The tongue appears red and smooth due to the enlargement of the fungiform papillae. Smooth tongue caused by a nutritional disorder such as vitamin B complex (the most common one).

4. Candidiasis (Thrush)
Candidiasis or Thrush is a condition caused by an overgrowth of fungus (yeast) called Candida albicans.  In normal condition; the amount of Candida and good bacteria in the mouth and digestive tracts are in proper balance.

When the immune system becomes weak from illness, chemotherapy, HIV or not fully developed as in the case of infants, the Candida will overgrow and lead to infection.

The most common cause for Candidiasis is; prolong use of medications such as antibiotics, steroid drugs that upset the microorganisms balance (bacteria and yeast) in the mouth.

The typical appearance of candidiasis is white or yellow raised patches located on:
  • Top of the tongue
  • Inner cheeks
  • Roof of your mouth,
  • Back of the throat 
  • gums 
The lesion can be painful and may cause bleeding when try to remove them by scraping or brushing.

The treatment for Candidiasis is antifungal medications. Since candida infection can spread to other parts of the body, consultation with a physician for medical care is necessary.

Oral thrush is a very common infection in infants younger than six months old and older adults. It can lead to vaginal (yeast) infection and diaper rashes. 

Summary of the causes of microorganism imbalance are:

  1. Prolong use of antibiotics, steroids, birth control pills
  2. Uncontrolled diabetes
  3. Aids
  4. Cancer
  5. Dry mouth
  6. Pregnancy
  7. Dentures that do not fit properly
  8. Smoking 
  9. impaired immune system, secondary to disease (diabetes, HIV)
  10. Regular use of mouthwash that contains peroxide or other oxidizing agents

  • Remove the causes or irritants
  • Use saliva substitutes that are available over the counter (e.g., Biotene or Oasis mouthwash)
  • Maintain proper hydration through adequate fluid intake
  • Use antimycotic medication
  • Add the yogurt with lactobacilli in the diet to increase the number of good bacteria. 
  • Avoid using the tongue scraper, an attempt to scrape the white patch off can cause bleeding.

Developmental Abnormalities of Tongue
Tongue-Tie (Ankyloglossia)

In the early development of tongue, the lingual frenum extends almost to the tip and gradually recedes in time.  Occasionally, the lingual frenum fails to retreat, results in a tongue tie. In an adult, intervention by laser surgery seems to release the tongue to the standard functionality.   In a baby, surgery is not indicated unless t becomes an obstacle for feeding.

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