Tongue Disorders

It is a fact that the tongue is the most active muscle in the body. It is typically made from a network of different muscle fibers that allow the proper functioning of the tongue in the mouth. Usually, a healthy tongue is characterized by a coral pink color and presence of small nodular lumps on the surface called the tongue papillae.

Several tongue disorders can disrupt the harmony of this oral tissue. Often the tongue disorders bring a lot of pain and discomfort for the patient. Moreover, it can change the appearance of the tongue, as well. Some of the potential causes of tongue disorders may include infectious conditions, cancerous lesions, and nutritional deficiencies.

It is essential always to consult a dentist immediately. The type of treatment for tongue disorders depends on the specific cause. Today’s article will highlight some of the common tongue disorders of the mouth, its diagnosis, and treatment.

Let’s know our tongue

The tongue is a crucial part of our mouth. It is typically made from a network of skeletal muscles that are covered by a soft mucous membrane. The dorsal surface of the tongue has a characteristic rough appearance due to the development of tongue papilla. (1) Typically, there are three main types of papilla –

  • Filiform – characterized as multiple small structures that give a hairy appearance
  • Fungiform – these are red slightly thicker than filiform papillae. Fungiform papillae are located on the sides and tip of the tongue.
  • Circumvallate – these papillae are 8-12 in number and are usually located at the back of the tongue near the junction of the oral and pharyngeal tongue.

Some of the prime functions of the tongue include –

  • Taste perception
  • Mastication
  • Deglutition
  • Speech

What are the different tongue disorders?

There is a wide range of tongue disorders that can affect the oral health and well-being of the patient. The symptoms may be characteristic of some of the tongue disorders. However, all the tongue disorders produce the following common signs and symptoms –

  • Partial or complete loss of taste
  • Difficulty in moving the tongue
  • Pain and discomfort
  • Inflammation or swelling of the tongue surface
  • Change in the color that may vary from white, red, black to brown (2)
  • Loss of tongue papillae
  • Burning or a tingling sensation on the tongue surface
  • Soreness of the tongue
  • The hairy appearance of the tongue

Some of the common tongue disorders are categorized as follows –

White tongue disorders

White tongue disorders can be characterized in multiple forms. Often such diseases are caused by coating of food debris, plaque, and bacteria. Some of the typical white tongue lesions are listed below – 

  • Oral thrush – this condition is characteristic of oral fungal infection, which forms a scrapable white coating on the tongue surface. Usually, on scraping the lesion, it may leave a red irregular cover on the tongue. Oral thrush is commonly caused by weak immune systems, medications, stress, and prolonged antibiotic treatment. Usually, antifungal therapy is followed to treat this disorder.
  • Leukoplakia – this is similar to oral thrush. However, the white coating on the tongue surface cannot be scraped off. Often leukoplakia is caused by the use of tobacco. The white patches form on the sides of the tongue and may aggravate by constant rubbing of the lesion against the teeth. Leukoplakia is considered as a pre-cancerous lesion. Therefore, biopsy reports are essential to diagnose the condition. (3)
  • Oral lichen planus – oral lichen planus is characterized as a chronic inflammatory disease that is caused due to an autoimmune reaction. It forms as a white lace-like pattern and often predisposes to the pre-cancerous lesions.
  • Hairy leukoplakia – this condition is characteristic of HIV/AIDS caused by the Epstein Barr virus. It forms as a white patch with elongated filiform papillae that gives a hairy appearance.
  • Linea alba – this condition is characterized as a thin white line formed at the lateral borders of the tongue. Often this condition is caused by thickening of the epithelial layer due to irritation to the tongue surface.

Red tongue disorders

Some of the common causes of red tongue lesions include the consumption of acidic food, underlying systemic condition, and vitamin deficiencies. Kawasaki disease and scarlet fever are also some of the typical reasons for red tongue lesions.

Some cancerous lesions like erythroplakia are characteristic of red tongue lesions. This condition may appear as a red lesion or a combination of red and white lesions on the tongue surface. Erythroplakia is a painful condition. It is diagnosed with the help of a biopsy report. (4)

Black tongue disorders

Black tongue disorders are considered as harmless lesions out of all other types. The prime factors that contribute to the formation of a black tongue include medications, tobacco, poor oral hygiene, and dry mouth. A hairy black tongue is a condition that is typically characterized by the elongation of filiform papillae on the tongue surface. Hairy tongue is usually caused by prolonged antibiotic treatment that mainly consists of Pepto-Bismuth as the main ingredient. (5)

Tongue inflammation

Several factors often cause tongue inflammation or enlargement. Some of them are listed below –

  • Reactions from medications – antihypertensive drugs like ACE inhibitors and NSAIDs like aspirin and Advil have the potential to cause tongue enlargement.
  • Allergies – Allergic reactions can happen from mediation or any ongoing therapy, bee sting, or food allergy. Allergic reactions are potentially dangerous as they cause rapid enlargement of the tongue, which may obstruct the airway passage. (6)
  • Underlying health condition – Amyloidosis is one such health condition that has a direct effect on the tongue. Clinically tongue enlargements are referred to as macroglossia. Other medical conditions that may cause tongue enlargement include sarcoidosis, acromegaly, hypothyroidism, and cancer.

Abnormal growth on the tongue

Abnormal overgrowth is typical signs of pre-cancerous lesions. Some of the common conditions that may cause abnormal growth on the tongue surface include –

  • Traumatic fibroma – this leads to the formation of raised, thick nodules on the dorsal surface of the tongue. The color of the growth may vary from pink to white.
  • Squamous cell carcinoma – squamous cell carcinoma makes around 90% of all the oral cancers. Usually, this lesion develops on the base of the tongue and progresses to involve the floor of the mouth. (7)

Some other common tongue disorders that cause abnormal growth include leukoplakia, erythroplakia, and erythroleukoplakia.

Changes in tongue surface

Usually, tongue surface appears as rough due to the presence of tongue papillae. Changes in the tongue surface are frequently associated with nutritional deficiencies like iron, folate, and vitamin B12. Some of the typical conditions that bring changes on the tongue surface include –

  • Geographic tongue – geographic tongue is the most common tongue condition that affects almost 14% of the U.S population. In this condition, the tongue looks smooth due to the loss of papilla. Often distinct white boundaries may be formed that gives a patchy tongue surface.
  • Fissured tongue – this is the second most common tongue condition which is characterized by deep fissures on the tongue surface. It is usually associated with the process of aging. However, some health conditions like Sjogren’s syndrome and down’s syndrome may lead to the formation of the fissured tongue.
  • Median rhomboid glossitis – it is a midline lesion that usually forms on the dorsal surface of the tongue. The characteristic appearance of this condition looks like a smooth, shiny red rhomboidal shaped lesion on the tongue surface.

Other potential disorders include –

  • Pain – tongue pain is associated with anemia, canker sore, herpes, burning mouth syndrome, and nutritional deficiencies. Often stress and anxiety also contribute to tongue pain. Usually, symptomatic treatment is followed.
  • Taste alteration
  • Inhibited tongue movement – tongue-tie or ankyloglossia is a tongue condition wherein the band of tissue that connects the tongue to the floor of the mouth is too thick and short. It inhibits the proper movement of the tongue in the mouth. Moreover, it interferes with speech and swallowing.
  • Abnormal positioning of the tongue – Glossoptosis is a condition characterized by the downward and backward placement of the tongue. Often this condition can cause blockage of the throat and airway.

Treatment of ankyloglossia usually involves frenulectomy – a surgical procedure that relieves the tight band of tissue from restricting the tongue movement. It is crucial, especially during the growth and developmental stages of children.

What causes tongue disorders?

 There are several potential causes of tongue disorders. Some of the mare listed below –

  • Hormonal changes during pregnancy or menopause may cause burning mouth sensation (8)
  • Nutritional deficiency like deficiency of vitamin B12, folate and allergic reactions to gluten
  • Weak immune response due to hepatitis C
  • Canker sore or cold sore formation
  • Traumatic injury to the tongue tissue
  • Cancerous lesions
  • Anemia and leukemia
  • Neuralgias
  • Genetic disorders like down’s syndrome

How are tongue disorders diagnosed?

Typically, the diagnosis of tongue lesions follows a standard protocol wherein the dentist takes a complete medical and dental history to rule out the presence of any systemic health conditions. A thorough oral examination is done, which helps to identify the clinical signs and symptoms of the tongue disorder. These include the following –

  • Presence of pain and soreness
  • Tenderness of the tongue
  • Large ulcerative lesions
  • Abnormal nodular overgrowths
  • Persistent pain that has lasted for more than two weeks
  • Flu-like symptoms that include fever and nausea

 The dentist may ask some details about the tongue disorder or the appearance of changes in the tongue. Usually, these questions are related to the duration, type, and character of the pain associated with the lesion. Moreover, the dentist may ask about the incidence of taste alteration or any other issues in the mouth. (9)

Often suspicion of a cancerous lesion may require a biopsy test to diagnose the condition. The patient’s blood work and systemic tests may also be necessary for a further treatment plan. Other diagnostic modalities include CT scan and MRI of the tongue to locate the lesion and extent.

What is the treatment for tongue disorders?

Treatment of tongue disorders depends on the type of underlying cause. For minor traumatic injuries or tongue problems, no therapy may be required. The symptomatic approach is usually followed in the form of medications. For extensive lesions surgical intervention may be suggested. Cancerous lesions generally undergo radiotherapy and chemotherapy along with surgical removal of the lesion. (10)

Home care is essential to ensure proper healing of the tongue disorders. Some of the typical home preventive measures include –

  • Maintenance of proper oral hygiene
  • Avoid spicy, hot and acidic food that may irritate the tongue
  • Follow a soft diet until the pain and soreness heal completely
  • Pain medication like acetaminophen may help to subside the symptoms
  • Always rinse your mouth with warm salt water at least 2-3 times a day
  • Suck on ice candy to relieve pain and discomfort
  • Follow up with your regular dental appointments to keep a check on the healing of the tongue

Take away message

The tongue performs some of the crucial responsibilities in our mouth. Some of these functions include speaking, swallowing, chewing, and taste. Development of tongue disorders not only interferes with the normal functions of the tongue; it also affects the ability to breathe by blocking the airway passage. Tongue disorders can be broadly categorized into changes in the color, texture, and shape of the tongue.

Some conditions may also affect the taste and inhibit the tongue movement. Several causes potentially lead to painful tongue conditions. It is essential to understand the characteristic features of the tongue disorders, so you can consult the dentist and get prompt treatment.